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Generate impression based on findings. | Reason: patient with previous fungal PNA, which cleared on CT on 9/28. However, he spiked a fever last night and is neutropenic. Evaluation for any pulmonary etiology of fever History: neutropenia, fever LUNGS AND PLEURA: Linear and ground glass opacities are unchanged where there had been likely fungal nodules two studies ago, with no new abnormalities.No specific evidence of active infection or new findings. MEDIASTINUM AND HILA: There is no mediastinal or hilar lymphadenopathy.The main pulmonary artery caliber is upper normal.A right jugular catheter terminates in the SVC.CHEST WALL: Degenerative abnormalities affect the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Residual pulmonary opacities where earlier there had been likely fungal nodules, without specific evidence of active infection or new abnormalities. |
Generate impression based on findings. | Male; 77 years old. Reason: Assess for intrapulmonary pathology History: Fatigue in the setting of recently diagnosed relapsed AML LUNGS AND PLEURA: No focal consolidation, pleural effusion, or pneumothorax. No suspicious pulmonary nodules or masses. Scattered pleural calcifications are compatible with prior asbestos exposure. MEDIASTINUM AND HILA: Calcified right thyroid nodule. Dense coronary and aortic atherosclerotic calcifications. No significant mediastinal or hilar lymphadenopathy. Normal heart size without pericardial effusion. Markedly dilated pulmonary trunk is compatible with pulmonary arterial hypertension. CHEST WALL: Right central venous catheter tip in SVC. Mild degenerative disease affects the visualized spine. Large soft tissue defect in the left chest wall and adjacent thickened musculature may represent fungating tumor or less likely, infection. UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. Fatty pancreatic atrophy. | 1.No acute cardiopulmonary abnormality.2.Findings compatible with pulmonary arterial hypertension. 3.Large soft tissue defect in left chest wall, which may represent fungating tumor or less likely, infection. |
Generate impression based on findings. | Male, 55 years old, history of oral cavity cancer, status post CRT. Surgical change is redemonstrated including evidence of partial left mandibulectomy as well as left floor of mouth and submandibular space dissection. The mandibulectomy defect is bridged by bone graft which is fixed to the native mandible by a plate and screw device. These changes are stable relative to the prior examination. No evidence of recurrent mass or suspicious enhancement is seen within the surgical bed.Significant interval enlargement of a right level 3 lymph node is noted. This lesion measures 2.9 x 2.4 cm (image 53 series 4) and demonstrates inhomogeneous enhancement. This lesion on the prior examination measured 1.2 x 0.9 cm.Additional lymph nodes in the right neck have also increased in size by 1 or 2 mm. This includes nodes at levels 1b, 2, 3 and 4. None of these is pathologically enlarged by size criteria, but the interval increase in size, in the context of clear progressive adenopathy at level 3, is concerning.The aerodigestive tract is otherwise unremarkable. The remaining salivary glands and thyroid are free of focal lesions. The cervical vessels are patent and unremarkable. Lung apices are clear. No concerning bony lesions are detected. | 1. Progressive level 3 lymphadenopathy on the right. Additional lymph nodes in the right neck have also increased in size by 1 or 2 mm which is concerning as well.2. Surgical change involving the left mandible, floor of mouth and submandibular space appears similar to the prior exam. No evidence of recurrent disease in the surgical bed. |
Generate impression based on findings. | Reason: h/o HNC, compare to previous, measurements pls, s/p CRT History: none LUNGS AND PLEURA: No sign of pulmonary or pleural metastases.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy noted. Previously discussed small normal-sized right hilar lymph node stable.CHEST WALL: Mild degenerative abnormalities affect the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | No evidence of metastases or interval change. |
Generate impression based on findings. | Metastatic head and neck cancer pretreatment scans CHEST:LUNGS AND PLEURA: Interval increase in size and number of pulmonary nodules and masses. Largest lesion in the left lung measures 4.2 x 5.1 cm (previously 2.3 x 4.1 cm on 8/14/13) and is contiguous with adjacent left hilar and interlobar lymphadenopathy (4/86). This lesion encases adjacent venous and arterial branches.Largest lesion in the right lung a lateral segment of the right middle lobe measures 19-mm (5/94), previously 8-mm.Loculated moderate left pleural fluid collection with enhancing, thickened visceral and parietal pleura consistent with metastatic involvement absent clinical signs of infection, and appearing more extensive compared to the prior exam. Mild pleural thickening also noted on the right.MEDIASTINUM AND HILA: Bilateral mediastinal lymphadenopathy. Mild low cervical lymphadenopathy bilaterally. Necrotic lymphadenopathy on the left extending from the paraaortic to subaortic spaces, 4.3-cm (4/57), previously 3.1-cm. Moderate left hilar and interlobar lymphadenopathy contiguous with the lower lobe mass. No significant pleural fluid. Proximal thoracic esophagus is patulous and contains debris.CHEST WALL: Metastasis in the prevertebral space at the thoracic inlet (4/17), slightly larger. Left upper lobe posterior medial metastasis invades the subpleural fat (4/34). Diffuse subcutaneous edema fat stranding. Left chest port.Median sternotomy. Diffuse skeletal lucencies may reflect areas of osteoporosis versus from diffuse metastases.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Calcified lesions presumably reflect granulomas. Thickening of the adjacent diaphragmatic undersurface consistent with peritoneal metastases.SPLEEN: Nonspecific hypoattenuating lesion less than one cm (4/1 to two) not visible previously, too small to characterize. Extrinsic compression upon the lateral border of the spleen by peritoneal metastases.ADRENAL GLANDS: Nodular thickening of the left adrenal gland unchanged. Numerous small adjacent retroperitoneal nodules.KIDNEYS, URETERS: Bilateral cortical thinning and atrophy. Mixed density partially exophytic lesion arising from the cortex of the mid pole left kidney (4/146) atypical for a cyst and may represent a metastasis. Additional smaller renal lesions are too small to accurately characterize. Extensive vascular calcifications.Partially visualized renal transplant in the right pelvis.PANCREAS: Pancreas is atrophic.RETROPERITONEUM, LYMPH NODES: Extensive atherosclerotic calcifications. Numerous small retroperitoneal lymph nodes bilaterally, abnormal in multiplicity and enhancement. Lymphadenopathy adjacent to the GE junction (4/111). BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.There is residual barium contrast in the colon causing artifact.. Diffuse mesenteric stranding and nodularity consistent with metastases. Gastrostomy tube retention device in the stomach.BONES, SOFT TISSUES: A diffuse skeletal lucencies, nonspecific as to etiology.OTHER: No significant abnormality noted. | Diffuse thoracic and peritoneal metastases with increase in the size and number of pulmonary lesions. |
Generate impression based on findings. | Reason: hx ACC. Eval for mets History: none LUNGS AND PLEURA: Minimal basilar scarring.No significant pulmonary or pleural abnormality.MEDIASTINUM AND HILA: Enlarged right thyroid lobe which extends into the right peritracheal region almost to the level of the aortic arch, unchanged.Extensive vascular, valvular and coronary calcifications are present. CHEST WALL: Status postmedian sternotomy. Degenerative abnormalities affect the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Status post left adrenalectomy. The right adrenal is slightly nodular.Renal cysts like abnormalities and renal atrophy are unchanged. | Status post left adrenalectomy without evidence of metastases. Reference should be made, however, to an abdomen and pelvis MR reported separately. |
Generate impression based on findings. | Reason: metastatic head and neck cancer, pre-therapy scans, eval for dz with measurements History: as above CT neck:There is redemonstration of a 26 x 19 mm axial dimension ill-defined right tongue base lesion unchanged when compared to the prior exam. It appears to infiltrate the right sublingual space. On coronal imaging it measures 25 x 19 mm axial dimensionsWithin 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. Along the right posterior triangle at the level of the thyroid cartilage is a 7 x 7 mm lymph node present which was not readily identified on the prior examWithin the visceral space the thyroid gland appears intact.The airway appears patent.The parotid and the submandibular glands appear intact.The visualized lung apices demonstrate multiple nodules one in the right upper lobe measures 9 mm another one measures 6 mm one in the left upper lobe measures 22 x 35 mm and another 15 mm. There is a left-sided pleural effusion present. Comparison prior exam indicates interval progression.The carotid and vertebral vasculature visualized on this exam appears intact. Atherosclerotic calcifications are present at the carotid bifurcations.The cervical vertebral bodies in general are intact with no evidence for canal stenosis. There are multilevel degenerative changes present in the cervical spine with endplate and uncovertebral osteophytes at C5-6 with neural frontal encroachment in findings consistent with an old T1 spinous process fracture fractureCT head:The CSF spaces are appropriate for the patient's stated age with no midline shift. Periventricular and subcortical white matter hypodensities of a moderate degree are present.No abnormal enhancing mass lesions are appreciated intracranially. No acute intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses demonstrate some mild mucosal thickening in the maxillary sinuses and ethmoid sinuses and left frontal sinus. The visualized portions of the mastoid air cells demonstrate minor opacities. The visualized portions of the orbits are intact. The eyeball lenses are thin.Atherosclerotic calcifications are present along the distal internal carotid arteries. Atherosclerotic calcifications are present along the distal vertebral arteries. | 1.No lymphadenopathy on the basis of CT size criteria for lymphadenopathy is identified, however, a new lymph nodes identified in the right posterior triangle. Its significance is uncertain but the fact it is new in view of history of cancer could imply that this is metastatic2.stable right tongue base mass.3.No evidence for brain metastases.4.Multiple nodules scattered in both lungs associated with a left -sided pleural effusion is concerning for metastatic disease. These nodules have progressed since the prior exam5.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 6.Atherosclerotic calcifications narrowing carotid bifurcations left worse than right. |
Generate impression based on findings. | Prostate cancer metastatic to the bones. Rising PSA. CHEST:LUNGS AND PLEURA: Stable bilateral micronodulesMEDIASTINUM AND HILA: Stable left thyroid nodulesCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. Hypodense segment 2 lesions are unchanged and probably represent cysts. Hepatic and portal veins are patent. No new suspicious hepatic lesions. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal nodes are unchanged. Mild calcific arteriosclerotic disease of the aorta.BOWEL, MESENTERY: Stable subcentimeter lymph nodes at the gastrohepatic ligament. Multiple small nodes in the right lower abdomen adjacent to the ileocecal valve, unchanged.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: Right obturator node is stable measuring 2.0 x 0.8 cm (image 175; series 3).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No sclerotic metastases are evident.OTHER: No significant abnormality noted. | No substantial interval change with reference measurements given above. |
Generate impression based on findings. | Female; 62 years old. Reason: metastatic breast CA to chest and liver. Followup on chemo History: cough, shortness of breath on exertion. CHEST:LUNGS AND PLEURA: Small left pleural effusion and left basilar subsegmental atelectasis. Adjacent nodular pleural thickening is not significantly changed. Right lung is now clear s/p resolution of previously seen edema. MEDIASTINUM AND HILA: Heart size is normal. Large loculated pericardial effusion is not significantly changed and causes flattening of the right atrial wall. Reference subcarinal lymph node is significantly decreased in size and measures 6 mm, previously 11 mm (series 3, image 45). Multiple calcified hilar lymph nodes are compatible with prior granulomatous infection.CHEST WALL: Mildly enlarged axillary lymph nodes are not significantly changed. Unchanged left breast implant. Healing left 7th and 11th rib fractures are again noted. Mixed sclerotic/lytic lesions in T3, T5, and T6 vertebral bodies as well as T3 compression deformity are unchanged and compatible with metastatic disease. No new osseous lesions are identified. Sternal metastatic lesion is unchanged. ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Scattered hypodense hepatic lesions are compatible with metastases, decreased in extent since the prior CT.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts. PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal or gastrohepatic lymphadenopathy. BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Unchanged lytic lesion in S1 vertebral body. OTHER: No significant abnormality noted. | 1.Interval decrease in mediastinal lymphadenopathy and hepatic metastases, with stable osseous metastases. No new suspicious lesions are identified. 2.No significant interval change in large loculated pericardial effusion. |
Generate impression based on findings. | Reason: hx of left tonsil ca, s/p CRT ,eval for progression of dz History: as above LUNGS AND PLEURA: Benign-appearing micronodules, most calcified, unchanged.No evidence of pulmonary or pleural metastases.MEDIASTINUM AND HILA: There is no mediastinal or hilar lymphadenopathy.CHEST WALL: Degenerative abnormalities are mild, affecting the mid thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Multiple hepatic cysts like hypodensities are unchanged. A retention clip from a prior gastrostomy tube is present. | No change, and no evidence of metastases. |
Generate impression based on findings. | Reason: h/o recurrent HNC, compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: Numerous pulmonary and pleural nodules consistent with metastases, some of which have increased in size. For example, several non-referenced pleural-based nodules are larger:Anterior left upper lobe (series 5 image 35)Lateral right upper lobe (series 5 image 37)Subpleural lateral right middle lobe (series 5 image 81)There is new central groundglass within the left upper lobe (series 5 image 39).The reference left lower lobe nodule is stable, measuring 23 x 29 mm (series 5 image 85).New small right pleural effusion. No new pulmonary nodule.MEDIASTINUM AND HILA: The heart size remains normal. No pericardial effusion. No mediastinal or hilar lymphadenopathy. Several calcified lymph nodes are indicative of prior granulomatous disease.CHEST WALL: Degenerative changes of the right glenohumeral joint.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Two low density lesions are within the left hepatic lobe are stable, compatible with cysts.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Innumerable cystic lesions of various sizes in the kidneys not significantly changed.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: Sclerotic focus within L3 vertebral body of uncertain etiology. This was not included in previous fields of view. Otherwise, no changes in the visualized vertebral bodies.OTHER: No significant abnormality noted. | 1. Numerous pulmonary and pleural nodules consistent with metastases, many of which have increased in size. 2. Referenced pulmonary nodule remains stable in size.3. No interval mediastinal or hilar lymphadenopathy. |
Generate impression based on findings. | Reason: Change in size of lung nodule? Progression of bronchiectasis? Need for further scan. History: Cough and sputum LUNGS AND PLEURA: Left apical less than 5-mm groundglass nodule unchanged, image 14 series 4, likely atypical adenomatous hyperplasia.Unchanged smoothly marginated benign-appearing right middle lobe 5 mm nodule image 54 series 4, likely benign.New ill-defined 1.5 and 1 cm ground glass regions in the left lower lobe images 70 and 79 series 4 are likely inflammatory and were not present on the prior study.There is mild lower lung zone predominant bronchiectasis as well as scarring in the bases. MEDIASTINUM AND HILA: No evidence of mediastinal or hilar lymphadenopathy.CHEST WALL: Hypertrophic degenerative abnormalities affect the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Multiple hepatic cysts like hypodensities are stable. | No reliable evidence of malignancy. Likely atypical adenomatous hyperplasia in the left apex and what is likely a benign nodule in the right middle lobe all unchanged. New ground glass regions in the left lower lobe most likely are inflammatory. Three month follow-up recommended to reassess the left lower lobe. Otherwise, annual follow up recommended. |
Generate impression based on findings. | History of Ewing sarcoma status-post autotransplant, 100 day evaluation LUNGS AND PLEURA: No consolidation or pleural effusion. Perifissural nodules are seen along the right minor fissure and left major fissure and may represent intrapulmonary lymph nodes. Subpleural densities along the posterior right lower lobe likely represents atelectasis/scarring. Linear densities in the left lower lobe likely represents atelectasis/scarring.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy is seen. The right central venous catheter tip lies at the caval atrial junction. The heart size is normal and there is no pericardial effusion.CHEST WALL: No osseous lesions are identified. No axillary lymphadenopathy.UPPER ABDOMEN: No significant abnormality is seen in the upper abdomen. | No suspicious pulmonary mass or nodule. |
Generate impression based on findings. | Reason: 50 year old man with Hodgkin lymphoma s/p allogeneic stem cell transplant. Compare to prior studies. History: Pruritis and sweats. The right jugulodigastric node measures 10 x 12 mm in axial dimensions and is unchanged since prior exam. A left level 3 lymph node measures 8 x 5 mm axial dimensions and is unchanged since the prior exam.Within the suprahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated. Within the infrahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated.Within the visceral space the thyroid gland appears intact.The airway appears patent.The visualized intracranial structures which include the posterior fossa are intact. The visualized portions of the orbits are intact. The paranasal sinuses demonstrate mucus retention cysts in the right maxillary sinus. 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. | 1.No evidence for local recurrence or neck lymphadenopathy on the basis of CT size criteria for lymphadenopathy |
Generate impression based on findings. | Reason: metastatic thyroid ca, on therapy, compare to previous with measurements, eval for dz History: as above CHEST:LUNGS AND PLEURA: Scattered pulmonary micronodules are unchanged from the prior study. Nodular fissural densities at right major fissure stable, likely intrapulmonary lymph nodes. No consolidation or pleural effusion. No new suspiciousnodules identified.MEDIASTINUM AND HILA: Scattered areas of soft tissue thickening with enhancement along the right posterior paratracheal space has not significantly changed from the prior study. The previously referenced right paraesophageal lymph node is stable at 12 mm in short axis (image 29, series 3). The previously referenced right paratracheal lymph node is also stable, 12 mm in short axis (image 13, series 3). A non-referenced left bronchial lymph node is unchanged, 8 mm in short axis (image 41, series 3).Status post thyroidectomy. No hilar lymphadenopathy. The heart is normal in size. No pericardial effusion. Stenosis of the right brachiocephalic and rightinternal jugular veins is unchanged.CHEST WALL: Multiple right chest wall collaterals are again noted, likely due to thepreviously described stenosis. Degenerative changes throughout the thoracic spine are unchanged. Lucent lesion in the superior sternum stable.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Nonspecific hypodense liver lesions are unchanged, some of which aretoo small to characterize, likely simple cysts.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Prominent collateral vessels seen filled with contrastcoursing from the right abdominal wall to the IVC.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. | No change in referenced lesions. Slight increase in size of a non-index mediastinal lymph node. |
Generate impression based on findings. | Evaluate for enterovesicular or enterovaginal fistula. ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: 2.0-cm lobulated cystic structure in the right lobe likely represents a simple cyst. 4.2 x 3.9 cm hypodense lesion in segment 7 with peripheral nodular discontinuous enhancement likely represents a hemangioma. Additional scattered subcentimeter hypoattenuating lesions are too small to characterize.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Numerous parenchymal and parapelvic cysts. Multiple subcentimeter hypoattenuating renal lesions are too small to characterize on this exam.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No gross abnormalities noted.BONES, SOFT TISSUES: Moderate to severe degenerative changes affect the lower lumbar spine. Compression deformity of the L1 vertebral body, of indeterminate age.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy. BLADDER: No definite connection is seen between the colon and bladder. No air is seen within the bladder, suggesting against enterovesicular fistula. The fluid in the bladder measures simple fluid density.There is a punctate focus of air posterior to the urethra between the urethra and vagina (series 3, image 121) at the craniocaudal level of the pubic symphysis.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: A rectal tube is in place, with minimal contrast in the rectum. Sigmoid diverticulosis, without specific evidence of acute diverticulitis. Otherwise unremarkable loops of bowel.BONES, SOFT TISSUES: Severe bilateral degenerative changes at the hip joints.OTHER: No significant abnormality noted | Punctate focus of air between the urethra and vagina posterior to the pubic symphysis, which is suspicious for a urethrovaginal fistula versus urethral diverticulum. This may be further evaluated with a voiding cystourethrogram. There is no specific evidence of an enterovesicular fistula.Findings discussed with Dr. Packiam at 11:30 am on 10/4/13 |
Generate impression based on findings. | Reason: lung cancer History: lung cancer LUNGS AND PLEURA: Status post left upper lobectomy for lung cancer resection with no evidence of tumor recurrence.Punctate benign appearing micro-nodule right middle lobe image 60 series 5, stable.5-mm right lower lobe ground glass nodule image 81 series 5 stable, likely atypical adenomatous hyperplasia.MEDIASTINUM AND HILA: There is no mediastinal or hilar lymphadenopathy.A minimal amount of pericardial fluid persists.CHEST WALL: No change in T12 superior endplate depression.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. Status post left upper lobectomy.2. Stable ground glass nodule right lower lobe likely atypical adenomatous hyperplasia.3. Stable benign appearing right middle lobe micronodule.4. Annual surveillance recommended. |
Generate impression based on findings. | Male; 76 years old. Reason: lung nodule CHEST:LUNGS AND PLEURA: Right lower lobe ground glass nodule with a central cyst measures 12 mm in diameter, previously 15 mm (series 5, image 48). While not increased in size since the prior study, its morphology and increase in opacity since scans dating back to 1/19/2010 are highly suspicious for indolent primary adenocarcinoma. Scattered calcified granulomas. Streaky basilar scarring/atelectasis. MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. Mildly enlarged high left paratracheal lymph node measures 6 mm in diameter and is unchanged (series 3, image 20). There is no other significant mediastinal or hilar lymphadenopathy. Mild coronary and aortic calcifications.CHEST WALL: Mild gynecomastia. ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Scattered granulomata.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Large exophytic right renal cyst. Atypical exophytic cystic lesion arising from the lower pole of the left kidney is not significantly changed in size or appearance and measures 8.2 x 4.5 cm, previously 8.2 x 5.0 cm (series 80276, image 44). PANCREAS: Fatty atrophy of the pancreas. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Degenerative changes of the visualized spine including bridging anterior osteophytes. OTHER: No significant abnormality noted. | 1.Right lower lobe ground glass nodule with central cyst is highly suspicious for indolent adenocarcinoma when compared to earliest exam from 2010.2.No evidence of metastatic disease. 3.No significant interval change in size or appearance of atypical exophytic cystic lesion in left kidney. |
Generate impression based on findings. | Reason: History lung CA s/p resection yearly f/u History: Cough LUNGS AND PLEURA: Status post left upper lobectomy.Subtle groundglass centrilobular opacities have developed and progressed, suggestive of etiologies such as hypersensitivity pneumonitis or RB-ILD.No sign of tumor recurrence.MEDIASTINUM AND HILA: There is no mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | No evidence of tumor recurrence. Subtle centrilobular opacities are suggestive of hypersensitivity pneumonitis or RB-ILD. |
Generate impression based on findings. | Patient with stage IV Hodgkin's, now off therapy CHEST:LUNGS AND PLEURA: No consolidation or pleural effusion is seen. Right middle lobe pulmonary nodule is unchanged (image 57, series 4), however some of the previously noted pulmonary micronodules are longer present.MEDIASTINUM AND HILA: Several small pretracheal lymph nodes are again seen, the largest of which is a low right paratracheal lymph node measuring 1.8 x 0.6 cm (image 32, series 3), previously 2.0 x 0.9 cm. Heart is normal in size and there is no pericardial effusion. Port catheter tip is seen in the right atrium.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No focal liver lesion or biliary duct dilation is seen.SPLEEN: No focal splenic lesion is seen.PANCREAS: The pancreas appears normal.ADRENAL GLANDS: No nodule is seen in either adrenal gland.KIDNEYS, URETERS: The kidneys enhance homogeneously and symmetrically without hydronephrosis or perinephric stranding.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No bowel obstruction or free intraperitoneal air. The appendix is normal.BONES, SOFT TISSUES: The bones are normal in appearance. PELVIS:PROSTATE, SEMINAL VESICLES: The prostate and seminal vesicles are normal for the patient's age.BLADDER: No bladder wall thickening is seen.LYMPH NODES: No pelvic lymphadenopathy. The previously referenced right iliac lymph node now measures 9 x 5 mm (image 145, series 3).BOWEL, MESENTERY: No bowel obstruction or free intraperitoneal air.BONES, SOFT TISSUES: Right iliac wing destructive expansile lesion is again seen with a lamellated smooth periosteal reaction. | 1.No change in right iliac wing lesion. 2.Decrease in size of previously referenced lymph nodes.3.Many of the previously noted right upper and middle lobe pulmonary micronodules are no longer seen. One right middle lobe pulmonary micronodule is unchanged. |
Generate impression based on findings. | Male 56 years old; Reason: evaluate for change in fluid collection, PV thrombus History: s/p perforated diverticulitis ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. The left portal vein and anterior branch of right portal vein remains thrombosed . The right portal vein is patent.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: Inflammation adjacent to sigmoid colon has decreased. The inflammatory soft tissue measures 2.1 x 0.8 cm (image 89/series 3) previously, 3.2 x 1.6 cm. Mild inflammation adjacent to the sigmoid colon persists.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: Sigmoid colonic diverticulitis which has improved with decrease in the size of the inflammatory tissue. No drainable fluid collections.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Portal venous thrombosis as detailed above.2.Decrease in the inflammatory tissue adjacent to sigmoid colon with mild persistent inflammation of the sigmoid colon. |
Generate impression based on findings. | Total laryngectomy for laryngeal cancer status post left carotid stent, left carotid inferior embolization, left carotid superior suture for carotid blowout. LUNGS AND PLEURA: Apical fibrosis. Interval development of bronchial wall thickening and clustered peribronchial air space opacities in the dependent aspect of the right upper lobe compatible with bronchopneumonia. In the dependent lung fields elsewhere, right greater than left, the bronchiolitis pattern has worsened. Small pleural fluid collections, left greater than right with adjacent compressive atelectasis. Signs of prior barium aspiration on the right.MEDIASTINUM AND HILA: Postsurgical changes in the low neck, please refer to separately reported neck CT on same date. Tracheostomy. Vocal prosthesis. Streak artifact at the thoracic inlet limits assessment this level. New small fluid attenuation collection in at the thoracic inlet, left paraesophageal region, of unclear etiology. Numerous subcentimeter mediastinal lymph nodes increased in size. For reference, a subcarinal lymph node measures 17-mm in short axis, previously 8-mm (3/45). Bronchial wall thickening, right greater than left. Mild hilar lymphadenopathy on the left is new. Normal heart size. Trace pericardial fluid, increased.CHEST WALL: Mild compression deformity T4 vertebral body, unchanged. Superior endplate depression T8 also unchanged. UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Gastrojejunostomy tube retention device in the stomach. Hyperattenuating lesion in the left kidney may reflect a cyst. Gallbladder remains distended with a large volume of debris. | Worsening lower lung zone bronchiolitis with interval development of bronchopneumonia in the right upper lobe and mild lymphadenopathy. Debris within the airways suggests that this is at least partly aspiration related though chronicity and asymmetry remains suspicious for chronic indolent infection such as MAI or other agents. Degree of pulmonary findings limits sensitivity for detection of metastatic disease, suggest follow-up examination after medical management. |
Generate impression based on findings. | Reason: eval soft tissue mass at mandible, temple, neck History: eval soft tissue mass at mandible, temple, neck CT neck:There are multiple calcified lymph nodes present within the soft tissues of the neck as well as the visualized portions of the superior mediastinum. One located in the posterior triangle of the suprahyoid neck measures 32 x 38 millimeters axial dimensions. One at the right lower jugular chain measures 32 x 28 mm axial dimensions one at the left lower jugular chain measures 45 x 30 mm axial dimensions. There are multiple calcified mediastinal lymph nodes present one on the left side adjacent to the aorta measures 67 x 45 mm are multiple other calcified lymph nodes scattered throughout the mediastinum. The mediastinal lymphadenopathy appears similar to the prior CT of the chest from 8/22/13Within the visceral space the thyroid gland appears intact.The airway appears patent.The parotid and the submandibular glands appear intact.The visualized lung apices demonstrate a left-sided pleural effusion. This pleural effusion was not identified on prior chestThe 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 is mild reversal of the normal cervical curvature with some loss of disk space height and some endplate and uncal vertebral osteophytes at the C5-6 and C6-7.CT head:There are multiple lytic foci scattered throughout the calvarium. One along the squamous portion of the left temporal bone is expansile and measures 17 mm in thickness a 5 mm AP dimension. Additional lytic foci are present throughout the calvarium . Right-sided squamous portion of temporal bone lesion measures 39 x 14 mm axial dimensions.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No acute 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.There are multiple very large calcified lymph nodes throughout the soft tissues of the neck.2.Mediastinal lymphadenopathy in general appear stable compared to prior exam but is not completely evaluated on this exam.3.Left-sided pleural effusion is new since the prior CT chest exam4.multiple lytic lesions scattered in the calvarium. The largest ones are along the squamous portion of the temporal bones bilaterally. This can be amyloidoma or plasmacytomas or both.5.Lack of intravenous contrast may obscure subtle abnormalities6.No evidence for acute intracranial hemorrhage mass effect or edema.. |
Generate impression based on findings. | Male, 13 years old, history of stage IV Hodgkin's status post therapy. Small lymph nodes are evident on both sides of the neck. These have not significantly changed in size and none of them are pathologically enlarged. No new or progressive lymph nodes are demonstrated.The palatine tonsils are mildly prominent, but this is a stable finding and can be normal for age. The remainder of the aerodigestive tract is unremarkable. As on the prior examination, a small thyroglossal duct cyst may be present.The salivary glands and thyroid are free of focal lesions. Cervical vessels are patent. Lung apices are clear. No concerning bony lesions are demonstrated. | Stable examination with no evidence of progressive or new adenopathy. |
Generate impression based on findings. | Female 69 years old Reason: pt with metastatic breast cancer s/p everolimus and aromasin please assess response to therapy and compare to previous imaging CHEST:LUNGS AND PLEURA: Unchanged right lower lobe nodule, now 5 x 6 mm (series 10295, image 43), previously 5 x 6 mm. This nodule was not seen on the most recent examination secondary to atelectasis which has subsequently resolved.Nodular interstitial opacity in the right apex unchanged likely post radiation fibrosis/scarring. Decrease in size of the sub-pleural right middle lobe focal consolidation with associated ground glass opacity. Complete resolution of patchy ground glass opacities in the right upper posterior segment and left apex. Persistent but improved left lower lobe subsegmental atelectasis/consolidation. Diffuse mild bronchial wall thickening improved from the prior examination.Interval resolution of the bilateral pleural effusions.MEDIASTINUM AND HILA: Interval decrease in the prior two views mediastinal lymphadenopathy, but stable reference AP window lymph node now measuring 9 mm (image 29, series 3), previously 11 mm.Moderate atherosclerosis of the thoracic aorta and proximal LAD coronary artery.No evidence of pericardial effusion.CHEST WALL: Increase in size of the heterogeneous soft tissue mass in the right anterior chest wall now measuring 8.6 x 5.2 cm (image 10, series 3), previously measuring 6.5 x 4.0 cm. There is a new soft tissue component extending from the mass which obliterates the subpectoral fat plane with apparent extension into the medial subpectoralis muscle. There is no evidence of bony cortical invasion by the soft tissue mass.Small necrotic-appearing left axillary lymph node unchanged.Status post right mastectomy. The left breast is only partially included in the field of view.Compression fracture are sclerotic T12 vertebral body unchanged. Sclerotic focus in the lateral right fifth rib not significantly changed.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: There is a very small low density lesion in the right hepatic lobe, which is too small to characterize and not well seen on prior imaging (image 77, series 3). Attention should paid this area on subsequent imaging. Large calcified gallstone in the gallbladder lumen.SPLEEN: Incidental splenule.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral renal cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Moderate/severe atherosclerosis of the abdominal aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: T12 vertebral body compression fracture unchanged.OTHER: No significant abnormality noted. | 1. Resolution of bilateral pleural effusions and near complete resolution of multifocal air space opacities.2. Interval decrease in mediastinal lymphadenopathy, but grossly unchanged reference AP window lymph node.3. Stable right lower lobe nodule.4. Interval increase in size of the right chest wall mass with new extension into the subpectoralis muscle possible.5. Apparent new hypodense hepatic lesion too small to characterize, but attention should be paid on follow-up imaging. |
Generate impression based on findings. | Malignant melanoma of the scalp and neck. Clinical trial. CHEST:LUNGS AND PLEURA: No pulmonary nodules identified.MEDIASTINUM AND HILA: Tiny hypodense right thyroid lesion is unchanged. No mediastinal or hilar lymphadenopathy. The heart is normal in size and there is no pericardial effusion. Severe coronary artery stent/calcifications are unchanged.CHEST WALL: Status post sternotomy. No axillary lymphadenopathy. Degenerative changes are seen throughout the thoracic spine. Healed right rib fracture.ABDOMEN:LIVER, BILIARY TRACT: Nonspecific hypodense focus in the right liver is too small characterize.SPLEEN: An accessory spleen is seen medial to the spleen.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple hypodense lesions in both kidneys unchanged from the prior study likely represent simple cysts.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostatomegaly.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Colonic diverticulosis without complication.BONES, SOFT TISSUES: Probable vertebral body hemangioma in L4 is unchanged from prior study. | Stable exam with no definite evidence of metastatic disease. |
Generate impression based on findings. | Female 80 years old; Reason: increasing SOB, hx of appendicitis, hematoma History: sob, abdominal pain CHEST:LUNGS AND PLEURA: Severe bronchiectasis, bronchial wall thickening and mucous plugging involving the superior segment of the left lower lobe with cavitary changes and atelectasis/consolidation. Moderate bronchiectatic changes with mucus plugging involving the left lower lobe.Bronchiectatic changes involving the lingula and with areas of mucus plugging and centrilobular nodules, peripheral consolidation/atelectasis.Minimal bronchiectasis involving the medial subsegment of the right middle lobe with mild bronchiectasis, bronchial wall thickening mucous plugging and focal consolidation/atelectasis.Mild bronchiectasis involving the right lower lobe there is a ground-glass opacity, centrilobular pulmonary nodules.The pleural spaces are clear.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. Extensive coronary calcifications are mitral valvular calcification.CHEST WALL: Post operative changes from a right shoulder arthroplasty.Degenerative changes affect the thoracic spineABDOMEN:LIVER, BILIARY TRACT: Liver has a smooth contour. No suspicious hepatic lesions. Hepatic and portal veins are patent. No biliary ductal dilatation.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: Severe calcific arteriosclerotic disease of the aorta. The distal aorta is aneurysmal measuring 2.9-cm in greatest dimension.BOWEL, MESENTERY: Small bowel is normal in caliber. Post changes adjacent to the cecum from appendectomy.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: Postoperative changes in the small bowel. No bowel obstruction.BONES, SOFT TISSUES: The right body wall (rectus) collection has decreased in size and has nearly completely resolved.Degenerative changes affect the lumbar spine and S-shaped scoliosis of the thoracolumbar spine.OTHER: No significant abnormality noted. | 1.Chronic lung changes including bronchiectasis, areas of atelectasis and areas of infection. Findings are most suggestive of a mycobacterial infection (MAI) or other atypical infections.2.Resolution of the right lower body wall collection.3.No bowel obstruction.4.Mild aneurysmal dilatation of the distal abdominal aorta. |
Generate impression based on findings. | Lung nodule LUNGS AND PLEURA: Mild centrilobular emphysema. Paramediastinal fibrosis suggestive of prior radiation therapy. 12 x 9 mm nodule (5/54) in the right lower lobe is unchanged compared to the prior study and unchanged compared to the 8/12/11 exam when remeasured at 12 x 9 mm (5/46, 8/12/11) and most likely benign. Scattered micronodules and pulse were also stable and most consistent with benign lesions.. Clustered high attenuation material in the lung bases represents previously aspirated oral contrast material.MEDIASTINUM AND HILA: Nonspecific calcifications in the right thyroid lobe. Atherosclerotic calcifications of the aorta and its branches. Calcified and noncalcified mediastinal lymph nodes; some have decreased in size while others have developed calcification since 2011, consistent with healed granulomas. Coronary artery calcifications. Left and right atria mildly enlarged. Mitral annulus calcifications noted.CHEST WALL: Numerous coarse breast calcifications present previously but nonspecific by CT.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. Atherosclerotic calcification of the abdominal aorta. Gastrostomy tube retention device in the stomach. Hyperattenuating subcentimeter cyst apex of the left kidney. Lobular contour of the anterior left kidney unchanged. Hepatic cyst in the left lobe unchanged. Granulomas in the spleen. | Unchanged right lower lobe nodule, most consistent with a benign lesion. No additional CT follow-up is required unless clinically warranted. |
Generate impression based on findings. | Male, 67 years old, history of stage III melanoma. Soft tissue volume loss involving the scalp posterior to the right ear is redemonstrated, unchanged and likely reflective of prior surgery. The soft tissue which remains, posterior and superior to the right ear, is thickened similar to prior. An additional area of scalp infiltration is seen in the right parietal region, also stableNo pathologically enlarged or aggressive appearing lymph nodes are seen in the neck. A right level IIb reference node measures 4 x 3 mm (image 37 series 4), not significantly changed. Just below this level, there is stable mild infiltration and soft tissue thickening within the fat plane deep to the sternocleidomastoid muscle. The previously noted small enhancing focus along the anteromedial margin of the right sternocleidomastoid is not as conspicuous on today's study.The aerodigestive mucosa is within normal limits. The salivary glands are free of focal lesions. There is a small stable hypodense region within the right thyroid lobe. Lung apices are clear. No concerning bony lesions are demonstrated. | Stable examination. No evidence of active disease. |
Generate impression based on findings. | Reason: h/o total laryngectomy for laryngeal CA s/p L carotid stent, L carotid inferior embolization, L carotid superior suture for carotid blowout, evaluate for disease/recurrence History: h/o total laryngectomy for laryngeal CA s/p L carotid stent, L carotid inferior embolization, L carotid superior suture for carotid blowout, evaluate for disease/recurrence CT neck:Since the prior exam the patient has undergone left neck surgery and removal of the left common carotid and left internal carotid artery. There is infiltration of the soft tissues of the left neck where there was previously a neoplasm encasing the left common carotid artery there is a thrombosis of the left common carotid artery. Infiltration of the fat planes of the left neck extends from the level of the clavicle to the level of the C2 vertebral body level.Surgical clips are present throughout both right and left neck.The patient is status post laryngectomy and tracheal stoma appeared to endotracheal tube extends to the stoma.Some retained secretions are identified in the oropharynx.Within the suprahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated. Within the infrahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated.Within the visceral space the thyroid gland appears intact.The airway appears patent.The parotid glands appear intact.The visualized lung apices demonstrate a honeycomb appearance along the medial aspects of the upper lung fields consistent with prior radiation or along the right upper lung field there are patchy foci of ground glass appearance.There is redemonstration effacement of fat planes surrounding the right carotid which is stable when compared to the prior exam. There is no opacification of the distal left internal carotid artery above the tumor site and in no opacification of the trunk of the left external carotid artery is appreciated there appears to be some collateralization to the superficial temporal artery and occipital artery as well as possibly internal maxillary artery. The cervical vertebral bodies in general are intact with no evidence for canal stenosis.CT head:The CSF spaces are appropriate for the patient's stated age with no midline shift. Since the prior exam a hypodense focus in left frontal lobe as near completely resolved. The previously identified enhancing lesion in left frontal lobe prior July exam is smaller and measures approximately 7 mm x 5 mm and previously measured 14 mm x 10 mmNo abnormal enhancing mass lesions are appreciated intracranially. No acute 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.Since the prior examination the patient has undergone left and neck surgery. There there appears be residual neoplasm in the left neck possibly extending from as low as the left clavicle and as high as C2. A left common artery and left internal carotid artery have thrombosed. There is a plug present at the origin of the left common artery above which the left common carotid artery is occluded. There is no opacification of the distal left internal carotid artery above the tumor site and in no opacification of the trunk of the left external carotid artery is appreciated there appears to be some collateralization to the superficial temporal artery and occipital artery as well as possibly internal maxillary artery. The posterior communicating artery and anterior communicating artery are prominent2.post treatment changes in the right neck are reidentified and appear relatively stable3.a left orbital gyrus the lesion appears smaller on the current exam when compared with the prior exam. vasogenic edema has resolved4.patchy lesions in the right upper lung field and are suspicious for airspace disease. Please refer to chest CT for further comments |
Generate impression based on findings. | Male 43 years old; Reason: Hx of Follicular NHL History: s/p 4 cycles of Immunotherapy CHEST:LUNGS AND PLEURA: Minimal linear atelectasis adjacent to the lingula. No focal consolidation. The lungs are otherwise clear. The pleural spaces are clear. Central airways are patent.MEDIASTINUM AND HILA: Right thoracic inlet lymph node measures 1.2 x 1.1 cm (image 2/series 3) previously, 2.7 x 2.6 cm.Right paratracheal lymph node measures 2.2 x 1.5 cm (image 16/series 3) previously, 4.6 x 2.7 cm.CHEST WALL: Left axillary lymph node measures 1.2 x 0.9 cm (image 21/series 3) previously, 1.8 x 1.8 cm.OTHER: ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Cyst at the lower pole of the left kidney, unchanged. No hydronephrosis in either kidney.RETROPERITONEUM, LYMPH NODES: There are multiple retroperitoneal lymph nodes. Index left paraaortic node measures 2.3 x 2.2 cm (image 121/series 3) previously, 3.0 x 2.9 cm.BOWEL, MESENTERY: Multiple mesenteric lymph nodes remain. The reference mesenteric lymph node measures 2.1 x 1.9 cm (image 106/series 4) previously, 2.3 x 2.0 cm.Mesentery lymph node adjacent to the lower splenic edge measures 1.6 x 1.4 cm (image 101/series 3) previously, 1.8 x 1.4 cm.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Right external iliac node measures 1.1 x 0.7 cm (image 193/series 3) previously, 1.5 x 0.9 cm.BOWEL, MESENTERY: Please see above section.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Decrease in the lymphadenopathy in the chest, abdomen and pelvis. |
Generate impression based on findings. | Reason: h/o total laryngectomy for laryngeal CA s/p L carotid stent, L carotid inferior embolization, L carotid superior suture for carotid blowout, evaluate for disease/recurrence History: h/o total laryngectomy for laryngeal CA s/p L carotid stent, L carotid inferior embolization, L carotid superior suture for carotid blowout, evaluate for disease/recurrence CT neck:Since the prior exam the patient has undergone left neck surgery and removal of the left common carotid and left internal carotid artery. There is infiltration of the soft tissues of the left neck where there was previously a neoplasm encasing the left common carotid artery there is a thrombosis of the left common carotid artery. Infiltration of the fat planes of the left neck extends from the level of the clavicle to the level of the C2 vertebral body level.Surgical clips are present throughout both right and left neck.The patient is status post laryngectomy and tracheal stoma appeared to endotracheal tube extends to the stoma.Some retained secretions are identified in the oropharynx.Within the suprahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated. Within the infrahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated.Within the visceral space the thyroid gland appears intact.The airway appears patent.The parotid glands appear intact.The visualized lung apices demonstrate a honeycomb appearance along the medial aspects of the upper lung fields consistent with prior radiation or along the right upper lung field there are patchy foci of ground glass appearance.There is redemonstration effacement of fat planes surrounding the right carotid which is stable when compared to the prior exam. There is no opacification of the distal left internal carotid artery above the tumor site and in no opacification of the trunk of the left external carotid artery is appreciated there appears to be some collateralization to the superficial temporal artery and occipital artery as well as possibly internal maxillary artery. The cervical vertebral bodies in general are intact with no evidence for canal stenosis.CT head:The CSF spaces are appropriate for the patient's stated age with no midline shift. Since the prior exam a hypodense focus in left frontal lobe as near completely resolved. The previously identified enhancing lesion in left frontal lobe prior July exam is smaller and measures approximately 7 mm x 5 mm and previously measured 14 mm x 10 mmNo abnormal enhancing mass lesions are appreciated intracranially. No acute 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.Since the prior examination the patient has undergone left and neck surgery. There there appears be residual neoplasm in the left neck possibly extending from as low as the left clavicle and as high as C2. A left common artery and left internal carotid artery have thrombosed. There is a plug present at the origin of the left common artery above which the left common carotid artery is occluded. There is no opacification of the distal left internal carotid artery above the tumor site and in no opacification of the trunk of the left external carotid artery is appreciated there appears to be some collateralization to the superficial temporal artery and occipital artery as well as possibly internal maxillary artery. The posterior communicating artery and anterior communicating artery are prominent2.post treatment changes in the right neck are reidentified and appear relatively stable3.a left orbital gyrus the lesion appears smaller on the current exam when compared with the prior exam. vasogenic edema has resolved4.patchy lesions in the right upper lung field and are suspicious for airspace disease. Please refer to chest CT for further comments |
Generate impression based on findings. | BOT CA status post CRT 2.6 years. CHEST:LUNGS AND PLEURA: Scattered subpleural lymph nodes along the fissures. No pleural fluid or pneumothorax. No suspicious pulmonary nodules.MEDIASTINUM AND HILA: Right-sided aortic arch with aberrant left subclavian artery, normal anatomic variant. Numerous mildly enlarged dense, possibly calcified lymph nodes in the subcarinal space, right lower interlobar and lower lobe segmental lymph node distributions, present previously. One of the subcarinal lymph nodes (3/56) which was previously peripherally hyperattenuating or calcified now has areas of hypoattenuation and appears smaller. On closer inspection, some of the other lymph nodes in this region also appears smaller. The pattern of calcification is atypical but is usually seen in granulomatous disease.Unchanged 8 mm high left paratracheal region lymph node (3/10). Small hiatal hernia, incompletely assessed.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Subcentimeter hypoattenuating lesion in the right hepatic lobe (3/111) unchanged, too small to be accurately characterized but more likely to be benign than malignant.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter hypoattenuating lesions too small to accurately characterize.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.T-tacks in the stomach.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. No suspicious pulmonary nodules or masses.2. Mediastinal and right hilar region lymphadenopathy, some of which is smaller or decreasing density. The radiographic appearance and absence of hepatic or splenic lesions is atypical for granulomatous disease. Consider Castleman's disease. |
Generate impression based on findings. | History of breast and colon cancer, now with elevated CEA Please note that this examination is limited in sensitivity for solid organ pathology due to lack of IV contrast.CHEST:LUNGS AND PLEURA: Scattered calcified and noncalcified pulmonary nodules. Several subcentimeter calcified nodules are seen, likely secondary to prior granulomatous disease or small benign hamartomas. No focal air space opacities or pleural effusions.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Calcified mediastinal and hilar lymph nodes, likely secondary to prior granulomatous disease. AICD leads in the right atrial appendage and right ventricular apex. No pericardial effusion. Moderate atherosclerotic calcification of the coronary arteries and aorta.CHEST WALL: Postsurgical changes at the breasts bilaterally. No axillary lymphadenopathy. Bilateral punctate thyroid calcifications.ABDOMEN: LIVER, BILIARY TRACT: Status post cholecystectomy. No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral punctate calcific densities, most of which likely represent small non-obstructing renal calculi. PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Moderate atherosclerotic calcification of the abdominal aorta, without aneurysm.BOWEL, MESENTERY: Limited examination due to poor opacification of bowel by oral contrast. No gross abnormalities noted. Subcentimeter mesenteric lymph nodes.BONES, SOFT TISSUES: Degenerative disk disease and dextroscoliosis of the lumbar spine. No suspicious lytic or sclerotic lesions are seen. Mild diffuse subcutaneous soft tissue edema.OTHER: No significant abnormality noted. There is no ascites.PELVIS:UTERUS, ADNEXA: Surgically absent or atrophic.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Limited examination due to poor opacification of bowel by oral contrast. No significant abnormality noted. Subcentimeter mesenteric lymph nodes.BONES, SOFT TISSUES: No significant abnormality noted. No suspicious lytic or sclerotic lesions are seen. Mild diffuse subcutaneous soft tissue edema.OTHER: No significant abnormality noted. There is no ascites. | 1. Limited examination due to lack of IV contrast and poor opacification of bowel by oral contrast. Given these limitations, there is no specific evidence of metastatic disease. 2. Bilateral punctate thyroid calcifications. Ultrasound may be helpful to further evaluate this. |
Generate impression based on findings. | Reason: Hx of Follicular NHL History: s/p 4 cycles of Immunotherapy The patient is status post right parotid surgery. There is no evidence for recurrence of the patient's right parotid mass. A small hyperdensity in the right parotid gland identified on the prior exam has regressed, previously measuring 23 x 11 mm now measuring 18 x 6 mm in axial dimensions. Previously noted 14 by 8mm lymph node in the right posterior triangle at the level of the hyoid now measures 3 x 9 mm in axial dimensions. Previously noted lymph node in the right posterior triangle at the level of thyroid cartilage measures 7 mm at 8 mm. A right level 4 lymph node previously measured 19 x 22 mm now measures 14 x 13 mm. Small lymph nodes are identified in the left neck which don't meet size criteria for lymphadenopathy orWithin the visceral space the thyroid gland appears intact.The airway appears patent.The visualized intracranial structures which include the posterior fossa are intact. The visualized portions of the orbits are intact. The paranasal sinuses are clear. The mastoid air cells are clear.The left 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. | 1.Since the prior exam a right parotid lesion as well as right neck lymphadenopathy have continued to regress |
Generate impression based on findings. | Reason: mid-back pain approx T10 rule out facet pathology History: sharp pain worse with extension The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. | No evidence for pathologic lesion in the thoracic spine. No significant degenerative change or spinal stenosis or neural foraminal encroachment is identified in the thoracic spine. |
Generate impression based on findings. | Reason: confusion History: confusion 90 years old female 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.Atherosclerotic calcifications are present along the distal internal carotid 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. The left eyeball lenses is thin. | 1.No evidence for acute intracranial hemorrhage mass effect or edema. No CT findings that would help explain the patient's confusion2.CT is insensitive for the early detection of nonhemorrhagic CVA |
Generate impression based on findings. | Female 80 years old; Reason: metastatic breast cancer - evaluate response to treatment, compare with previous History: known lung mets CHEST:LUNGS AND PLEURA: Subpleural fibrotic changes worst in the lingula.Right upper lobe nodule is more solid measuring 0.8 x 0.8 cm (image 36/series 9) previously, 0.5 x 0.5 cm.Right middle lobe lesion with measures 2.0 x 1.0 cm (image 59/series 3) previously, 2.0 x 1.0 cm.No new suspicious lesions. Pleural spaces are clear.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion.Right chest wall port terminates at the cavoatrial junction.CHEST WALL: Postoperative and radiation changes in the left chest with multiple clips in the left axilla.Small right axillary lymph nodes persist.ABDOMEN:LIVER, BILIARY TRACT: Liver is diffusely hypodense compatible with fatty infiltration. No suspicious hepatic lesions.Hepatic and portal veins are patent.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 retroperitoneal lymphadenopathy. Calcific arteriosclerotic disease affects the aorta .BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis.BONES, SOFT TISSUES: Degenerative changes affect the lumbar spine.OTHER: No significant abnormality noted. | 1.Slight size increase in the right upper lobe pulmonary nodule which appears more solid. |
Generate impression based on findings. | Female, 38 years old, left parotid tumor status post surgery. Since the prior examination, the patient has undergone left parotid space surgery. The volume of remaining parotid gland is reduced relative to prior consistent with tumor resection. No definite evidence of residual or recurrent tumor is seen within the surgical bed. However, please note that the original tumor was similar in CT density to the parotid gland, and therefore, small lesions would be difficult to detect.Scattered nonpathologic lymph nodes are evident through both sides of the neck. None of these has substantially changed. There are no new or progressing lymph nodes.The aerodigestive mucosa is within normal limits. The other salivary glands are unremarkable. Hypodense foci in the left thyroid lobe and the thyroid isthmus are unchanged. A hypodense lesion seen previously in the right thyroid lobe is not well demonstrated.Cervical vessels are unremarkable. Lung apices are clear. No concerning bony lesions are demonstrated. | Postoperative change consistent with tumor resection from the left parotid space. No definite evidence of residual or recurrent tumor is seen. However, given that the original tumor was of similar density to the surrounding parotid gland, small lesions may be missed on CT. If clinically warranted, MRI would provide a more sensitive evaluation. |
Generate impression based on findings. | Reason: Pt with BOT Ca. s/p CRT 2.6 years. please re-eval and compare to prior scans History: as above Within the suprahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated. Within the infrahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated.Left jugulodigastric node measures 7 mm and is unchanged. Right jugulodigastric node measures 5 mm and is unchangedWithin 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 demonstrates small mucus and some cysts in the left maxillary sinus. 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. note is made of retro-esophageal aberrant l left subclavian arteryThe cervical vertebral bodies in general are intact with no evidence for canal stenosis. | 1.No evidence for local recurrence or neck lymphadenopathy on the basis of CT size criteria for lymphadenopathy |
Generate impression based on findings. | Prior small cell lung CA status post RT and chemo 10 years ago. Last CT mentioned nodules appeared more solid, please reevaluate. CHEST:LUNGS AND PLEURA: Mild centrilobular and paraseptal emphysema. Paramediastinal radiation fibrosis predominantly in the upper left apex. No pleural fluid.Solid noncalcified nodule right upper lobe measures 11 x 10 mm (7/135), previously 10 x 9 mm on 9/26/12 and roughly 9 x 8mm on 9/28/11. The caudal border of the nodule appears slightly irregular and causes mild tenting of the minor fissure from which it is inseparable. The lesion has significantly increased in both size and density compared to remote earlier studies and is now consistent with an indolent primary malignancy.6cm below the level of the carina there is a right lower lobe spiculated mass inseparable from the right major fissure, adjacent lymphadenopathy and the bronchovascular bundle measuring 3.2 x 2.7 cm (7/154), previously a maximum of 15 x 9 mm on 9/26/12 and semi-solid in appearance on 9/28/11. When reviewing remote earlier films, the lesion has increased in both size and density and is now highly compatible with indolent primary pulmonary malignancy. MEDIASTINUM AND HILA: Small pericardial fluid collection. Although assessment is limited by unenhanced technique, fullness adjacent to the right lower lobe bronchus is consistent with lymphadenopathy. Unchanged appearance of the right hilum over several prior studies and additional small partially calcified lymph nodes are consistent with healed granulomatous infection. Coronary artery calcifications. Calcified mitral annulus.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis without evidence of cholecystitis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Chronically obstructed and hydronephrotic right kidney with cortical thinning.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications 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: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Slow-growing 3.2-cm mass in the right lower lobe is now highly compatible with primary pulmonary malignancy. Mass occurs 6-cm below the level of the carina and is inseparable from the right major fissure and adjacent bronchovascular structures.2. Slow growing right upper lobe nodule is also now consistent with a synchronous primary pulmonary malignancy. Unable to exclude invasion of the adjacent right minor fissure.3. Mild right inferior interlobar lymphadenopathy.4. Small pericardial fluid collection.5. No pleural fluid or visible abdominal metastases. |
Generate impression based on findings. | Reason: s/p fall History: dizziness The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Periventricular and subcortical white matter hypodensities of a moderate degree are present.Macro as are ICAThe 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. Incidental note is made of a osteoma adjacent right frontal lobe protruding intracranially | 1.No evidence for acute intracranial hemorrhage mass effect or edema.2.CT is insensitive for the early detection of nonhemorrhagic CVA3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. |
Generate impression based on findings. | Female, 30 years old, sickle cell disease with crisis, weakness. Evaluate for hemorrhage. The cerebral and cerebellar hemispheres and brainstem are normal in attenuation and morphology. No intracranial hemorrhage or abnormal extra-axial fluid collection is seen. There is no evidence of mass effect or midline shift. The ventricles and basal cisterns are patent and normal in size. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.The bones of the calvarium and skull base are intact. | Normal exam. No acute intracranial abnormality. |
Generate impression based on findings. | Male 64 years old; Reason: met prostate cancer, now with palpable mass in epigastric region, pain in abdomen History: met prostate cancer, now with palpable mass in epigastric region, pain in abdomen CHEST:LUNGS AND PLEURA: No suspicious primary nodules. Minimal nodularity along right major and minor fissures. The pleural spaces are clear.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. Ascending aorta is mildly ectatic measuring 3.8-cm.CHEST WALL: Sclerotic osseous metastatic disease.OTHER: ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right renal cysts. No suspicious lesions in either kidney.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes.BOWEL, MESENTERY: Colonic diverticulosis. No surrounding inflammatory changes.BONES, SOFT TISSUES: No focal mass in the epigastric area to correlate with the patient's palpable abnormality.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Sclerotic metastatic disease. Post operative changes in the left hip.OTHER: No significant abnormality noted | 1.Osseous metastatic disease.2.No focal body wall mass or intra-abdominal mass to correlate with the palpable epigastric abnormality. |
Generate impression based on findings. | Male, 78 years old, with headache. Periventricular hypoattenuation is demonstrated along with areas of hypoattenuation involving the left internal capsule and the left thalamus. These have not significantly changed from prior examination and likely reflect age indeterminate small vessel ischemic disease.No mass effect or midline shift is seen. No intracranial hemorrhage or abnormal extra-axial fluid collection is detected. The ventricular system is patent and normal in size.The bones of the calvarium and skull base are intact. Paranasal sinuses and mastoid air cells are clear. | 1. No acute intracranial normality.2. Age indeterminate small vessel ischemic disease, not substantially changed from the prior examination. |
Generate impression based on findings. | 37 year-old female with left eye swelling the past 3 weeks Prominence is noted of the soft tissues involving the lateral aspect of the left eyelid with adjacent stranding noted in the subcutaneous tissues overlying the anterior most zygomatic arch. This is not associated with a focal fluid collection and there are no post-septal abnormalities.The globes, lenses, extraocular muscles, optic nerves, and intraconal space are symmetric and normal. No radiopaque foreign body is identified. The right orbital soft tissues are normal. The osseous structures are unremarkable with no evidence of fracture. The mastoids are clear. Limited view of the intracranial structure is unremarkable. Other than minimal mucosal thickening within the next they sinus is, the frontal sinuses, frontal-ethmoid recesses, anterior/posterior ethmoids, sphenoid sinuses, and maxillary sinuses are well developed and clear. The osteomeatal complexes are normal with intact uncinate processes and patent infundibuli. The intersphenoid septum is normal. The nasal turbinates and nasal septum are normal. The cribriform plate, fovea ethmoidalis and lamina papyraceae appear normal. The osseous structures are unremarkable. | Prominence is noted of the soft tissues involving the lateral aspect of the left eyelid with adjacent stranding noted in the subcutaneous tissues overlying the anterior most zygomatic arch. This is not associated with a focal fluid collection and there are no post-septal abnormalities. These findings are most suggestive of a superficial cellulitis. |
Generate impression based on findings. | Heart replaced by transplant. Fever, unspecified. Evaluate for infection. CHEST:LUNGS AND PLEURA: Previously described multiple peripheral wedge-shaped masses have cavitated since the prior examination which may reflect treatment response. Areas of atelectasis and parenchymal disease at the lung bases appear similar to the prior examination. Bilateral effusions (left greater than right) are also similar. MEDIASTINUM AND HILA: Tracheostomy terminates above the carina unchanged. A left-sided pacemaker has been removed in the interim. Right-sided central venous catheter unchanged. Subcentimeter mediastinal lymph nodes. Small amount of pericardial fluid. New internal jugular venous catheter terminates in the left brachiocephalic vein near the confluence with the SVC.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Perihepatic ascites unchanged. No focal liver lesions. Gallbladder appears unremarkable.SPLEEN: Mild splenomegaly.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Endstage native kidneys. Hyperdense, exophytic left renal nodule appears similar to previous.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Presumed debris noted within the lumen of the stomach correlate clinically. Mushroom retained G-tube located in the stomach.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: Transplant kidney noted in the right iliac fossa. Ureteral stent appears to be in adequate position. Mild dilatation of both common iliac arteries with the right common iliac artery measuring 2.4 cm in diameter. | Interval cavitation of multiple peripheral cavitary lung nodules, possibly reflecting treatment response to infection or evolving septic emboli. Abdominal and pelvic ascites is unchanged. |
Generate impression based on findings. | Esophageal CA status post CRT CHEST:LUNGS AND PLEURA: No suspicious pulmonary nodules or masses. Paramediastinal bronchiectasis and fibrosis has progressed. There is a nodular component medially within the left lower lobe (4/74) which falls within the the radiation field and is more likely to be post therapeutic than metastatic. This can be followed on subsequent exams.MEDIASTINUM AND HILA: Interval increase in size and number of mediastinal lymph nodes bilaterally. For example a retrotracheal lymph node has increased from 7-mm to 13-mm in short axis (3/9). Lymph node enlargement has also occurred in the right paratracheal, low left paratracheal, sub-aortic and para-aortic spaces. Right hilar lymphadenopathy is new (3/44). Diffuse lymphatic tissue enlargement around the lower lobe airways bilaterally stable to minimally worse.Mild bilateral paraesophageal lymphadenopathy (3/50).Eccentric position and narrowing of the esophageal lumen at the level of the carina now compatible with an underlying mass at this level (3/38, sagittal image 65). Diffuse mild wall thickening of the lower esophagus about the same. Previously measured mass at the GE junction is no longer discrete; reference level measurement of the esophagus is 15 x 33-mm (3/73), previously 27 x 27 mm, differences in measurement likely can be attributed to esophageal compression on the current study.CHEST WALL: Right chest port with tip in the SVC. Left axillary lymph node measures 7-mm, unchanged (3/20).ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Unchanged scalloping of the anterior liver border.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Mild thickening of the left adrenal gland not appreciably changed.KIDNEYS, URETERS: Right renal cyst.PANCREAS: Calcifications in the head of the pancreas suggestive of prior pancreatitis.RETROPERITONEUM, LYMPH NODES: Subcentimeter lymph node adjacent to the suprahepatic IVC slightly larger and is now enhancing, suspicious for nodal metastasis. Index gastrohepatic ligament lymph node measures 16 x 17 mm, unchanged (3/93). Soft tissue surrounding the celiac axis appears less dense.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Numerous small lymph nodes, not significantly changed.BONES, SOFT TISSUES: Punched-out lytic lesion in the inferior right scapula unchanged compared to 12/19/12.OTHER: No significant abnormality noted. | 1. Esophageal mass just above the level of the carina with development of thoracic lymphadenopathy, highly suspicious for a synchronous primary tumor and nodal metastases. Please note that a newly enlarged lymph node adjacent to the suprahepatic IVC is also identified and may indicate spread of disease related to this proximal mass rather than the initial distal esophageal mass.2. No conclusive pulmonary metastases.3. Lower esophageal mass is no longer reliably measurable.4. Stable appearance of gastrohepatic/celiac axis region lymphadenopathy and numerous small mesenteric lymph nodes. |
Generate impression based on findings. | Malignant neoplasm of the prostate. Assess metastatic disease. ABDOMEN:LUNG BASES: Minimal punctate nodularity medially at the left lung base is of unclear etiology and should be followed. This may reflect aspiration.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Widespread bony metastases. Correlate with bone scan.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Soft tissue mass in the expected region of the right seminal vesicle a common distal ureter, and bladder measures 2.3 x 5.1 cm (image 87; series 3). I cannot ascertain the etiology.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Widespread bony metastases. Correlate with bone scan.OTHER: No significant abnormality noted | Widespread bony metastases. Soft tissue mass in the region of the right seminal vesicle and distal ureter; I cannot determine organ of etiology. |
Generate impression based on findings. | Patient history of metastatic thyroid cancer for surveillance. Head CT: There is no intracranial mass, fluid collection, hemorrhage, hydrocephalus or evidence of acute ischemia. There is no pathological enhancement. Gray-white matter differentiation is maintained bilaterally and the midline is intact. The imaged portions of the orbits and paranasal sinuses are unremarkable.Neck CT: There are postoperative changes related to prior thyroidectomy and tracheostomy placement. There are no soft tissue masses or lymph nodes which are pathologic by size or morphologic criteria. There are no mucosal lesions demonstrated along the imaged portion of the aerodigestive tract. There is fatty replacement of the parotids with normal submandibular glands. The tongue has a normal appearance. There is no abnormality demonstrated within the posterior triangle.There are degenerative changes most prominent at the C2-5 levels where there are uncovertebral and facet osteophytes as well as endplate sclerosis. There are no focally aggressive lesions demonstrated.There are multiple pulmonary masses demonstrated within the imaged portions of the apices which have been demonstrated previously. Refer to the report of a CT chest for further details. | 1.No intracranial abnormality. 2.Stable postoperative changes related to thyroidectomy and tracheostomy placement.3.No evidence of local recurrence or metastatic disease including lymphadenopathy.4.Degenerative changes of the cervical spine as described.5.Multiple pulmonary nodules related to metastatic deposits. Refer to CT chest report for further detail. |
Generate impression based on findings. | 72 year-old female with history of medullary thyroid cancer. Evaluate for metastatic disease. CHEST:LUNGS AND PLEURA: 2-mm micronodule left upper lobe.MEDIASTINUM AND HILA: Borderline right hilar adenopathy with node on image 33/142 measuring 1.4 x 1.5 cm. Elevation of the left hemidiaphragm.CHEST WALL: Post thyroidectomy. 1.2 x 1.7 cm left sub-pectoral lymph node on image 12/142hemangioma at T9ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: There is a small focus of decreased attenuation in the inferior right lobe on image 94/142 portal venous phase which is not hypervascular on arterial phase imaging and is non--- specific. No arterially -- enhancing mass is identified within the liver.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Small to borderline retrocrural lymph nodes.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. Subpectoral lymph node on the left.2. Borderline right hilar and retrocrural adenopathy.3. No definite evidence for hepatic metastatic disease. |
Generate impression based on findings. | Metastatic prostate cancer. Evaluate disease for baseline. CHEST:LUNGS AND PLEURA: Severe centrilobular emphysema. There is a 3.8 x 3.7 cm left upper lobe lung mass (image 28; series 5) which has an appearance most compatible with primary lung carcinoma. Radiation changes are also noted in the left lung. Moderate to large left pleural effusion with overlying compressive atelectasis.MEDIASTINUM AND HILA: Mediastinal adenopathy. Precarinal lymph node measures 2.7 x 2.0 cm (image 38; series 3). Pericardial effusion.CHEST WALL: Right internal jugular vein chest port terminates in the right atrium. Extensive bony metastases.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Hypoplastic spleen.PANCREAS: No significant abnormality notedADRENAL GLANDS: Bilateral adrenal gland masses presumably represent metastases.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Adenopathy. Reference right common femoral lymph node measures 1.7 x 1.7 cm (image 23; series 3).BOWEL, MESENTERY: No significant abnormality identifiedBONES, SOFT TISSUES: Widespread bony metastasesOTHER: No significant abnormality noted | Widespread bony metastases. Left upper lobe lung mass (presumably representing primary bronchogenic carcinoma) with mediastinal lymphadenopathy and bilateral adrenal metastases. Pelvic adenopathy with measurements given above. |
Generate impression based on findings. | Female, 63 years old, history of metastatic thyroid cancer. Mottled lucency is again seen involving the right parietal bone, the squamous right temporal bone, and a small portion of the right retromastoid occipital bone. The right sphenoid wing is also mottled and irregularly lucent with involvement of the lateral orbital wall, the floor of the middle cranial fossa and the pterygoid plates. These findings have not significantly changed. No definite new destructive calvarial lesions are seen.Subtle areas of dural thickening and enhancement are redemonstrated along the right parietal bone and the right squamous temporal bone. Within the limitations of CT, these have probably not progressed. Also redemonstrated is epidural thickening and enhancement along the floor of the right middle cranial fossa which extends through the permeated skull base to involve the infratemporal fossa. Again, no significant change is seen relative to the immediate prior examination, and the appearance remains improved when compared to a more remote examination from 06/11/13. The adjacent right pterygopalatine fossa is infiltrated by abnormal soft tissue, similar to prior.A rim enhancing, centrally hypodense nodule at level IIb on the right measures 1.6 x 1.3 cm (image 30 series 4), unchanged in size but appearing more centrally hypodense. An additional reference nodule, slightly more inferiorly, demonstrates similar imaging characteristics and measures 9 x 8 mm (image 39 series 4), also not significantly changed. A left submandibular node measures 1.4 x 1.1 cm (image 44 series 4), previously 1.6 x 1.1 cm. Please note that a prior reference node described as being in the "right-sided suprahyoid neck" is not indicated with measurements are narrow and therefore cannot be confidently identified.Enhancing tissue, too ill-defined to accurately measure, is evident along the left posterolateral aspect of the cricoid cartilage. This has probably not significantly changed from the immediate prior study, and is less conspicuous when compared to the examination of 06/11/13.The patient is status post thyroidectomy. Small soft tissue nodules within or adjacent to the thyroid bed show no significant interval change. Small mediastinal lymph nodes are also demonstrated.The aerodigestive mucosa is otherwise unremarkable. The salivary glands are free of focal lesions. The cervical vessels are patent. Lung apices demonstrate a couple of tiny micronodules with no new abnormality.Lytic change involving the posterior elements of C2, C3, C4 and C6 has not significantly changed. There is a chronic fracture of the T1 spinous process. The partially visualized right scapula is also mottled and lucent without change. | 1. Stable lytic change involving the right aspect of the calvarium and the floor of the right middle cranial fossa.2. Epidural tumor along the right parietal and temporal bones, the floor of the right middle cranial fossa, and extending into the infratemporal fossa has probably not significantly changed. Please note that MRI would provide a more sensitive evaluation in this regard.3. Scattered reference nodules in the neck have not increased in size and some may be slightly smaller. No new lesions are demonstrated.4. Stable lytic change involving the cervical spine and the right scapula as above. |
Generate impression based on findings. | Female 59 years old Reason: s/p 8 mo after Right video-assisted robotic resection of the right upper lobe lung cancer, Talc Pleurodesis History: f/u CHEST:LUNGS AND PLEURA: There has been a right upper lobe wedge resection of the previously described right lobe nodule; however, multiple new solid nodules are seen in the area of the prior resection the largest measuring 15 x 14 mm (image 29, series 5). This is concerning for local recurrence. New right upper lobe 10-mm solid nodule concerning for intrapulmonary metastasis (image 39, series 5). Previously described 5-mm anterior right upper lobe nodule not identified on this exam. Reference left lower lobe nodule now measures 5 mm (image 61, series 5), previously 6 mm.Subpleural thickening and scarring adjacent to the surgical site.Severe emphysema and mild apical scarring unchanged.MEDIASTINUM AND HILA: No evidence of mediastinal or hilar lymphadenopathy. Moderate calcifications of the aorta and coronary arteries.CHEST WALL: Round lucency in T1 vertebral body likely hemangioma, unchanged.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Small contrast enhancing lesion in hepatic segment 7, incompletely characterized on this examination and may represent variable perfusion, focal fat sparing, or less likely metastasis. Attention should be paid to this area on future imaging studies.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small left renal cyst unchanged.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Severe atherosclerotic disease of the abdominal aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Local recurrence at the site of wedge resection.2. Stable reference left lower lobe lung nodule and new right upper lobe lung nodule.3. Severe emphysema unchanged.4. Hepatic segment 7 lesion incompletely characterized on this examination, special attention should be paid on future imaging studies. |
Generate impression based on findings. | Female; 49 years old. Reason: Rule out PE History: SOB PULMONARY ARTERIES: No evidence of pulmonary embolism. LUNGS AND PLEURA: Small bilateral pleural effusions and overlying compressive atelectasis, left greater than right. No focal air space opacity. No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. No mediastinal or hilar lymphadenopathy. Mild thickening of the distal esophagus is nonspecific considering the recent postoperative period.CHEST WALL: No axillary lymphadenopathy. UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. Postsurgical changes compatible with gastric bypass surgery. | 1.No evidence of pulmonary embolism.2.Small bilateral pleural effusions and overlying compressive atelectasis, left greater than right. |
Generate impression based on findings. | Abdominal pain ABDOMEN:LUNG BASES: Trace bilateral pleural effusions with overlying subsegmental atelectasis.LIVER, BILIARY TRACT: No focal hepatic lesions are seen. No intrahepatic or extrahepatic biliary ductal dilatation. Normal CT appearance of the gallbladder.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Hypoattenuating subcentimeter left renal lesions, which are too small to characterize.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Few prominent nonspecific subcentimeter mesenteric and retroperitoneal lymph nodes.BOWEL, MESENTERY: Postsurgical changes of a gastric bypass. There is mild mesenteric stranding surrounding the stomach with left upper quadrant peritoneal thickening, which is within normal postsurgical limits. There is no fluid collection seen. There is no pneumoperitoneum.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Large uterine and cervical fibroids. Fluid density structure with peripheral enhancement in the left adnexa, likely representing a hemorrhagic cyst. BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality noted. Normal-appearing appendix.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Trace pelvic free fluid, likely physiologic. | Post-surgical changes in the left upper abdominal quadrant, without specific evidence of complication or acute abnormality otherwise.Probable left adnexal hemorrhagic/ruptured cyst |
Generate impression based on findings. | Metastatic thyroid cancer on treatment CHEST:LUNGS AND PLEURA: Numerous pulmonary nodules consistent with metastases. Left lower lobe index nodule measures 22 x 19-mm (5/53), previously 18 x 16 mm. A second left lower lobe index nodule (5/59) measures 18 x 23 mm, previously 15 x 21 mm. Right lower lobe index nodule difficult to reproducibly measure due to differences in scan variability in the long axis, 17-mm on the current and prior examinations. The short axis has decreased to 12-mm from prior measurement of 14-mm (5/52).MEDIASTINUM AND HILA: Tracheostomy tube tip at the level of the clavicular heads. Postsurgical changes of prior CABG. Native coronary arteries are heavily calcified. No significant lymphadenopathy. No pericardial fluid.CHEST WALL: Endplate sclerosis at the distal cervical spine incompletely included within this scanning range. Prior sternotomy with wires in place. ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Incompletely characterized centrally hypoattenuating, peripherally enhancing irregular mass at the hepatic dome not appreciably unchanged. Cholelithiasis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Pulmonary metastases with minimal increase in reference measurements. Hepatic mass is unchanged over the past several scans but is incompletely characterized. If accurate characterization would alter clinical management of the patient, a dedicated hepatic CT may be of use. |
Generate impression based on findings. | 66-year-old female with left inguinal hernia, evaluate for recurrence. 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: Lumbar vertebral body screws and disk spacers are noted. Degenerative changes of the SI joints.OTHER: Postoperative change of right inguinal hernia repair without evidence of recurrence. No additional hernias are noted. Atherosclerotic calcification of the abdominal aorta and its branches. | No evidence of hernia. |
Generate impression based on findings. | Male; 84 years old. Reason: 84 yo M with h/o NSCLC s/p hypofractionated RT > 1 year ago. Please assess for recurrence. CHEST:LUNGS AND PLEURA: Reference peripheral nodule in right upper lobe is not reliably measurable due to adjacent consolidation and fibrosis from radiation therapy. There is abrupt airway cutoff in the region of consolidation, but its anterior portion appears improved since the prior CT. Streaky basilar opacities likely represent scarring, right greater than left. Centrilobular and paraseptal emphysema. No focal air space opacity or pleural effusion. Scattered unchanged pulmonary micronodules, some of which are calcified. No new suspicious pulmonary nodules or masses are seen.MEDIASTINUM AND HILA: Enlarged heterogeneous thyroid gland is consistent with goiter but incompletely assessed by CT. Normal heart size without pericardial effusion. Mild coronary and aortic arch calcifications. Calcified mediastinal and hilar lymph nodes most consistent with prior granulomatous infection. Reference left paratracheal lymph node is unchanged and measures 8 mm (series 3, image 38).CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Splenic granulomata.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted. BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Mild multilevel degenerative changes of the visualized spine. Diffuse osteopenia limits sensitivity in detection of osseous metastases. OTHER: Abdominal aortic calcifications. | 1.Mild interval improvement in right upper lobe radiation reaction, but underlying spiculated lung nodule remains obscured and not measurable. 2.No new suspicious lesions or interval change. |
Generate impression based on findings. | Left ureteral injury and hydronephrosis. Flank pain. The following observations are made given the limitations of an unenhanced study.ABDOMEN:LUNG BASES: Two separate 4-mm nodules at the right lung base are nonspecific (image 10, 4; series 3).LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Atrophic left kidney. Right kidney appears unremarkable. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Small calcifications presumed representing calculi are noted along the course of the distal left ureter. For reference purposes, the largest measures 6-mm calculus (image 110; series 4) | Distal left ureteral calculi and atrophic left kidney. |
Generate impression based on findings. | Metastatic breast cancer status post S/P RT to 3 lung lesions and right level 12 node 3/13. RML lesion was untreated. Occasional cough. CHEST:LUNGS AND PLEURA: Right apical fibrosis. Subpleural fibrosis in the anterior right lung consistent with RT. Bronchiectasis and architectural distortion of the proximal right middle and right lower lobe airways with associated atelectasis consistent with post-therapeutic change. Two fiducial markers noted in the right lower lobe presumably at the site of the prior nodules, now obscured due to atelectatic lung. An additional metallic clip or marker is seen in the right lower lobe abutting the right hemidiaphragm.Spiculated nodule in the anterior right lower lobe (5/62) measures 10 x 12 mm, previously 8 x 11 mm on 5/10/13 and 7 x 9 mm on 1/15/13. Peripherally enhancing, centrally low attenuation pleural metastasis in the right middle lobe slightly larger (5/66), but no right middle lobe intraparenchymal nodules are appreciated.A well circumscribed subpleural lymph node in the right major fissure has enlarged since the prior examination, 8-mm compared to 3-mm, suspicious for metastasis.MEDIASTINUM AND HILA: Subcentimeter lymph nodes in the high right paratracheal region increased since the previous study in size and number (4/15). New peripherally enhancing, centrally necrotic lymph node in the left prevascular region (4/26), measuring 8mm, previously 4-mm.Lesion in the prevascular space to the right of midline at the level of the great vessels measures 10 x 19 mm (4/20), previously 11 x 16 mm on 5/10/13 and and 10 x 13 mm on 1/15/13. Centrally necrotic, peripherally enhancing lesion to the right of the sternum (4/48) extends to the anterior mediastinum at the from the level of the aortic root (4/46) to the level of the aortic valve (4/57). This was present previously on the prior outside exam, slightly increased in size. Both of these lesions most likely represent necrotic internal mammary chain lymphadenopathy.A nonindex prevascular lymph node (4/33) has also enlarged. Chest port tip in the right atrium.CHEST WALL: Left single lumen chest port. Surgical clips in the right breast. Previously noted asymmetric soft tissue in the right pectoralis musculature is not clearly appreciated on today's study.Focal sclerosis right fourth rib suggests chronic fracture.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: 1 cm peripancreatic nodule (4/93), unchanged, nonspecific.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification 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: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Anterior right lower lobe metastasis measures minimally larger. Additional lesions obscured by post therapeutic change.2. Right pleural metastasis slightly larger. Interval enlargement of a subpleural lymph node in the right major fissure suspicious for metastasis.3. Necrotic right internal mammary chain metastases with extension into the anterior mediastinum slightly larger.4. Increase in size and number of mediastinal lymph nodes. |
Generate impression based on findings. | 42 year old female. Reason: CT pe rliving kidney donor protocol History: kidney donor ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedRIGHT KIDNEY: Right kidney measures 10 cm in length. Right kidney measures 6.2 cm in width. Distance between the renal artery origin and the first segmental bifurcation measures 3.2 cm. The first segmental bifurcation of the right renal artery occurs at the right IVC margin. The segmentary confluence of the right renal vein occurs less than 1 cm away from the IVC.LEFT KIDNEY: Left kidney measures 10.8 cm in length. Left kidney measures 5.7 cm in width. Distance between the renal artery origin and the first segmental bifurcation measures 2.7 cm. The distance between the segmentary confluence of the left renal vein and the IVC measure 3.3 cm.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Right ovarian cyst measuring 5.5 x 4.4 cm.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Mild levoscoliosis with degenerative joint disease at L2-L3.OTHER: No significant abnormality noted | 1.Solitary renal arteries with bifurcation of segmental arteries at the renal hilum bilaterally.2.Segmentary confluence of the right renal vein occurs less than 1cm from the IVC. |
Generate impression based on findings. | Regional enteritis of small intestine. History of Crohn's disease. Evaluate for abscess in the right lower quadrant. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral punctate renal calculi. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mild inflammatory changes of the terminal ileum compatible with history Crohn's disease with areas of narrowing. There is no evidence of a right lower quadrant abscess as clinically queried.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Left adnexal cystic nodule measures 3.5 x 3.2 cm (image 130; series 3) consider correlation with gynecologic ultrasound as clinically indicated.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Mild compression of the left common iliac vein by the right common iliac artery can be seen in May Thurner syndrome. Correlate with possible left leg venous congestion symptoms. | 1. No evidence of a right lower quadrant abscess as clinically queried. 2. Changes in the terminal ileum compatible with history of Crohn's disease. 3. Bilateral renal calculi which are nonobstructive.4. Right adnexal cystic nodule. Consider correlation with gynecologic ultrasound if clinically indicated. |
Generate impression based on findings. | Female 63 years old Reason: metastatic thyroid ca, on therapy, eval for dz, compare to previous with measurements History: as above CHEST:LUNGS AND PLEURA: Stable multiple bilateral pulmonary nodules. Stable mild emphysema.Reference nodule measurements are as follows:1.Apical right upper lobe nodule (series 4, image 24) measures 4 x 4 mm, previously 4 x 4 mm.2.Anterior right upper lobe nodule (series 4, image 27) measures 7 x 3 mm, previously 7 x 3 mm.3.Peripheral left upper lobe nodule (series 4, image 30) measures 6 x 5 mm, previously 6 x 5 mm.4.Right lower lobe nodule (series 4, image 77) measures 8 x 5 mm, previously 8 x 5 mm.MEDIASTINUM AND HILA: No evidence of supraclavicular, mediastinal or hilar lymphadenopathy.Soft tissue density adjacent to the posterior trachea at the level of the surgical bed is incompletely visualized and appears grossly unchanged in size.CHEST WALL: Bony cortical changes in the right scapular tip unchanged. Lytic lesion of the right glenoid and posterior nondisplaced fracture unchanged. Two right healing rib fractures unchangedABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Multiple hepatic cysts unchanged. Hydropic gallbladder without evidence of cholecystitis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral heterogeneous enhancing renal mass is unchanged since the prior exam. Left superior pole index lesion now measures 4.0 x 2.7 cm (series 3, image 99), previous measuring 4.0 x 2.7 cm. No evidence of hydronephrosis.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Slightly prominent retroperitoneal lymph nodes unchanged.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Invasive soft tissue lesion in the transverse process of the L4 vertebrae unchanged. Mild multilevel degenerative changes in the thoracic and lumbar spine, but no other bony metastasis identified.OTHER: No significant abnormality noted. | 1. Unchanged reference pulmonary nodules. 2. Unchanged renal metastases.3. Unchanged osseous metastases and nondisplaced glenoid fracture. |
Generate impression based on findings. | Altered mental status. Hypotension. 44-year-old woman with metastatic squamous cell carcinoma presenting with acute respiratory distress syndrome and concern for liver abscess or metastasis. ABDOMEN:LUNG BASES: Numerous pulmonary nodules at both lung bases, some are cavitated. Bilateral effusions with overlying compressive-type atelectasis. Pleurx catheter noted on the right side. Anterior left lytic rib lesion (image 12; series 3) with possible adjacent soft tissue mass.LIVER, BILIARY TRACT: Multiple hypodense liver lesions compatible with metastases. Hyperdense material noted in the gallbladder may represent sludge or stones. No gallbladder wall thickening.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: 16.4 x 12.8 cm heterogeneous collection, presumably representing hemorrhage occupying the right renal fossa (image 82; series 3). Kidney cannot be differentiated from this collection. Multiple cysts noted in the left kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: NG tube terminates in the stomach.BONES, SOFT TISSUES: Anasarca.OTHER: Ascites.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Foley catheter decompresses the bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Anasarca.OTHER: Ascites. | Presumably widespread metastatic disease.1. Large renal/perirenal hemorrhage2. Bilateral pulmonary nodules, some of which are cavitated.3. Liver lesions, probably representing metastases4. Ascites and anasarca. 5. Left anterior rib lesion with associated osseous destruction.Findings were discussed with the clinical service (pager 3676) at time of dictation. |
Generate impression based on findings. | Female; 74 years old. Reason: 74 yo woman with new low back pain and urinary incontinence, evaluate for nerve impingement History: low back pain Five lumbar type vertebral bodies are presumed to be present. The vertebral body heights are well preserved without evidence of acute fracture. Minimal anterolisthesis of L4 on L5 is likely due to degenerative disk disease and facet joint arthritis at this level. Otherwise, there is normal alignment.Multilevel mild degenerative arthritic changes of the lumbar spine. There is diffuse degenerative disk disease with all disks demonstrating mild loss of height, vacuum cleft phenomenon, mild associated endplate sclerosis, and small endplate osteophytes. Mild disk bulges are noted at nearly all levels. Multilevel facet joint arthritis greatest in the lower lumbar spine particularly at L4-5, where both facet joints demonstrate vacuum cleft phenomenon. Within the limitations of evaluation of the central canal by CT, these degenerative changes contribute to at most mild central canal stenosis at L4-5 with the other levels demonstrating at most mild effacement of the ventral thecal sac. The neural foramina throughout the lumbar spine are patent aside from mild bilateral narrowing at L3-4.There is severe right greater than left arthritic change of the partially visualized sacroiliac joints.Atherosclerotic calcifications of the visualized abdominal aorta extending into the iliac arteries. | 1.Mild multilevel degenerative arthritic changes. No significant central canal stenosis aside from mild stenosis at L4-5. No significant neural foraminal narrowing aside from mild bilateral narrowing at L3-4.2.There is severe right greater than left arthritic change of the partially visualized sacroiliac joints. |
Generate impression based on findings. | Reason: parotid cancer surveillance--restaging History: surveillance CHEST:LUNGS AND PLEURA: No evidence of pulmonary or pleural metastases.MEDIASTINUM AND HILA: High left paratracheal lymph node still 7 mm, image 14 series 3. Other small mediastinal lymph nodes are stable in size.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Hepatic dome hypoattenuating lesion consistent with a hemangioma, unchanged.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No change, and no sign of metastases. |
Generate impression based on findings. | Pancreatitis ABDOMEN:LUNG BASES: Small bilateral pleural effusions, left greater than right, with overlying atelectasis. Punctate clustered densities within the atelectatic right lung base may represent a small calcified nodule or aspirated oral contrast.LIVER, BILIARY TRACT: No significant abnormality noted within the liver. The gallbladder wall appears mildly thickened, which is nonspecific in the setting of ascites.SPLEEN: Scattered subcentimeter hypoattenuating lesions, which are too small characterize.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Diffuse bilateral hypoattenuating subcentimeter renal lesions, which are too small to characterize.PANCREAS: There is a 5.3 x 3.4 cm cystic lesion in the pancreatic tail. The focal nature of this lesion, its location, its peripheral hyperattenuation, and the sparing of the remainder of the pancreas make this more suspicious for a cystic pancreatic tumor rather than necrosis. There are two cystic lesions at the periphery of the pancreatic head, measuring 5 mm (3/36) and 8 mm (3/31), without associated pancreatic ductal dilatation. These are too small to fully characterize on this study, though may represent IPMNs.RETROPERITONEUM, LYMPH NODES: Subcentimeter retroperitoneal and mesenteric lymph nodes.BOWEL, MESENTERY: No gross abnormalities noted.BONES, SOFT TISSUES: Levoscoliosis and mild degenerative disease of the lumbar spine. Mild diffuse soft tissue edemaOTHER: There is a small amount of ascitesPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Mild diffuse soft tissue edema. No significant abnormality noted otherwise.OTHER: No significant abnormality noted | 1. 5.3 x 3.4 cm lesion in the pancreatic tail, suspicious for a cystic pancreatic mass. Focal pancreatic necrosis is also a possibility, though less likely given the constellation of findings, as described above.2. Subcentimeter cystic lesions in the pancreatic head, which are too small to fully characterize on this exam, though may represent IPMNs.3. Bilateral pleural effusions |
Generate impression based on findings. | Reason: 8 months dry cough History: asthma, 13 pack year history LUNGS AND PLEURA: Poorly marginated 24 x 24 mm right lower lobe nodule image 81 series 5, consistent with primary lung cancer.Linear scarring is present bilaterally.There is no evidence of interstitial lung disease or air trapping on expiration series.MEDIASTINUM AND HILA: There are no significantly enlarged mediastinal or hilar lymph nodes.Calcified mediastinal and hilar nodes are the result of prior granulomatous disease.Moderate size hiatal hernia with omental fat. CHEST WALL: Degenerative changes affect the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Calcified splenic artery, and splenic granulomata are present. | Right lower lobe nodule highly consistent with primary lung cancer. Findings were discussed with Dr. Davis at the time of reporting 10/4/2013, 1412. |
Generate impression based on findings. | Reason: pt with lung ca s/p resection 2010 History: now needs yearly evaluation compare to previous scans and comment CHEST:LUNGS AND PLEURA: Right upper lobe scarring with sutures status post cancer resection.Severe centrilobular predominant emphysema is present.There is no evidence of new or recurrent tumor in the lungs.MEDIASTINUM AND HILA: There is no mediastinal or hilar lymphadenopathy. Aortic and coronary artery calcifications are severe. The heart is mildly enlarged.CHEST WALL: Degenerative abnormalities affect the thoracic spine. ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small renal cystlike hypodensities are unchanged.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Abdominal aortic aneurysm as well is an aorto bi-iliac endograft are unchanged.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Degenerative abnormalities affect the lumbar spine.OTHER: No significant abnormality noted. | 1. Severe emphysema.2. No evidence of tumor recurrence or new lung cancer.3. Stable abdominal aortic aneurysm. |
Generate impression based on findings. | Reason: Evaluate for cause of fever History: Fever LUNGS AND PLEURA: No pulmonary nodules noted on the and so no specific evidence of fungal infection.Peripheral reticular interstitial opacities have developed or progressed since/28/2013, with some dependent atelectasis but no significant sized pleural effusions. This could represent pulmonary toxicity from chemotherapy. MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | No specific evidence of infection. However, there has been progression or development over the last 8 months of age chronic-appearing interstitial abnormality possibly drug reaction given the patient's history. This would be atypical for infection. |
Generate impression based on findings. | HNC soft palate radiotherapy. CHEST:LUNGS AND PLEURA: Centrally necrotic lower lung zone nodules consistent with metastases. Left lower lobe nodule is noted inseparable from an adjacent smaller lesion together measuring 13-mm in short axis, previously 6 and 3-mm (4/56).Larger of the two right lower lobe nodules has increased to 14-mm from 8-mm previously (4/78). Additional right lower lobe lesion (4/76) now appears spiculated but similar in size. Right middle lobe lesion nearly resolved though there is a small area of atelectasis or scarring in its place.Mild emphysema. Clustered calcifications in the right upper lobe may be postinfectious. Debris in airways of the left lower lobe.MEDIASTINUM AND HILA: Right chest port tip at the SVC/RA junction. Severe coronary artery calcifications. Normal heart size.New enlarged subcarinal lymph node (3/45). Index necrotic subcarinal lesion (3/48) measures 18 mm, previously 14-mm. New paraesophageal lymph nodes both anterior and posterior to the distal thoracic esophagus (3/51).Left interlobar lymphadenopathy is worse (3/48).CHEST WALL: Right chest port. Numerous small to mildly enlarged lymph nodes in the left axilla measuring up to 9-mm (3/26) not significantly changed since 2012 making metastases less likely. Stable left lateral chest wall lesion in the subcutaneous fat (3/62).Interval increase in sclerosis of the left posterior sixth rib lesion nonspecific. Faint sclerosis in the right scapular spine unchanged. T11 superior endplate depression unchanged. T9 small sclerotic focus unchanged. ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Renal cysts and subcentimeter lesions too small to accurately characterize. 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: Focal sclerosis right iliac crest, unchanged.OTHER: No significant abnormality noted. | 1. Interval increase in size of two of the pulmonary metastases, the third lesion is now spiculated, also likely metastatic.2. Worsening mediastinal and left interlobar lymphadenopathy compatible with nodal metastases.3. Nonspecific sclerotic osseous lesions, one of which has increased in density. Indolent metastatic disease cannot be excluded. |
Generate impression based on findings. | 52-year-old male with ascending aortic aneurysm. Dyspnea. CHEST:LUNGS AND PLEURA: Mild bibasilar subsegmental atelectasis. No focal air space opacities or pleural effusions. No large central pulmonary embolus is seen.MEDIASTINUM AND HILA: The ascending aorta measures 4.6 cm in AP dimension on axial images at the level of the main pulmonary artery (9/78). There is a bicuspid aortic valve with calcification along a leaflet. Soft and calcified plaques are seen in the left and right coronary arterial systems. No mediastinal or hilar lymphadenopathy. No pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Please note that evaluation of the abdomen is limited by lack of oral contrast.Hepatic steatosis. No significant abnormality noted otherwise. | 1. 4.6 cm ascending aortic aneurysm, as described above.2. Bicuspid aortic valve with calcification.3. Coronary artery atherosclerosis. |
Generate impression based on findings. | Male 58 years old Reason: Lung cancer compare to last CT \T\ measure lesions using recist criteria History: pre chemo CHEST:LUNGS AND PLEURA: Left upper lobe nodule unchanged, measuring 8 mm (image 24, series 4) previously measuring 8 mm.The right necrotic appearing perihilar mass is difficult to measure because of the associated atelectasis; measuring approximately 5.8 x 5.4 cm (image 7, series 3), previously 5.4 x 5 cm. On the coronal sequence it measures 9.1 cm (image 34, series 8024), previously measuring 8.1 cm in craniocaudal dimension.There is near complete collapse of the right lower lobe and incomplete atelectasis of the middle lobe with hazy opacification of the remaining expanded parenchyma and near complete obliteration of the bronchus intermedius by tumor. Peripheral consolidation may contain a component of post obstructive pneumonia in the appropriate clinical setting. There are also new patchy consolidation and ground glass opacities with associated atelectasis in the right middle lobe. Moderate emphysema unchanged. Diffuse bronchial wall thickening, most notably on the right.MEDIASTINUM AND HILA: Esophageal wall thickening/edema unchanged.No discrete mediastinal lymphadenopathy; however, right hilar region lymphadenopathy may be obscured by the right hilar mass. The right inferior pulmonary vein is occluded by tumor.Small retrocrural lymph nodes again evident.Moderate coronary calcifications again noted. CHEST WALL: Old posttraumatic left rib fractures unchanged.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Streaky areas of hypoattenuation in the renal parenchyma suspicious for metastases, infarcts cannot be excluded.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Moderate atherosclerotic disease of the abdominal aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Abdominal mass previously seen in the fat anterior to the liver is now seen more inferiorly and measures 3.4 x 3.4 cm (image 140, series 3), previously measuring 1.9 cm. Proximal SMA appears stenotic.BONES, SOFT TISSUES: Multilevel degenerative changes of the thoracic and lumbar spine without evidence of osseous metastasis.OTHER: No significant abnormality noted. | 1. Near complete occlusion of the bronchus intermedius by tumor.2. No significant change in left upper lobe nodule and right perihilar necrotic mass. 3. New atelectasis and consolidation of the right middle lobe and persistent atelectasis and new ground glass opacities in the right middle lobe; post obstructive pneumonia can be considered in the appropriate clinical context.4. Enlarging mesenteric mass compatible with metastatic disease.5. Abnormal attenuation pattern in the renal parenchyma is poorly assessed but is suspicious for metastases versus infarcts. Recommend dedicated Doppler ultrasound of the kidneys to further characterize.These findings were relayed to Dr. Janisch at 16:43 on 10/4/2013 |
Generate impression based on findings. | Female; 51 years old. Reason: super D protocol, compare to previous, history of breast cancer and radiation History: lung mass LUNGS AND PLEURA: Radiation changes are noted at the right apex. Scattered unchanged pulmonary micronodules are noted, but there are no suspicious lesions to suggest recurrent disease. No focal airspace opacity or pleural effusion. Small cluster of micronodules in the left upper lobe are most likely infectious or post inflammatory in etiology.No mass identified.MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. No significant mediastinal or hilar lymphadenopathy.CHEST WALL: No significant axillary lymphadenopathy. Bilateral breast implants are again noted. UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | No evidence of metastatic disease. Left upper findings consistent with atypical mycobacterial infection. |
Generate impression based on findings. | Large cell lymphoma. Restaging. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Right central venous catheter terminates in the right atrium.CHEST WALL: Small axillary lymph nodes.ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. No focal liver lesions or intrahepatic biliary ductal dilatation.SPLEEN: Status post splenectomy.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Irregular, nodular right kidney presumably represents scarring.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes for reference purposes, left periaortic node measures 1.2 x 1.0 cm (image 112; series 3)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: Small pelvic lymph nodes reference purposes, a right external iliac lymph node measures 1.3 x 0.9 cm (image 165; series 3)BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Scattered lymph nodes reference measurements given above. Heterogeneous right kidney, presumably reflects underlying scarring. |
Generate impression based on findings. | Nodular lymphoma CHEST:LUNGS AND PLEURA: A lymph node in the minor fissure measures 0.9 x 0.7 cm (6/48). No focal air space opacities or pleural effusions.MEDIASTINUM AND HILA: Numerous subcentimeter mediastinal and hilar lymph nodes. Normal sized heart without pericardial effusion.CHEST WALL: Extensive bilateral axillary lymphadenopathy. For reference, a left axillary lymph node measures 1.9 x 1.3 cm (401/28).ABDOMEN: 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: Enlarged retroperitoneal lymph nodes. For reference, a left para-aortic lymph node measures 2.7 x 1.8 cm (401/123).BOWEL, MESENTERY: No gross abnormalities noted.BONES, SOFT TISSUES: Mild degenerative changes of the lower lumbar spine.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Extensive bilateral lymphadenopathy. For reference, a conglomeration of right pelvic lymph nodes measures 8.5 x 3.4 cm (401/183).BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: There is a left lumbosacral transitional vertebra. OTHER: A small hernia mesh is seen at the right inguinal canal. | Extensive lymphadenopathy in the chest, abdomen, and pelvis, with reference measurements provided. |
Generate impression based on findings. | Evaluate pancreas. Elevated liver function tests. Transplant rejection. The following observations are made given limitations of an unenhanced study.ABDOMEN:LUNG BASES: A small left pleural effusion with overlying compressive-type atelectasis. Scarring or atelectasis anteriorly at the right lung base. Small pericardial effusion.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedKIDNEYS, URETERS: End-stage kidneys.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes. For reference purposes, a left para-aortic node measures 1.4 x 1.2cm (image 51; series 3)BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Renal transplant in the left iliac fossa appears unremarkable. Pancreas transplant in the right central pelvis also appears unremarkable given limitations of the study. No adjacent fluid collections identified. | Status post kidney pancreas transplant. Small retroperitoneal lymph nodes. Left pleural effusion with atelectasis. |
Generate impression based on findings. | Reason: 61 female with ALL, neutropenic fever. r/o infiltrate History: Neutropenic fever LUNGS AND PLEURA: Left upper lobe scar like abnormality unchanged since the prior study and improved compared 2/28/2013. Indolent infection in this region is unlikely given the stability, but is in the differential diagnosis. Otherwise, the lungs are clear.Azygos pseudo-lobe, normal variant.MEDIASTINUM AND HILA: There is no mediastinal or hilar lymphadenopathy. Moderate vascular calcifications are present.CHEST WALL: Degenerative abnormalities affect the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Residual and unchanged scarlike abnormality left upper lobe, indolent infection unlikely although in the differential diagnosis. |
Generate impression based on findings. | Follow up recurrent laryngeal CA status post total laryngectomy, thyroidectomy. CRT 7/13. CHEST:LUNGS AND PLEURA: Pleural thickening and calcified plaques consistent with prior asbestos exposure. Diffuse fine emphysema pattern. Areas of peripheral subpleural opacity suggestive of organizing pneumonia increased. Subpleural opacities in the right costophrenic angle minimally improved. Dependent groundglass opacity in the left lower lobe, nonspecific. Scattered subpleural nodular opacities containing calcification, but no suspicious pulmonary nodules.MEDIASTINUM AND HILA: Fluid attenuation collection containing a small amount of air and with peripheral enhancement extending posterior to the trachea and to the right of the esophagus at the level of the thoracic inlet highly suspicious for tracheal-mediastinal fistula and abscess. Trisha Heinlen verbally notified at the time of dictation.Near circumferential wall thickening of the proximal thoracic trachea with adjacent enhancing lymphadenopathy may be post infectious and/or inflammatory. The adjacent proximal thoracic esophagus has wall thickening and irregularity consistent with inflammatory change. These findings extend caudally to approximate level of the aortic arch.Heterogeneously enhancing subcarinal lymphadenopathy, 16 x 27 mm (3/38), previously 19 x 18 mm. Right hilar lymph node 14 mm, previously 19-mm. Index lymphadenopathy in the subcarinal region is worse, lymph nodes elsewhere are not significantly changed. Mild cardiomegaly.Soft tissue thickening consistent with inflammatory change surrounds the proximal aspects of the great vessels. Peripherally enhancing centrally hypoattenuating lesion at the level of the thoracic inlet on the right (3/4), unchanged, please refer to neck CT.CHEST WALL: Infiltrative soft tissue surrounds the vasculature in the right neck. The right jugular vein is occluded. Proximal right subclavian artery stent is patent however immediately distal to the stent the vessel is obliterated. 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: Small amount of perinephric fluid on the right.PANCREAS: Pancreatic atrophy, calcification and ductal dilatation consistent with sequelae of chronic pancreatitis.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: Osteopenia limits sensitivity for detection of metastases. Degenerative change of the spine.OTHER: No significant abnormality noted. | Interval development of a peripherally enhancing fluid collection containing a small amount of air in the right posterior tracheal region highly suspicious for an abscess due to malignant tracheal-mediastinal fistula. Patricia Heinlen was verbally notified at 4:30 p.m. on 10/4/13. Interval increase in lymphadenopathy and inflammatory change around the proximal trachea and esophagus may be a combination of tumor and infection. |
Generate impression based on findings. | Male; 84 years old. Reason: Evaluate for evidence of lung cancer recurrence. Had resection of part of right upper lobe and left upper lobe due to non-small cell lung cancer. LUNGS AND PLEURA: Postsurgical changes compatible with partial right upper lobe and left upper lobe resections. There is a solid 5 mm pulmonary nodule in the right upper lobe for which follow-up imaging is recommended as recurrent disease cannot be excluded. No focal air space opacity or pleural effusion.MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. Scattered small mediastinal lymph nodes are noted. CHEST WALL: Mild multilevel degenerative disease affects the visualized spine. No evidence of osseous metastatic disease. UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Solid 5 mm right lower lobe pulmonary nodule, for which CT follow-up in 3 months then annually is recommended as new disease cannot be excluded. |
Generate impression based on findings. | Uterine carcinosarcoma. The following observations are made given the limitations of an unenhanced study.CHEST:LUNGS AND PLEURA: Scattered granulomas. Ill-defined soft tissue nodule anteriorly at the right lung base (image 49; series 5) measures 0.8 x 0.6 cm. This was not included on the prior examination and should be followed.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.STOMACH: Sutures noted along the lesser curvature from prior gastrectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post left nephrectomy.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy. Ovaries not visualized.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. | Status post left nephrectomy and hysterectomy. Ill-defined subcentimeter pulmonary nodule at the right lung base can be followed. |
Generate impression based on findings. | Malignant neoplasm of upper lobe bronchus. Secondary malignant neoplasm of bone or bone marrow. CHEST:LUNGS AND PLEURA: Innumerable small solid pulmonary nodules have slightly increased in size and number since the previous scan and remain compatible with metastases. Left lower lobe opacity with volume loss and air bronchograms consistent with irradiated tumor is slightly smaller than previous. Decreased perfusion and volume in the left lung is unchanged.MEDIASTINUM AND HILA: No significant lymphadenopathy.CHEST WALL: Multiple sclerotic bone metastases and partial collapse of the T9 vertebra are unchanged.ABDOMEN:LIVER, BILIARY TRACT: Small nonspecific hypodensity in the right lobe is unchanged. No definite evidence of metastatic disease.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Probable cysts, unchanged. Nonobstructive left renal calculus.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic vertebral lesions consistent with metastases, unchangedOTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Status post hysterectomy. Ovaries not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Scattered sclerotic foci in the pelvic bones and lumbar spine and sacrum redemonstrated consistent with metastases, unchanged.OTHER: No significant abnormality noted. | Progression of disease based on increase in size and number of lung nodules. Sclerotic osseous lesions are unchanged. |
Generate impression based on findings. | Female; 25 years old. Reason: r/o abscess, mass History: right LNA x 1 week with pain The visualized intracranial compartment is unremarkable without abnormal enhancement evident. The paranasal sinuses and mastoid air complexes are clear. The orbits are unremarkable.There is a smoothly marginated, mildy lobulated, enhancing mass spanning right level 2a, measuring 3 x 3 x 4-cm (AP by transverse by craniocaudal) (image 38, series 4, and image 14, series 8038). The mass causes moderate compression of the adjacent internal jugular vein, but the vein is patent without evidence of thrombus. No additional masses or lymphadenopathy by CT size criteria. The bilateral palatine tonsils are enlarged, right greater than left, which causes asymmetric effacement of the left palato-lingual recess. Otherwise, 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. | Enhancing mass in right level 2a felt to represent a conglomerate of enlarged lymph nodes. The size and morphology would be atypical for reactive or inflammatory lymphadenopathy, though these are possibilities. Advise follow-up to resolution to exclude neoplastic process. |
Generate impression based on findings. | 41 year old man with atypical chest pain. His coronary risk factors include hyperlipidemia and a family history of accelerated coronary artery disease.CPT Code: 75574 Coronary arteries: LM: The left main coronary artery arises normally from the left sinus of valsalva and bifurcates into the left anterior descending and left circumflex coronary arteries. There are no significant stenoses present in the left main.LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove, supplying the diagonal and septal branches. There are no significant stenoses in the LAD.LCx: The left circumflex coronary artery is non-dominant. It courses normally in the left AV groove. It gives rise to the obtuse marginal branches. There are no significant stenoses in the LCx.RCA: The right coronary artery is large and arises normally from the right sinus of valsalva. It is the dominant coronary artery supplying a posterior descending artery and a posterolateral branch. There are no significant stenoses in the right coronary artery.Left Ventricle: The left ventricular late diastolic volume is normal (LV volume 166ml).Right Ventricle: Visually the right ventricular late diastolic volume is within normal limits.Left Atrium: Visually, the left atrial volume appears to be normal in size. There are four distinct pulmonary veins which drain normally into the left atrium. There is no evidence of left atrial appendage thrombus.Right atrium, vena cavae, and coronary sinus: The right atrial volume appears to be normal in size. The superior and inferior vena cavae are grossly normal. The coronary sinus is normal in size. Valves: There is no calcification on the aortic or mitral valves.Great vessels: The visualized portions of the thoracic aorta demonstrate no evidence of dissection or aneurysm. The aortic arch is not seen. The main pulmonary artery is normal in size.Pericardium: The pericardium is normal in thickness. There is no pericardial effusion. | 1.There are no significant coronary artery stenoses present.This portion of the report pertains to the heart and great vessels only. The remaining soft tissues of the thorax and upper abdomen will be interpreted by the attending chest radiologist and included as an addendum to this report. |
Generate impression based on findings. | Malignant neoplasm of bladder. Evaluate for metastasis. Delayed imaging. ABDOMEN:LUNG BASES: Minimal left lower lobe scarring without focal opacities or pleural effusions, stable.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts. Near complete visualization of the entire lengths of the left and right ureters, with focal discontinuities likely secondary to peristalsis. No mural irregularities, visible masses, or obstruction suspicious for malignancy.RETROPERITONEUM, LYMPH NODES: 1.4-cm retrocrural lymph node (series 7, image 23) versus dilated cisterna chyli. This is unchanged.BOWEL, MESENTERY: Partially visualized moderate-sized hiatal hernia containing stomach and mesentery is unchanged.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Large, round, single-dominant, heterogeneously dense, 8.1 x 8.0 cm uterine mass (series 7, image 101) appears stable; correlate with gynecologic ultrasound as clinically indicated. Small 1.6-cm unilocular right adnexal cystic lesion (series 7, image 99) also appears unchanged.BLADDER: No evidence of bladder wall thickening or irregularity suspicious for recurrent disease.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Sigmoid diverticulosis without evidence of diverticulitis, stable.BONES, SOFT TISSUES: Lumbar dextroscoliosis with significant degenerative changes as noted previously. No focal lesions suspicious for osseous metastatic disease.OTHER: No significant abnormality noted. | Stable examination.1.No definite evidence of recurrent or metastatic disease2.Large, round, single-dominant, heterogeneously dense, 8.1 x 8.0 cm uterine mass. As noted previously, CT is not specific for evaluation and correlation with gynecologic ultrasound can be performed if clinically indicated.3.Unchanged 1.6cm unilocular right adnexal cystic lesion. 4.Moderate-sized hiatal hernia |
Generate impression based on findings. | Female 62 years old Reason: PE? pna? edema? History: SOB, tachycardia PULMONARY ARTERIES: Technically adequate study without evidence of pulmonary embolism or right heart strain.LUNGS AND PLEURA: Multiple small pulmonary nodules unchanged. Minimally increased bilateral basilar predominant dependent atelectasis. Small trace right and left pleural effusions unchanged. No new focal air space opacity.MEDIASTINUM AND HILA: No evidence of pericardial effusion, and anterior nodularity of the pericardium unchanged.Mediastinal lymphadenopathy unchanged The reference prevascular node now measures 31 x 15 mm (image 82, series 6), previously 31 x 16 mm. Internal mammary chain lymphadenopathy unchanged.Contrast is seen filling the esophageal lumen. CHEST WALL: Large homogeneous moderately circumscribed soft tissue anterior body wall mass arising at the level of the xiphoid process and extending inferiorly, with infiltration into the subcutaneous tissues, rectus abdominous muscle, peritoneum, mesenteric fat and possibly hepatic segment 7, grossly unchanged. Right chest Port-A-Cath with tip in the cavoatrial junction. Left axillary and supraclavicular lymphadenopathy unchanged. Sclerotic lesion of the right ninth rib unchanged, and no new suspicious bony lesions identified. UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. The stomach is distended with contrast and there is a single visualized loop of bowel, which lacks haustra and is compatible with dilated small bowel and is better assessed on a CT abdomen and pelvis from the same day. Segment 4 hypodense liver unchanged. | 1. No evidence of pulmonary embolism 2. Minimal increase in dependent atelectasis without pulmonary etiology found to explain patient's shortness of breath.3. Stable extensive metastatic disease.4. Findings consistent with bowel obstruction better evaluated on CT abdomen and pelvis from the same day. |
Generate impression based on findings. | Female 25 years old Reason: pulmonary embolism? History: pleuritic chest pain, worse with inspiration PULMONARY ARTERIES: Technically adequate study without evidence of right heart strain or pulmonary embolism.LUNGS AND PLEURA: Minimal dependent atelectasis right greater than left, without evidence of focal consolidation. Normal appearance of the pleura.MEDIASTINUM AND HILA: No evidence of coronary artery calcifications. No evidence of mediastinal or hilar lymphadenopathy.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. No etiology found to explain the patient's pleuritic chest pain. |
Generate impression based on findings. | Female 81 years old Reason: evaluate for PE History: 81yo F with supraglottic SCC p/w tachycardia and hypoxia following chemoXRT PULMONARY ARTERIES: Technically adequate study without evidence of right heart strain or pulmonary embolism.LUNGS AND PLEURA: Moderate basilar bronchial wall thickening right greater than left with debris/mucous plugging seen in the right lower subsegmental bronchi. Atelectasis with associated consolidation in the right lower lobe compatible with aspiration, and aspiration pneumonia in the appropriate clinical setting. Two new small cavitary nodular opacities seen in the right middle lobe likely related to aspiration or infection but metastasis cannot be excluded. Recommend continued CT surveillance to confirm resolution.MEDIASTINUM AND HILA: No evidence of mediastinal or hilar lymphadenopathy. Mild/moderate atherosclerosis of the thoracic aorta and coronary arteries.CHEST WALL: Right chest wall Port-A-Cath with tip in high right atrium. Moderate multilevel degenerative changes of the thoracic spine without evidence of osseous metastasis.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Moderate/severe atherosclerosis of the abdominal aorta. Multiple left renal cysts. Mild intrahepatic biliary ductal dilatation unchanged. Left adrenal nodule unchanged and incompletely characterized in this examination. | 1. No evidence of pulmonary embolism.2. Atelectasis/consolidation in the right lower lobe with associated mucous plugging and bronchial wall thickening consistent with aspiration or aspiration pneumonia in the appropriate clinical setting.3. Two cavitary subcentimeter nodular opacities in the right middle lobe likely related to aspiration/infection but metastasis cannot be excluded. Recommend continued CT surveillance to confirm resolution. |
Generate impression based on findings. | 86 year old patient. Stroke. There is ventricular prominence and atrophic change in keeping with a the patients age. There is no intracranial mass, fluid collection, hemorrhage, hydrocephalus or CT evidence of acute ischemia. Gray-white matter differentiation is normal bilaterally and the midline is intact. Orbits are unremarkable. Soft tissue density within the inferior aspect of the left maxillary sinus most likely represents mucus retention cyst. | No acute intracranial pathology demonstrated. CT is of suboptimal sensitivity in the assessment of acute ischemia and if of persisting concern, MRI could be considered. |
Generate impression based on findings. | First time seizure. There is ill-defined patchy hypoattenuation within subcortical and periventricular white matter in keeping with a degree of chronic small vessel ischemic disease. There is hyperattenuation in keeping with mineralization of the medial lentiform nuclei bilaterally which is most likely idiopathic. Infratentorially, there is focal hypoattenuation demonstrated within the mid aspect of the left cerebellar hemisphere (images 7, 6) which is not associated with any edema, mass-effect and is unlikely to be of clinical significance. There is no supratentorial mass, fluid collection or CT evidence of ischemia. Gray-white matter differentiation is appropriate and the midline is intact. There is mucosal thickening within the right maxillary sinus. Remaining paranasal sinuses are unremarkable. | No acute findings and no pathology demonstrated which would explain the patient's seizures. |
Generate impression based on findings. | Female 75 years old Reason: rule out PE History: shortness of breath, tachycardia PULMONARY ARTERIES: Technically adequate study without evidence of right heart strain or pulmonary embolism.LUNGS AND PLEURA: Bilateral small pleural effusions, left greater than right with associated basilar compressive atelectasis left greater than right. Right middle lobe 8-mm groundglass nodule seen along the major fissure, may represent adenomatous hyperplasia or minimally invasive lung adenocarcinoma. Scattered pulmonary micronodules.Mild/moderate emphysema.MEDIASTINUM AND HILA: Enlarged diaphragmatic lymph nodes, reference right pericardial node measuring 10 mm (image 191, series 8).CHEST WALL: Multilevel degenerative changes seen in the thoracic spine. Sclerotic lesion seen in an inferior vertebral endplate of a lower thoracic vertebral body likely represents a bone island; however, metastasis cannot be excluded.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Mild perisplenic and perihepatic ascites. Nodularity of the inferior surface of the diaphragm, peritoneum and mesentery compatible with peritoneal carcinomatosis. | 1. No evidence of pulmonary embolism.2. Findings compatible with peritoneal carcinomatosis; if this is a new diagnosis, recommend dedicated abdominal and pelvic CT to confirm and evaluate extent of disease.3. Bilateral small pleural effusions with associated compressive atelectasis.4. 8 mm groundglass nodule along the right major fissure suggestive of adenomatous hyperplasia, attention should be paid to this area on subsequent CT surveillance. |
Generate impression based on findings. | Reason: R/o aneurysm History: Chest and back pain with costophrenic angle opacity on CXR The phase of contrast is optimized for evaluation of the arterial system. Evaluation of solid organ and mediastinal pathology is limited.CHEST:LUNGS AND PLEURA: Mild upper lobe predominant centrilobular emphysema. Dependent atelectasis. No pleural effusions.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. No significant lymphadenopathy. No evident pulmonary embolus. The pulmonary artery is of normal caliber.VASCULATURE: No evidence of thoracic aortic aneurysm or dissection.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 significant abnormality noted.VASCULATURE: No evidence of abdominal aortic aneurysm or dissection. The celiac axis, SMA, and IMA are patent. Mild atherosclerotic calcification at the abdominal aorta bifurcation. The common iliac arteries are of normal caliber.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No evidence of aneurysm or dissection. Opacity visualized on chest x-ray corresponds to prominent epicardial fat pad on CT.Contrast reaction description:Supervising radiologist: Dr. VasnaniContrast type: Omnipaque (iodine containing)Signs and symptoms: Facial hivesTreatment given: None, patient refused BenadrylDischarge instructions given: Yes |
Generate impression based on findings. | Acute mental status change. Rule out intracranial process. There is patchy hypoattenuation within a periventricular and subcortical distribution in keeping with sequela of chronic small vessel ischemic disease. There is mild diffuse sulcal and ventricular prominence in keeping with the patient's age. No intracranial mass, fluid collection, hemorrhage or CT evidence of acute ischemia. Gray-white matter differentiation is maintained bilaterally and the midline is intact.The visualized portions of the orbits and paranasal air sinuses are unremarkable. | No acute intracranial pathology demonstrated. |
Generate impression based on findings. | Female; 73 years old. Reason: back pain History: back pain CT thoracic spine:Moderate motion artifact as well as marked streak artifact from posterior fusion hardware limits sensitivity for acute pathology. There is also inherent low soft tissue resolution of this exam, which makes detection of soft tissue abnormalities of vertebral column and including herniated disk and impossible multiple levels. The bones are diffusely demineralized, which may be due to osteopenia or osteoporosis, and this also limits sensitivity for acute fracture. Within these limitations, the thoracic spine appears stable when compared to prior study on 6/3/2011.Postsurgical changes of long posterior thoracolumbar spinal fusion with laminar hooks and rods extending from T4 to L2-3. Hardware appears intact. Moderate levoscoliosis of the thoracic spine, not significantly changed. Otherwise, the thoracic vertebral bodies are appropriate in the overall alignment and height. No acute fracture or malalignment is evident.Multilevel degenerative disk disease similar to prior study. The study is severely limited for evaluation of central canal stenosis.Stable right upper lobe pulmonary micronodules (image 26, series 4). Bilateral hip arthroplasties are noted on the scout images.CT lumbar spine:Marked streak artifact from posterior fusion hardware and a low soft tissue resolution limits evaluation particularly of the upper lumbar spine. Within this limitation, the lumbar spine appears stable since since prior study of 5/12/2010.Above-mentioned postsurgical changes of posterior thoracolumbar spinal fusion are seen extending inferiorly to level of L2-3. Hardware appears intact.Lumbar vertebral body heights are well preserved. No definite acute fracture or malalignment.Mild multilevel degenerative arthritic changes are similar to prior study, with multiple disk bulges similar prior study in detailed below. Please note that low soft tissue resolution of this exam makes detection of soft tissue abnormalities of vertebral column and including herniated disk difficult.T12-L1:There is no detectable central spinal stenosis or neural foramina compromise. Reformatted images demonstrate no detectable abnormal bulge of disk material. This exam cannot entirely rule out disk herniation. L1-L2:No significant degenerative disk disease is detected. No central spinal stenosis or neural foramina compromise.L2-L3:No detectable central spinal stenosis or neural foramina compromise. Minimal bulge of disk material on sagittal reformatted images is detected, similar prior study.L3-L4:No central spinal stenosis or neural foramina compromise. Mild hypertrophic changes of posterior elements and broad-based bulge of disk material, similar prior study.L4-L5:Broad-based bulge of disk material and mild hypertrophic changes of posterior elements, similar to prior study. No significant central spinal stenosis or neural foramina compromise.L5-S1:Mild broad-based bulge of disk material, similar prior study. No central spinal stenosis or neural foramina compromise. | 1.Within the severe limitations of this exam, no acute fracture or malalignment evident.2.Mild multilevel degenerative arthritic changes are similar to prior study without evidence of significant central spinal stenosis.3. Stable appearance of posterior spinal fusion without evidence of hardware loosening. |
Generate impression based on findings. | Female 61 years old; Reason: Colitis History: LLQ abd pain ABDOMEN:LUNGS BASES: Basilar honeycombing and interstitial changes most suggestive of fibrosis. Ground glass opacities indicates active inflammation.LIVER, BILIARY TRACT: Liver has a smooth contour. No suspicious hepatic lesions. Hepatic and portal veins are patent. Moderate to severe intrahepatic biliary ductal dilatation with the common bile duct measuring up to 17 mm in the head of the pancreas. There are multiple stones within the gallbladder which shows mild gallbladder wall thickening but no pericholecystic fluid. Hyperdense material within the common bile duct suggestive of non-calcified stones.SPLEEN: No significant abnormality noted.PANCREAS: No evident findings for pancreatitis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mild right hydronephrosis due to 5 mm mid right mid ureter calculus. No suspicious lesions in either kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small bowel is normal in caliber and course. Colon is not distended. No mesenteric lymphadenopathy or fluid collections.BONES, SOFT: Degenerative changes affect the lumbar spine. Superior endplate compression fracture of L3.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Absent or atrophic .BLADDER: The bladder is well distended and unremarkable.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.Cholelithiasis and possible choledocholithiasis causing moderate to severe intrahepatic and extrahepatic ductal dilatation for which M.R.C.P. is recommended.2.Partially obstructing 5-mm right mid ureter calculus.3.Pulmonary fibrosis with basilar interstitial changes. Dedicated high resolution CT of the chest and pulmonology consult are recommended. |
Generate impression based on findings. | Weakness. Rule out CVA. There are two wedge-shaped foci of hypoattenuation demonstrated within the right frontal and right parietal lobes. There is no associated mass effect or hemorrhage. These are in keeping with encephalomalacia related to chronic infarct. There is no evidence of acute CVA and the midline is intact. Intracranial mass, fluid collection or hydrocephalus.Visualized portions of the orbits and paranasal sinuses are unremarkable. Incidental note is made of an atypical configuration of the C1 vertebral body wherein the ossified ring is incomplete at the right lateral aspect. This is most likely related to a congenital fusion anomaly. There is normal alignment of the most superior aspect of the C-spine and the superior canal is of normal caliber. | Findings related to chronic infarct without CT evidence of acute ischemia. CT is suboptimal in its sensitivity for detecting acute ischemia. If there is persistent concern, MRI could be considered. Incidental note is what most likely represents a congenital fusion anomaly at C1. |
Generate impression based on findings. | Female 69 years old; Reason: evaluation of abscess and anastomosis History: colostomy in place ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver has a smooth contour. No suspicious hepatic lesions. Mild intrahepatic ductal dilatation following cholecystectomy. Hepatic and portal veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral probable extrarenal pelvis. Small bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Right lower abdominal conduit. Left lower abdominal ileostomy.BONES, SOFT TISSUES: Fluid and gas within the lower abdominal wall at midline.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: HysterectomyBLADDER: Status post cystectomyLYMPH NODES: Pelvic lymph node dissection without evident lymphadenopathy.BOWEL, MESENTERY: Post operative changes in the rectum with soft tissue thickening in the presacral space.BONES, SOFT TISSUES: Pelvic drain with terminates within a small fluid collection with an enhancing wall measuring 5.8 x 0.4 cm and is significantly decreased from prior.OTHER: No significant abnormality noted. | 1.Decrease in the size the pelvic fluid collection following drain placement with minimal residual. |
Generate impression based on findings. | Reason: pt s/p subtotal colectomy, end ileostomy, s/p ostomy reversal hx of colitis now w/ leukocytosis, GNR bactermia: r/o colitis, anastomotic leak, abscess, fluid collection History: abdominal pain, nausea ABDOMEN:LUNG BASES: Basilar subsegmental atelectasis.LIVER, BILIARY TRACT: Mild to moderate perihepatic ascites without loculation. The common bile duct is prominent status post cholecystectomy. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple appearing renal cysts. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post subtotal colectomy with anastomosis in the right hemipelvis. No evidence of bowel obstruction or enteric leak. Improving minimal bowel wall thickening in the pelvis. A rectal catheter is in place. No drainable fluid collections in the abdomen/pelvis. Small amount of free fluid in the pelvis. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Surgically absent.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Postsurgical changes without evidence of bowel obstruction or enteric leak. 2.Mild to moderate abdominal and pelvic ascites of unclear etiology. No loculated fluid collections. |
Generate impression based on findings. | Female 62 years old; Reason: eval for intraabdominal process History: hx of metastatic thyroid CA, now with suprapubic, RUQ and LUQ pain/tenderness ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver has a smooth contour. Scattered intrahepatic calcifications represent granulomatous disease.Hepatic and portal veins are patent. There is minimal intrahepatic biliary ductal dilatation following cholecystectomy. Common bile duct is normal in caliber.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Nonobstructive right renal calculi. No hydronephrosis in either kidney.RETROPERITONEUM, LYMPH NODES: Calcific arteriosclerotic disease of the aorta. Small retroperitoneal lymph nodes.BOWEL, MESENTERY: Colonic mucosal thickening involving the ascending and transverse colon with mild pericolonic fluid involving the retroperitoneum in the right hemi-abdomen.Scattered colonic diverticula involving the sigmoid colon without surrounding inflammation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No intraperitoneal free air or drainable fluid collections.PELVIS:UTERUS, ADNEXA: Status post hysterectomy. Adnexa are unremarkable .BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: As aboveBONES, SOFT TISSUES: Degenerative changes affect the lumbar spine.OTHER: No significant abnormality noted. | 1.Findings suspicious for a colitis with some pericolonic fluid posterior to the right colon. |
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