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Generate impression based on findings. | Female 72 years old; Reason: r/o pancreatitis, mass, pseudocyst History: epigastric TTP ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas enhances homogeneously. Splenic vein is patent. No peripancreatic fluid collections. Pancreatic duct is normal in caliber.ADRENAL GLANDS: Right adrenal gland appears to characterize as an adenoma is unchanged.KIDNEYS, URETERS: Cyst right kidney measures 2.8 x 3.5 cm with a septation internally and minimal wall thickening represent a Bosniak class 2F. Scattered hypodensities in the right kidney are too small to characterize theAt least two minimally complex cysts in the left kidney, at the upper pole and lower pole, unchanged.RETROPERITONEUM, LYMPH NODES: Calcific arteriosclerotic disease of the aorta. Severe calcification at the ostia of the renal arteries suggests renal artery stenosis. No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Small bowel normal in caliber and course. Appendix is normal. No pericolonic inflammation or drainable fluid collections. No mesentery lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the L5 S1 disk space.OTHER: No significant abnormality noted. | 1.No CT findings of acute pancreatitis.2.Complex right renal cyst and smaller left renal cysts are unchanged. |
Generate impression based on findings. | Syncope. Medical history includes brain tumor. Evaluate for intracranial lesion. There are sequela of the left parietal craniotomy. There is some ventricular prominence, particularly in the left occipital horn where there is ex vacuo dilatation related to an area of overlying encephalomalacia. There is no intracranial mass, fluid collection, hemorrhage, hydrocephalus or CT evidence of acute ischemia. The midline is intact.Imaged portions of the orbits are unremarkable. There is soft tissue density representing secretions in the right frontal sinus. | Sequela of prior craniotomy with left temporoparietal encephalomalacia. No acute pathology demonstrated. |
Generate impression based on findings. | Male 24 years old; Reason: stone History: hematuria ABDOMEN:LUNGS BASES: Hilar and mediastinal calcified nodes.LIVER, BILIARY TRACT: Hepatic calcifications presumably from prior granulomatous disease. The liver is otherwise unremarkable for unenhanced technique.SPLEEN: Scattered splenic granulomata.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No nephrolithiasis, hydronephrosis or perinephric fluid collections.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No distal ureteral or bladder calculi.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.No evident nephrolithiasis, or hydronephrosis. |
Generate impression based on findings. | Male 22 years old; Reason: h/o multiple operations, open abdomen with wound vac, concern for ec fistula History: tachycardia, bilious drainage from vac ABDOMEN:LUNGS BASES: Patchy ground glass opacities at the lung bases, most likely infectious. Atelectatic changes at the left lung base with a small left pleural effusion. Trace pericardial effusion.LIVER, BILIARY TRACT: Patchy perfusion abnormalities of the liver which is diffusely hypodense compatible with severe fatty infiltration. Hepatic and portal veins are patent. Nonspecific peripheral hypodense lesions in the liver for example as seen on image 68/series 3.SPLEEN: Spleen is normal in size. Linear perfusion defects in the spleen may represent clefts versus small infarctions.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis or nephrolithiasis in either kidney.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: The small bowel loops are collapsed. The small bowel wall is hyper enhancing. There are postoperative changes in the small bowel. Gas locules adjacent to the anterior small bowel loops extend to the open defect and may represent an enterocutaneous fistula.Left subdiaphragmatic fluid collection in the left upper abdomen adjacent to the spleen measures at least 7.0 x 12.0 cm - it has peripheral wall enhancement and mass effect and is suspicious for abscess. A second smaller intra-abdominal fluid collection in the left abdomen measures 6.0 x 5.3 cm with peripheral wall enhancement and mass effect and is compatible with a second abscess. The two collections connect with each other and with smaller intra-abdominal collections..A left anterior abdominal drain terminates adjacent to the omentum and does not drain the abscess.There is congestion of the mesentery and multiple small mesenteric lymph nodes.BONES, SOFT TISSUES: Large ventral defect with gas adjacent to the small bowel and bowel dehiscence or enterocutaneous fistula is not entirely excluded.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: Bladder is decompressed by Foley catheter.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Large pelvic fluid collection measuring 6.3 x 7.0 cm posterior and superior to the urinary bladder compatible with an abscess.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.At least 3 large wall enhancing fluid collections two in the left upper abdomen and one within the pelvis suspicious for large intra-abdominal abscess.2.Left upper abdominal drain does not enter either the collections.3.Fatty liver with perfusion abnormalities but patent vasculature.4.Large ventral body wall defect with small bowel and gas locules adjacent to it suspicious for an enterocutaneous fistula.5.Hyperenhancement of the bowel wall may be due to shock bowel or peritonitis. |
Generate impression based on findings. | Reason: SBO - partial vs complete? History: nausea/vomiting ABDOMEN:LUNG BASES: Subcentimeter right upper lobe pulmonary nodule adjacent to the major fissure is unchanged (series 10, image 5). Small bilateral pleural effusions, unchanged. Cardiophrenic lymphadenopathy without significant interval change.LIVER, BILIARY TRACT: Indeterminate segment IVb hypodense lesion in contiguity with the body wall, unchanged. The hepatic and portal veins are patent. Status post cholecystectomy.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: Retroperitoneal lymphadenopathy. Reference para-aortic lymph node measures 1.7 x 1.0 cm (series 9, image 55), previously 1.5 to 1.0 cm.BOWEL, MESENTERY: Postsurgical changes with left lower quadrant colostomy and right lower quadrant urostomy. Multiple dilated loops of small bowel in the pelvis measuring up to 4.7 cm with a transition point in the right lower quadrant adjacent to an inflamed and thickened loop of bowel (series 9, image 90).Infraumbilical ventral hernia containing multiple loops of dilated small bowel. Small amount of free fluid in the pelvis. No pneumatosis intestinalis or pneumoperitoneum. No drainable fluid collections in the abdomen / pelvis.Multiple mesenteric soft tissue deposits compatible with metastatic disease. Reference anterior mesenteric lesion measures 2.1 x 1.7 cm (series 9, image 55), previously 2.4 x 2.0 cm.BONES, SOFT TISSUES: Extensive soft tissue nodularity of the anterior abdominal wall.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Small bowel obstruction with transition point in the right lower quadrant adjacent to an inflamed thickened loop of bowel.2.Widespread metastatic disease. |
Generate impression based on findings. | Female; 73 years old. Reason: syncope History: syncope No significant interval change since prior study.Mild global parenchymal volume loss, commensurate for the patient's age. The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is preserved. There is no mass effect, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. Intracranial atherosclerotic calcifications noted.The osseous structures are unremarkable. The orbits are within normal limits. The paranasal sinuses and mastoid air cells are clear. | No acute intracranial abnormality. |
Generate impression based on findings. | Reason: obstruction History: abdominal pain, mass ABDOMEN:LUNG BASES: Motion artifact limits evaluation of the lung bases. Small left pleural effusion. Basilar atelectasis.LIVER, BILIARY TRACT: Status post cholecystectomy.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: Percutaneous gastrostomy tube within the stomach. No evidence of enteric contrast extravasation. Surrounding subcutaneous fat stranding with foci of air. No loculated fluid collections. Ventral hernia contains nondilated transverse colon. No pneumatosis intestinalis, free intraperitoneal air, or free fluid in the pelvis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Heterogeneous right adnexal mass measures 9.8 x 12.4 cm (axial image 112).BLADDER: Collapsed secondary to Foley catheter.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Heterogeneous right adnexal mass. Correlate with pelvic ultrasound.2.Percutaneous gastrostomy with surrounding subcutaneous fat stranding and foci of air suggesting cellulitis. No drainable fluid collections.3.No evidence of bowel obstruction. |
Generate impression based on findings. | Reason: rule out stone History: flank pain Lack of IV contrast limits evaluation of solid organ pathology.ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis or nephroureterolithiasis.RETROPERITONEUM, LYMPH NODES: Left gonadal vein phleboliths, unchanged.BOWEL, MESENTERY: No evidence of bowel obstruction. The appendix is normal.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 hydronephrosis or nephroureterolithiasis. |
Generate impression based on findings. | Reason: ?pancreatitis ?cholelithiasis History: abdominal pain ABDOMEN:LUNG BASES: Basilar atelectasis/scarring.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of bowel obstruction. The appendix is normal. No pneumatosis intestinalis, free intraperitoneal air, or free fluid in the pelvis.BONES, SOFT TISSUES: Foci of air in the right anterior abdominal wall subcutaneous soft tissues.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: IUD is in place.BLADDER: Distended bladder.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Stool distends the rectum. There are mild perirectal inflammatory changes. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Stool distended rectum with mild perirectal inflammatory changes. Correlate for stercoral colitis. 2.No evidence of bowel obstruction, cholelithiasis or pancreatitis. |
Generate impression based on findings. | Reason: evaluate for intra-abdominal pathology History: epigastric, RUQ, LUQ pain/tenderness ABDOMEN:LUNG BASES: Bibasilar atelectasis and consolidation. Previously referenced right upper lobe pulmonary nodule is incompletely visualized.Mural thrombus along the posterior wall of the distal thoracic aorta, unchanged.LIVER, BILIARY TRACT: Scattered nonspecific hepatic hypodensities are too small further characterize, but unchanged and likely benign.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable left renal cyst.RETROPERITONEUM, LYMPH NODES: Moderate atherosclerosis of the abdominal aorta and its branches without aneurysmal dilatation.BOWEL, MESENTERY: Dilated loops of small bowel in the left lower quadrant measuring up to 3.3 cm with associated small bowel feces sign. There is a transition point in the left lower quadrant (series 3, image 106). No pneumatosis intestinalis, free intraperitoneal air, or free fluid in the pelvis. No drainable fluid collections in the abdomen or pelvis. Diffuse colonic diverticulosis without diverticulitis.BONES, SOFT TISSUES: L2 compression deformity, unchanged. Degenerative changes of the thoracolumbar spine.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. | Small bowel obstruction with a transition point in the left lower quadrant. |
Generate impression based on findings. | Female, 54 years old, history of testis, otitis media, hearing loss, chronic sinusitis. The frontal sinuses and frontoethmoidal recesses are clear. Ethmoid air cells are clear. Sphenoid sinuses and sphenoethmoidal recesses are clear.The maxillary sinuses are clear. The maxillary ostia is not well seen on the right but this may be technical. The ostia on the left is patent. The infundibular are likewise unremarkable.The anterior nasal septum deviates leftward which results in narrowing of the left nasal cavity and expansion of the right. The turbinates are unremarkable.CT TEMPORAL BONE | 1. No evidence of active sinusitis.2. Partial opacification of the right mastoid air cells is noted which is a nonspecific finding but may indicate an inflammatory process.3. Unremarkable evaluation of the temporal bone structures. No middle ear masses or other specific findings are seen to account for the patient's tenderness. |
Generate impression based on findings. | 45 year old patient for surveillance of bilateral subdural hematoma. The previously documented subdural hematomas are demonstrated overlying the frontal and parietal lobes bilaterally. These have demonstrated expected interval evolution including layering of hyperattenuating blood products dependently without significant change in dimension since the prior examinations. The suprasellar cistern is somewhat crowded (stable) though there is no CT evidence of herniation or ischemia. Cerebellar tonsils are in appropriate position. Orbits and paranasal sinuses are unremarkable. | Expected interval evolution of bilateral subdural hematomas without new collection or significant change in dimension. |
Generate impression based on findings. | Female 53 years old; Flatulence, eructation, and gas pain Regional enteritis of small intestine with large intestine ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. Probable cyst in the right hepatic lobe . Hepatic and portal veins are patent. Status post cholecystectomy.SPLEEN: The spleen is mildly enlarged.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: Status post colectomy. Postoperative sutures within the bowel in the pelvis.There are at least 4 to 5 areas of small bowel mucosal thickening, hyperenhancement and bowel lumen narrowing involving the ileum. The largest such segments is in the mid abdomen measuring 4 cm in length. There are areas of bowel dilatation and narrowing adjacent to these areas of mucosal irregularity. No intra-abdominal abscess is evident. There are areas where bowel loops are located adjacent to each other an interloop fistula is not entirely excluded.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: See bowel section above for details. Post operative changes in the area of the rectum.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Findings of ongoing bowel inflammation involving multiple areas of the ileum with possible areas of stricturing. This could be better evaluated with a dynamic study such as a small bowel follow-through. |
Generate impression based on findings. | Female, 85 years old, with intracranial hemorrhage. A large amount of parenchymal hemorrhage is present within the posterior left frontal, left parietal and left occipital lobes. The blood product is of differing CT density suggesting blood at different stages of evolution. On many slices, a prominent blood fluid level is seen.Extensive subdural blood product is also evident extending along the left cerebral hemisphere from nearly the vertex down to the temporal region. Blood tracks along both sides of the left tentorium and along the interhemispheric fissure as well. At its point of maximal thickness, the subdural collection measures 2.2 cm along the left frontal lobe.Although the basal cisterns are effaced and difficult to assess, there is probably some subarachnoid blood present, at least within the left sylvian fissure if not the suprasellar cistern.Severe generalized mass effect is present with subfalcine herniation and midline shift to the right of approximately 2.1 cm. The suprasellar and quadrigeminal plate cisterns are effaced. There is transtentorial herniation of the left parietal temporal region which indents the underlying cerebellum and likely causes mass effect upon the brainstem. The posterior fossa and foramen magnum are crowded as well.Extensive parenchymal hypoattenuation is seen surrounding the hematomas as above affecting the posterior left frontal lobe, parietal lobe, occipital and temporal lobes. Hypo-attenuation also extends into the brainstem, pons and probably the cerebellum. The possibility that this hypoattenuation may reflect ischemic change cannot be excluded.The left temporal horn and left ventricular atrium are completely effaced. The left frontal horn is partially effaced. The right lateral ventricle is enlarged consistent with obstruction. The third and fourth ventricles are effaced. | Extensive parenchymal, subdural and probably subarachnoid hemorrhage involving predominantly the left cerebral hemisphere. This results in severe generalized mass effect with marked subfalcine and transtentorial herniation. Parenchymal hypoattenuation surrounding the large hematomas and extending to the brain stem may reflect either edema or ischemic change. |
Generate impression based on findings. | Male, 53 years old, history of base of tongue squamous cell carcinoma. Mild treatment related changes are redemonstrated in the neck. No evidence of recurrent tongue base tumor or pathologic adenopathy is demonstrated. A reference right submandibular node measures 10 x 7 mm (series 4 image 48), previously 9 x 6 mm. A reference left submandibular node measures 12 x 6 mm (series 4 image 49), previously 9 x 5 mm.The aerodigestive mucosa is unremarkable. Cervical vessels are patent and normal. Salivary glands are normal with the exception of the right submandibular gland which is not seen. The thyroid is free of focal lesions. Lung apices are clear. No concerning bony lesions detected. | Stable treatment related change in the neck. No evidence of active disease. |
Generate impression based on findings. | Female, 13 years old, loss of consciousness, new diagnosis of lupus, increased intracranial pressure. Subtle parenchymal and leptomeningeal abnormalities noted on the prior MRI cannot be distinguished on CT. Within this limitation, no discrete parenchymal abnormalities are identified. No edema, mass effect or midline shift is detected. No intracranial hemorrhage or abnormal extra-axial fluid collections are present. Ventricular system is patent and normal in size. The bones of the calvarium and skull base are intact. Mucosal thickening is evident within the left maxillary sinus. The paranasal sinuses are otherwise clear. | Unremarkable CT examination of the head. |
Generate impression based on findings. | Male, 62 years old, base of tongue cancer. Treatment related changes are redemonstrated in the neck. No focal tongue base or mucosal lesions are seen to suggest recurrent disease. No pathologic adenopathy is detected in the neck by size criteria.Sallivary glands are within normal limits. Subcentimeter left thyroid nodule is stable. Cervical vessels are patent. Scarring noted at the lung apices. No concerning bony lesion seen. | Treatment related change in the neck. No evidence of recurrent disease. |
Generate impression based on findings. | Male, 45 years old, cervicalgia. The the palatine tonsils are slightly bulky with scattered tonsilliths. The left base of tongue mucosa is also slightly prominent causing partial effacement of the left vallecula. Otherwise, the aerodigestive mucosal spaces are within normal limits.Scattered cervical lymph nodes are identified, but none of these is pathologically enlarged or shows aggressive features.The parotid glands contain small enhancing nodules which likely represent lymph nodes. The submandibular glands are unremarkable. The thyroid is free of focal lesions.The cervical vessels are patent. Lung apices are unremarkable. No focally destructive or concerning bony lesions are demonstrated. Please note that this examination is not tailored for evaluation of the cervical spine. Within this limitation, there is a small posterior disk-osteophyte complex at C5-6 which probably causes no significant spinal canal narrowing. There is no evidence of significant compromise of the bony spinal canal or the bony neural foramina. | Mild prominence of the left base of tongue mucosa likely reflect asymmetric lymphoid tissue. There is, however, some resulting effacement of the left vallecula. Visual inspection may be considered if clinically warranted.The soft tissues of the neck are otherwise unremarkable. No mass lesions or pathologic adenopathy is detected.No focally destructive bony lesions are seen. There is at most mild degenerative disk disease as discussed above. Please note that CT is insensitive for the detection of soft tissue and disk abnormalities. If further evaluation for cervicalgia is warranted, MRI would provide a better assessment. |
Generate impression based on findings. | Male, 66 years old, history of tonsil cancer. Treatment related change is seen including soft palate hyperemia as well is infiltration in the left neck. No soft tissue masses are identified.No pathologic adenopathy can be detected. A left level 2/3 reference node measures 5 x 4 mm (image 48 series 5), unchanged.The salivary glands are free of focal lesions. The right thyroid lobe has been resected in the interval. The left thyroid lobe is free of focal lesions.The cervical vessels are patent. The lung apices are unremarkable. No concerning bony lesions are seen. | Treatment related change in the neck with no evidence of recurrent disease or pathologic adenopathy.Interval resection of the right thyroid lobe. |
Generate impression based on findings. | Male, 49 years old, stroke, status post hemi-craniectomy, follow-up after fully anticoagulate. Surgical change is again seen compatible with a right hemicraniectomy. Sequelae of right MCA stroke are redemonstrated including substantial edema of the frontal, parietal and temporal lobes. The brain herniates through the craniectomy defect, but this is mildly improved relative to the prior examination. No appreciable midline shift is demonstrated at this time.The affected parenchyma remains very heterogeneously hypodense. There are scattered areas of mildly increased density which likely represent small foci of hemorrhagic transformation. Some of these are less distinct than on the prior examination. No evidence of new hemorrhagic transformation is seen.No new extra-axial fluid collections are detected. The ventricular system is patent allowing for mild effacement of the right lateral ventricle. | Post craniectomy change for decompression of a large right MCA distribution stroke. There is mild interval improvement in the degree of brain herniation through the craniectomy defect. Evidence of mild hemorrhagic transformation is again seen within the infarct region. No new hemorrhage is detected. No evidence of new ischemia is seen. |
Generate impression based on findings. | Male 39 years old; Reason: concern for mesenteric ischemia History: acute abdomen, recent VTE, no anticoag, persistent lactic acidosis ABDOMEN:LUNGS BASES: Bilateral pleural effusions are not significantly changed in size. There is basilar atelectasis.LIVER, BILIARY TRACT: Hepatic parenchyma is diffusely abnormal. The liver is enlarged measuring over 21 cm in craniocaudal dimension. The right hepatic lobe has diffuse hypoattenuation with innumerable hypoattenuating foci in the left lobe. The intrahepatic portal vein in the right lobe is mildly narrowed but patent. The hepatic veins are patent. Gallbladder is collapsed.SPLEEN: Spleen has peripheral hypodensities most suggestive of infarctions. More rounded lesions are suggestive of metastatic disease. Splenic vein is patent. Spleen is enlarged measuring 16.2 cm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis in either kidney. No perinephric fluid collections.RETROPERITONEUM, LYMPH NODES: IVC filter. Reference right retroperitoneal lymph node measures 1.6 x 0.6 cm (image 47/series 3) previously, 1.8 x .9 cm.The celiac artery, SMA and IMA are patent.BOWEL, MESENTERY: Centralization of the small bowel loops. No bowel distention to suggest obstruction.The colon is decompressed. No free intraperitoneal air.Extensive upper abdominal ascites with nodular thickening of the mesentery suggestive of peritoneal carcinomatosis.BONES, SOFT TISSUES: Extensive lytic metastases throughout the imaged thoracic and abdominal osseous structures.OTHER: Ascites.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: Please see above section.BONES, SOFT TISSUES: Extensive body wall anasarca, inguinal hernia containing fluid. Enhancing nodule in the right gluteus is unchanged. Extensive lytic metastases in the pelvic osseous structures.OTHER: No significant abnormality noted. | 1.New significant abnormality involving the liver. Differential considerations include new, extensive metastatic disease, hepatic infarction, asymmetric fatty deposition. Correlation with hepatic enzymes is recommended.2.Peripheral hypodensities in the spleen most suggestive of infarctions. Rounded lesions are more suggestive of metastatic disease. 3.Large volume abdominal and pelvic ascites with peritoneal nodularity most suggestive of peritoneal carcinomatosis and malignant ascites.4.Extensive osseous metastatic disease. |
Generate impression based on findings. | Male 32 years old; Reason: Etiology of severe neutropenic fevers- evidence of fungal or bacterial infections? History: persistently febrile to 40 degrees, C diff positive CHEST:LUNGS AND PLEURA: No dominant lung lesion. Micronodule in the right upper lobe (image 10/series 5) nonspecific. The pleural spaces are clear. The central airways are patent.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. No mediastinal lymphadenopathy. Right central venous catheter terminates at the cavoatrial junction.CHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No nephrolithiasis or hydronephrosis. No perinephric fluid collections.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Small bowel is normal in caliber. Colon is not distended .BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.No definite infectious source identified in the chest, abdomen or pelvis.2.No evident lymphadenopathy.3.No bowel obstruction. |
Generate impression based on findings. | Female 58 years old; Reason: pancreatitis History: abd pain, elevated lipase ABDOMEN:LUNGS BASES: Bilateral lower lobe scattered ground glass opacifications with areas of dense opacities.LIVER, BILIARY TRACT: Liver has a smooth contour. No suspicious hepatic lesions. Mild intrahepatic or ductal dilatation following cholecystectomy. Hepatic and portal veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic duct is mildly prominent. No surrounding inflammation to suggest acute pancreatitis. No fluid collections. Soft tissue polypoid nodule within the duodenum adjacent to the ampulla may represent the major papilla or duodenal nodule or debrisADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis in either kidney. Small probable cysts in the right kidney some with internal complexity are too small to characterize. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small bowel is normal in caliber. Colon is suboptimally distended . There is suggestion of colonic wall thickening involving the cecum, suboptimally evaluated.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 bowel obstruction is evident.BONES, SOFT TISSUES: Fluid in a right inguinal canal.OTHER: No significant abnormality noted. | 1.Lower lobe ground-glass opacities may be infectious. Dedicated chest imaging is suggested.2.Polypoid focus adjacent to the ampulla in the duodenum of unclear etiology, follow-up is recommended.3.Suggestion of colonic wall thickening involving the cecum, suboptimally evaluated without proper enteric contrast / colonic distention.4.Mildly prominent pancreatic duct without evident findings of acute pancreatitis.5.Complex right lower pole renal cysts, suboptimally evaluated due to their size. |
Generate impression based on findings. | Female 31 years old; Reason: s/p wound debridement 10/2 now with acute renal failure; r/o intraabdominal bleeding History: abdominal pain ABDOMEN:LUNGS BASES: Trace right pleural effusion.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 hydronephrosis in either kidney.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy. No retroperitoneal hematoma is evident.BOWEL, MESENTERY: Small bowel is normal in caliber and course. No bowel obstruction is evident. No free air.Infiltration of the fat in the left upper abdomen adjacent to the postsurgical site without a discrete fluid collection.BONES, SOFT TISSUES: Large ventral soft tissue defect with packing. There is some fluid and gas within the subcutaneous tissues, rectus fascia and extending into the pelvis. OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: The bladder is decompressed by Foley catheter.LYMPH NODES: Multiple borderline enlarged lymph nodes not significantly changed and may be due to the acute process in the abdomen.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Inflammation and fluid extending from the ventral defect to the pelvis, anterior to the uterus. The intra-abdominal component approximately measures 6.6 x 2.1 cm in. It is unclear if this represents fluid or infiltration of the fat.OTHER: No significant abnormality noted. | 1.Large body wall defect with inflammation and fluid extending to the pelvis. The lack of intravenous contrast limits evaluation of the fluid collection.2.No definite hematoma. |
Generate impression based on findings. | 35-year-old female with tachycardia and hypoxia post operative. Evaluate for pulmonary embolus. Additional history as per clinical service: patient with history of ectopic pregnancy, status post laparoscopic salpingectomy (postoperative day 2). PULMONARY ARTERIES: No evidence of a pulmonary embolus.LUNGS AND PLEURA: No focal pulmonary opacities to suggest an infection. There is mild bibasilar atelectasis. No pleural effusions or pneumothorax.MEDIASTINUM AND HILA: Heart is normal in size. No evidence of a pericardial effusion. No mediastinal or hilar lymphadenopathy.CHEST WALL: There is small amount of subcutaneous emphysema in the right chest wall.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. There is high density perihepatic and perisplenic fluid in the visualized upper abdomen measuring approximately 40 Hounsfield units. Additionally, there is small amount of intraperitoneal air. | 1. No evidence of a pulmonary embolus. 2. Small amount of free intraperitoneal air and high density perihepatic and perisplenic fluid. Findings are likely postoperative in etiology given clinical history above. However, if there is further clinical concern, evaluation with CT abdomen and pelvis is recommended.3. Nonspecific mild right chest wall subcutaneous emphysema.Findings were relayed to Dr. Abida Hasan covering pager 8142 over the phone at approximately 0943 hours. |
Generate impression based on findings. | Female 19 years old; Reason: 19 yo with history of indeterminate colitis presents complaining of worsening abdominal pain, fever 101, CRP 178.Please eval for intra-abdominal abscess. History: abdominal pain, fever. ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver has a smooth contour. 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 significant abnormality noted.BOWEL, MESENTERY: Extensive inflammation involving the entire colon worst in the ascending colon (image 61 series 4). There are multiple small adjacent mesenteric lymph nodes. No discrete pericolonic abscess. The inflammation extends into the appendix (image 72/series 4) which has an enhancing wall.The terminal ileum is also likely involved.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Probable bilateral physiologic cysts.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Wall thickening and hyperenhancement of the sigmoid colon.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace pelvic ascites. | 1.Findings of a diffuse colitis without evident abscess. |
Generate impression based on findings. | Female 30 years old; Reason: R/O malignancy or other lesions, pt with multiple enhancing lesions on MRI brain History: see above CHEST:LUNGS AND PLEURA: Multiple pulmonary opacities with a solid spiculated mass in theright upper lobe measuring 1.3 x 0.9 cm (image 28/series 5). No pleural effusions. No cavitation.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. There is extensive mediastinal and hilar lymphadenopathy.A left subcarinal lymph node measures 2.9 x 1.8 cm (image 42/series 3) .CHEST WALL: Mildly enlarged axillary lymph nodes. A right axillary lymph node measures 1.3 x 1.3 cm (image 13/series 3). ABDOMEN:LIVER, BILIARY TRACT: Liver has a smooth contour. No suspicious hepatic lesions. Hepatic and portal veins are patent. Gallbladder contains multiple calculi. Extensive portacaval and peripancreatic adenopathy.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: Extensive retroperitoneal lymphadenopathy. A reference left para-aortic node measures 1.9 x 1.5 cm (image 109/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: Enlarged pelvic and inguinal lymphadenopathy. Left pelvic sidewall node measures 2.9 x 2.0 cm (image 169/series 3). BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Extensive lymphadenopathy in the chest, abdomen and pelvis. Findings are most suggestive of a lymphoproliferative disorder.2.Pulmonary parenchymal opacities represent either of infectious or malignant etiology.3.Cholelithiasis. |
Generate impression based on findings. | Female 68 years old; Reason: suspicious lesion in lumbar spine; concern for mets History: as above CHEST:LUNGS AND PLEURA: Calcified lesion in the right upper lobe. There are ipsilateral calcified hilar nodes. The pleural spaces are clear. The central airways are patent.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. Calcified hilar lymph nodes.There are small mediastinal lymph nodes.CHEST WALL: Bilateral enlarged axillary lymph nodes. A reference left enlarged axillary lymph node measures 2.2 x 1.7 cm (image 32/series 3). Compression deformities of T7 and T5.Thyroid nodules.ABDOMEN:LIVER, BILIARY TRACT: Liver morphology is normal. 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: Multiple small retroperitoneal lymph nodes. Left para-aortic lymph node measures 1.0 x 0.8 cm (image 123/series 3). BOWEL, MESENTERY: Small bowel is normal in caliber. Suboptimally evaluated due to poor opacification by contrast.BONES, SOFT TISSUES: Large infiltrative lesion destroying the L5 vertebral body and pedicle with collapse.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Pelvic lymphadenopathy. Right external iliac lymph node measures 2.6 x 2.0 cm (image 170/series 3). BOWEL, MESENTERY: Destruction of the L5 vertebral body.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Destructive lesion of L5 vertebral body with a lymphadenopathy in the axilla and pelvis. Differential considerations include lymphoma or metastatic disease. |
Generate impression based on findings. | 59-year-old male with shortness of breath. Patient is status post DVT and off anticoagulation for one month. Evaluate for pulmonary embolus. PULMONARY ARTERIES: Examination is diagnostic to the segmental level. No evidence of pulmonary embolus to the segmental level.LUNGS AND PLEURA: Mild to moderate centrilobular emphysema. No pulmonary opacities to suggest infection. Bibasilar atelectasis. Bronchiectasis affects the lower lobes. No pleural effusions or pneumothorax. Atherosclerotic calcifications affect to the thoracic aorta.MEDIASTINUM AND HILA: Cardiomegaly without evidence of a pericardial effusion. There is bilalteral hilar and mediastinal lymphadenopathy. There is soft tissue density surrounding the left main pulmonary artery and appears to be encasing the vessel. The contour of the vessel itself is irregular suggesting invasion or perhaps intraluminal invasion.CHEST WALL: Left-sided pacemaker is identified. There are collateral vessels in the posterior soft tissues on the left chest wall.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. There is an incompletely evaluated hypodense structure in the upper pole of the right kidney which measures approximately 2.5 x 2.3 cm (series 8, image 327). Mild to moderate atherosclerotic calcification of the splenic artery, abdominal aorta, and branches of the abdominal aorta. | 1. No evidence of pulmonary embolus to at least the segmental level. 2. Soft tissue density appears to encase the left main pulmonary artery raising the question of a malignant invasive process. Further evaluation with a dedicated CT chest examination with contrast is recommended.3. Hilar and mediastinal lymphadenopathy. 4. Mild to moderate centrilobular emphysema and dependent bronchiectasis. 5. Cardiomegaly.6. Incompletely characterized hypodense lesion in the right kidney.Findings relayed to the Dr. Amy Reid, covering pager 3453, over the phone at approximately 1248 hours. |
Generate impression based on findings. | 71-year-old female with hypertension, high right-sided pressures, McConnell's sign and history of DVT. Evaluate for pulmonary embolus. PULMONARY ARTERIES: Examination is nondiagnostic for evaluation of pulmonary embolus. There is no large saddle embolus.LUNGS AND PLEURA: Trace right pleural effusion. Small left pleural effusion with underlying atelectasis.MEDIASTINUM AND HILA: Cardiomegaly. No evidence of pericardial effusion. No mediastinal or hilar lymphadenopathy. Left jugular catheter with tip in the cavoatrial junction.CHEST WALL: There is chronic occlusion of the right subclavian vein, brachiocephalic vein, and the superior vena cava with multiple mediastinal collaterals and opacification of a large azygos vein.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Small hiatal hernia. Mild atherosclerotic calcifications affect the visualized abdominal aorta. | 1. Nondiagnostic examination for evaluation of pulmonary embolus. No evidence of large saddle embolus.2. Chronic occlusion of the right subclavian vein, brachiocephalic vein, and the superior vena cava with multiple mediastinal collaterals and opacification of a large azygos vein. |
Generate impression based on findings. | Female 78 years old; Reason: r/o retroperitoneal hematoma History: acute drop in hgb ABDOMEN:LUNGS BASES: Small bilateral pleural effusions with associated atelectasis. There is a calcified granuloma in the right lung base.LIVER, BILIARY TRACT: Nonspecific hypervascular foci in the liver. Few scattered hepatic calcifications.Filling defect in the superior mesenteric vein most likely due to a phase of imaging. The portal veins are patent. SPLEEN: Splenic granulomata.PANCREAS: Pancreatic ductal dilatation stable. No evident mass.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Renal cortical atrophy without hydronephrosis or perinephric fluid collections. Poor enhancement of the native kidneys.RETROPERITONEUM, LYMPH NODES: Arteriosclerotic disease of the aorta. No retroperitoneal hematoma.BOWEL, MESENTERY: No bowel obstruction is evident. Right lower abdominal ostomy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Calcifications within the uterus.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy is evident.BOWEL, MESENTERY: Right lower abdominal ostomy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: A left femoral catheter terminates in the IVC adjacent to the liver.There are body wall collaterals. | 1.No evident retroperitoneal or body wall hematoma. |
Generate impression based on findings. | Male 44 years old; Reason: small bowel obstruction History: distension, nausea, vomiting, lack of BM ABDOMEN:LUNGS BASES: 6-mm left lower lobe pulmonary nodule (image 17/series 6) this may represent a discrete nodule versus area of atelectasis.LIVER, BILIARY TRACT: Scattered intrahepatic pneumobilia. Gallbladder is absent. No ductal dilatation. Hepatic and portal veins are patent .SPLEEN: The spleen is normal in size. Splenic vein is patent.PANCREAS: Findings of chronic pancreatitis with pancreatic atrophy and calcifications of the head of the pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: IVC filter which extends past the wall of the IVC.BOWEL, MESENTERY: Mild distention of the small bowel loops in the upper abdomen without a discrete transition point. The duodenum and proximal jejunum are distended. Moderate to large amount of colonic fecal debris throughout the colon suggests constipation. No mesenteric fluid collections or lymphadenopathy.BONES, SOFT TISSUES: Scattered venous collaterals in the body wall.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Scattered pelvic lymph nodes.BOWEL, MESENTERY: Refer to bowel section above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Extensive fecal material within the colon suggests constipation.2.Mild distention of the duodenum and jejunum without a discrete transition point suggest partial obstruction or small bowel ileus.3.6mm pulmonary nodule; follow up is suggested.4.Chronic pancreatitis with pancreatic atrophy. If needed, consider M.R.C.P. for further evaluation. |
Generate impression based on findings. | Female 42 years old; Reason: eval for obstruction History: pt with severe abd pain, s/p colectomy ABDOMEN:LUNGS BASES: Moderate size pericardial effusion, partially imaged.LIVER, BILIARY TRACT: Liver is enlarged measuring over 20 cm in craniocaudal, dimension. No biliary ductal dilatation. Hepatic and portal veins are patent. No suspicious 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: No retroperitoneal lymphadenopathy. BOWEL, MESENTERY: Small bowel loops in the upper abdomen are dilated. There are multiple surgical anastomoses in the small bowel. There are multiple air-fluid levels. A transition point is noted in the right lower abdomen/pelvis (image 122/series 3) with distal collapsed bowel loops indicating a bowel obstruction. There are multiple borderline enlarged mesenteric lymph nodes of unclear etiology. A reference mesenteric lymph node (image 103/series 3) measures 1.7 x 1.3-cm.BONES, SOFT TISSUES: Postoperative changes in the anterior abdominal wall.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: Bowel obstruction detailed above. The rectum is unremarkable.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of pelvic ascites. | 1.Findings of a bowel obstruction with the transition point in the right lower abdomen, most likely due to adhesions.2.Trace pelvic ascites may be physiologic or due to bowel obstruction.3.Pericardial effusion |
Generate impression based on findings. | Female 26 years old; Reason: free fluid in abd History: abd pain ABDOMEN:LUNGS BASES: Trace pericardial effusion. No basilar pleural effusions.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 retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Small bowel is normal in caliber. Colon is not distended. No mesenteric fluid collections or lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Mild thickening of the endometrial cavity, likely physiologic in a young female.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Transverse lie of the ascending colon with the cecum located in the left lower abdomen. The appendix is normal in caliber and partially fills with contrast (image 28/series 80232 )BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace pelvic fluid | 1.No bowel obstruction as clinically questioned.2.No findings of appendicitis.3.Trace pelvic fluid. |
Generate impression based on findings. | Slurred speech. Rule out CVA. There are two small areas of hypoattenuation within the subcortical white matter of the right frontal lobe (axial image 20) and right basal ganglia. No associated hemorrhage or mass effect. Gray-white differentiation is normal elsewhere. Incidental note is made of hyperattenuation consistent with mineralization within the medial basal ganglia bilaterally. There is no hydrocephalus or extra-axial fluid collection.Orbits and paranasal sinuses are unremarkable. | Small areas of hypoattenuation within subcortical white matter and basal ganglia. These most likely represent sequelae of ischemia which are age indeterminate by CT criteria. The patient went on to undergo an MRI examination, refer to report for further detail. |
Generate impression based on findings. | Vertigo with nausea and vomiting. Rule out intracranial hemorrhage. There is no intracranial mass, fluid collection, hemorrhage, hydrocephalus or evidence of acute ischemia. Gray-white matter differentiation is unremarkable and the midline is intact.Visualized portions of the orbits and paranasal sinuses are unremarkable. | No acute intracranial pathology |
Generate impression based on findings. | Male, 55 years old, history of thyroid cancer and is Tesio neuroblastoma. Neck mass felt on exam. Evaluate for recurrence. Extensive surgical changes redemonstrated within the nasal cavity. The ostiomeatal units have been removed as have all of the nasal cavity structures with the exception of the inferior turbinates. The lamina papyracea and the floor of the anterior skull base have also been removed along with the sphenoid sinuses. Soft tissue thickening along the residual sphenoid bone, which projects into the upper clivus, appears similar to the prior examination in terms of thickness and morphology. No definite suspicious soft tissue lesions are seen within the nasal cavity.Limited intracranial views are remarkable only for encephalomalacia of the bilateral inferior frontal lobes.Since the prior CT examination the patient has undergone total thyroidectomy. There are surgical clips and ill-defined stranding in the thyroidectomy bed. Below the thyroidectomy bed, in the pretracheal space, there are several low density subcentimeter nodules. One of these measures 6 cm in diameter (image 88 series 4), was present on the prior examination, and has not substantially changed. A suspicious lesion noted on prior ultrasound at the level of the thyroid isthmus cannot be clearly identified, perhaps secondary to altered morphology following biopsy. No additional suspicious lesions are seen within the thyroidectomy bed, along the strap muscles of the neck, or along the adjacent sternocleidomastoid muscles.Previously seen pathologic adenopathy in the right neck has been resected. There is no evidence of pathologic adenopathy on the current examination.The salivary glands are unremarkable. The cervical vessels are patent. Lung apices are clear. No concerning bony lesions are seen. | 1. Redemonstration of extensive postsurgical change in the nasal cavity. Soft tissue along the residual sphenoid bone, extending into the clivus, has not significantly changed from prior exams. No findings to suggest locally recurrent esthesioneuroblastoma are seen.2. Postsurgical change compatible with thyroidectomy is redemonstrated. A suspicious nodule at the level of the thyroid isthmus, identified and subsequently biopsied under ultrasound, cannot be clearly identified on this exam.3. Below the level of the thyroid, there are several subcentimeter nonenhancing nodules which are nonspecific. A least one of these was present on the prior CT examination and has not significantly changed.4. No evidence of pathologic adenopathy is seen in the neck. |
Generate impression based on findings. | Acute mental status change. There is mild patchy periventricular and subcortical hypoattenuation which likely represents sequela of chronic small vessel ischemic disease. There is no intracranial mass, fluid collection, hemorrhage, hydrocephalus or CT evidence of acute ischemia. Gray-white matter differentiation is normal and the midline is intact.There is an unchanged soft tissue density within the inferior aspect of the left maxillary sinus most likely representing a mucus retention cyst. Orbits are unremarkable. | No acute intracranial pathology demonstrated. |
Generate impression based on findings. | 51-year-old male who had acute worsening of hypoxia. Evaluate for pulmonary embolus or infarction. PULMONARY ARTERIES: No evidence of pulmonary embolus.LUNGS AND PLEURA: There is a small left apical pneumothorax. Bilateral small pleural effusions with underlying atelectasis. There are small vague areas of ground glass opacities in the right upper and lower lobes (series 6, images 53, 61, 67, 71).MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. There is a large left hilar mass, likely a adenopathy measuring 3.7 x 3.6 cm (series 5, image 96) and one and 3.7 x 2.5 cm (series 5, image 114). The left hilar adenopathy results in attenuation of the left upper lobe pulmonary artery. This mass is stable compared to the CT chest examination from outside hospital.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Visualized upper abdomen is unremarkable. | 1. No pulmonary embolus. 2. Small left apical pneumothorax. 3. Large left hilar mass as detailed above results in attenuation of the left upper lobe pulmonary artery.3. Bilateral small pleural effusions. 4. Vague areas of groundglass opacities in the right upper and lower lobes; diagnostic considerations may include atypical infection versus inflammatory changes.Findings were relayed to Dr. Jasmine Swaniker, pager 1392, over the phone at approximately 1214 hrs. |
Generate impression based on findings. | 44 year-old patient. Headache. Rule out intracranial hemorrhage. No intracranial mass, fluid collection, hemorrhage, hydrocephalus or evidence of acute ischemia. Gray-white matter differentiation is maintained bilaterally and the midline is intact. There is soft tissue density consistent with maxillary and ethmoid sinus disease. Bones and orbits are unremarkable. | No acute intracranial pathology demonstrated. |
Generate impression based on findings. | C-spine tenderness and tingling of lower extremities following helmet to helmet contact. CT head: There is no intracranial mass, fluid collection, hemorrhage, hydrocephalus or evidence of acute ischemia. Gray-white differentiation is maintained bilaterally and the midline is intact. There is mild mucosal thickening in the ethmoid and maxillary sinuses which could be related to sinusitis.CT Cervical spine: There is minimizationof the cervical lordosis which is likely positional or related to the neck brace. There is normal vertebral body and intervertebral disk height. There is no fracture or dislocation. The odontoid is intact. | No abnormality of the head or cervical spine demonstrated. |
Generate impression based on findings. | 35 year-old female with new onset hypoxia with dyspnea on exertion. Evaluate for pulmonary embolus versus edema. Motion artifact limits evaluation. Within this limitation, the following findings are noted.PULMONARY ARTERIES: No evidence of pulmonary embolus.LUNGS AND PLEURA: Bilateral small pleural effusions with underlying atelectasis. Diffuse bilateral alveolar ground glass opacities, compatible with pulmonary edema. There is pulmonary opacity in the right middle lobe (series 6, image 148) and in the right lower lobe; findings are suspicious for an infection. Small region of atelectasis in left upper lobe (series 6, image 69) and lingular region (series 6, image 159).MEDIASTINUM AND HILA: Cardiomegaly without evidence of pericardial effusion. No mediastinal or hilar lymphadenopathy. Mild to moderate atherosclerotic calcifications affect the thoracic aorta.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Mild to moderate atherosclerotic calcifications affect the abdominal aorta and its branches. Dense atherosclerotic calcifications affect the splenic artery. Cholecystectomy clips. | 1 No evidence of pulmonary embolus. 2. Findings suspicious for right middle lobe and right lower lobe pneumonia. 3. Findings as described above suspicious for congestive heart failure.4. Mild to moderate atherosclerotic disease as detailed.Findings relayed to Dr. Anshu Verma, covering pager 2987, over the phone at approximately 1222 hrs. |
Generate impression based on findings. | 18 years old. Vomiting following head trauma. There is no intracranial mass, fluid collection, hemorrhage, hydrocephalus or evidence of acute ischemia. Gray-white matter differentiation is maintained bilaterally and the midline is intact.Orbits, paranasal sinuses and mastoid air cells are unremarkable. | No visualized intracranial abnormality. |
Generate impression based on findings. | Male, 32 years old, persistently febrile to 40 degrees, neutropenic. The frontal sinuses are clear. There is mild opacification at the level of the frontoethmoidal recesses. Patchy opacification of the ethmoid air cells is demonstrated. Mild soft tissue thickening is present within the sphenoid sinuses. The sphenoethmoidal recess on the right is patent. The sphenoethmoidal recess on the left is effaced.Mucosal thickening is evident within both maxillary sinuses, left side more than right, also noted on prior MRI. Both ostiomeatal units are effaced by soft tissue thickening. The premaxillary and retromaxillary fat is clear.Mild debris is present within the left middle meatus. The nasal cavity is otherwise clear. The nasal septum is intact with leftward deviation of its anterior aspect. The nasal turbinates are unremarkable. | Patchy opacification through the ethmoid air cells could reflect an inflammatory or infectious process. Mucosal thickening within the maxillary sinuses demonstrates more the appearance of mucous retention cysts, and in any event, was present on prior MRI. No findings to suggest an aggressive or invasive sinus infection are seen. |
Generate impression based on findings. | Assault with loss of consciousness. No intracranial mass, fluid collection, hemorrhage, hydrocephalus or evidence of acute ischemia. Gray-white matter differentiation is maintained bilaterally and the midline is intact. | No intracranial abnormality demonstrated. |
Generate impression based on findings. | 22-year-old male status post significant vascular surgery. Intermittent desaturations. Assess for pulmonary embolus. PULMONARY ARTERIES: Suboptimal opacification of the pulmonary artery limits evaluation. Within this limitation, no evidence of a large pulmonary embolus.LUNGS AND PLEURA: Moderate sized bilateral pleural effusions with underlying atelectasis. There are multiple pulmonary nodules, suspicious for metastatic disease. Reference measurements are provided as follows: Right upper lobe nodule measures 1.3 x 0.9 cm (series 10, image 37).Right middle lobe nodule measures 0.9 x 0.8 cm (series 10, image 106).Vague groundglass opacity in the right lower lobe measures 0.5 x 0.4 cm (series 7, image 68). Left upper lobe nodule measures 0.8 x 0.8 cm (series 2, image 49). Lingular nodule measures 0.6 x 0.5 cm (series 10, image 70).MEDIASTINUM AND HILA: Heart size is normal. No pericardial fusion. No mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Perihepatic and perisplenic ascites in the visualized upper abdomen. Small amount of free abdominal air, likely secondary to recent surgical intervention. There is an incompletely evaluated soft tissue density anterior to the pancreas (series 6, image 336). | 1. Suboptimal examination for evaluation of pulmonary embolus as detailed. No large saddle embolus. 2. Multiple pulmonary nodules with reference measurements as detailed; findings are suspicious for metastatic disease.3. Abdominal ascites and incompletely evaluated soft tissue density anterior to the pancreas. Further evaluation with CT abdomen and pelvis may be considered if clinically indicated.4. Small amount of free abdominal air, likely secondary to recent surgical intervention.Findings relayed to Dr. Charles Nottingham, covering pager 9772, over the phone at approximately 1228 hours. |
Generate impression based on findings. | 55-year-old patient with right hand numbness. There are small foci of hypoattenuation within the internal capsules bilaterally. No significant mass effect, or associated hemorrhage. There are no other intracranial masses or fluid collections. Gray-white differentiation is maintained and the midline is intact. There is no hydrocephalus. Orbits, paranasal sinuses and mastoid air cells are unremarkable. | Small foci of hypoattenuation within the internal capsules noted. This is a nonspecific finding, though could represent small age indeterminate lacunar infarction or prominent perivascular space. An MRI is in progress at the time of this dictation. |
Generate impression based on findings. | Male, 66 years old, status post fall, head trauma, now with subdural and subarachnoid hemorrhage. Stable hyperdense extra-axial blood along the right frontal lobe. Stable intermediate density extra-axial clot along the left frontal lobe. Subarachnoid hemorrhage within the right sylvian fissure is less dense and less conspicuous than on the prior exam. Intermediate attenuation clot within the interhemispheric fissure has decreased in density. Mild blood product along the midbrain and pons has not significantly changed. Minimal parietal region subarachnoid blood product is barely detectable on the present study.No evidence of new intracranial hemorrhage is seen. No significant generalized mass-effect is demonstrated. The ventricular system remains patent and normal in size. | Scattered intracranial blood product is stable or reduced in conspicuity. No progressive or new hemorrhage is seen. |
Generate impression based on findings. | 62 year-old female with tachycardia and chest pain. Evaluate for pulmonary embolus Motion artifact somewhat limits evaluation. Within this limitation, the following findings are noted.PULMONARY ARTERIES: No evidence of pulmonary embolus. LUNGS AND PLEURA: Bilateral small pleural effusions with underlying atelectasis/consolidation. Small areas of consolidation in the right middle lobe (series 8, image 98), lingular region (series 8, images 88 and 106), and left upper lobe (series 8, image 112). No pneumothorax.MEDIASTINUM AND HILA: Mild to moderate cardiomegaly. Small pericardial effusion. No mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Large left lobe of the liver noted. Otherwise, the visualized upper abdomen is unremarkable. | 1. No evidence of pulmonary embolus. 2. Bilateral small pleural effusions with underlying atelectasis/consolidation. 3. Mild to moderate cardiomegaly with small pericardial effusion. 4. Hepatomegaly. |
Generate impression based on findings. | 31 year old patient. Headache and left arm weakness for 5 days. There is no intracranial mass, fluid collection, hemorrhage, hydrocephalus or CT evidence of ischemia. Gray-white matter differentiation is maintained bilaterally and the midline is intact. The orbits, paranasal sinuses and mastoid air cells are unremarkable. | No intracranial abnormality visualized. Given the patient has previously documented MS, if there is concern regarding an acute flare, MRI is a more sensitive technique for assessing the inflammation associated with MS. |
Generate impression based on findings. | 54-year-old male with tachycardia. Evaluate for pulmonary embolus Streak artifact from spinal hardware somewhat limits evaluation. Within this limitation, the following findings are noted.PULMONARY ARTERIES: There is a filling defect in the right lower lobe segmental pulmonary artery, extending into the subsegmental branches; findings are consistent with acute pulmonary embolus.LUNGS AND PLEURA: Small bilateral pleural effusions with underlying atelectasis. No pulmonary opacities to suggest infection. No pneumothorax.MEDIASTINUM AND HILA: Small area of soft tissue density is noted within the the trachea (series 7, image 65). No mediastinal or hilar lymph adenopathy by CT criteria. Heart is normal in size. No evidence of pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted in the visualized upper abdomen. | 1. Right lower lobe segmental pulmonary artery embolus that extends into the subsegmental branches. 2. Small bilateral pleural effusions with underlying atelectasis.3. Small area of soft tissue density in the upper trachea. This may represent debris; however, follow up is recommended to document resolution.Findings relayed to Dr. Sean Polster, covering pager 2911, over the phone at approximately 1234. |
Generate impression based on findings. | Female, 64 years old, altered mental status, subdural hemorrhage. Right parietal extra-axial blood product is redemonstrated, not substantially changed in size but reduced in CT density. Small low-density extra-axial collection overlying the left parietal lobe is not significantly changed.No hemorrhage is detected. The brain parenchyma is stable in appearance with no new areas of focal edema or mass effect. The ventricular system remains patent and normal in size. | No progressive or new hemorrhage. Hematoma along the right parietal lobe has reduced in CT density compatible with expected evolution. A small low-density left parietal extra-axial collection is unchanged. |
Generate impression based on findings. | Acute mental status change. History of metastatic lung cancer There is significant motion artifact limiting sensitivity. A ventriculostomy catheter is in unchanged position, approaching the right lateral ventricle from a right frontal burr hole. There has been a slight interval increase in the amount of pneumocephalus associated with the tract, which is likely related to interval access. Allowing for differences in acquisition angle, there are no significant differences in the multiple bilateral cerebellar and supratentorial hyperattenuating lesions since the examination one day prior. Note is made that these have increased in size since the examination dated 9/30/2013. The cerebellar lesions result in mass effect including partial effacement of the prepontine cistern and crowding of the foreman magnum. The ventricles remain prominent, though slightly less so than the prior exam.Orbits, paranasal sinuses and mastoid air cells are unremarkable. | 1.Interval slight decrease in ventricular caliber, though the examination is somewhat limited by motion artifact. 2.No acute changes in the multiple bilateral metastatic lesions, though increase in size as been demonstrated since an examination dated 9/30/2013. |
Generate impression based on findings. | Male 72 years old; Reason: aortic dissection History: chest pain CHEST:LUNGS AND PLEURA: Ground-glass nodule adjacent to the right minor fissure measures 1.9 x 1.6 cm (image 61/series 10). Scattered calcified and noncalcified right subcentimeter nodules.The pleural spaces are clear. MEDIASTINUM AND HILA: Heart size normal; no pericardial effusion. No mediastinal lymphadenopathy. Thoracic aorta is normal in caliber. No evident dissection. Extensive coronary calcifications.No filling defects in the central pulmonary arteries.CHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: Liver has a smooth contour. Probable cholelithiasis with a calcified stone in the gallbladder neck.SPLEEN: The spleen is normal in size. 9 mm splenic artery pseudoaneurysm (image 25 series 11), unchanged.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Abdominal aorta is normal in caliber. No evident dissection. Mild arteriosclerotic disease.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: The prostate is enlarged and heterogeneous.BLADDER: No significant abnormality notedLYMPH NODES: Small pelvic lymph nodes.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.No thoracoabdominal aneurysm or evident dissection.2.Ground-glass opacity along the right minor fissure may be infectious or inflammatory. Follow up recommended.3.9-mm splenic artery pseudoaneurysm, unchanged. |
Generate impression based on findings. | Female, 25 years old, status post shunt removal. Redemonstrated is evidence of multiple right sided craniotomies and right hemispherectomy defect. A left parietal approach shunt catheter, terminating within the diskectomy defect, is in place. This may be a revised catheter as it no longer connects to a subcutaneous reservoir. A previous right parietal approach catheter has been removed and replaced with a new catheter. This catheter traverses the hemispherectomy defect, coursing anteromedially, to terminate within the anterior cranial fossa, just beneath the inferior frontal lobes. This catheter no longer connects to the above-mentioned left parietal approach catheter. Pneumocephalus and intraventricular air are compatible with recent procedure.Contrast material within the hemispherectomy defect seen on the prior examination has been resorbed. Shift of midline to the right is unchanged. No new mass-effect, focal parenchymal edema or other significant changes are detected. | Revision of bilateral drainage catheters. A left parietal approach catheter terminates in similar position to what was seen on the prior examination. A right parietal approach catheter now terminates within the anterior cranial fossa, beneath the inferior frontal lobes. Other findings are not substantially changed. |
Generate impression based on findings. | Female, 25 years old, sudden onset severe headache. 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. |
Generate impression based on findings. | Female, 25 years old, headache. Precontrast head CT images remain within normal limits.The components of the anterior circulation including the ICAs, MCAs and ACAs demonstrate normal caliber and morphology. No high-grade stenosis, vascular occlusion or aneurysm is detected.The components of the posterior circulation including the vertebral arteries, the basilar artery and PCAs demonstrate normal caliber and morphology. No high-grade stenosis, vascular occlusion or aneurysm is detected. | Unremarkable CT angiogram of the head. No aneurysms are detected. |
Generate impression based on findings. | 32 year-old female with metastatic non-small cell lung carcinoma including brain metastases with right upper extremity weakness. Evaluate for hemorrhage. The ventriculostomy catheter which approaches the right lateral ventricle from a right frontal approach is in unchanged position from previous. There is been interval decrease in the amount of pneumocephalus since prior exam. There is been interval increase in size of the ventricles bilaterally in keeping with developing hydrocephalus.Several of the multiple hyperattenuating lesions demonstrated within the cerebellum and cerebral hemispheres bilaterally demonstrate increase in size. For example, the 19 x 27 mm lesion at the left posterior frontal convexity previously measured 18 x 21 mm on 9/30/2013. There is also been increase in the amount of vasogenic edema associated this lesion. There is mass effect associated with the lesions, most prominently demonstrated within the posterior fossa where there is effacement of the prepontine cistern and crowding of the foreman magnum. No findings suggest overt herniation at this point. | 1.Interval increase in ventricular caliber since examination dated 9/30/2013 suggesting developing hydrocephalus. 2.Interval increase in size of the multiple intraparenchymal metastatic deposits of non-small cell lung cancer as well as associated edema which results in mass effect most prominent in the posterior fossa. |
Generate impression based on findings. | 32-year-old patient. HIV not on medications. Mass. There is no intracranial mass, fluid collection, hemorrhage, hydrocephalus, focus of pathologic enhancement or CT evidence of ischemia. Gray-white matter differentiation is maintained bilaterally and the midline is intact.The orbits and bony structures are unremarkable. | No intracranial pathology demonstrated. |
Generate impression based on findings. | Seizure. Rule out mass. No intracranial mass, fluid collection, hemorrhage, hydrocephalus or CT evidence of acute ischemia. Gray-white matter differentiation is maintained bilaterally and the midline is intact.Orbits and paranasal sinuses are unremarkable. | No intracranial pathology demonstrated. |
Generate impression based on findings. | Trauma. There is no intracranial mass, fluid collection, hemorrhage, hydrocephalus or CT evidence of acute ischemia. Gray-white matter differentiation is maintained bilaterally and the midline is intact. There are no visualized fractures or bony anomalies. Orbits, paranasal sinuses and mastoid air cells are unremarkable. | No visualized sequelae of trauma. |
Generate impression based on findings. | Acute onset headache. Rule out mass. No intracranial mass, fluid collection, hemorrhage, hydrocephalus or evidence of acute ischemia. Gray-white matter differentiation is appropriate and the midline is intact. There is a contour abnormality at the posterior aspect of the globes bilaterally consistent with bilateral staphyloma. The paranasal sinuses and mastoid air cells are unremarkable. There are no bony abnormalities demonstrated. | No acute intracranial abnormality demonstrated. |
Generate impression based on findings. | Male, 59 years old, history of tonsil cancer, right cheek opening, evaluate for recurrence. Since the prior examination, an ill-defined enhancing mass has developed infiltrating through the right masticator space. The lesion encompasses the right mandibular ramus extending inferiorly down to the level of the previously noted mandibular erosion. Tumor extends anteriorly through the soft tissues of the face to at least the mid point of the maxilla, and posteriorly to encompass the entire mandibular ramus. Medially, the tumor extends at least to the level of the lateral pterygoid plate if not further, and laterally to the skin surface. At the level of the mandibular ramus, the tumor, inclusive of infiltrated masticator and pterygoid musculature, measures 6.5 x 3.7 cm. No discretely measurable tumor was seen at this site on the prior exam.The skin of the right face is thickened and the subcutaneous fat is infiltrated throughout. Soft tissue thickening extends up to the right periorbital region. The etiology of this finding is uncertain. Congestive edema is favored, perhaps from tumor related venous outflow compromise, but the possibility of superficial tumor invasion cannot be entirely excluded. The intraorbital contents are preserved.Redemonstrated is extensive lytic change involving the right hemimandible. This has substantially progressed relative to the prior examination and there is now marked lytic change involving the mandibular ramus which was previously intact. The right posterior maxilla may also be partially eroded appearing similar to prior.Below the level of the tumor, a right neck myocutaneous flap is redemonstrated appearing similar to the prior examination. A tracheostomy is in place also appearing similar to prior exam. The right aspect of the thyroid cartilage is not present and has presumably been resected.No pathologic adenopathy is identified in the neck by size criteria. The bilateral carotid arteries are patent. In particular, the right internal carotid artery is uninvolved by the progressive tumor noted above. Neither internal jugular vein is well seen. Lung apices are unremarkable. Except as above, no new or concerning bony lesions are seen. Mucosal thickening is present in both maxillary sinuses, similar to prior. | Progression of disease with interval development of a large mass infiltrating through the right masticator space with extension into the soft tissues of the right face. Cutaneous and subcutaneous thickening extends as far superiorly as the right periorbital region. This may reflect venous congestion, but the possibility of superficial tumor infiltration cannot be excluded. Lytic change involving the right mandible has also substantially progressed. |
Generate impression based on findings. | Neck pain and dizziness. Evaluate neck vasculature. There is normal anatomy at the aortic arch. The carotids demonstrate normal course bilaterally. There are no aneurysms or significant stenotic lesions. including at the bifurcations bilaterally. The vertebral arteries demonstrate normal course. There are no aneurysms or significant stenotic lesions. There are no abnormalities of the imaged portion of the intracranial arteries including the circle of Willis.There are no aggressive bony lesions, fractures or degenerative change. Paraspinal soft tissues are unremarkable. | No abnormality demonstrated including stenotic lesion or aneurysm |
Generate impression based on findings. | Female, 48 years old, altered mental status. Unequal pupils. Given the limitations of portable technique and patient motion, no acute intracranial abnormalities are detected. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. No focal parenchymal edema or generalized mass effect is seen. Ventricular system is patent and normal in size.The bony structures of the calvarium and skull base are intact. The paranasal sinuses mastoid air cells are normally pneumatized. NG and ET tubes are in place. | No acute intracranial abnormalities. |
Generate impression based on findings. | Male 71 years old; Reason: history renal cancer, on systemic therapy, assess for progression History: upper back pain CHEST:LUNGS AND PLEURA: Nodularity along the major fissure in the right lung is unchanged. Scattered micronodules in the right middle lobe and ground-glass opacities in the lingula and left lower lobe. Pleural spaces are clear.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. Reference mediastinal lymph node in the aorticopulmonary window measures 2.2 x 2.2 cm (image 39/series 3) previously, 1.9 x 1.9 cm.Right hilar lymph node measures 2.0 x 1.2 cm (image 64/series 3) previously, 2.1 x 1.4 cm.CHEST WALL: New compression deformity of the T7 vertebral body with a lytic lesion involving the right pedicle.OTHER: ABDOMEN:LIVER, BILIARY TRACT: Hypervascular left hepatic lobe focus is unchanged. Stable hepatic cysts.Gallbladder contains calcified stones without distention or biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: Progressive pancreatic atrophy. The pancreatic tail lesion measures 1.2 x 1.2 cm (image 106/series 3) previously, 1.2 x 1.1 cm.ADRENAL GLANDS: Right adrenal gland has been resected. Left adrenal gland is unchanged in morphology.KIDNEYS, URETERS: Status post right nephrectomy. No suspicious lesions in the right renal fossa. The left kidney enhances homogeneously. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Calcific arteriosclerotic disease affects the aorta. No retroperitoneal lymphadenopathy has developed.BOWEL, MESENTERY: Small bowel is normal in caliber. Scattered descending colonic diverticula with mild inflammation as seen on image 171/series 3. This more likely corresponds to inflammation the epiploic fat rather than acute diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Right T7 pedicle lytic lesion with compression fracture. Thoracic MRI is suggested for evaluation of the cord.2.Slight increase in the size of the mediastinal lymph node.3.Mild inflammation of the fat adjacent to the proximal sigmoid colon suggests epiploic appendagitis. |
Generate impression based on findings. | 70 year old patient. Evaluate for subdural hematoma. There is sulcal and ventricular prominence globally. There is periventricular and subcortical white matter patchy hypoattenuation most likely representing sequela of chronic small vessel ischemic disease. There are no focal abnormalities including intracranial mass, fluid collection, hemorrhage, hydrocephalus or CT evidence of acute ischemia. Gray-white matter differentiation is maintained bilaterally and the midline is intact. There has been interval improvement in the left periorbital soft tissue swelling.There are a few small lucent areas within the skull which demonstrate nonaggressive features and have been stable since an examination dated 8/30/2012. | Unchanged examination. No acute intracranial pathology demonstrated. |
Generate impression based on findings. | Status post fight with loss of consciousness. Evaluate for bleed. There is no intracranial mass, fluid collection, hemorrhage, hydrocephalus or CT evidence of ischemia. Gray-white matter differentiation is maintained bilaterally and the midline is intact. A defect of the posterior arch of the C1 vertebral body on the right. This is not clearly corticated, and while this may represent a congenital abnormality, given the traumatic history, designated imaging of the C-spine is recommended.There is a left frontal subcutaneous hematoma and asymmetry of soft tissues in the temporal areas suggesting right temporal hematoma as well. The orbits are unremarkable. There is a small amount of secretion demonstrated within the right maxillary sinus. Sinuses are otherwise unremarkable. | 1.Incomplete arch of C1 posteriorly which may be congenital, though given the patient's history of trauma designated imaging of the C-spine is recommended. 2.Left frontal and right temporal superficial cutaneous hematomas.3.No acute intracranial abnormality.This result was communicated to the emergency room physician by telephone at 12:55 p.m. on 6/10/2013.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Female 59 years old; Reason: Stage IV colon cancer please assess and provide index lesion measurements for RECIST History: as above CHEST:LUNGS AND PLEURA: Left lower lobe pulmonary nodule measures 0.9 x 0.7 cm (image 64/series 3) .The pleural spaces are clear.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. No mediastinal lymphadenopathy.CHEST WALL: A right chest wall port terminates at the caval atrial junction. There is nonfilling of the right jugular vein most likely due to thrombus, partially evaluated. It is also thickening of the fascia planes suggestive of hematoma.ABDOMEN:LIVER, BILIARY TRACT: Extensive bilobar hepatic metastases. A reference segment 4 the lesion measures 5.5 x 4.0 cm (image 106/series 3). Hepatic and portal veins are patent. Calcified gallstones within a nondistended gallbladder without 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: No retroperitoneal lymphadenopathy. BOWEL, MESENTERY: Small bowel is normal in caliber. No bowel obstruction is evident. Circumferential rectal mass likely represents the patient's primary malignancy.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.BOWEL, MESENTERY: Circumferential rectal wall thickeningBONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace pelvic ascites. | 1.Left lower lobe pulmonary nodule and extensive hepatic metastatic disease.2.Trace pelvic ascites with circumferential mass involving the rectum.3.Likely thrombosis of the right jugular vein with effacement of the fascial planes suggestive of hematoma.4.Findings sent to Dr. Polite via email. |
Generate impression based on findings. | Male 63 years old; Reason: HCC screening History: cirrhosis ABDOMEN:LUNGS BASES: Calcified left lower lobe granulomata.LIVER, BILIARY TRACT: Liver contour: The liver contour is nodular..No intra-or extrahepatic ductal dilatation. Features of portal hypertension: Splenomegaly. No ascites. Portal vein: The portal vein is patent. Hepatic veins: Hepatic vein is patent.Hepatic artery: Conventional hepatic arterial anatomy.Lesions: 1.0 x 0.9 cm lesion (image 24, series 9) in segment 4 A., arterial enhancement - yes, washout - no. No peripheral enhancement. SPLEEN: Spleen is enlarged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Calcific arteriosclerotic disease of the aorta. A bullet fragment in the proximal right psoas muscle.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Cirrhosis with hypervascular foci but no evident lesion that meets the criteria for HCC. |
Generate impression based on findings. | Female 50 years old; Reason: r/o abd path History: abd pain and swelling, periumbilical; hx of fibroids ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver has a smooth contour. Non-enhancing hypodense hepatic foci likely represent small cysts.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis in either kidney. Fluid attenuating lesions in the left kidney represent cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small bowel is normal in caliber. Colon is not distended. Umbilical hernia contains portion of small bowel without obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Multiple uterine fibroids. The lesions show decreased enhancement following embolization.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: Trace pelvic fluid, likely physiologic. | 1.Uterine fibroids which show decreased enhancement following embolization.2.No bowel obstruction. Umbilical hernia without obstruction.3.No drainable fluid collections. |
Generate impression based on findings. | recurrent abdominal pain x2 years and mesenteric adenitis (4 months ago). Recent abd US was normal. Recurrent abdominal pain. ABDOMEN:LUNG BASES: Nonspecific ground glass opacities in the left lower lobe.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Multiple prominent subcentimeter mesenteric lymph nodes.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: Multiple prominent subcentimeter mesenteric lymph nodes.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Irregularity to the left ischium which may be variation of normal.OTHER: No significant abnormality noted | Multiple prominent subcentimeter mesenteric lymph nodes. No abnormal fluid collection. |
Generate impression based on findings. | Male 39 years old; Reason: abdominal pain and hematuria, r/o kidney stone History: abdominal pain and hematuria ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Cortical scarring and probable upper pole cyst in the right kidney. No hydronephrosis or nephrolithiasis in the right kidney.Stone within the left renal pelvis in a staghorn configuration measuring at least 1.6-cm. No hydronephrosis in the left kidney. Areas of cortical scarring at the upper pole of the left kidney. No perinephric collections. RETROPERITONEUM, LYMPH NODES: Calcific arteriosclerotic disease of the aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Compression deformity of T8 vertebral body.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No distal ureteral or bladder calculi.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.Left renal calculus in a staghorn configuration without hydronephrosis. |
Generate impression based on findings. | Male 67 years old; Reason: duodenal obstruction, possibly adenocarcinoma - evaluate for tumor invasion in vessels History: duodenal obstruction, N/V ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver has a smooth contour. No suspicious hepatic lesions. Hepatic and portal veins are patent.Mild gallbladder distention which contains calculi. Common bile duct measures 13 mm at the head of the pancreas.SPLEEN: No significant abnormality noted.PANCREAS: Primary tumor: 3.0 x 2.6 x 3.0 cm mass in the pancreatic head extending into the duodenum. It causes partial obstruction of the common bile duct. Mild to moderate pancreatic atrophy.Pancreatic duct: 2 mm.Mesenteric Arteries:Arterial anatomy: Conventional celiac and superior mesenteric artery anatomy.Arterial tumor abutment or encasement: (1) Proximal celiac artery, SMA, and hepatic artery: Tumor does not extend to the arterial vessels.(2) Tumor abutment or encasement of additional arteries: Tumor does not extend to the arterial vessels.Mesenteric Veins:Venous anatomy: (1) Superior mesenteric vein (SMV) first jejunal branch: anterior to SMA. SMV terminates as mesentery veins. (2) Inferior mesenteric vein (IMV) drains into the superior mesenteric vein.Venous tumor abutment or encasement: SMV-PV-splenic vein confluence: No evident tumor.First jejunal vein branch: No evident tumor.SMV, PV, or segmental SMV-PV occlusion: No evident tumor. Other: Portal venous system: PatentInferior vena cava (IVC): PatentADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral renal cysts. Hyperdense left upper pole renal cyst. Some of these cysts are complex. Small hypervascular right lobe pole renal lesion measuring 11-mm suspicious for a small solid renal mass (image 83/series 8).No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Portacaval lymph node adjacent to the pancreatic head mass measures 1.8 x 1.7 cm (image 52/series 10). Multiple small nodes are noted adjacent to the duodenum.BOWEL, MESENTERY: Tumor mass in the duodenum inseparable from the distal common bile duct. No bowel obstruction.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: Colonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Mass centered in/around the distal common bile duct causing some ductal obstruction and invading the duodenum with regional lymphadenopathy but no vascular encasement.2.Findings suspicious for a small right lower pole renal cell carcinoma.3.Bilateral renal cysts some which are complex and can be followed up with a 6 to 12 month CT.4.Cholelithiasis |
Generate impression based on findings. | Male, 18 years old, head trauma. 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. | No acute intracranial abnormality. |
Generate impression based on findings. | Male, 28 years old, motor vehicle collision, C-spine tenderness C3 to C5. 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 left maxillary sinus and the ethmoid air cells are partially opacified. This likely reflects sinus inflammation as there is no evidence of facial bone deformity.The bones of the calvarium and skull base are intact. Straightening of the cervical lordosis is likely positional. Alignment is otherwise anatomic.Cervical spine vertebral body morphology is normal. No fracture or acute malalignment is demonstrated. | 1. No acute intracranial abnormality.2. No C-spine fracture or traumatic malalignment. |
Generate impression based on findings. | Male, 62 years old, larynx cancer, baseline scans to start treatment. No mass effect, focal edema or suspicious enhancement is seen to suggest brain parenchymal metastatic disease. The bones of the calvarium and skull base are intact. Infiltrating, irregular enhancing tumor is redemonstrated involving the supraglottic larynx. As before, accurate measurements are difficult due to the complexity of the lesion. Although the contours of the tumor have changed a bit, there has been no significant qualitative change in the size and extent of tumor at this level. The largest component resides at the level of the left piriform sinus. Tumor infiltrates into the hypopharyngeal wall, the aryepiglottic folds, the paraglottic and preepiglottic spaces.As before, tumor abuts the inner cortex of the thyroid cartilage bilaterally. The thyroid cartilage demonstrates a mottled and irregular appearance. On the left, tumor likely permeates through the inner cortex with thinning if not frank permeation of the outer cortex as well. No definite gross tumor is seen beyond the margin of the outer cortex or into the strap muscles. On the right, permeative lucency through the inner and outer cortex has progressed, superiorly at the level of the superior cornu and likely inferiorly as well. The arytenoid cartilages remain engulfed and lucent with progressive erosion of the left arytenoid.The hypopharynx remains thickened and likely is infiltrated by tumor down to the level of the esophagus. Bulky heterogeneous tumor is reidentified along the tracheoesophageal groove, inseparable from the posterior trachea and esophagus. This lesion measures 4.2 x 3.6 (image 8 series 5), previously 4.2 x 2.5 cm. There is new tumor invasion of the underlying T2 vertebral body. An additional reference lesion along the left tracheoesophageal groove measures 2.8 x 1.7 m (image 75 series 5 is present, previously 2.0 x 1.8 cm.There has been continued interval progression of a left supraclavicular fossa mass. Additional pathologic adenopathy elsewhere in the neck is probably not substantially changed.A tracheostomy tube remains in place. The cervical arterial structures are patent. The left internal jugular vein is small throughout and in some places it does not appear to opacify. | Irregular, infiltrating tumor at the supraglottic level has clearly changed in gross size. However, there is evidence of progressive erosion/invasion of the thyroid cartilage and the left arytenoid cartilage.Tumor along the tracheoesophageal grooves has increased in size, and there is new bony invasion of the T2 vertebral body.Progression of a left supraclavicular fossa mass, likely an aggregate of lymph nodes. Additional smaller scattered nodes in the neck have not appreciably changed.No intracranial metastatic disease. |
Generate impression based on findings. | 45 year old patient with bilateral subdural hematomas experiencing headache and confusion, extraventricular drain placement. There has been interval placement of bilateral subdural catheters into the patient's bilateral subdural hematomas. Post procedure pneumocephalus is present, without evidence of new hemorrhage or overt hematoma formation. When measured at the same locations at that use in the comparison study, both hematomas have slightly decreased in size. The left measures up to 10 mm (previously 16 mm) and the right 11 mm (previously 12 mm). Whereas the left-sided subdural hematoma previously demonstrated 18 4 level, after the procedure there has now been redistribution. Accompanying overlying calvarial and soft tissue changes are noted, expected postprocedural findings. Orbits and paranasal sinuses are unremarkable. | 1.There has been interval placement of bilateral subdural catheters into the patient's bilateral subdural hematomas. Post procedure pneumocephalus is present, without evidence of new hemorrhage or overt hematoma formation. 2.Both hematomas have slightly decreased in size. |
Generate impression based on findings. | Male 69 years old Reason: hypoxia, hypotension History: sob PULMONARY ARTERIES: Sensitivity degraded by patient motion. No evidence of pulmonary embolism or right heart strain.LUNGS AND PLEURA: Sensitivity limited by patient motion. Bilateral moderate pleural effusions measuring with associated basilar predominant compressive atelectasis. Moderate bilateral bronchial thickening. Pulmonary edema.MEDIASTINUM AND HILA: Pleural fluid tracks into the hila. No evidence of mediastinal or lymphadenopathy. Right internal jugular venous catheter with tip in the distal SVC. Small amount of air surrounding catheter consistent with recent insertion.CHEST WALL: Destructive process involving T9 and T10 vertebral bodies and posterior elements with a soft tissue density between the fragments. The etiology is unclear, but may relate to a malignant or infectious process.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Enhancing gallbladder wall with associated pericholecystic. Gastrostomy tube in place. Hypodense hepatic segment 7/8 cyst. Please refer to CT of abdomen and pelvis from the same day for further evaluation. | 1. No evidence of pulmonary embolism.2. Bilateral moderate partially loculated pleural effusions with associated compressive atelectasis and pulmonary edema.3. Destructive process involving T9 and T10 vertebral bodies and posterior elements with a soft tissue density between the fragments. The etiology is unclear, but may relate to a malignant or infectious process.4. See abdomen CT report for other findings as above. |
Generate impression based on findings. | 21 month old male with history of pelvic sarcoma, now with right hip/leg pain evaluate for progression of tumor Motion artifact slightly limits the study.ABDOMEN:LUNG BASES: No consolidation or pleural effusion is seen in the lung bases.LIVER, BILIARY TRACT: No focal liver lesion or biliary duct dilation.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 enhanced symmetrically and homogeneously without hydronephrosis or perinephric stranding.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Bowel loops are displaced from the pelvis and lower abdomen.BONES, SOFT TISSUES: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Displaced to the left and anteriorly.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: Displaced by large pelvic mass.BONES, SOFT TISSUES: Mixed cystic and solid right pelvic mass with heterogeneous enhancement has increased in size and now measures 9.0 x 9.9 x 10.7 cm (AP by transverse by CC). This mass is inseparable from the right psoas and right obturator internus muscles and likely invading these muscles. The underlying bones appear normal.The right external iliac vessels are again displaced anteromedially by this mass. Right gluteal and proximal leg muscles are atrophied relative to the left. | Increase in size right pelvic mass consistent with given history of sarcoma. New involvement of right obturator internus muscle. |
Generate impression based on findings. | Reason: patient s/p robotic hysterectomy on 9/16 now with flank pain and hydronephrosis, rule out ureteral injury History: see above ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The kidneys enhance and excrete contrast symmetrically without evident extravasation. Hypodense layering filling defects are present in the distal left ureter with mild to moderate upstream left hydronephrosis. No nephroureterolithiasis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small amount of free intraperitoneal air is likely postoperative. No evidence of bowel obstruction. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: status post hysterectomy. previously described cystic adnexal masses are not well appreciated due to adjacent fluid, however mostly appear unchanged. 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: Small amount of simple free fluid in the pelvis, likely post-operative. | 1.Layering filling defects in the distal left ureter may represent debris/blood products or inflammation secondary to recent instrumentation. No contrast extravasation to suggest ureteral injury. 2.Mild to moderate left hydronephrosis. |
Generate impression based on findings. | Male; 78 years old. Reason: empyema, PNA History: fever LUNGS AND PLEURA: Postsurgical changes and subcutaneous emphysema are compatible with recent left lower lobe wedge resection. There is also evidence of more remote right lower lobe wedge resection. Consolidation in the posterior left upper lobe with air bronchograms and surrounding ground glass opacity is compatible with infection. There is an adjacent loculated fluid collection with pockets of air that are of uncertain etiology; possibilities include sequelae of recent surgery or bronchopleural fistula. Differential considerations for the loculated effusion include empyema or parapneumonic effusion. Left basilar atelectasis and subpulmonic effusion are also noted. A subpleural nodule seen previously in the left upper lobe is not visualized due to superimposed consolidation/loculated pleural effusion.MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. No significant mediastinal or hilar lymphadenopathy. Dense aortic and coronary artery calcifications.CHEST WALL: Right fifth and sixth rib deformities are unchanged and most likely due to old trauma. Moderate degenerative disease affects the visualized spine. Evidence of old clamshell sternotomy.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Splenic granulomata. | 1.Left upper lobe consolidation and surrounding ground glass opacity are compatible with pneumonia.2.Adjacent loculated fluid collection with air pockets, for which differential considerations include empyema or parapneumonic effusion. 3.Postsurgical changes compatible with recent left lower lobe wedge resection as described above. |
Generate impression based on findings. | Male; 66 years old. Reason: r/o PE, hx metastatic prostate CA History: pleuritic CP, SOB PULMONARY ARTERIES: No evidence of pulmonary embolism. Enlargement of the pulmonary trunk diameter is compatible with pulmonary arterial hypertension.LUNGS AND PLEURA: Minimal basilar scarring. No focal air space opacity or pleural effusion. Left basilar pleural thickening and calcification are likely post-infectious in etiology.MEDIASTINUM AND HILA: Hypodense right thyroid nodule. Normal heart size with small pericardial effusion. No significant mediastinal or hilar lymphadenopathy.CHEST WALL: There are innumerable sclerotic osseous metastatic lesions in the vertebral bodies, ribs, sternum, and scapulae. These are associated with compression fractures in multiple lower thoracic vertebral bodies and demonstrate expansile components that may be causing the patient's chest pain. Diffusely demineralized background bone. Right central venous catheter tip in SVC. UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. Mild gallbladder wall thickening, possibly secondary to underdistention. | 1.No evidence of pulmonary embolism.2.Findings compatible with pulmonary arterial hypertension.3.Extensive osseous metastatic disease and associated collapsed vertebrae, stable since the prior CT. Lesions demonstrate expansile components that may be responsible for the patient's chest pain. |
Generate impression based on findings. | s/p fall, on heparin. Head: There is no evidence of acute intracranial hemorrhage, mass, or cerebral edema. However, there is extensive encephalomalacia in the left basal ganglia and left parieto-occipital region underlying a burr hole with associated ex vacuo dilatation of the left lateral ventricle. There is also a background of extensive confluent cerebral white matter hypoattenuation that likely represents small vessel ischemic disease. There is no midline shift or herniation. There are several rounded metal foreign bodies in the right temporal scalp and temporomandibular joint regions, where there are several small well-corticated osseous fragments that likely represents a remote gunshot wound. There is extensive soft tissue within the right external auditory canal without associated bony erosion that may represent keratosis obturans.Maxillofacial: There is a 12 mm inferiorly displaced right orbital floor fracture with herniation of orbital fat and hemorrhage into the infundibulum. The inferior rectus muscles is mildly swelling and inferiorly displaced, but has not herniated through the defect. There is a mild degree of retrobulbar hemorrhage. There is an air-fluid level within the right maxillary sinus, compatible with hemosinus. There is a subcutaneous hematoma in the right cheek and inferior preseptal region. The left orbit is unremarkable. There is partially imaged periodontal lucency of ADA 8. | 1. Acute 12 mm inferiorly displaced right orbital floor fracture with mild retrobulbar hemorrhage and herniation of orbital fat, but no inferior rectus muscle herniation. The right hemosinus and cheek and preseptal hematoma are also associated with the fracture.2. Likely remote right scalp and temporomandibular joint gunshot wound with extensive soft tissue in the right external auditory canal that may represent keratosis obturans likely related to prior trauma.3. Extensive encephalomalacia in the left basal ganglia and left parieto-occipital region underlying a burr hole with associated ex vacuo dilatation of the left lateral ventricle and a background of extensive confluent cerebral white matter hypoattenuation that likely represents small vessel ischemic disease. No evidence of acute intracranial hemorrhage. |
Generate impression based on findings. | 6 month old female. MVC. Evaluate for bleed/perforation. ABDOMEN:LUNG BASES: Lung bases are clear.LIVER, BILIARY TRACT: Normal hepatic contour. No focal hepatic lesion. No biliary ductal dilatation.SPLEEN: Normal appearance of the spleen.PANCREAS: Normal appearance of the pancreas.ADRENAL GLANDS: Normal appearance of the adrenal glands.KIDNEYS, URETERS: Normal appearance of the kidneys. No hydronephrosis. RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Normal caliber of the bowel.BONES, SOFT TISSUES: Normal appearance of the bones.OTHER: No free fluid. No pneumoperitoneum.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Normal appearance of a distended bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Normal appearance of the bowel.BONES, SOFT TISSUES: Normal appearance of the bones.OTHER: No significant abnormality noted | No evidence of solid organ injury or free fluid. |
Generate impression based on findings. | Reason: evaluate for thrombus burden and possibility for IR thrombectomy History: bilateral LE swelling with DVT, additional history includes metastatic prostate cancer ABDOMEN:LUNG BASES: Basilar scarring.LIVER, BILIARY TRACT: Cholelithiasis. No intra-or extra hepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Moderate to severe left hydronephrosis with hypoenhancing, edematous renal parenchyma. Mild right hydronephrosis.RETROPERITONEUM, LYMPH NODES: Extensive, partially necrotic, retroperitoneal lymphadenopathy. Aortocaval lymph node conglomerate measures 6.1 x 3.8 cm (series 4, image 36). The infrarenal IVC is obstructed with extensive thrombus visualized bilaterally throughout the iliac and femoral veins.BOWEL, MESENTERY: No evidence of bowel obstruction. No free intraperitoneal air, pneumatosis intestinalis, or mesenteric free fluid.BONES, SOFT TISSUES: Lower extremity subcutaneous edema.OTHER: Large hiatal hernia.PELVIS: Evaluation of the pelvis is limited due to streak artifact of right hip arthroplasty.PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: Asymmetric thickening of the right wall may represent tumor invasion.LYMPH NODES: Necrotic right pelvic lymph node mass measures 7.2 x 4.6 cm (series 4, image 81).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Extensive retroperitoneal and pelvic lymphadenopathy with obstruction of the infrarenal IVC.2.Asymmetric right sided bladder wall thickening may represent tumor/lymph node invasion.3.Extensive thrombosis within the bilateral iliac and femoral veins.4.Bilateral hydronephrosis with hypo-enhancing edematous parenchyma on the left likely secondary to chronic obstruction. |
Generate impression based on findings. | Reason: please evaluate for intra-abdominal abscess and for leakage from urinary tract. Please perform 3-phase (non-contrast, arterial phase, and delayed phase) CT UROGRAM History: s/p spence marsupialization and ileal conduit ABDOMEN: Exam is limited due to minimal delivered contrast following extravasation.LUNG BASES: Subsegmental atelectasis or infiltrate of the right inferior lobe. Mild basal atelectasis on the left inferior lobe. Interval enlargement of left base nodular focus previously measuring 0.7 x 0.9 cm, currently measuring 1.6 x 2.5 cm. LIVER, BILIARY TRACT: Unchanged fatty liver without mass. Hyperdense, dependent layering in the gallbladder likely represents gravel cholelithiasis.SPLEEN: No significant abnormality noted. Splenule noted adjacent to the spleen.PANCREAS: Atrophic pancreas with fatty infiltration.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Vascular calcifications of bilateral kidneys.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the aorta and bilateral iliac arteries.BOWEL, MESENTERY: Scattered, subcentimeter mesenteric lymph nodes. No evidence of intra-abdominal abscess or fluid collections. Parastomal hernia without evidence of bowel obstruction.BONES, SOFT TISSUES: Mid abdominal wall defect with 3 surgical drains. Anasarca. Abdominal wall soft tissue fat stranding.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Partially collapsed bladder. No evidence of contrast extravasation from urinary tract.LYMPH NODES: Scattered, bilateral inguinal lymph nodes.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Evidence of left hip surgery.OTHER: No significant abnormality noted | 1.Interval increase in size of left base nodular focus, which requires follow-up to exclude primary malignancy.2.No evidence of drainable fluid collections or abscesses.3.No evidence of contrast extravasation from the urinary tract.4.Midline abdominal wall defect with evidence of repair and multiple surgical drains.5.Cholelithiasis without evidence of acute inflammation.6.Redemonstration of parastomal hernia without evidence of bowel obstruction.7.Redemonstration of fatty infiltration of the liver.Contrast extravasation description:Supervising radiologist: Dr. Eric BlaschkeMinor or major extravasation: MinorContrast type: 60 cc of Omnipaque 350/saline were administered. Comment on saline chaser if appropriateAmount extravasated: 60 ccLocation of extravasation: Right neckSigns and symptoms: Mild neck discomfortTreatment given: Cold compressDischarge instructions given: Yes, returned to the care of clinical service |
Generate impression based on findings. | Abscess. Stable postoperative changes related to right sided craniotomies, right anterior temporal resection cavity, encephalomalacia within the right parietal/occipital lobes and ex vacuo dilatation of the right temporal horn. There is diffuse right-sided dural enhancement associated with the subdural hypoattenuating fluid collection that has slightly decreased in size measuring 5 mm in greatest thickness anteriorly (previously 6 mm).Thickening of the right temporalis muscle is demonstrated again. No focal fluid collection within the muscle is demonstrated and this may represent muscle edema.When accounting for differences in slice angle, the small extra-axial fluid collection associated with the dilated right ventricular occipital horn is unchanged measuring 23 x 11 mm. There is no hydrocephalus or evidence of ischemia. There is no intraparenchymal mass or acute hemorrhage. The midline is intact. Visualized portions of the orbits and paranasal sinuses are unremarkable. Mastoid air cells are aerated. | Sequelae of right craniotomies with slight interval improvement in dimensions of the curvilinear peripherally enhancing subdural fluid collection overlying the right hemisphere. Associated dural enhancement which could be in the basis of prior surgery or infection. |
Generate impression based on findings. | Right facial abscess. There is a rim-enhancing fluid collection within the right nasolabial fold that measures 17 AP x 20 RL x 17 SI mm. There is associated extensive overlying cellulitis and mild narrowing of the right nasal vestibule and external nasal valve. There is a carious ADA 7 with associated periodontal lucency and defect of the overlying lingual cortex that extends towards the fluid collection. There are also periapical lucencies affecting ADA 27 and 29. The orbits are unremarkable. There is a right Onodi cell and a small retention cyst in the right sphenoethmoid recess as well as minimal mucosal thickening within the bilateral maxillary sinuses. The mastoid air cells are clear. The intracranial structures are grossly unremarkable. | Right nasolabial fold fluid collection compatible with an abscess that measures up to 20 mm with overlying cellulitis and an underlying carious ADA 7 with a defect of the lingual cortex that extends to the abscess. Periapical lucencies also affect ADA 27 and 29.Discussed with Dr. Gupta at 9:30 AM on 10/7/13. |
Generate impression based on findings. | Reason: s/p ex lap, APR and cystectomy with ileal conduit, prolonged ileus, eval for abscess, obstruction History: above ABDOMEN:LUNG BASES: Moderate bilateral pleural effusions with overlying compressive atelectasis. Coronary artery calcifications.LIVER, BILIARY TRACT: Mild perihepatic ascites. Gallbladder sludge.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral nephroureteral stents.RETROPERITONEUM, LYMPH NODES: IVC filter noted.BOWEL, MESENTERY: Ileal conduit with right lower quadrant urostomy. Left lower quadrant colostomy. A pelvic drain is in place with its tip terminating in the presacral soft tissues. No loculated fluid collection in the abdomen or pelvis. No evidence of bowel obstruction. Mesenteric stranding is likely postoperative. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Enteric tube terminates in the stomach.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: Surgically absent.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mildly thickened loops of bowel in the pelvis.BONES, SOFT TISSUES: Bilateral inguinal hernias with increasing fluid on the left.OTHER: No significant abnormality noted. | 1.Postsurgical changes with ileal conduit and right lower quadrant urostomy and right lower quadrant colostomy without evidence of bowel obstruction. Non specific small bowel wall thickening in the pelvis likely post-operative status.2.No loculated fluid collections in the abdomen or pelvis.3.Moderate bilateral pleural effusions. |
Generate impression based on findings. | 41-year-old male with infarction experiencing bilateral upper extremity shaking Redemonstrated is a hypodense focus involving gray and white matter in the left precentral gyrus with some mild mass effect which remains stable.Foci of encephalomalacia are again noted within the right superior frontal gyrus, right postcentral gyrus, the right inferior parietal lobule, the left parietal lobe and of the left occipital lobe, all of which are stable when compared to the prior exam. A hypodense focus in the left cerebellar hemisphere and a focus of encephalomalacia in the left cerebellar hemisphere are also stable.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.Stable subacute infarction in the left precentral gyrus laterally from the hand motor area with no evidence for hemorrhagic conversion2.Redemonstrated are multiple foci of encephalomalacia in both hemispheres of the brain as well as the cerebellum, compatible with prior foci of infarction. |
Generate impression based on findings. | Reason: eval acute injury History: abd pain, epigastric, LUQ, s/p peds v auto ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Scattered right hepatic lobe hypodensities are too small to further characterize, but likely benign.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right lower pole simple cyst.RETROPERITONEUM, LYMPH NODES: No evidence of obstruction or appendicitis. Diverticulosis without evidence of diverticulitis. No free intraperitoneal air, pneumatosis intestinalis, or mesenteric fluid.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No acute intraabdominal abnormality. |
Generate impression based on findings. | Left foot pain. Evaluate for healing of the calcaneus fracture There is diffuse osseous demineralization. There is an obliquely-oriented comminuted fracture of the calcaneus, extending from the middle facet to the anterior articular surface, with mild lateral displacement. This may represent an insufficiency fracture. There is a mild pes planus deformity. There is partial fusion of the fracture, compatible with healing.There is very mild soft tissue swelling, without joint effusion. | Subacute healing calcaneus fracture |
Generate impression based on findings. | Follow up base of tongue squamous cell carcinoma T1N2B BOT SCC with ECE, 2/44 LN + -> TPF X2 -> TFHX 6/2/12 CHEST:LUNGS AND PLEURA: Linear scarring or atelectasis at the bases and lingula unchanged. No new pulmonary nodules.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Double IVC, anatomic variant.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Negative.BONES, SOFT TISSUES: Degenerative change but no evidence of metastatic disease.OTHER: No significant abnormality noted. | No evidence of metastatic disease. |
Generate impression based on findings. | Reason: eval for stone History: L flank apin ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal stones, left greater than right, measuring up to 2.2 x 1.1 cm (series 4, image 45). No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of bowel obstruction. The appendix is normal in appearance. Scattered colonic diverticula. No free intraperitoneal air or mesenteric fluid.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Calcified uterine fibroids.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Bilateral renal pelvis calculi, left greater than right. No hydronephrosis. |
Generate impression based on findings. | 70 year-old male with history of heart transplant complicated by seizures with worsening acute mental status change. On heparin for DVT. Evaluate for ICH. There is diffuse prominence of ventricular and extra axial fluid spaces which has been similar in extent and distribution since the earliest exam available performed 12/16/2011. There is a more focal area of encephalomalacia within the left hemisphere incorporating both pre-and post central gyri with widening of the central sulcus, again stable since at least 2011.There are no acute intracranial abnormalities including mass, fluid collection, hemorrhage, hydrocephalus or CT evidence of acute ischemia. Gray-white matter differentiation is maintained bilaterally and the midline is intact. There is calcification of supraclinoid and vertebral arteries bilaterally. Orbits and visualized paranasal air sinuses are unremarkable. Mastoid air cells are aerated and there are no bony abnormalities. | Chronic findings including that of a left sided stroke, though no acute pathology is demonstrated which would account for the patient's recent symptoms. |
Generate impression based on findings. | Base of tongue cancer. History of head and neck cancer status post CRT. CHEST:LUNGS AND PLEURA: Reference 6-mm left upper lobe pulmonary nodule has decreased to 4 mm (image 30/166). Other punctate micronodules are unchanged. A subpleural punctate nodular opacity in the right upper lobe (image 42/166) was equivocally present on prior. No new pulmonary nodules are noted. MEDIASTINUM AND HILA: Calcified nodes consistent with healed granulomatous disease. Coronary calcification.CHEST WALL: Stable lucency in the T8 vertebral body which is likely a hemangioma. Degenerative change.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Multiple hypodense hepatic lesions are unchanged but too small to characterize. They are likely benign.SPLEEN: Calcified granulomas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts. Left renal nonobstructing calculus.PANCREAS: No significant abnormality noted.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. | Previously referenced left upper lobe pulmonary nodule has significantly decreased in size. No new pulmonary nodules or other signs of metastatic disease, though continued follow up is recommended given the history of waxing/waning nodules. |
Generate impression based on findings. | Known chronic osteomyelitis in the sacrum secondary to chronic sacral ulcer. Now with fevers, nausea, vomiting. Evaluate for progression or acute osteomyelitis Again seen is a large decubitus ulcer which extends to what remains of the left iliac wing and sacrum. There are several extensive sinus tracts extending along the along the right ilium, proximal left femur, left ilium, and into the pelvis, which appears mildly increased compared to prior. In particular, there are regions of soft tissue inflammation immediately adjacent to the right ilium (80268/28) and left ilium (80268/37) with associated indistinctness of the cortical margin. There is no frank osseous destruction. The deformity of the pelvic bones and bilateral hip disarticulation appears similar to prior. A right lower quadrant ostomy is present. There is wall thickening at the rectum. | Increased soft tissue inflammation with osseous findings highly suspicious for acute osteomyelitis. |
Generate impression based on findings. | Reason: evaluate for obstruction History: abdominal pain,nausea, vomiting ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Status-post cholecystectomy. No suspicious liver lesions. No evidence of intrahepatic or extrahepatic ductal dilatation.SPLEEN: Small splenule noted anterior to the spleen.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Scattered, subcentimeter retroperitoneal lymph nodes.BOWEL, MESENTERY: Status post gastric bypass. Scattered mesenteric lymph nodes. No evidence of obstruction.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: Scattered mesenteric lymph nodes.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Status post bariatric surgery without evidence of obstruction. |
Generate impression based on findings. | 50-year-old patient with acute mental status change. Evaluate for intracranial abnormality. No intracranial mass, fluid collection, hemorrhage, hydrocephalus or CT evidence of acute ischemia. Gray-white matter differentiation is maintained bilaterally and the midline is intact. Orbits are unremarkable. There is soft tissue density within the inferior aspect of the left maxillary sinus implying sinus disease. Bones are unremarkable. | No acute intracranial pathology demonstrated. |
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