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Generate impression based on findings. | 32 year-old female with intraventricular drainage and headaches The patient's ventriculostomy catheter is in unchanged position, approaching the right lateral ventricle from a right frontal burr hole. There has been near interval resolution of pneumocephalus. The lateral and third ventricles have slightly decreased in size. There is been some redistribution of ventricular hemorrhage, now noted to layer within the right occipital horn.There are no significant differences in the multiple bilateral cerebellar and supratentorial hyperattenuating lesions. As before cannot cerebellar lesions result in mass effect including partial effacement of the prepontine cistern and crowding of the foreman magnum.Orbits, paranasal sinuses and mastoid air cells are unremarkable. | 1.Decrease in lateral and third ventricle sizes.2.No acute changes in the multiple bilateral metastatic lesions. |
Generate impression based on findings. | Intoxicated, fell onto ground. Evaluate for intracranial abnormality. 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. Orbits and mastoid air cells are normal. There are no bony fractures. There are soft tissue densities in the inferior aspect of left maxillary sinus likely representing sequela of sinus disease. | Unchanged examination. No intracranial abnormality demonstrated. |
Generate impression based on findings. | Lung cancer status post chemo/RT/surgery, then consolidation chemotherapy CHEST:LUNGS AND PLEURA: New complete consolidation of left upper lobe, which obscures the left upper lobe reference nodule. This is presumably related to radiation pneumonitis, however pneumonia could present similarly. Continued follow-up is recommended.Reference left lower lobe pulmonary nodule is stable at 10 x 6 mm on image 55/119. Multiple additional small subcentimeter nodules, including a cluster of peripheral nodules in the right upper lobe (image 56/119) are stable.MEDIASTINUM AND HILA: Left hilar lymphadenopathy is unchanged (image 50/157).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: Nonobstructing calculus in the right lower pole, unchanged.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | New complete consolidation of left upper lobe, which obscures the left upper lobe reference nodule. This is presumably related to radiation pneumonitis, however pneumonia could present similarly. Continued follow-up is recommended.Reference left lower lobe pulmonary nodule, other small subcentimeter nodules and left hilar lymphadenopathy are stable. |
Generate impression based on findings. | Status post motor vehicle collision. ABDOMEN:LUNG BASES: No consolidation or pleural effusion is seen in the lung bases.LIVER, BILIARY TRACT: No liver lesion or biliary duct dilation is seen.SPLEEN: No focal splenic lesion.PANCREAS: The pancreas appears normal.ADRENAL GLANDS: No nodule is seen in either adrenal gland.KIDNEYS, URETERS: The kidneys enhance symmetrically and homogeneously without hydronephrosis or perinephric stranding.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Nasogastric tube tip extends into the stomach. Bowel containing umbilical hernia is seen without evidence of bowel obstruction or free intraperitoneal air.BONES, SOFT TISSUES: No acute fracture.PELVIS:UTERUS, ADNEXA: Normal for the patient's age.BLADDER: The bladder is distended without bladder wall thickening.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No bowel obstruction or free intraperitoneal air.BONES, SOFT TISSUES: No acute fracture or dislocation. | Nonobstructive bowel containing umbilical hernia. Otherwise normal examination. |
Generate impression based on findings. | 24 hours of right sided weakness. Unenhanced CT examination of the head. Hypoattenuation within bilateral ACA territories anteriorly represent sequela of the ACA infarct documented on 3/21/2013. There is no associated hemorrhage. No intracranial mass, fluid collection, hemorrhage, hydrocephalus or CT evidence of acute ischemia. Gray-white matter differentiation is maintained elsewhere in the midline is intact. Visualized portions of orbits and paranasal sinuses are unremarkable. Bony structures are normal | Sequela of the bilateral ACA infarcts documented 3/25/2013. No hemorrhagic conversion or new abnormality. |
Generate impression based on findings. | Injury s/p high speed MVA. There is no evidence of intracranial hemorrhage, mass, or cerebral edema. There is mild prominence of the bilateral extra-axial CSF spaces particularly in the bilateral frontal convexities. Otherwise, the ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. | Mild prominence of the bilateral extra-axial CSF spaces particularly in the bilateral frontal convexities. Otherwise, no evidence of acute intracranial hemorrhage, mass, cerebral edema, or displaced calvarial fracture. |
Generate impression based on findings. | History of head and neck cancer. CHEST:LUNGS AND PLEURA: Scattered punctate micronodules are unchanged. 4 mm scarlike nodule in the left upper lobe (image 24/105) is unchanged. Emphysema. No new nodules.MEDIASTINUM AND HILA: Previously referenced thyroid nodule is not within the field of view of study. Please see neck CT report for further details. Coronary calcification.CHEST WALL: Degenerative change involving thoracic spine.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Stable subcapsular hypodensity adjacent to the ligamentum teres consistent with focal fatty infiltration.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable presumed renal cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the aorta.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.No evidence of metastatic disease in the chest or upper abdomen.2. Small nodule in the left upper lobe is nonspecific and unchanged, but continued follow-up is recommended as part of the patient's cancer surveillance. This potentially represent an early indolent primary lung malignancy. It is not typical of metastatic disease. |
Generate impression based on findings. | Reason: eval stone History: h/o stones, R CVAT, RLQ pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Nonobstructive bilateral renal pelvis calculi measuring up to 8 mm on the left. Faint nonobstructive punctate stone in the left proximal ureter. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Bilateral nonobstructive renal calculi with a punctate stone in the proximal left ureter. |
Generate impression based on findings. | Large cell lymphoma CHEST:LUNGS AND PLEURA: Stable micronodulesMEDIASTINUM AND HILA: Stable large hiatal herniaCHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.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: Significant interval decrease in size of pelvic and right inguinal adenopathy. Reference large right inguinal mass as seen on image 199 of series 4 now measures 4.6 x 4.4 cm; this is in comparison to 13.6 x 11.7 cm on 8/2/2013. Reference left obturator lymph node best seen on image 183 of series 4 now measures 1.6 x 0.5 cm; this is in comparison to 2.6 x 1 cm on 8/2/2013.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Significant interval decrease in size of pelvic and right inguinal adenopathy. No new adenopathy. |
Generate impression based on findings. | 74-year-old male with head and neck cancer now with abdominal distention, flatulence air eructation, and gas pain. Evaluate for abdominal mass, seroma, ventral hernia, rule out partial small bowel obstruction. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral, punctate calyceal calculi without obstruction. Bilateral cortical cysts. No other significant abnormality seen. No hydronephrosis. No perinephric fluid collections.RETROPERITONEUM, LYMPH NODES: No, adenopathy or masses seen..BOWEL, MESENTERY: Postop changes about the stomach. Again seen, unchanged. No abnormal fluid collections or masses in this area. Orally administered contrast progresses through normal appearing small bowel without pollution or significant distention into the distal ileum. Colon shows feces throughout without excessive distention to suggest obstruction.BONES, SOFT TISSUES: The large anterior abdominal wall fluid collection within the abdominal rectus sheath remains minimally changed in size (series 3, 50) now measures 18.3 x 9.7 cm compared with with 20.4 x 11.0 cm, previously. No evidence of other intra-abdominal wall hernia is seen.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: A large, smooth prostate.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Pelvic large and small bowel shows no diagnostic abnormality or evidence of obstruction. There is a small amount of free mesenteric fluid in the dependent pelvis (series 3, image 89), but without loculation.BONES, SOFT TISSUES: The large anterior abdominal wall fluid collection within the abdominal rectus sheath remains minimally changed in size (series 3, 50) now measures 18.3 x 9.7 cm compared with with 20.4 x 11.0 cm, previously. No evidence of other intra-abdominal wall hernia is seen.OTHER: No significant abnormality noted | 1. Large anterior abdominal wall fluid collection, unchanged since 9/sec/13. 2. No other finding seen to account for patient's symptomatology. |
Generate impression based on findings. | Headaches after trauma. There is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. | No evidence of intracranial hemorrhage, mass, or cerebral edema. |
Generate impression based on findings. | 59-year-old, evaluate for mesenteric ischemia or perforation ABDOMEN:LUNG BASES: Right lower lobe atelectasis.LIVER, BILIARY TRACT: Cirrhotic morphology of the liver. Portal vein is patent. Multiple scattered heterogenous hypodense attenuation within the liver without any distinctly arterially enhancing lesions. Subhepatic fluid noted. No intrahepatic biliary ductal dilatation. Previously described hypodense lesion in segment 7 right lobe of liver is unchanged.SPLEEN: Spleen is not enlarged. Multiple portosystemic collaterals noted at the splenic hilum and along the spleno renal shunt.PANCREAS: Pancreatic duct is not enlarged. Stable hypodense lesion in the head of the pancreas.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral small hypodensities mostly unchanged could represent cysts.RETROPERITONEUM, LYMPH NODES: No specific evidence of mesenteric ischemia. Aorta and its branches demonstrate good opacification without evidence of filling defects.BOWEL, MESENTERY: Nonspecific proximal small bowel wall thickening without obstruction. Umbilical hernia filled with ascites.BONES, SOFT TISSUES: Hardware noted within the left femoral neck is stable. Sclerotic lesion in T12 vertebral body.OTHER: Abdominal and pelvic ascitesPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Mild ascites | 1. Cirrhotic liver morphology with atrophic left lobe without focal lesions. Portal hypertension and spleno renal shunt with ascites.2. Stable pancreatic cystic lesion.3. No specific evidence of mesenteric ischemia as clinically questioned.4. Mild to moderate abdominal and pelvic ascites.5. Nonspecific proximal small bowel wall thickening. |
Generate impression based on findings. | History of tonsil cancer. Rule out chest metastases. LUNGS AND PLEURA: New cluster of faint subcentimeter nodular opacities in the left lung base and posterior left upper lobe (image 60, 64/111). Emphysema. Stable pleural thickening. Scattered punctate micronodules are stable.MEDIASTINUM AND HILA: Status post tracheostomy. Atherosclerotic calcification of the aorta and branches. Stable mild intrathoracic lymphadenopathy.CHEST WALL: Small axillary lymph nodes are unchanged.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Small upper abdominal lymph nodes are unchanged. Presumed left adrenal myolipoma is unchanged. | New clustered left-sided subcentimeter nodular opacities are nonspecific but most likely related to aspiration. However, continued follow-up is recommended to exclude metastatic disease. Other findings, including intrathoracic lymphadenopathy, are stable. |
Generate impression based on findings. | Neck pain, with midline tenderness. There is no evidence of cervical spine fracture or spondylolisthesis. There is fusion of the C2 and C3 vertebral bodies, spinous processes, and facet joints, which is likely congenital. The craniocervical junction is intact. There is a small partially calcified posterior disc-osteophyte complex at T1-2. The prevertebral and paravertebral soft tissues are unremarkable. The imaged intracranial structures are grossly are unremarkable. The imaged portions of the lungs are clear. | 1. No evidence of cervical spine fracture or spondylolisthesis.2. Fusion of C2 and C3 vertebral elements is likely congenital. |
Generate impression based on findings. | Intracranial hemorrhage with left sided weakness. There has been interval increase in size of the large intraparenchymal hematoma centered in the right basal ganglia, which now measures 70 AP x 40 RL x 57 SI mm, previously 65 AP x 37 RL x 55 SI mm. There is also a greater degree of intraventricular extension of hemorrhage into the ventricular system, particularly within the left occipital horn and third ventricle. Thre appears to be a small amount of subarachnoid hemorrhage within the right circular sulcus. There is slight increased in the degree of midline shift, now approximately 14 mm, previously 12 mm. Likewise, there is interval increase in the degree of left lateral ventricle dilatation. There is right uncal herniation and effacement of the perimesencephalic cistern. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. | Interval increase in size of the large intraparenchymal hematoma centered in the right basal ganglia, which now measures up to 70 mm, previously 65 mm, as well as a greater degree of intraventricular extension of hemorrhage into the ventricular system, slight increased in the degree of midline shift, now approximately 14 mm, previously 12 mm, and increased dilatation of the trapped left ventricle.Discussed with Dr. Mar at 9:20 AM on 10/7/13. |
Generate impression based on findings. | Metastatic SCC of larynx. CHEST:LUNGS AND PLEURA: Previously referenced subpleural nodule at the left base has decreased from 8 to 7 mm on image 87/116. New clustered irregular nodular opacities in the posterior right lower lobe and posterior medial left lower lobe. These are nonspecific but more typical of aspiration than metastases, though continued follow-up is recommended. Postop change left lower lobe.MEDIASTINUM AND HILA: Tracheostomy tube present. Reference mass posterior to the trachea in the superior mediastinum measures 30 mm on image 25/162 (27 mm on prior). Reference paraesophageal soft tissue mass near the thoracic inlet measures 16 mm on image 19/162, unchanged.Hiatal hernia. Other small nodes are unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Irregular hypodense lesion in the liver measures 21 x 16 mm on image 111/162 (16 x 16 mm on prior). Previously noted hypodense focus adjacent to the falciform ligament in the right lobe on image 126/162 is not significantly changed but is too small to characterize.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Gastrostomy tube tip in stomach.BONES, SOFT TISSUES: Degenerative change involving spine.OTHER: No significant abnormality noted. | 1. Multifocal metastases as above.2. New clustered irregular nodular opacities in the posterior right lower lobe and posterior medial left lower lobe. These are nonspecific but more typical of aspiration than metastases. Continued follow-up is recommended. |
Generate impression based on findings. | 26-year-old abdominal pain, generalized, diffuse abdominal pain, elevated WBC count ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Mild asymmetric hypodensities within the cortex of both kidneys which could be due to timing of the contrast injection. However, striated nephrogram suggesting pyelonephritis is also likely. Please correlate with urine analysis and culture. No evidence of stones or perinephric fat stranding or loculated collections.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The appendix is not definitely seen in the right lower quadrant however no secondary signs of inflammation are noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Mild asymmetric hypodensities in bilateral renal cortices could be due to timing of contrast injection. However, striated nephrogram suggesting pyelonephritis is also likely. Please correlate with urine analysis and culture. . |
Generate impression based on findings. | 18-year-old right lower quadrant pain, rule out appendicitis ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Appendix is seen in the right of the pelvis with normal caliber without any secondary signs of inflammation around it.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No acute intra-abdominal abnormality. |
Generate impression based on findings. | Reason: eval for fluid collection History: abd pain, hx crohns and diverticulitis, mult bowel resections Lack of IV contrast limits evaluation of solid organ pathology.ABDOMEN:LUNG BASES: Basilar scarring/atelectasis.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerosis of the abdominal aorta and its branches.BOWEL, MESENTERY: Status post multiple bowel resections with right lower quadrant ileostomy. No evidence of bowel obstruction. There is mild fat stranding about a suture line in the right upper quadrant of indeterminate etiology, possibly infectious/inflammatory. Mildly prominent adjacent mesenteric lymph nodes. No discrete fluid collections on this limited exam.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Foley catheter is in place.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Limited study due to lack of intravenous or oral contrast1.Mild mesenteric inflammatory change in the right upper quadrant/hepatic flexure of indeterminate etiology, possibly infectious/inflammatory. Adjacent suture line is intact. 2.No evidence of loculated fluid collections on this limited examination. |
Generate impression based on findings. | Left sided weakness. There is a large intraparenchymal hematoma centered in the right basal ganglia, which now measures 70 AP x 40 RL x 57 SI mm, previously 65 AP x 37 RL x 55 SI mm. There is also intraventricular extension of hemorrhage into the ventricular system, particularly within the left occipital horn and third ventricle. There appears to be a small amount of subarachnoid hemorrhage within the right circular sulcus. There is 12 mm of midline shift to the left. There is also left lateral ventricle dilatation, but effacement of the right lateral and third ventricles. There is right uncal herniation and effacement of the perimesencephalic cistern. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. | Large intraparenchymal hematoma centered in the right basal ganglia that measures up to 65 mm, as well as intraventricular extension of hemorrhage, 12 mm of midline shift, and dilatation of the trapped left ventricle. |
Generate impression based on findings. | AML in blast crisis with WBC > 100,000. There is extensive diffuse lymphadenopathy in the imaged portions of the neck. Reference lymph nodes include the following:* A right level 2A lymph node measures 15 x 26 mm (image 51, series 4).* A left level 2B lymph node measures 12 x 11 mm (image 52, series 4). * A left level 3 lymph node that measures 15 x 10 mm (image 63, series 4). There is marked diffuse enlargement of the bilateral palatine tonsils with associated moderate narrowing of the oropharyngeal airway. There is new swelling of the right retropharyngeal tissues are the level of the hypopharyngeal with effacement of the right piriform sinus. There is also mild stranding of the parapharyngeal fat that extends towards the right submandibular gland. There is no evidence of abscess. There is a left subclavian venous catheter. The major cervical vessels are otherwise patent. There is a small right frontal sinus retention cyst. The mastoid air cells are clear. The orbits are unremarkable. The thyroid gland and major salivary glands are unremarkable. The imaged intracranial structures are grossly unremarkable. The imaged portions of the lungs are clear. There are no lytic or blastic lesions. | 1. Extensive diffuse cervical lymphadenopathy and marked diffuse enlargement of the bilateral palatine tonsils with associated moderate narrowing of the oropharyngeal airway, compatible with leukemia. 2. New diffuse right retropharyngeal soft tissue swelling may represent pharyngitis, but no evidence of abscess. |
Generate impression based on findings. | Reason: 70-year-old male presents with fever and pyelonephritis. Evaluate for renal collection History: h/o xanthogranulomatous pyelonephritis ABDOMEN: Within the limitations of a non-IV contrast enhanced examination which limits evaluation of solid organ parenchyma and vascular structures, the following observations can be made:LUNG BASES: Redemonstration of bilateral pleural effusions with adjacent consolidation/atelectasis. Hilar lymphadenopathy with calcified portions, similar to prior.LIVER, BILIARY TRACT: Hypodense liver lesions, largest measuring 2.1 x 1.7 cm in the right lobe of the liver are incompletely characterized without contrast. No evidence of intrahepatic or extrahepatic ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Right adrenal gland lesion with microscopic fat measuring 2.5 x 2.5 cm is stable in size, consistent with a myelolipoma. Redemonstration of nodular thickening of the left adrenal gland with punctate calcifications.KIDNEYS, URETERS: Redemonstration of right kidney that is almost entirely replaced with large cystic lesions. There is a large renal calcification in the center of the right kidney measuring 1.3-cm. There is mild perinephric stranding around the right kidney. Left kidney with hyperdense lesion in the upper pole, slightly increased in size. Another hyperdense lesion in the midpole left kidney. RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the aorta and bilateral iliac arteries.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Thickening and induration of the anterior abdominal wall soft tissue.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy.BLADDER: Partially collapsed bladder.LYMPH NODES: No significant abnormality noted BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Stable sclerotic foci in the right pelvis and proximal left femur.OTHER: Mild pelvic ascites. | 1.Interval worsening of perinephric stranding about a right kidney that is almost entirely placed with large cystic lesions containing a central calcified stone. Differential includes pyonephrosis from obstruction versus xanthogranulomatous pyelonephritis.2.Relatively stable hypodense hepatic lesions. Characterization is limited due to noncontrast study. |
Generate impression based on findings. | 40 year-old female with lump in chest LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy. Cardiac size is normal without evidence of a pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Scattered small hepatic hypodensities too small to characterize. | No significant pulmonary or pleural abnormalities. |
Generate impression based on findings. | Male 59 years old Reason: , enlarged pulm art on CT PE, mediastinal LAD with soft tissue mass encasing the pulm art History: SOB and JVD, hepatojugular reflex, contrast reflux into IVC, dilated IVC on bedside TTE LUNGS AND PLEURA: Multiple calcified pulmonary nodules compatible with prior granulomatous disease. Bibasilar atelectasis/fibrosis and bronchiectasis. Moderate apical predominant centrilobular and paraseptal emphysema.MEDIASTINUM AND HILA: Thrombi seen in the left and right pulmonary arteries, which are adherent to the arterial wall and extend into the segmental arteries. The main and segmental pulmonary arteries are patent and the pulmonary trunk is enlarged, measuring 3.6 cm in diameter. These findings are compatible with chronic organized pulmonary emboli.Mediastinal and retrocrural lymphadenopathy. Small sliding type hiatal hernia. Multichamber cardiomegaly and severe atherosclerotic disease of the aorta and coronary arteries. CHEST WALL: Left subclavian biventricular pacemaker with leads in expected position. UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Right renal sinus cyst and multiple punctate calcifications within the renal sinus likely vascular or nonobstructive nephrolithiasis. Moderate atherosclerosis of the abdominal aorta and its branches. | 1. Bilateral chronic pulmonary mural thrombi with associated pulmonary artery enlargement.2. Moderate emphysema with bibasilar bronchiectasis, scarring and atelectasis.These findings were relayed by phone to Dr. Elliot at 1:54 on 10/7/2013 |
Generate impression based on findings. | Reason: Pleural effusion History: Shortness of breath / CXR findings LUNGS AND PLEURA: Interval increase in left pleural effusion with underlying atelectasis in the left lung.Calcified granulomas in the atelectatic lung compatible with previous infection.Mild scarring and bronchiectasis at the right base.MEDIASTINUM AND HILA: Large main pulmonary artery suggestive of pulmonary hypertension.Mild a large prevascular space lymph node and enlarged left cardiophrenic angle lymph node, not significantly changed.Calcified lymph nodes compatible with previous infection.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Status post right nephrectomy. | Increased left pleural effusion and increased atelectasis in the left lung. |
Generate impression based on findings. | Reason: eval for mets History: sarcoma LUNGS AND PLEURA: Calcification left upper lobe and scattered nonspecific micronodules are unchanged.No new suspicious pulmonary nodules or masses.No pleural effusions.MEDIASTINUM AND HILA: No hilar or mediastinal or mediastinal lymphadenopathy.Cardiac size is normal without evidence of a pericardial effusion.Calcified left hilar lymph nodes compatible with prior granulomatous disease.CHEST WALL: Degenerative changes within the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Cholelithiasis.Scattered small hepatic hypodensities too small to characterize.Splenic calcifications compatible with prior granulomatous disease.Right nonobstructing renal calculus. | No interval change. No evidence of metastatic disease. |
Generate impression based on findings. | Reason: uncontrolled asthma History: Shortness, tighness cough LUNGS AND PLEURA: Very small nonspecific nodules and scars, unchanged.No sign of pneumonia or other significant pulmonary abnormalities.MEDIASTINUM AND HILA: No significant lymphadenopathy or pericardial effusion.CHEST WALL: 7-mm smoothly marginated left breast nodule, unchanged since 2008 and likely benign.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | No significant abnormalities. |
Generate impression based on findings. | EGUS last cancer. Starting treatment. Needs new baseline. CHEST:LUNGS AND PLEURA: Emphysema. Scattered punctate micronodules are unchanged and presumably postinflammatory. No evidence of pulmonary metastases.MEDIASTINUM AND HILA: Large right thyroid nodule is unchanged. Coronary calcification. Scattered small subcentimeter nodes. Small focus of air in the RVOT presumably related to power injection. Thinning of the LV apex with calcification suggestive of prior MI, Small associated focus of thrombus, unchanged. Mild nonspecific thickening of distal esophagus. CHEST WALL: Degenerative changes are seen to the thoracic spine. No axillary lymphadenopathy.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Multiple hypodense hepatic lesions are too small to characterize but unchanged and presumably benign.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Ptotic irregular right kidney is unchanged. Stable hypodense renal lesions, presumably benign.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic hesitation the aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Calcification and thickening in near GE junction is unchanged. Fat stranding near GE junction unchanged and may be due to locally invasive tumor or adenopathy (image 87/166).BONES, SOFT TISSUES: Degenerative change.OTHER: No significant abnormality noted. | Residual thickening near GE junction related to known primary malignancy. No evidence of pulmonary metastases. |
Generate impression based on findings. | Reason: 82 year old female with history of head and neck cancer (resected History: as above CHEST:LUNGS AND PLEURA: Multiple small bilateral pulmonary nodules are present, slightly increased from previous, suspicious for metastases. Referenced nodule at the left lower lobe (series 6 image 80) is now 6 mm in diameter, increased from 4 mm previously.MEDIASTINUM AND HILA: Moderately large subcarinal lymph nodes measuring 16 mm in short axis, slightly increased from 14 mm previously.Moderately severe coronary artery calcification.CHEST WALL: A left subpectoral lymph node measuring about 8 mm in diameter, not significantly changed.Subcutaneous nodule in the posterior left axilla consistent with a sebaceous cyst, unchanged.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Aortic and iliac atherosclerosis.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Degenerative disease in the spine.OTHER: No significant abnormality noted. | Interval slight increase in the size of multiple small pulmonary nodules, compatible with metastases. |
Generate impression based on findings. | Male; 43 years old. Reason: AML, patient to start induction chemotherapy, would like baseline scan History: mouth pain, AML. LUNGS AND PLEURA: Very faint patch airspace opacity in the medial right middle lobe (image 56/114) is nonspecific but more likely atelectasis or aspirate than pneumonia. Patchy faint subcentimeter scarlike opacities are seen bilaterally. No pleural effusion. Lungs are overall better aerated than on 9/30/2013 study.MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. Multiple prominent mediastinal and hilar lymph nodes are compatible with patient history of AML. CHEST WALL: No significant abnormality noted. Left PICC tip in SVC.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Mild gastrohepatic and periaortic lymphadenopathy. Splenomegaly. Postsurgical changes compatible with right nephrectomy. Subcentimeter hypodensity in right lobe of liver is incompletely evaluated but the visualized portion is stable and this is presumably benign. | Very faint patch airspace opacity in the medial right middle lobe is nonspecific but more likely atelectasis or aspirate than pneumonia. |
Generate impression based on findings. | Reason: Evaluate for progression of prior R sided opacity, new L sided opacity History: cough, fevers/chills, myalgias LUNGS AND PLEURA: A patient motion limits evaluation.Previously noted subpleural right upper lobe and right lower lobe opacities demonstrate interval improvement.Increasing ground glass basilar opacities bilaterally may represent aspiration.No pleural effusions.MEDIASTINUM AND HILA: Redemonstration of postoperative changes related to a previous cardiac transplant.Retained epicardial pacing wire is unchanged.Cardiac size is normal without evidence of a pericardial effusion.No hilar or mediastinal lymphadenopathy.Small hiatal hernia.CHEST WALL: Almost complete resolution of the left chest wall fluid collection.Median sternotomy intact.Degenerative changes in the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Fat-containing ventral hernia unchanged. | 1.Almost complete resolution of the right lung sub-pleural opacities previously.2.Basilar groundglass opacities suggestive of aspiration, atelectasis, or edema.3.Interval resolution of the left chest wall fluid collection. |
Generate impression based on findings. | Nasopharyngeal carcinoma status post CRT. Evaluate for recurrence CHEST:LUNGS AND PLEURA: No significant abnormality noted.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: Status post cholecystectomy.SPLEEN: Calcified granuloma.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No evidence of metastatic disease. |
Generate impression based on findings. | Reason: CVA History: CVA The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Periventricular and subcortical white matter hypodensities of a mild degree are present.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The left eyeball lens is thin. | 1.No evidence for acute intracranial hemorrhage mass effect or edema. CT is insensitive for early detection of nonhemorrhagic CVA2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. |
Generate impression based on findings. | Female; 58 years old. Reason: Neuroendocrine tumor arising from ileum and carcinoid syndrome please evaluate for thoracic involvement. LUNGS AND PLEURA: No significant abnormality noted. No suspicious pulmonary nodules or masses. MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. Scattered small subcentimeter mediastinal nodes. Mild coronary artery calcifications. Hiatal hernia.CHEST WALL: T12-L1 posterior disk herniation with mass effect on cord.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Hypodense lesion in the right hepatic lobe is nonspecific, see recent abdomen CT report for details. Exophytic left upper pole renal cyst. Mild wall thickening of stomach and visualized bowel. No significant lymphadenopathy. | 1. No evidence of pulmonary metastatic disease.2. T12-L1 posterior disk herniation with mass effect on cord.The above findings were discussed with Kenisha Allen, RN of the referring clinical service at the time of report dictation. |
Generate impression based on findings. | Reason: hx H\T\N ca, post CRT, evaluate dx and compare measurements to previous scans History: as above CHEST:LUNGS AND PLEURA: Multiple bilateral nonspecific micronodules, some of which are calcified, compatible with previous infection, unchanged.No suspicious nodules.Chronic basilar interstitial abnormalities with fibrosis and bronchiectasis, unchanged.MEDIASTINUM AND HILA: No significant lymphadenopathy.Moderate coronary artery calcification.ICD leads extending to the right atrium, right ventricle and a left ventricular vein.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Unchanged small hypodensities, consistent with cysts. Cholelithiasis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No sign of metastases and no change. |
Generate impression based on findings. | Reason: scleroderma - ILD PROTOCOL History: DOE LUNGS AND PLEURA: Bilateral predominantly subpleural and basilar chronic interstitial opacity with reticular components and mild traction bronchiectasis compatible with fibrosis.MEDIASTINUM AND HILA: Moderately enlarged prevascular, subcarinal and lower paratracheal lymph nodes measuring up to 11 mm in short axis diameter. Moderate coronary artery calcification.No significant pericardial effusion.Small sliding hiatal hernia.Moderate enlargement pulmonary artery measuring 35 mm in diameter, raising the question of pulmonary hypertension.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Small nonspecific hypodensity in the left lobe of the liver, probably a cyst.Cholelithiasis. | Moderate basilar predominant interstitial fibrosis with architectural distortion and mild traction bronchiectasis but no overt honeycombing, compatible with scleroderma related lung disease. |
Generate impression based on findings. | Routine follow up for right upper lobe ground glass nodule CHEST:LUNGS AND PLEURA: Innumerable ground glass opacities in the right upper lobe are stable versus 2/28/2013 but increased versus 5/13/2011 and are suspicious for slowly growing adenocarcinomas. The previously referenced right upper lobe ground glass lesion again measures 11 mm (image 148, series 4), unchanged from the prior study, however increased in size from the study dated 5/13/2011 it measured 7 mm.A subpleural right upper lobe lesion measures 11 x 9 mm (image 85, series 5), not significantly changed from the prior study, but demonstrates very slow growth dating back to 6/24/2009. Negative Hounsfield units are seen within this lesion which is suggestive of fat, and this likely represents a benign hamartoma.Post op change on the left.MEDIASTINUM AND HILA: Coronary calcification.CHEST WALL: Degenerative change involving spine. Small presumed sebaceous cyst in midline of back (image 7/163).ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Hypodense liver lesions likely represent simple cysts and are unchanged from the prior study.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate, nonobstructive renal calculi, unchanged.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Colonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Persistent multiple glass lesions suspicious for indolent adenocarcinomas, stable in size and density. |
Generate impression based on findings. | Chronic airway obstruction LUNGS AND PLEURA: Left paramediastinal consolidation, fibrosis , and left upper lobe volume loss unchanged.Adjacent 3.2 cm x 1.2 cm area of consolidation with internal cavitation (image 31 series 5) similar in appearance to the prior exam and unchanged in size compared the exam dated 7/25/13.Left apical nodule (image 21 series 5) measuring 11 mm x 11 mm is unchanged compared to the two prior exams. Scattered micronodules are unchanged.No new suspicious pulmonary nodules or masses.Severe upper lobe predominant centrilobular emphysema.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of pericardial effusion.Severe coronary artery calcificationCHEST WALL: Degenerative changes within the thoracic spine.Left rib healed fracture.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Cholelithiasis. | 1.Left upper lobe paramediastinal area of consolidation/atelectasis and volume loss compatible with postinflammatory changes.2.Adjacent left upper lobe focal area of consolidation with internal cavitation unchanged compared to the prior exam and may represent organizing pneumonia. Malignancy still cannot be excluded. Follow-up examination in 3 months is recommended.3.Left apical nodule unchanged over the prior two exams. |
Generate impression based on findings. | Reason: cT4aN2bMx vocal cord squamous cell carcinoma s/p induction chemotherapy. please eval and compare to prior scans History: as above CHEST:LUNGS AND PLEURA: Approximately 6 mm subpleural nodule in the left lower lobe, unchanged and likely benign.No suspicious nodules.MEDIASTINUM AND HILA: Mildly enlarged left cervical and mediastinal lymph nodes, some of which are calcified, unchanged.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: Status post left nephrectomy.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No sign of metastases. |
Generate impression based on findings. | Reason: 69 M with profound hypotension, recent G tube placement at OSH, concern for complications, History: hypotension ABDOMEN:LUNG BASES: Moderate, bilateral pleural effusions. Bilateral, right greater than left consolidation/atelectasis of the lung bases. Mild mediastinal lymphadenopathy. LIVER, BILIARY TRACT: Pericholecystic fluid with mild gallbladder wall thickening and gallbladder sludge. Mild dilatation of the common bile duct. No evidence of intrahepatic ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: G-tube balloon within the stomach.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate with calcifications.BLADDER: Mild gallbladder wall thickening compatible with enlarged prostate.LYMPH NODES: Scattered, bilateral inguinal lymph nodes. BOWEL, MESENTERY: Multiple loculated fluid collections with enhancing rims within the pelvis along the right iliac muscle measuring 7.8 x 3.1 cm (series 18, image 104). Large bowel and small bowel wall thickening is nonspecific and may be secondary to patient's nutritional status.BONES, SOFT TISSUES: Large fluid collection adjacent to the left hip tracking along the muscle partial layers measuring 2.7 x 5.5 cm (series 18, image 131). Amorphous, hyperdense lesion at the level of the pubis symphysis may represent a lymph node. Sclerotic calcification of the right pelvis and dystrophic calcifications around the hips. Destruction of the T10 vertebral body. OTHER: Mild amount of pelvic ascites. | 1.Gallbladder sludge with mild gallbladder wall thickening and pericholecystic fluid suggestive of acute cholecystitis. Dedicated right upper quadrant ultrasound for further evaluation is advised.2.Multiseptated fluid collections within the pelvis suggestive of abscesses or possible necrotic metastatic deposits. 3.Bilateral moderate pleural effusions with basilar compressive atelectasis.4.Large bowel and small bowel wall thickening is nonspecific and may be secondary to patient's nutritional status. |
Generate impression based on findings. | 61-year-old male with headache and vision changes There is new hypodensity in bilateral parietal and occipital lobes, not in a typical vascular distribution. There is no significant mass effect from this nor are there findings of acute hemorrhage.A small focal encephalomalacic defect is noted in right periventricular white matter involving the adjacent corpus callosum, unchanged.Redemonstrated is mild ectopia of cerebellar tonsils. Dilated supratentorial ventricular system remain stable in size and morphology. Unremarkable cerebral cortex, cortical sulci, and CSF spaces otherwise. Calvarium is intact. Limited images through the orbits are unremarkable. The paranasal sinuses and bilateral mastoid air cells/middle ear cavities are well pneumatized. | 1.New CT findings suspicious for posterior reversible encephalopathy syndrome (PRES). MRI with gadolinium is recommended to further characterize this abnormality and perhaps exclude other possibilities.2.Findings were discussed with Dr. Lindsey on 10/7/2013 approximately 11:15 a.m. |
Generate impression based on findings. | Reason: mesothelioma s/p 2 cycles of chemo. please evaluate for disease and compare with previous scans History: mesothelioma CHEST:LUNGS AND PLEURA: The diffuse nodular pleural thickening in the right hemithorax with loculated fluid collections and pleural calcification or possibly radiopaque material from previous pleurodesis if the history is consistent.Diffuse interstitial opacity with intralobular septal thickening compatible with edema, and volume loss in the underlying lung.Reference measurements as follows.1. At the level of the carina (series 4 image 52): 6 mm at one o'clock (corresponding to 12 o'clock previously), 9 mm at 4 o'clock (corresponding to 6 o'clock previously), and 7 mm at 10 o'clock, unchanged.2. The level of the main pulmonary artery (series 4 image 62) 15 mm at one o'clock (corresponding to 12 o'clock previously) unchanged, 8 mm at 8 o'clock unchanged, and 7 mm at 10 o'clock, decreased from 13 mm.3. At the level of the left atrium (series 4 image 71) 12 mm at 10 o'clock, not significantly changed, and 8 mm at 9 o'clock (previously called 7 o'clock), not significantly changed.MEDIASTINUM AND HILA: Subcarinal lymph node measuring 18 mm in short axis, not significantly changed.Reference right hilar node measures 11 mm in short axis, not significantly changed.Multiple thyroid cysts and calcifications.New right jugular vein thrombosis.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Very small hyperdensity consistent with a cyst.SPLEEN: Absent spleen.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Stable disease. |
Generate impression based on findings. | Male 78 years old Reason: follow-up of histoplasmosis History: cough LUNGS AND PLEURA: Smoothly marginated lingular nodule has not significantly changed and measures 17 x 14 mm (image 67, series 5), previously measuring 17 x 14 mm. This nodule has not significantly changed when compared to multiple prior studies dating back to 7/27/2012.Multiple nonspecific pulmonary micronodules unchanged.Upper lobe predominant centrilobular emphysema and minimal basilar atelectasis.MEDIASTINUM AND HILA: Previously referenced aortopulmonary window node again measures 9 mm in short axis (image 41, series 3). Remainder of enlarged mediastinal lymph nodes appear unchanged. No new lymphadenopathy identified.Coronary artery stents in place and cardiomegaly unchanged.CHEST WALL: Left subclavian ICD unchanged. Gynecomastia unchanged.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Mild atherosclerosis of the abdominal aorta. Left nephrectomy. | Lingular nodule unchanged and consistent with pathologic diagnosis of histoplasmosis. |
Generate impression based on findings. | Reason: history of breast cancer, receiving treatment. eval for response/progression using measurements if applicable. pls compare with previous. History: see above CHEST:LUNGS AND PLEURA: Severe centrilobular emphysema. Bilateral pulmonary nodules. Reference left upper lobe pulmonary nodule measures 6 mm (series 4, image 35), previously 7 mm. Subpleural reticulation and fibrosis compatible with radiation changes. No new suspicious pulmonary nodules or masses. No pleural effusions.MEDIASTINUM AND HILA: Necrotic right cardiophrenic angle lymph node measures 1.6 cm (axial image 65), previously 1.1 cm. no new enlarged lymph nodes. Heart size is normal. No pericardial effusion.CHEST WALL: Right chest wall mass with underlying bone destruction measures 5.7 x 2.5 cm (series 4, image 58), unchanged from the prior exam. The axillae are not completely imaged. No axillary lymphadenopathy within the field of view. Status post right mastectomy. Left chest wall Port-A-Cath tip terminates at the cavoatrial junction.ABDOMEN:LIVER, BILIARY TRACT: No suspicious focal hepatic lesions.SPLEEN: Accessory splenule.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerosis of the abdominal aorta and its branches. No lymphadenopathy.BOWEL, MESENTERY: Nonspecific mild pericecal fat stranding, unchanged.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: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Decreasing reference pulmonary nodule.2.Increasing reference cardiophrenic lymph node.3.Unchanged reference chest wall mass with underlying bone destruction.4.No measurable disease in the abdomen or pelvis. |
Generate impression based on findings. | 39-year-old with end-stage renal disease, evaluate vasculature for transplant Limited study, intravenous contrast not administered. This limits sensitivity to detect small lesions in solid organs and bowel.ABDOMEN:LUNG BASES: Moderate left pleural effusion with underlying atelectasis. Mild pericardial effusion.LIVER, BILIARY TRACT: Cholelithiasis. AscitesSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral hilar vascular calcifications are noted. Mild nonspecific perinephric fat stranding noted. No evidence of renal stones. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of bowel, obstruction. Ascites.BONES, SOFT TISSUES: Generalized anasarca.Atherosclerotic changes of abdominal aorta and bilateral external and internal iliac vesselsOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Uterus and adnexa appear unremarkable.BLADDER: No significant abnormality noted. LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Ascites | 1. Atherosclerotic changes of abdominal aorta and bilateral external and internal iliac vessels and Vascular calcifications within the kidneys2. Moderate left pleural effusion and mild pericardial effusion.3. Abdominal and pelvic ascites.4. Generalized anasarca. |
Generate impression based on findings. | 57 year old man with recent diagnosis of SLL based on an FNA of a left neck lymph. There has been interval decrease in the degree of subcutaneous stranding and skin thickening overlying the superior left sternocleidomastoid muscle, where there is a biopsy clip. There are diffuse cervical lymph nodes with spheroid morphologies that are otherwise not significantly enlarged by size criteria. The oral cavity, oropharynx, nasopharynx, hypopharynx, and larynx are unremarkable. The major salivary glands and thyroid glands are unremarkable. There is unchanged multilevel degenerative spondylosis without evidence of lytic or blastic lesions. The major cervical vessels are patent. The imaged portions of the intracranial structures and orbits are unremarkable. The imaged portions of the lungs are clear. | 1. Interval decrease in the degree of subcutaneous stranding and skin thickening overlying the superior left sternocleidomastoid muscle, where there is a biopsy clip. 2. Diffuse cervical lymph nodes with spheroid morphologies that are otherwise not significantly enlarged by size criteria. |
Generate impression based on findings. | History of metastatic breast cancer on treatment. CHEST:LUNGS AND PLEURA: Scattered punctate micronodules measuring up to 5 mm (image 76/99 in the right lower lobe) unchanged.MEDIASTINUM AND HILA: Stable 9 mm left thyroid nodule (image 5 such 149).CHEST WALL: Left breast mass measures 28 x 13 mm on image 53/149 (28 x 15 mm and prior). Left axillary lymphadenopathy with reference node measuring 16 mm on image 24/149, unchanged.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Stable pulmonary nodule, left breast mass and axillary node are not significantly changed. No new sites of disease. |
Generate impression based on findings. | 67 year old female with a family history of CAD (sister recent anterior MI), dyslipidemia, and history of smoking. Nuclear stress test mildly abnormal showing mild-moderate LAD territory ischemia but likely submaximal performance. Question regarding evidence of obstructive CAD. Calcium Score:LM: 0LAD: 224LCx: 133RCA: 41Total: 398, This represents the 52% for this patients age and gender.The aortic arch is left sided. Visualized portions of the aorta demonstrate no evidence of dissection or aneurysm. The SVC is normal in size and without structural abnormality. The IVC is normal in size and without structural abnormality.The pericardium is normal in thickness. There is no pericardial effusion.Coronary Artery Anatomy:LM: The left main coronary artery arises normally from the left sinus of Valsalva and bifurcates into the left anterior descending and left circumflex coronary arteries. There is no significant plaque in the left main.LAD: The LAD gives rise to three diagonal and several septal branches. There is complex plaque that involves the bifurcation of the proximal LAD and circumflex arteries. The plaque involving the proximal LAD is predominantly noncalcified and contains a focus of high density that is suggestive of contrast, indicating an ulcerating plaque. The caliber of the proximal LAD is diffusely narrowed over a length of 1.7cm to the point of initiation of a heavily calcified plaque in the mid LAD. This dense calcification precludes quantification of stenosis in this location. Immediately distal to D2, there is a focal loss of contrast in the mid LAD which is highly suspicious for a focal occlusion. Contrast is noted distal to this point, within the distal LAD, which may be the result of retrograde flow via collaterals that fall below the limits of resolution on this exam.The first diagonal branch is large and nonstenotic. D2 is small and difficult to assess for stenosis. D3 at the apex is also diminutive; too small to evaluate on the post processing workstation. LCx: The left circumflex artery gives rise to two obtuse marginal branches. As noted, there is disease involving the proximal circumflex from the ostial level. This contains heavily calcified plaque. Two small and tortuous vessels arise from the proximal circumflex that course toward the proximal LAD in a fashion atypical for obtuse marginal branches. They enter the proximal interventricular septum and are suggestive of collateral vessels.The first OM is large and demonstrates multifocal mild to moderate stenoses. OM2 is smaller and is free of significant stenosis. The circumflex terminates immediately distal to OM2 in the presence of a right dominant system.RCA: The RCA arises normally from the right sinus of Valsalva. It is the dominant coronary artery giving rise to the posterior descending artery and a posterolateral branch. There is a moderate stenosis in the mid RCA from a noncalcified plaque.Few scattered calcified granulomas occupy the left lower lobe. | 1.Total Calcium score was 398; 52% for age and gender.2. Significant plaque demonstrated by the LAD and circumflex coronary arteries with suggestion of ulcerated lesion involving the proximal LAD. 3. Suspected focal occlusion of mid to distal LAD with likely retrograde flow by collaterals. 4. Moderate stenosis of mid RCA by noncalcified plaque.. |
Generate impression based on findings. | 35-year-old male with left flank and left lower quadrant abdominal pain. Assess for left-sided kidney stone. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Punctate calcific density in the left lower pole calix without obstruction. No other calcification seen. There is slight increased perinephric fluid about the left kidney and mild hydronephrosis when compared with the right. No other abnormality seen in the kidneys, although without IV contrast, examination is limited and cannot exclude mass lesions.The left ureter remains slightly dilated when compared with the right proximally, but cannot be seen is dilated. More distally in the pelvis. Note ureteral calculus are seen in the visualized course. There are calcified phleboliths in the pelvis which appear not to be in the expected course of the distal ureter, although one punctate density (series 3, image 132) approaches to bladder and while favored to be a phlebolith, a punctate, distal ureteral/UP junction stone cannot be excluded. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: The left ureter remains slightly dilated when compared with the right proximally, but cannot be seen is dilated. More distally in the pelvis. Note ureteral calculus are seen in the visualized course. There are calcified phleboliths in the pelvis which appear not to be in the expected course of the distal ureter, although one punctate density (series 3, image 132) approaches to bladder and while favored to be a phlebolith, a punctate, distal ureteral/UP junction stone cannot be excluded. | 1. Punctate, nonobstructing left lower pole calix. 2. Slight hydronephrosis of the left kidney and dilatation of proximal ureter with mild perinephric fluid stranding. These findings may be due to a recently passed stone or the calcific density in the pelvis, which while favored to be a phlebolith, could represent a punctate, distal ureteral stone. |
Generate impression based on findings. | Reason: with lung cancer, eval for progression of disease History: with lung cancer, eval for progression of disease CHEST:LUNGS AND PLEURA: Right lower lobe mass (image 72 series 5) is unchanged measuring 5.1 cm x 3.3 cm previously measuring 5.1 cm x 3.2 cm.Right upper lobe subpleural nodule (image 37 series 5) is stable measuring 4 mm.New 22 mm x 18 mm nodular opacity adjacent to the major fissure (image 81 series 5).New 15 mm x 14 mm nodule in the superior segment of the right lower lobe. Left lower lobe consolidation slightly improved.Mild interval decrease in the pleural effusions.Severe emphysema and calcified pleural plaques unchanged.And debris within bronchi again noted.MEDIASTINUM AND HILA: Precarinal referenced lymph node has increased in size (image 46 series 3) now measuring 14 mm previously measuring 10 mm.Additional AP window and hilar lymphadenopathy appears to be similar in size although exact measurements are limited due to lack of intravenous contrast.Debris within the trachea redemonstrated. CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Right hepatic lobe metastasis has increased in size (image 105 series 3). Again noted is distention of the gallbladder without signs of acute cholecystitis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Left adrenal metastases (image 103 series 3) measures 2.8 cm x 3.9 cm previously measuring 2.9 cm x 3.7 cm.KIDNEYS, URETERS: Status post left nephrectomy. Exophytic hypodense mass extending from the lower pole right kidney most likely represents a cyst.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Right lower lobe mass with two new right lower lobe nodules compatible with metastatic disease.2.Hilar mediastinal lymphadenopathy with interval increase in precarinal referenced lesion.3.Increase size of presumed liver metastasis. Stable left adrenal gland nodule.4.Mild interval decrease in pleural effusions and improvement in the left lower lobe consolidation and air space opacity most likely representing aspiration pneumonia. |
Generate impression based on findings. | 32 male with ulcers colitis, status post total abdominal colectomy with Hartmann's pouch. Two weeks ago, readmitted with distention, abdominal pain -- now tachycardic and hypotensive and febrile out. Rule-out perforation versus bowel change. Abdominal distention. ABDOMEN:LUNG BASES: New small left pleural effusion and bibasilar atelectasis.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: As before the patient is status post subtotal colectomy with a Hartmann's pouch and right lower quadrant ileostomy. New since prior exam is a moderately extensive amount of scattered diffuse ascites. The ascites appears free throughout much of the mesenteric, but does have a loculated collection with enhancing wall in the midpelvis near the Hartmann's pouch suture line (series 4, image 110). This collection measures 8.2 x 4 .1 cm -- no air is seen within this collection, however, CT cannot characterize fluid collections. Adjacent bowel loops shows slight wall thickening, which may be accentuated by lack of distention, but adjacent enteritis, cannot be excluded.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: As before the patient is status post subtotal colectomy with a Hartmann's pouch and right lower quadrant ileostomy. New since prior exam is a moderately extensive amount of scattered diffuse ascites. The ascites appears free throughout much of the mesenteric, but does have a loculated collection with enhancing wall in the midpelvis near the Hartmann's pouch suture line (series 4, image 110). This collection measures 8.2 x 4 .1 cm -- no air is seen within this collection, however, CT cannot characterize fluid collections. Adjacent bowel loops shows slight wall thickening, which may be accentuated by lack of distention, but adjacent enteritis, cannot be excluded.BONES, SOFT TISSUES: Bilateral inguinal hernias containing only mesenteric fat.OTHER: No significant abnormality noted | 1. Moderate amount of ascites throughout the abdomen and in the, mesentery, new since 10/1/13. 2. Loculated mesenteric fluid collection in the pelvis. CT cannot characterize fluid is infected or noninfected although no signs for infection, such as air to suggest infection or involvement by bowel are seen. 3. Suggestion of small bowel wall thickening and regions of fluid which may suggest ileitis or could be exacerbated by lack of distention. 4. Small new left pleural effusion. |
Generate impression based on findings. | History of smoking status post OHT. Eval for new tx. LUNGS AND PLEURA: Small bilateral pleural effusions. No suspicious pulmonary nodules.MEDIASTINUM AND HILA: Orphaned left-sided pacemaker. Postop changes from OHT with severe cardiomegaly, especially biatrial. Coronary calcification.Scattered small borderline mediastinal nodes are present. Small soft tissue density anterior to the SVC (image 41/107) may be residual postop change.CHEST WALL: S/P median sternotomy.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Well-circumscribed hypodensities in the right lobe of liver are stable versus 9/9/2013 abdomen pelvis CT and presumably benign. | Small bilateral pleural effusions. No suspicious pulmonary nodules. |
Generate impression based on findings. | Male, 81 years old, history of parotid cancer, status post resection, evaluate for recurrence. The previously seen enhancing lesion involving the cavernous sinus, Meckel's cave and the prepontine cistern on the left is no longer distinctly visualized. Meckel's cave on the left remains expanded relative to the right, but no definite enhancing tumor is seen within it.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. Surgical change consistent with partial parotidectomy is evident on the right. Please note that extensive dental streak artifact does obscure visualization of this region. However, within this limitation, the appearance of the surgical bed has not significantly changed and no suspicious lesions are identified.A reference right submandibular node measures 1.7 x 1.0 cm (image 50 series 4), previously 1.7 x 0.9 cm. A reference right level 3 node measures 1.7 x 1.2 cm the (image 60 series 4), previously 1.1 x 1.0 cm. This node has shifted laterally relative to the prior exam and now resides mostly beyond the lateral margin of the sternocleidomastoid muscle (technically at the level 5 nodal station).Numerous additional scattered cervical lymph nodes are stable or at most increased in size by 1 or 2 mm. None of these meets imaging criteria for pathologic enlargement.The remaining salivary glands are unremarkable. The thyroid remains mildly heterogeneous, unchanged. The cervical arteries are patent. The right internal jugular vein is small in caliber but it seems to be patent.No concerning lesion seen in the lung apices. No concerning or focal destructive bony lesions are demonstrated. Again seen is advanced degenerative disk disease in the cervical spine particularly at C5-6 and C6-7. | 1. Apparent interval resolution of an enhancing mass at the level of the left cavernous sinus, Meckel's cave and prepontine cistern, likely representing response to therapy. Please note that MRI would provide a more sensitive evaluation of this lesion.2. No other evidence of intracranial metastatic disease.3. Stable surgical change of the right parotid space. No evidence of locally recurrent tumor.4. A previously referenced right level 3 lymph node has shifted laterally in position, now residing mostly at the level 5 nodal station. By size, this node measures slightly larger than on the prior examination. The significance of this change is uncertain as some of it may be attributable to shift and/or rotation of position.5. Additional scattered lymph nodes are reidentified through the neck, some of which are 1 or 2 mm larger. None meet imaging criteria for pathologic enlargement, and as such, these changes are nonspecific and may simply be reactive. |
Generate impression based on findings. | Reason: restaging s/p 6k cycles of oral TKI therapy History: hx of metastatic renal cell cancer LUNGS AND PLEURA: 4 mm solid nodule posteriorly in the right upper lobe (series 4 image 23), unchanged,Multiple new <4 mm micronodules too small to definitively characterize but suspicious for metastatic disease (images 42 and 75/106 show the largest).MEDIASTINUM AND HILA: Tracheal diverticulum. Scattered small subcentimeter nodes.Mild coronary artery calcification.CHEST WALL: Wedge deformity of the T12 vertebra, unchanged.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Multiple hepatic metastases, better characterized on a previous MRI scan are still present but not sufficiently visualized for accurate comparison.Status post splenectomy and left nephrectomy. | 1. While the reference pulmonary is stable, there are multiple new <4 mm micronodules too small to definitively characterize but suspicious for metastatic disease. Continued follow up is recommended.2. Hepatic metastases are grossly stable given limits of technique. |
Generate impression based on findings. | Chronic polypoid sinusitis. There are postoperative findings related to bilateral uncinectomy, middle turbinectomy, partial internal ethmoidectomy, and septoplasty. There is mild mucosal thickening within the bilateral maxillary sinuses. There is partial obstruction of the right neo-infundibulum due to mucosal thickening. There is complete opacification of the bilateral anterior ethmoid sinuses and frontal sinuses. Polypoid opacities extend into the bilateral nasal cavities, left greater than right. There is neo-osteogenesis in the posterior left ethmoid air cells. There is moderate mucosal thickening within the right sphenoid sinus. The left sphenoid sinus is clear. There is no significant nasal septal deviation. The ethmoid roofs are symmetric and intact. The optic canals and carotid grooves are covered by bone. The orbits are unremarkable. The intracranial structures are grossly unremarkable. | Postoperative findings related to bilateral uncinectomy, middle turbinectomy, partial internal ethmoidectomy, and septoplasty with scattered paranasal sinus opacification predominantly in the bilateral ethmoid and frontal sinuses, as well as polypoid lesions projecting into the nasal cavity that may represent sinonasal polyposis. |
Generate impression based on findings. | T3N3 tonsil SCC s/p right neck dissection and chemoradiation completed five years ago. Head: There is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull is unremarkable. Neck: There are post-treatment findings in the region of the right tonsillar fossa with associated volume loss, but no evidence of tumor recurrence. There is no significant cervical lymphadenopathy. However, there is interval increased mixed lucency and sclerosis of the right mandible surrounding the extraction sites of ADA 30 and 31, as well as fragmentation of the overlying buccal cortex. The major salivary glands are unchanged with deficiency of the submandibular glands. The larynx and trachea are unremarkable. The major cervical vessels are patent. The paranasal sinuses and mastoid air cells are clear. The imaged portions of the lungs are clear. | 1. Post-treatment findings in the region of the right tonsillar fossa with no evidence of tumor recurrence or significant cervical lymphadenopathy. 2. Interval increased mixed lucency and sclerosis of the right mandible surrounding the extraction sites of ADA 30 and 31, as well as fragmentation of the overlying buccal cortex, which is consistent with progressive osteoradionecrosis, although superimposed osteomyelitis cannot be excluded based on imaging alone. 3. No evidence of intracranial metastases. |
Generate impression based on findings. | Male, 74 years old, history of larynx cancer, post CRT. Mild asymmetry of the tonsillar tissue persists at the left tongue base, unchanged. No concerning the aerodigestive mucosal lesions are identified.No pathologic adenopathy is seen by size criteria. A reference right level 2 lymph node measures 6 x 6 mm (image 51 series 4), previously 6 x 5 mm. A reference left level 4 node measures 9 x 8 mm (image 75 series 4), previously 8 x 8 mm.The salivary glands and thyroid are free of suspicious lesions. Cervical vessels remain patent. Again noted is prominence of the right superior ophthalmic vein, unchanged. Lung apices are unremarkable. No concerning bony lesions are detected. | Stable examination with no evidence of active disease. |
Generate impression based on findings. | 65-year-old with malignant neoplasm of penis, Hodgkin's disease, reevaluate and compare to previous CHEST:LUNGS AND PLEURA: Mild to moderate interval increase in bilateral upper lobe paraseptal/centrilobar emphysema. Stable right upper lobe noncalcified micronodule, best seen on image 18, 5.MEDIASTINUM AND HILA: Stable mediastinal lymph nodes. Reference precarinal lymph node measures 2 x 1 cm, previous measured 1.9 cm x 1.1 cm (series 3 image 34).CHEST WALL: Right chest port with catheter tip in the superior vena cava. Interval decrease in left axillary and subpectoral lymphadenopathy. Reference left axillary lymph node measures 1.3 x 1 .1 cm, previously measured 1.6 cm x 1.2 cm (series 3 image 18). The other reference left axillary lymph node on series 3 image 24 measures 1 x 0 .8 cm, previously measured 1.1 cm x 0.9 cm (image 21, 3).ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Simple right renal cyst.RETROPERITONEUM, LYMPH NODES: Unchanged aneurysmal dilatation of the distal abdominal aorta and left common iliac artery.BOWEL, MESENTERY: Midline ventral hernia containing large bowel loops and left Spigelian hernia containing bowel loops, without obstruction or fluid in the hernia sac. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Referenced left inguinal lymph node (image 183, 3), measures 1.1 x 0 .7 cm, unchanged from prior study.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Hardware noted in the lumbosacral spine.OTHER: No significant abnormality noted | Stable mediastinal and inguinal lymphadenopathyMinimal interval decrease in left axillary lymphadenopathy.Interval increase in bilateral upper lobe paraseptal/centrilobar emphysema. |
Generate impression based on findings. | Reason: MCA aneurysm, preop CTA,, eval for changes History: preop CTA for surgery 10/10/2013 Brain CTA: There is opacification of the distal internal carotid arteries, the distal vertebral arteries and the proximal anterior middle and posterior cerebral arteries. There is a 7 x 7 mm axial dimension the left middle cerebral artery aneurysm present which is directed posterior laterally and slightly superiorly at the level of the mid M1 segment. There is a small superior division branch coming off the base of the aneurysm. The inferior division appears to be very dominant in this patient. IfThere is fetal origin of the left posterior cerebral artery with an infundibulum at its origin.The right vertebral artery is hypoplasticThe anterior communicating artery and the posterior communicating arteries are identified and are intact.CT head:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Incidental note is made of a partial fusion of C1 and C2There is opacity present in the external artery canals most likely represents cerumen | 1.There is redemonstration of a left middle cerebral artery aneurysm which has not changed since the prior examination2.No evidence for cerebral vascular occlusive disease. |
Generate impression based on findings. | T4aN2Mx vocal cord squamous cell carcinoma status post induction chemotherapy. The bilateral transglottic soft tissue mass is now considerably less bulky, including decrease in size of the paraglottic and extralaryngeal components. There is unchanged thyroid cartilage demonstrates irregularity of the right posterior aspect and diffuse demineralization anteriorly, which is unchanged. The cricoid cartilage appears unchanged as well, without focal defects. The cluster of left supraclavicular nodes is unchanged, measuring 1.7 x 1.7 cm. Other cervical lymph nodes are not significantly enlarged by size criteria. The oral cavity, oropharynx, and nasopharynx are unremarkable. The thyroid is normal. The major arterial and venous structures of the neck are intact. The paranasal sinuses and mastoid air cells are clear. There is multilevel degenerative spondylosis. The imaged portions of the intracranial structures and orbits are unremarkable. There are emphysematous changed in the lungs. The images portions of the lungs are otherwise clear. There is a carious ADA 17 with associated periapical lucency. | 1.Interval decrease in size of the bilateral transglottic squamous cell carcinoma, indicating treatment response. 2.Stable cluster of lymph nodes within the left supraclavicular fossa without other significant lymphadenopathy.3. Carious ADA 17 with associated periapical lucency. |
Generate impression based on findings. | Male, 78 years old, Hodgkin's disease, nodular sclerosis, status-post 3 cycles of chemotherapy. Since the prior examination, there has been a substantial response to therapy with reduction in size of all of the previously visualized left neck and mediastinal lymph nodes. A left level 2 reference aggregate now measures 2.0 x 1.1 cm (image 52 series 1202), previously 3.5 x 1.9 cm. A right pretracheal node measures 2.1 x 1.4 cm (image 97 series 1202), previous 2.4 x 1.9 cm.Mild stranding is evident through the fascial planes of the left neck, similar to prior. No pathologic adenopathy is identified in the right neck. The aerodigestive tract is unremarkable. The salivary glands and thyroid are free of focal lesions. The cervical vessels are unremarkable. Lung apices are clear. No concerning bony lesions are demonstrated. Redemonstrated is a lucency through the posterior arch of C1, likely congenital. | Interval improvement in adenopathy. |
Generate impression based on findings. | 78-year-old Hodgkin's disease nodular sclerosis unspecified site. Extranodal and solid organ sites. Status post 3 cycles of chemotherapy and need of restaging, please compare CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Interval decrease in left supraclavicular lymphadenopathy. Referenced left supraclavicular lymph node measures 0.7 x 0 .9 cm, previously measured 1.7 x 1.5 cm (image 12, 701).Minimal interval decrease in mediastinal adenopathy. Referenced precarinal lymph node measures 2 x 0.9 cm previously measured 2.2 x 1.1 cm (image 44)CHEST WALL: Tip of right-sided port catheter at the junction of right atrium and SVC.ABDOMEN:LIVER, BILIARY TRACT: Few hypodense lesions in right lobe of liver are mostly unchanged from prior study and are nonspecific. Hepatic vessels are patent.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Interval decrease in respiratory lymphadenopathy. Referenced, but a celiac lymph node measures 1.2 x 0 .5 cm, previously measured 1.8 x 0.9 cm (image 112).Stable borderline mesenteric lymph nodes noted. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Markedly enlarged prostate is unchangedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Few small subchondral cyst in bilateral femoral heads. Mild degenerative changes of lumbosacral spine.OTHER: No significant abnormality noted | 1. Interval reduction in left supraclavicular, mediastinal and retroperitoneal lymphadenopathy.2. Stable mesenteric lymphadenopathy.3. No new sites of disease |
Generate impression based on findings. | 17-year-old with neurofibromatosis type I and VP shunt with abdominal pain and headaches, evaluate for change in loculations. ABDOMEN:LUNG BASES: Bilateral dependent atelectasis with small left pleural effusion.LIVER, BILIARY TRACT: No focal liver lesion or biliary duct dilation.SPLEEN: No focal splenic lesion.PANCREAS: The pancreas appears normal.ADRENAL GLANDS: No nodule is seen in either adrenal gland.KIDNEYS, URETERS: The kidneys enhance homogeneously and symmetrically without hydronephrosis or perinephric stranding.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No bowel obstruction is seen.BONES, SOFT TISSUES: Left paraspinal soft tissue mass at the T10/T11 level is difficult to visualize due to the presence of a left pleural effusion, however it is likely unchanged in size.Two ventriculoperitoneal shunt catheters are seen with one tip in the left upper quadrant and the other tip in the right mid abdomen.PELVIS:PROSTATE, SEMINAL VESICLES: Normal for the patient's age.BLADDER: Distended without bladder wall thickening.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No bowel obstruction is seen.BONES, SOFT TISSUES: Two loculated fluid collections are seen without surrounding inflammatory changes, both of which have decreased in size. The left lower quadrant now measures 2.8 x 0.8 x 0.9 cm. The right lower quadrant loculated fluid collection now measures 2.2 x 1.6 x 2.6 cm. The left lower quadrant collection no longer contacts the shunt tubing. No pelvic free fluid.Innumerable subcutaneous nodules are unchanged, likely neurofibromas. Subcutaneous edema is seen in the lower back. | Decrease in size of loculated fluid collections. |
Generate impression based on findings. | Reason: r/o retroperitoneal hemorrhage History: hgb drop, s/p nephrostomy tube accidental removal on left Lack of IV contrast limits evaluation of solid organ pathology.ABDOMEN:LUNG BASES: Small pleural effusions, left greater than right, with overlying compressive atelectasis. Basilar scarring.LIVER, BILIARY TRACT: New moderate perihepatic ascites measures simple fluid attenuation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy. Interval removal of left percutaneous nephrostomy tube. A left nephroureteral stent is in appropriate position, unchanged. There is increasing moderate left-sided hydronephrosis. No perinephric collections to suggest hematoma.RETROPERITONEUM, LYMPH NODES: Infiltrative changes involving the mesentery and omentum compatible with peritoneal carcinomatosis without significant interval change.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: Nondistended.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Infiltrative changes involving the mesentery and omentum compatible with peritoneal carcinomatosis without significant interval change.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Interval removal of left percutaneous nephrostomy tube without perinephric collection to suggest hematoma.2.Increasing moderate left hydronephrosis.3.Mesenteric and omental thickening compatible with peritoneal carcinomatosis, unchanged.4.Increasing perihepatic ascites.5.Bilateral pleural effusions. |
Generate impression based on findings. | Male; 57 years old. Reason: eval ICH History: s/p ICH Neck CTA: There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. The left common carotid artery originates from the brachiocephalic artery. There is mild narrowing of the bilateral proximal internal carotid arteries, right greater than left, due to atherosclerotic plaque. On the right, the proximal internal carotid artery measures up to 4.1 mm just past the bifurcation and 4.8 mm more distally. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. The right vertebral artery is larger than the left. There is no significant stenosis along the course of the vertebral arteries.Brain CTA: There is opacification of the distal internal carotid arteries, the distal vertebral arteries and the proximal anterior middle and posterior cerebral arteries. No aneurysms or intracranial stenosis is appreciated. Note is made of extracranial origin of the left PICA.The anterior communicating artery and the posterior communicating arteries are identified and are intact. The bilateral PCOMs are medium-sized, and the ACOM is small. There is a small infundibulum noted at the origin of the left PCOM.CT head:Previously seen large intraparenchymal hematoma centered in the right basal ganglia is not significantly changed in size since prior study and measures 72 x 40 mm (image 32, series 4), previously 70 x 40 mm. There is stable midline shift measuring 14 mm (image 32). Mild right uncal herniation with effacement of the perimesencephalic cistern is not significantly changed.There has been interval placement of a left ventriculostomy catheter with tip in the body of the left lateral ventricle. There is a very small amount of new acute hemorrhage in the left frontal lobe tracking around the catheter. There is also mildly increased amount of blood seen layering in the left lateral ventricle, which is mildly increased in size since prior study. 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.Endotracheal tube in place and terminates above the carina. There is a partially visualized airspace opacity in the right upper lung field.Multilevel degenerative changes of the cervical spine greatest at C5-6, where a posterior disk osteophyte complex and facet joint hypertrophy contribute to mild encroachment of the bilateral neural foramina and mild central canal stenosis. | 1. No evidence for intracranial aneurysm, acute arterial thrombus or dissection.2. Large right basal ganglia intraparenchymal hematoma associated with a midline shift and uncal herniation is not significantly changed in size.3. Interval placement of left frontal approach ventriculostomy catheter with tip in the body of the left lateral ventricle.4. Mildly increased amount of blood layering in the left lateral ventricle, which is mildly increased in size. |
Generate impression based on findings. | Female; 63 years old. Reason: question of PE History: new onset pleuritic chest pain, recent immobilization, tachycardia, hypoxia PULMONARY ARTERIES: No evidence of pulmonary embolism. Enlarged main pulmonary trunk diameter is compatible with pulmonary hypertension.LUNGS AND PLEURA: Diffuse but upper lobe predominant reticular opacities, traction bronchiectasis, and architectural distortion are present . No convincing evidence of honeycombing. No focal airspace opacity or pleural effusion superimposed on this background of interstitial lung disease. MEDIASTINUM AND HILA: Multiple enlarged mediastinal and hilar lymph nodes. Reference AP window node measures 9 mm in short axis and is unchanged (series 8, image 97). Mild cardiomegaly without pericardial effusion. Mild coronary calcifications. CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. Cholecystectomy clips. | 1.No evidence of pulmonary embolism. 2.Upper lobe predominant interstitial lung disease as described above and significant mediastinal/hilar lymphadenopathy. Findings are not significantly changed and differential considerations include sarcoidosis, mixed connective tissue disease, and chronic hypersensitivity. 3.Findings compatible with pulmonary hypertension. |
Generate impression based on findings. | Hematuria ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Benign left renal cysts. No worrisome mass, stone, or acute inflammatory process involving the kidneys. Unremarkable collecting systems bilaterally.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Moderately enlarged prostate gland.BLADDER: No significant abnormality notedLYMPH NODES: Mildly enlarged left pelvic lymph nodes. A representative left external iliac lymph node best seen on image 105 of series 7 measures 1.3 by 2 cm.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Negative for GU related abnormality. Benign left renal cysts without evidence for worrisome mass, acute inflammation, stone, or obstruction.Moderately enlarged prostate gland.Mildly enlarged left pelvic lymph nodes of unclear significance. |
Generate impression based on findings. | Reason: HCC s/p Y90-surveillance imaging post procedure History: as above CHEST:LUNGS AND PLEURA: Sub-solid pulmonary nodules without significant interval change. No new pulmonary nodules or masses. No pleural effusions. Mild basilar atelectasis.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. No significant mediastinal or hilar lymphadenopathy. Reference precarinal lymph node measures 1.4 x 1.1 cm (series 11, image 45), previously 1.6 x 1.1 cm. reference right hilar lymph node measures 1.4 x 0.7 cm (series 11, image 50), previously 1.4 x 0.8 cm. Coronary artery and thoracic aorta calcification.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology. Multiple arterially enhancing lesions, which demonstrate washout on portal venous and delayed images. Reference right hepatic lobe lesion measures 1.5 x 1.2 cm (series 10, image 36), previously 1.3 x 1.2 cm. Reference inferior right hepatic lobe lesion measures 3.1 x 2.7 cm (series 10, image 45), previously 3.7 x 3.9 cm. The portal vein is patent. No significant porta hepatis lymphadenopathy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerosis of the abdominal aorta and its branches without aneurysmal dilatation.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Increasing cystic lesion in the right hemipelvis measures 2.6 x 2.4 cm (series 11, image 148), previously 2.5 x 1.9 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Multifocal HCC with mixed response of reference measurements. Patent portal vein.2.Increasing cystic lesion in the right hemipelvis, previously thought to be a cystic adnexal lesion. Differential includes increasing lymphadenopathy.3.Sub-solid pulmonary nodules are unchanged and possibly post-infectious in etiology. |
Generate impression based on findings. | Female, 58 years old, metastatic esophageal cancer. As on the prior examination, diffuse stranding through the fascial planes of the neck is seen. Mucosal edema/hyperemia is also demonstrated involving the tongue base, larynx and hypopharynx. The prevertebral musculature is also mildly edematous. These findings are likely related to therapy and have not substantially changed.No focal soft tissue mass or pathologic enhancement is demonstrated within the neck. As before, the esophagus is patulous superiorly, and inferiorly, the lumen is effaced which may reflect other wall thickening or presence of debris.No pathologic adenopathy is detected in the neck by size criteria. The cervical vessels are patent. Atherosclerotic calcification is present at both carotid bifurcations. The right internal jugular vein is normal in caliber at the skull base but tapers to a thin string above the entry of the right chest porta catheter, at which point it no longer opacifies, a stable finding. The salivary glands are free of focal lesions. The left thyroid lobe remains enlarged and heterogeneous. A right upper lobe mass is better assessed on the accompanying dedicated chest CT.The cervical lordosis is reversed. There are bulky anterior osteophytes at C4 through C6. No concerning or focally destructive bony lesions are seen. | 1. Stable treatment-related changes in the neck. No definite evidence of progressive disease.2. A right upper lobe mass is better assessed on the accompanying dedicated chest CT. |
Generate impression based on findings. | Nephrotic syndrome with anemia CHEST:LUNGS AND PLEURA: Scattered micronodules. Small bilateral pleural effusions MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Bilateral axillary adenopathy. A representative left axillary lymph node best seen on image 32 of series 3 measures 2.2 x 1.6 cm.ABDOMEN:LIVER, BILIARY TRACT: Gallbladder absentSPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable right renal cystRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Uterus absentBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Diffuse anasarcaOTHER: No significant abnormality noted. | Bilateral axillary adenopathy, indeterminate in nature. |
Generate impression based on findings. | History of smoking with submandibular lymph node enlargement. There is no evidence of submandibular mass lesions or significant cervical lymphadenopathy based on size criteria. There is a punctate focus calcific density focus in the left parotid gland. The nasopharynx, oropharynx, hypopharynx, and larynx are unremarkable. There is an aberrant right subclavian artery with mild narrowing secondary to mixed attenuation plaque. There is mild proximal ICA atherosclerotic plaque, left greater than right. The thyroid gland is unremarkable. However, there is a midline linear hyperdensity that extends between the hyoid and thyroid cartilage that likely represents undescended thyroid tissue. The imaged portions of the intracranial structures and orbits are unremarkable. The paranasal sinuses and mastoid air cells are clear. There are multiple cervical spine Schmorl nodes. The imaged portions of the lungs are clear. | No definite evidence of submandibular mass lesions or significant cervical lymphadenopathy based on size criteria. |
Generate impression based on findings. | Reason: evaluate for AAA and mediastinum History: h/o AAA CHEST:LUNGS AND PLEURA: Emphysematous changes in bilateral lung apices, right greater than left. Honeycombing of the lateral lung bases, right greater than left.MEDIASTINUM AND HILA: Mild atherosclerotic calcification of the aortic arch. Coronary artery calcifications and/or stents. Mild filling defect of the descending thoracic aorta compatible with ulcerated plaque. Mild mediastinal lymphadenopathy.CHEST WALL: No significant abnormality noted. Scattered axillary lymph nodes bilaterally.ABDOMEN:LIVER, BILIARY TRACT: Multiple enhancing hepatic lesions. No intrahepatic or extrahepatic ductal dilatation. Gallbladder is without cholelithiasis.Multiple arterially enhancing hepatic lesions throughout the liver; could represent flash filling hemangiomas and less likely HCC. Background liver parenchyma appears unremarkable.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Nodularity of the left adrenal gland with fat density suggestive of a lipid rich adrenal adenoma.KIDNEYS, URETERS: Nonobstructing stone in the left kidney. Supernumerary renal arteries bilaterally.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of an ectatic descending aorta. There is an infrarenal fusiform aneurysm of the descending aorta at the L2-L3 level. The largest diameter the aorta reaches is 3.8 cm. There is a mural thrombus in the inferior portion of the aneurysm.BOWEL, MESENTERY: Small hiatal hernia. Multiple isolated diverticula without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noteddPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate with calcifications.BLADDER: No significant abnormality noteddLYMPH NODES: Bilateral, scattered inguinal lymph nodes.BOWEL, MESENTERY: Bilateral inguinal hernias containing only mesenteric fat. Scattered, subcentimeter mesenteric lymph nodes.BONES, SOFT TISSUES: No significant abnormality noteddOTHER: No significant abnormality notedd | 1.There is a infrarenal fusiform aneurysm with intramural thrombus.2.Multiple arterially enhancing hepatic lesions throughout the liver; could represent flash filling hemangiomas. Background liver parenchyma appears unremarkable. MR liver protocol is recommended for further evaluation. 3.Bilateral inguinal hernias containing only mesenteric fat.4.Small hiatal hernia. |
Generate impression based on findings. | Reason: lung cancer, s/p chemo and RT and s/p lobectomy, pls c/w previous study and evaluate dzx status. History: lung ca CHEST:LUNGS AND PLEURA: Interval right upper lobectomy.Dense airspace opacity in the superior segment of the right lower lobe, suggestive of pneumonia.Moderately large partly loculated right pleural effusion.Mild streaky opacities at the left base suggestive of subsegmental atelectasis.MEDIASTINUM AND HILA: Slightly decreased subcarinal lymphadenopathy now 6 mm in short axis.Moderate coronary artery and aortic calcification.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: Stable right adrenal nodule measuring 20 mm in diameter, likely benign.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Extensive new airspace opacity in the superior segment of the right lower lobe suggestive of infection.No specific evidence of recurrent tumor. |
Generate impression based on findings. | Lung transplant workup. Shortness of breath. LUNGS AND PLEURA: Subsegmental right middle and right base scarring and/or atelectasis not significantly changed. Mild nonspecific bronchial wall thickening likely due to asthma/bronchitis. Multifocal air trapping on expiratory phase imaging consistent with small airways disease/bronciholitis. Some early findings of emphysema are seen at the apices.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Degenerative change involving thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Hepatic steatosis. | Multifocal scarring and atelectasis with bronchial wall thickening and air trapping consistent with small airways disease/asthma. Early findings of emphysema are seen at the apices. |
Generate impression based on findings. | Post nasal drip, evaluate for sinusitis. There is mild to moderate mucosal thickening within the bilateral maxillary sinuses, which extends into the bilateral infundibula. There is moderate opacification of the anterior ethmoid air cells and frontoethmoid recesses. The frontal sinuses are otherwise clear. There are bubbly secretions within the right sphenoid sinus. The left sphenoid sinuses is clear. There is a defect in the left lacrimal fossa, which is likely attributable to dacryocystorhinostomy. There is no significant nasal septal deviation. The mastoid air cells are clear. There may be partial dehiscence of the right optic canal adjacent to the right sphenoid sinus. There is also partial dehiscence of the left Vidian canal in the left sphenoid sinus. The carotid grooves are covered by bone. There is a punctate calcified focus within the left frontal scalp, which may represent a pilomatrixoma. The imaged intracranial structures are grossly unremarkable. | Scattered paranasal sinus opacification in a sporadic pattern, including bubble secretions within the right sphenoid sinus, which may indicate acute sinusitis. |
Generate impression based on findings. | Reason: s/p 3 mo after after neoadjuvant chemotherapy/radiation followed by resection of lingula and anterior segments LUL for management of regionally advanced NSCLC History: 3 mo f/u CHEST:LUNGS AND PLEURA: Interval resection of a left upper lobe nodule.Perihilar consolidation and atelectasis consistent with radiation reaction with a small amount of residual pleural fluid or thickening.Emphysema at the right apex.MEDIASTINUM AND HILA: Dilated main pulmonary artery suggestive of pulmonary retention. Severe coronary artery calcifications.No significant lymphadenopathy. The previously referenced AP window node is not clearly visible.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: 18-mm hypodensity consistent with a cyst unchanged.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Stable right adrenal nodule measuring approximately 20 1 x 20 mm, likely benign.KIDNEYS, URETERS: Right renal cyst.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Postoperative findings with radiation reaction. No sign of recurrent tumor. |
Generate impression based on findings. | Female; 60 years old. Reason: ILD, lung transplant work-up History: SOB LUNGS AND PLEURA: Again demonstrated are diffuse ground glass and coarse reticulonodular opacities with relatively uniform distribution throughout the lungs. There is mild associated traction bronchiectasis and architectural distortion. No honeycombing or pleural effusion is identified. Surgical sutures in the right lung compatible with prior wedge resection.MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. Mild mediastinal adenopathy appears similar to the prior study. Mild coronary artery calcifications. Small hiatal hernia.CHEST WALL: Unchanged sclerotic focus in the left sixth rib which may represent old trauma or a bone island.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Pulmonary findings compatible with chronic interstitial lung disease without significant interval change. Primary differential considerations include chronic hypersensitivity pneumonitis and sarcoidosis. |
Generate impression based on findings. | : Pt with metastatic cervical esop ca s/p C5/C6 of 5-FU q21 days. Please re-eval pulm nodules. CHEST:LUNGS AND PLEURA: Multiple pulmonary metastases.Reference anterior right upper lobe nodule (series 5 image 17) 23 x 18 mm (22 x 17 mm previously).Lingular nodule (series 5 image 52) 25 x 23 mm (25 x 23 mm previously).12-mm left lower lobe subpleural nodule (series 5 image 68) unchanged.Postsurgical scarring in the right upper lobe unchanged.Emphysema.MEDIASTINUM AND HILA: Subcarinal lymph node stable at 7 mm (image 40/154). Port tip at RA/SVC junction. Diffuse esophageal thickening unchanged. Trace pericardial fluid versus thickening unchanged. Atherosclerotic calcification of the aorta and its branches. Coronary calcification. Multiple hypodense thyroid nodules are unchanged.CHEST WALL: Degenerative disease involving spine. Right chest wall port.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Punctate hypodensity right lobe of liver is too small to characterize but stable and presumably a cyst (image 105/154).SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right kidney not visualized. Stable presumed cysts on the left.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Stable small lymph nodes.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Gastrostomy tube tip in stomach.BONES, SOFT TISSUES: Soft tissue stranding and nodularity anterior abdominal wall presumably from medication injection. Degenerative change involving spine.OTHER: No significant abnormality noted. | Grossly stable metastases with measurements as above. No new sites of disease. |
Generate impression based on findings. | Male 80 years old Reason: evaluate RUL cavity / compare to prior CT scans History: productive cough; MAI in sputum; bronchoscopic lavage was negative for M tuberculosis and malignancy LUNGS AND PLEURA: Right apical thick walled cavity now measuring 5.0 x 4.2 cm (image 17 of series 4), previously 3.9 x 2.9 cm. The surrounding consolidation has significantly increased in extent. There is extensive associated bronchiectasis, and the previously described fibrosis has been replaced by consolidation.The left apical fibrosis, bronchiectasis and consolidation has increased. The multifocal areas of tree in bud opacities have increased in extent, and there is new/worsening multifocal patchy subpleural consolidation and pleural thickening.No evidence of pleural effusions.MEDIASTINUM AND HILA: Increasing mediastinal lymphadenopathy.Small sliding type hiatal hernia.Ectatic ascending aorta and moderate coronary artery calcifications.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Minimally complex left renal cyst is incompletely visualized. | 1. Increasing right apical cavity, bronchiectasis and multifocal tree in bud opacities with associated consolidation compatible with progressive tuberculous or fungal infection. This less likely represent malignancy.2. Increased left apical fibrosis consolidation.3. Mediastinal lymphadenopathy. |
Generate impression based on findings. | Female 85 years old; Reason: RTC arthropathy, evaluate glenoid bone stock History: pain. Severe degenerative changes are noted of the right shoulder. The humeral head is high riding consistent with chronic rotator cuff tear. The glenoid no longer articulates with the humerus head but rather articulates along the inferior aspect of the humeral head and along the proximal humeral neck which is causing marked cortical thinning in this region. There is a large joint effusion and there is notable atrophy of the supraspinatus and infraspinatus muscles. | 1.High riding humeral head consistent with chronic rotator cuff tear.2.Articulation of the glenoid with the proximal humeral neck is causing severe cortical thinning in this region.3.Severe degenerative changes noted elsewhere of the shoulder.4.Large shoulder joint effusion increased from previous exam. |
Generate impression based on findings. | Reason: sp 3 week craniotomy unruptured aneurysm rupture , with small subdural, evaluate for changes History: 3 week post op Since the previous examination the patient has undergone left-sided craniotomy for drainage of a left-sided subdural hematoma. There is a left-sided subdural collection present which measures 8 mm in thickness on the current exam. There is currently 5 mm midline shift towards the right.A ventriculostomy tube course through the right parietal into the body of the right lateral ventricle across the midline and has its tip along the frontal horn of the left lateral ventricle. This is stable since the prior examHypodensity involving gray and white matter is present along the right inferior parietal lobule extending to the right temporal lobe and right occipital lobe. This is associated with asymmetric enlargement of the trigone of the right lateral ventricle as well as the temporal horn of the right lateral ventricle. The ventriculostomy tube courses through the center of this focus of encephalomalacia.The patient is status post left-sided posterior communicating artery clip placementAnother smaller hypodense focus is present along the right superior frontal gyrus involving gray matter and some underlying white matter.The patient is status post embolic coil occlusion of a right posterior communicating artery aneurysmThe 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.Status post left-sided craniotomy for subdural evacuation. There is a residual left-sided subdural collection present. Since the prior MR angiogram there is less midline shift and a subdural collection has decreased in size2.Status post coiling of a right posterior communicating artery and clipping of the left posterior communicating artery aneurysm3.Encephalomalacia involving right occipital, parietal and posterior temporal lobes. |
Generate impression based on findings. | 70 year-old nonspecific abnormal findings on radiologic and other examination of biliary tract ABDOMEN:Intravenous contrast was not administered. This limits the sensitivity to detect small lesions in solid organs and bowel.LUNG BASES: Coronary artery Calcifications noted.LIVER, BILIARY TRACT: No evidence of intrahepatic or ductal dilatation. No focal lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Multiple calcified fibroids noted.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Atherosclerotic changes of abdominal aorta and its branches. | Unremarkable examination. |
Generate impression based on findings. | Abdominal pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Low-attenuation of the liver, suggestive for fatty infiltrationSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Mild left hydronephrosis and hydroureter associated with mild perinephric soft tissue infiltrationRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: 5 mm left UV junction stone best seen on image 93 of series 3. Additional subcentimeter stone within the bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 5-mm left UV junction stone associated with mild left hydronephrosis and hydroureter. Additional subcentimeter bladder calculus. |
Generate impression based on findings. | Reason: mets lung ca, ALK+, on ASP3026, s/p 6 cycles, pls c/w previous study and evaluate dz status and tx response. History: lung ca CHEST:LUNGS AND PLEURA: Postsurgical changes in the right hemithorax. Reference left subpleural nodule measures 4 mm (series 5, image 39), previously 5 cm. No suspicious pulmonary nodules or masses. No pleural effusions.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. No lymphadenopathy.CHEST WALL: Sclerotic manubrial lesion with underlying bone destruction, unchanged.ABDOMEN:LIVER, BILIARY TRACT: Punctate left hepatic lobe hypodensity is 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: Punctate right lower pole calculus.RETROPERITONEUM, LYMPH NODES: Increasing left para-aortic lymph node measures 2.9 x 2.2 cm (series 4, image 126), previously 2.6 x 1.8 cm.BOWEL, MESENTERY: Small fat containing umbilical hernia.BONES, SOFT TISSUES: Sclerotic lesions of the T1 vertebral body and right iliac wing, unchanged. 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.No suspicious pulmonary nodules or masses.2.Slightly increasing left para-aortic lymph node.3.Osseous lesions, unchanged. |
Generate impression based on findings. | Reason: History of bladder cancer History: none CHEST:LUNGS AND PLEURA: Emphysematous changes of bilateral lung apices, right greater than left. Intrafissural soft tissue density in the right lung likely represents an intrafissural lymph node.MEDIASTINUM AND HILA: Small, scattered subcentimeter normal appearing mediastinal and hilar lymph nodes. No significant lymphadenopathy.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple water density lesions likely representing benign renal cysts in the left kidney. There is prominent enhancement of the distal left ureter.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the aorta and bilateral iliac arteries. BOWEL, MESENTERY: Mild diverticulosis of the sigmoid and descending colon without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Soft tissue density mass arising from the bladder wall with ill-defined margins. The extent of the mass is best appreciated on coronal images. There is diffuse bladder wall thickening. There is mild stranding around the mass and invasion into the lateral and posterior fat surrounding the bladder cannot be excluded. Small scattered lymph nodes in the pelvis bilaterally.LYMPH NODES: No significant lymphadenopathy.BOWEL, MESENTERY: Left inguinal hernia containing only mesenteric fat.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Emphysematous changes of the lung apices, right greater than left.2.No suspicious lymphadenopathy in the chest and abdomen to suggest metastatic involvement.3.A soft tissue mass with ill-defined margins arising from the posterior lateral wall of the bladder is compatible with provided history of bladder cancer.4.Subcentimeter lymphadenopathy in the pelvis bilaterally. |
Generate impression based on findings. | Reason: bladder cancer liver mets SOB History: bladder cancer CHEST:LUNGS AND PLEURA: Previously described left lower lobe subpleural nodule is not seen on the current exam. Scattered pulmonary micronodules are unchanged. No dominant pulmonary lesion. No pleural effusion.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. No lymphadenopathy.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Heterogeneous lesion in the right hepatic lobe measures 0.9 x 0.8 cm (series 3, image 91), previously 1.0 x 0.9 cm.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Indeterminate left adrenal nodule measures 2.0 x 0.9 cm (series 3, image 108), previously 2.1 x 0.9 cm.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic disease of the abdominal aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Metallic density in the posterior thoracic soft tissues.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Calcifications of the prostate.BLADDER: Bladder wall thickening with infiltration of the perivesicular fat, unchanged.LYMPH NODES: Small pelvic lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic lesion of the left sacrum is unchanged.OTHER: No significant abnormality noted. | 1.Bladder wall thickening with infiltration of the perivesicular fat, unchanged. 2.Indeterminate left adrenal nodule, unchanged. 3.Right hepatic lobe lesion, unchanged. |
Generate impression based on findings. | Gross hematuria and dysuria ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: 2 x 1.2 cm left adrenal nodule, best seen on image 37 of series 8, without washout characteristics suggestive for benign adrenal adenoma. Bilateral adrenal calcification; favor chronic benign process.KIDNEYS, URETERS: Benign right renal cyst. No worrisome mass, inflammatory process, stone, or hydronephrosis. Unremarkable collecting systems bilaterally.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Uterus absentBLADDER: 1.6 x 1.6 enhancing polypoid mass arising from the right bladder trigone best seen on image 5 of series 6.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Enhancing polypoid mass arising from the right bladder; a malignant process such as transitional cell carcinoma must be excluded.No evidence for metastatic process or regional adenopathy.Left adrenal adenoma. Bilateral adrenal calcifications; favor benign chronic process. |
Generate impression based on findings. | Female, 8 months old, status post craniofacial reconstruction. Evaluate for subdural. Postsurgical change consistent with cranioplasty of the anterior skull is demonstrated. This includes multiple craniotomies, intracranial air, and the presence of a subcutaneous drain.There is a large pocket of intracalvarial air is along the right supraorbital cranioplasty. Also noted at this site is a small hyperdense fluid level which likely represents dependent blood product. This blood is most likely extradural rather than intradural given its morphology.Elsewhere, no evidence of abnormal extra-axial fluid is seen. No parenchymal hemorrhage is detected. Brain morphology is within normal limits. There are no focal lesions or areas of parenchymal edema. No mass effect is detected. Ventricular system is patent and within normal limits for size. | Extensive surgical change compatible with anterior calvarial cranioplasty. Layering extra dural blood product is seen along the right supraorbital cranioplasty. No evidence of extra-axial hemorrhage is seen elsewhere. |
Generate impression based on findings. | Reason: Pt with T2N1B Tonsil SCC p16 negative, s/p CRT 7/20/2012 CHEST:LUNGS AND PLEURA: Previously noted new nodule in the right lower lobe has resolved. Slightly more superiorly a similar but smaller area of opacity in the right lower lob is present and is most likely related to scarring or aspirate (image 57/109). Continued follow-up is recommended.MEDIASTINUM AND HILA: Interval port removal. Slightly increased soft tissue thickening just posterior to the right sternoclavicular joint, of uncertain significance. It may be due to prior radiation therapy or related to the recent port removal. It is not typical of metastatic disease though continued follow-up is recommended. Small subcentimeter mediastinal and hilar nodes are unchanged. Coronary calcification.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Previously noted right lower lobe pulmonary nodule has resolved. A similar but smaller opacity is noted in the right lower lobe and is again atypical for metastatic disease but may be due to aspirate/postinflammatory. No definitive evidence of metastatic disease though continued follow up is recommended. |
Generate impression based on findings. | Reason: hx of tonsil ca, s/p CRT, eval for dz, compare to previous History: as above CHEST:LUNGS AND PLEURA: Stable scattered nonspecific micronodules.No new suspicious pulmonary nodules or masses.No pleural effusions.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.Cardiac size is normal without evidence the pericardial effusion.Mild coronary artery and aortic valvular calcification.CHEST WALL: Degenerative changes with stable small foci of subcortical and subchondral bony sclerosis.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Scattered hepatic cysts unchanged.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Gastric surgical clips and associated soft tissue thickening extending to the anterior abdominal wall compatible with previous gastrostomy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No interval change. No evidence of metastatic disease. |
Generate impression based on findings. | Female, 70 years old, history of tonsil cancer. Treatment related change is seen in the left neck including thickening of the platysma as well as infiltration and stranding through the fascial planes. The soft palate and pharyngeal mucosa is mildly hyperemic, and there is a small retropharyngeal effusion. Within this background, no soft tissue mass or concerning enhancement is seen.No pathologic adenopathy is detected in the neck by size criteria. Within the upper mediastinum, anterior to the subclavian vein, ill-defined nonenhancing soft tissue thickening has developed measuring approximately 1.5 x 0.7 cm (image 75 series 4). No such tissue is seen at this location on the prior examination. An additional area of progressive soft tissue thickening is seen more inferiorly, just deep to the manubrium (image 81 series 4).The salivary glands are unremarkable. A small hypodense focus is unchanged within the left thyroid lobe. The cervical vessels are patent with atherosclerotic calcification at the bifurcations bilaterally. Mild scarring is noted at the lung apices. No concerning bony lesions are detected. Degenerative disk disease is again seen most conspicuously at C5-6. | 1. Treatment related change in the neck with no evidence of local tumor recurrence.2. No pathologic adenopathy is seen in the upper neck. 3. Within the upper mediastinum, however, ill-defined nonenhancing soft tissue thickening has developed along the carotid/subclavian junction. An additional focus of soft tissue thickening is also seen more inferiorly just deep to the manubrium. These findings are concerning for progressive adenopathy, though benign processes such as scarring do remain in the differential. Correlation with findings elsewhere in the chest, and/or PET imaging, may be helpful to better characterize these lesions. |
Generate impression based on findings. | Female 85 years old Reason: history of early-stage lung cancer of RLL s/p SBRT 1 month ago. Please evaluate for interval chagne History: post treatment surveillance CHEST:LUNGS AND PLEURA: The previously shown to be hypermetabolic right lower lobe nodule now measures 16 x 12 mm (image 74, series 5). This is approximately equivalent to the PET/CT dated 4/4/2013 however direct comparison is difficult due to differences in technique. The left upper lobe, reportedly non-FDG avid nodule measures 9 mm x 7 mm (image 37, series 5).Minimal bibasilar atelectasis.MEDIASTINUM AND HILA: Heterogeneous multinodular goiter with a 2.0 x 4.5 cm (image two, series 80340) well-circumscribed heterogeneous enhancing exophytic mass arising off the right thyroid lobe. Comparison with the prior PET/CT is difficult due to the lack of contrast administration on the prior exam. This lesion is suggestive of malignancy.No evidence of mediastinal or hilar lymphadenopathy. Severe atherosclerosis of the thoracic aorta and coronary arteries.CHEST WALL: Left breast calcification. Mild multilevel degenerative changes in the thoracic and lumbar spine.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Exam sensitivity is degraded by patient motion.LIVER, BILIARY TRACT: Segment 8 hepatic cyst. Additional subcentimeter hypodensity in right lobe is too small to characterize (image 115/133). Cholelithiasis. SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Nonspecific bilateral adrenal gland thickening incompletely characterized on this examination.KIDNEYS, URETERS: Multiple bilateral simple renal cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Severe atherosclerotic disease of the abdominal aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Multilevel degenerative changes of the thoracic and lumbar spine.OTHER: No significant abnormality noted. | 1. Stable right lower lobe nodule corresponding to known adenocarcinoma.2. Multinodular goiter and associated thyroid mass suggestive of malignancy.3. The left upper lobe nodule unchanged, and may be benign. |
Generate impression based on findings. | 60 year-old female end-stage renal disease, prekidney transplant evaluation ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Status post cholecystectomy. No intrahepatic biliary ductal dilatation. No focal lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple hypodense lesions in both kidneys could represent cysts however, not completely characterized due to lack of dedicated kidney protocol. No hydronephrosis. A large exophytic cystic lesion arising from the mid pole of the left kidney extending inferiorly measures 6.9 x 5.2 cm (image 67 ), no septation or calcifications are evident. Dedicated CT or MRI renal protocol would-be helpful for characterization of these hypodense lesions.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes in lumbosacral spine. Early AVN in the right hip joint.OTHER: Mild atherosclerotic changes of abdominal aorta PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Multiple hypodensities within both kidneys with cortical thinning, not completely characterized however, could represent cysts. Large exophytic left renal hypodense lesion, mostly a simple cyst. Dedicated CT or MRI renal protocol would-be helpful for characterization of these hypodense lesions. |
Generate impression based on findings. | Female 60 years old; Reason: breast Ca never recurrent. Abnormal LFT's, found to have lesions on outside ultrasound. Evaluate for mets, other primary tumor. History: weight loss CHEST:LUNGS AND PLEURA: No dominant lung lesion. Micronodule adjacent to the right major fissure. The pleural spaces are clear.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Post operative changes with multiple clips. Enlarged left axillary lymphadenopathy. Large left axillary lymph node measures 4.9 x 4.6 cm (image 13/series 3) .ABDOMEN:LIVER, BILIARY TRACT: Liver has a smooth contour. There are multiple hepatic metastases. A reference right hepatic lobe lesion located in segment 7 measures 4.3 x 3.6 cm (image 99/series 3). 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: Calcific arteriosclerotic disease of the aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic metastatic disease involving the lumbar spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Multiple calcified uterine fibroids.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic metastases to the left ilium.OTHER: No significant abnormality noted. | 1.Enlarged left axillary lymph nodes. Hepatic and osseous metastatic disease. |
Generate impression based on findings. | 52-year-old malignant neoplasm of pancreas. Evaluate response to chemotherapy CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Tip of Port-A-Cath at the junction of right atrium and SVC.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Status post CBD stent. Expected pneumobilia within the mildly dilated intrahepatic ductal system.SPLEEN: No significant abnormality notedPANCREAS: Upstream dilatation of the pancreatic duct measuring up to 7 millimeters (image 104, 3). The duct is abruptly narrowed in the region of the head and uncinate process by a subtle, hypodense mass measuring 1.8 x 1.9 cm (image 117, 3). The mass abuts the SMA and SMV is seen on image 116.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left-sided moderate hydronephrosis with proximal hydroureter caused by a 7-mm proximal ureteral stone. Multiple small punctate stones identified within the left kidney. Few nonobstructing stones also identified within the lower pole of right kidneyRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Known pancreatic head/uncinate process mass with CBD stent placement. The mass abuts the SMV and SMA.2. 7-mm obstructing left proximal ureteral calculus causing left-sided hydronephrosis with proximal hydroureter.Multiple nonobstructing calculi noted in both kidneys. |
Generate impression based on findings. | Status post gunshot wound to left buttock, retained missile ABDOMEN:LUNG BASES: No consolidation or pleural effusion is seen the lung bases.LIVER, BILIARY TRACT: No focal liver lesion or biliary duct dilation.SPLEEN: No focal splenic lesion.PANCREAS: The pancreas appears normal.ADRENAL GLANDS: The adrenal glands appear normal.KIDNEYS, URETERS: The kidneys enhance symmetrically and homogeneously without hydronephrosis or perinephric joint.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Free intraperitoneal air is seen anterior to the liver. BONES, SOFT TISSUES: Ascites is present.PELVIS:PROSTATE, SEMINAL VESICLES: Not well visualized.BLADDER: The bladder wall is not well visualized, however bullet fragments are seen adjacent to the posterior wall. Injury to the bladder wall cannot be entirely excluded.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: Multiple bullet fragments are seen in around the rectum. In combination with the free intraperitoneal air, there has likely been rectal injury.BONES, SOFT TISSUES: A focus of active contrast extravasation is seen in the right pelvis (images 87-90, series 10256). Moderate amount of ascites is present with areas of high density, likely hemoperitoneum.Comminuted fracture of the posterior left ilium and left sacrum are present. The largest bullet fragment is lodged in the medial right acetabulum. Due to metallic streak artifact, involvement of the joint cannot be excluded. Multiple bullet fragments are seen in the left gluteal muscles and around the left sacroiliac joint. | 1.Focus of active contrast extravasation in the right pelvis. Hemoperitoneum.2.Free intraperitoneal air and multiple bullet fragments around the rectum and posterior bladder. There is likely been rectal injury and injury to the bladder cannot be entirely excluded.3.Comminuted fracture of the posterior left ilium and left sacrum. Largest bullet fragment lodged in the medial right acetabulum. |
Generate impression based on findings. | Reason: r/o mass vs. aneurysm History: sharp low back pain L>R, lung CA ABDOMEN:LUNG BASES: Severe paraseptal emphysema.LIVER, BILIARY TRACT: Cirrhotic morphology. No ascites. Nonspecific left hepatic lobe hypodensity is too small to further characterize, likely benign. SPLEEN: Splenomegaly. Accessory splenule.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerosis of the abdominal aorta and its branches. Small periportal and retroperitoneal lymph nodes are nonspecific in the setting of chronic liver disease.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: New compression deformity of the T11 vertebral body. T9 and L1 vertebral body compression deformities are unchanged.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: High density material in the bladder represents excreted contrast.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.New compression fracture of the T11 vertebral body.2.No acute intra-abdominal abnormality. |
Generate impression based on findings. | Reason: is there aneurysm History: headache Brain CTA: There is opacification of the distal internal carotid arteries, the distal vertebral arteries and the proximal anterior middle and posterior cerebral arteries. No aneurysms or intracranial stenosis is appreciated.The anterior communicating artery is large. The left A1 segment is small. the posterior communicating arteries are tiny.The right vertebral artery is very small and hypoplastic distal to the origin of the right posterior inferior cerebellar artery.CT head:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.No evidence for aneurysm.2.No evidence for cerebral vascular occlusive disease |
Generate impression based on findings. | Reason: is there aneurysm History: headache Brain CTA: There is opacification of the distal internal carotid arteries, the distal vertebral arteries and the proximal anterior middle and posterior cerebral arteries. No aneurysms or intracranial stenosis is appreciated.The anterior communicating artery is large. The left A1 segment is small. the posterior communicating arteries are tiny.The right vertebral artery is very small and hypoplastic distal to the origin of the right posterior inferior cerebellar artery.CT head:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.No evidence for aneurysm.2.No evidence for cerebral vascular occlusive disease |
Generate impression based on findings. | Clinical question: Rule out intracranial increase pressure, has Omaya reservoir. Signs and symptoms: Nausea and vomiting. Nonenhanced head CT: There is no evidence of increased intracranial pressure. Normal size of shunted supratentorial ventricular system remains stable in size and placement of right sided ventricular catheter.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation.Unremarkable calvarium and soft tissues of the scalp.Unremarkable images through the orbits.Unremarkable all paranasal sinuses and bilateral mastoid air cells. | No acute intracranial process. Stable exam since prior study. |
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