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Generate impression based on findings. | Clinical question: 70-year-old male with OHT and seizure disorder, history of CVA. Having acute changes in mental status. Signs and symptoms: As above. Nonenhanced head CT:There is no detectable acute intracranial process. CT however is insensitive for detection of acute nonhemorrhagic ischemic strokes.Focus of encephalomalacia consistent with a chronic stroke is noted in the right posterior frontal and anterior parietal similar to prior exam.Stable mildly dilated supratentorial ventricular system and cortical sulci. Unremarkable images through posterior fossa.Unremarkable calvarium and soft tissues of the scalp, orbits, paranasal sinuses and mastoid air cells. | No acute intracranial process. Stable exam since prior study. |
Generate impression based on findings. | Male 70 years old Reason: r/o PE History: sob, doe PULMONARY ARTERIES: Technically adequate study. No evidence of pulmonary emboli or right heart strain.LUNGS AND PLEURA: Severe bilateral paraseptal and centrilobular emphysema unchanged.Posterior right upper lobe subpleural mass now measures 29 x 58 mm (image 49, series 8), previously 29 x 58 mm. The mass now has increased pleural contact, best seen on the sagittal reconstruction. Adjacent pleural thickening and calcifications unchanged. The previously demonstrated nonspecific subpleural left upper lobe nodule is no longer identified. Additional micronodules unchanged.Apical pleural thickening and calcifications unchanged.New mild bibasilar dependent atelectasis.MEDIASTINUM AND HILA: Enlarged lower right paratracheal and subcarinal lymph node unchanged.Moderate coronary artery calcifications and mild calcifications of the thoracic aorta.CHEST WALL: Sclerosis of the inferior T9 and superior T10 endplates with associated depression in T10, suggestive of prior infection, unchanged. New compression fracture deformity of the T12 vertebral body.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Splenomegaly unchanged. Enlarged inferior paraesophageal and retroperitoneal lymph nodes unchanged. | 1. No evidence of pulmonary emboli.2. New compression fracture of the T12 vertebral body.3. Extremely severe paraseptal and centrilobular emphysema.4. Increased pleural contact of the right upper lobe subpleural mass compatible with known adenocarcinoma.5. Lymphadenopathy unchanged. |
Generate impression based on findings. | Reason: ICH History: ICHIntracerebral hemorrhageUnspecified cerebral artery occlusion with cerebral infarctionIntracerebral hemorrhageIntracerebral hemorrhage There is a redemonstration of a large right basal ganglia hematoma currently measuring 48 x 84 mm axial dimensions and previously measuring 3 x 48 mm axial dimensions. The patient is status post drainage catheter placement within this hematoma. A small amount of blood is adjacent to the drainage catheterThe punctate hematoma measuring 8 x 5 mm axial dimensions is redemonstrated in the right thalamusThe patient is also status post ventriculostomy tube placement coursing to the left frontal lobe into the left lateral ventricle with tip in the frontal horn of the left lateral ventricle in the region of foramen of Monro. A small amount of blood is present adjacent to the ventriculostomy tube. There is redemonstration of intraventricular blood as well some dilation of the temporal horn of the right lateral ventricle indicating entrapment. The sulci are completely effaced. The septum pellucidum is shifted 18 mm to the left of midlineThere is uncal herniation, subfalcine and transtentorial herniation which are stableThe visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.There is redemonstration and no change of a large right basal ganglia hematoma associated with significant mass-effect with sulcal effacement and midline shift, uncal herniation, subfalcine and transtentorial herniation which are stable . There is a extensive intra-to the in the lateral and third ventricles as well as a small hemorrhage in the right thalamus2.status post hematoma drainage tube in stable position3.Status post left-sided ventriculostomy tube in stable position. |
Generate impression based on findings. | Reason: Pt s/p en bloc tumor rxn w/ sigmoid colon, end colostomy 9/25 for peritonitis/stool spillage/peritonitis - pt has persistant elevated WBC - please eval for undrained abscess History: Elevated WBC ABDOMEN:LUNG BASES: Large left pleural effusion with overlying compressive atelectasis. Marked interval decrease in right pleural effusion. Bibasilar atelectasis.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Multiple loculated perisplenic fluid collections measuring up to 10.9 x 7.4 cm (coronal image 46) in the left subdiaphragmatic region. There are multiple foci of gas within this large collection, which appears larger and more well organized compared to the prior exam.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post left nephrectomy.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes.BOWEL, MESENTERY: Diffuse mesenteric stranding and increasing loculated mesenteric fluid. A surgical drain tip terminates in the left lower quadrant. There is a loculated fluid collection adjacent to a jejunal loop measuring 2.8 x 2.0 cm (series 3, image 71) without significant interval change. Mildly distended jejunal loops without evidence of obstruction. No pneumoperitoneum.BONES, SOFT TISSUES: Diffuse body wall anasarca. Small fat containing ventral hernia.OTHER: Enteric tube terminates in the duodenum.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: Small focus of air in the bladder is likely iatrogenic.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes in the pelvis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Increasing loculated mesenteric fluid and large left subdiaphragmatic collection with internal foci of gas.2.Decreasing right pleural effusion.3.No evidence of bowel obstruction or pneumoperitoneum. |
Generate impression based on findings. | Reason: 66 yo female with history of CD presents with abd pain concerning for SBO. SBFT showing mid small bowel wall thickening concerning for ischemia History: abdominal pain Residual barium is visualized in the transverse and proximal descending colon. The small amount of residual contrast is visualized in the sigmoid colon. Nonobstructive bowel gas pattern. | 1.Incomplete study due to residual barium from prior study. Scout image demonstrates residual barium in the transverse and proximal descending colon as well as the sigmoid colon. 2.Nonobstructive bowel gas pattern. |
Generate impression based on findings. | Hip pain, question of fracture. CT images of the right hip reveal osteophyte formation along the acetabulum, predominately along the superior aspect. There is no fracture or malalignment. There is no acute fracture of the visualized femur. Focus of endosteal scalloping seen on radiographs is again seen and filled with fatty marrow; this is likely of no clinical significance. | No evidence of fracture or malalignment. |
Generate impression based on findings. | 8 year-old female. Trauma. Clinical service wanted abd/pelvis scan with L-spine reconstructions to save the patient radiation. ABDOMEN:LUNG BASES: Lung bases are clear.LIVER, BILIARY TRACT: Normal appearance of the liver. No focal hepatic lesion. No biliary ductal dilatation.SPLEEN: Normal appearance of the spleen.PANCREAS: Normal appearance of the pancreas.ADRENAL GLANDS: Normal appearance of the adrenal glands.KIDNEYS, URETERS: Normal appearance of the kidneys. No hydronephrosis. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Normal caliber of the bowel. No pneumoperitoneum.BONES, SOFT TISSUES: No fracture identified.OTHER: No free fluid.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Normal appearance of the bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Normal caliber of the bowel. No pneumoperitoneum.BONES, SOFT TISSUES: Cortical step-off of the right superior pubic ramus is probably a buckle fracture (series 4, image 98). Lumbar spine alignment is anatomic without acute fracture.OTHER: No free fluid. | 1. Probable right superior pubic ramus buckle fracture. 2. No evidence of solid organ injury. |
Generate impression based on findings. | Neutropenic with fever and sinus pain. Evaluation for sinusitis. There is opacification of the right maxillary sinus as well as thin band of soft tissue density demonstrated within the retromaxillary fat immediately posterior to the right maxillary sinus wall which extends to involve the right pterygopalatine fossa. While there is no frank bony defect, the posterior wall of the sinus demonstrates a mottled appearance which is suggestive of potential bony involvement in an aggressive infectious process.The left maxillary sinus is partially opacified and there are punctate calcific foci demonstrate along the lateral wall. There is minimal involvement of the frontal sinuses. Ethmoid and sphenoid sinuses are partially opacified bilaterally. Within limits of the technique, orbits are normal. | Partial opacification of frontal, ethmoid, sphenoid and left maxillary sinuses. Near total opacification of the right maxillarysinus with findings suggesting extension beyond the confines of the right maxillary sinus including fat stranding and possible bony involvement of the posterior wall. These features suggest a more aggressive (potentially fungal) etiology for this patient's sinusitis. |
Generate impression based on findings. | Reason: concern for pneumonia s/p abdominal surgery History: concern for pneumonia s/p abdominal surgery CHEST:LUNGS AND PLEURA: Bilateral basilar airspace consolidation, right greater than left. MEDIASTINUM AND HILA: Endotracheal tube are noted. Nasogastric tube with tip in the distal antrum. Right internal jugular central line and right subclavian central line.CHEST WALL: Loculated fluid collection with a slightly enhancing wall within the soft tissue overlying the right pectoralis muscle may represent a seroma. Surgical clips surround the fluid collection. There is no evidence of air in the fluid collection or phlegmon in the fat to suggest infection but CT is limited in characterization of fluid.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter, hypodense lesion in the left lobe of the liver, segment 3 is too small to further characterize. SPLEEN: Subcentimeter, hypodense lesion in the spleen is too small to further characterize. No evidence of intrahepatic or extrahepatic dilatation. No evidence of cholelithiasis.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right kidney is surgically absent. Atrophic left kidney with multiple renal cysts of water density. Stable enhancing kidney lesion in the superior pole is poorly defined due to the screening nature of this study but is suspicious for malignancy.RETROPERITONEUM, LYMPH NODES: Scattered, subcentimeter retroperitoneal lymph nodes. Atherosclerotic calcifications of the descending aorta and bilateral iliac arteries. Splenic artery calcifications. Right retroperitoneal fluid collection.BOWEL, MESENTERY: Diffuse scattered, moderate amount of fluid collections throughout the peritoneum some of which appears loculated. Fluid collections in nondependent portions of the upper mid- and left lateral mid-abdomen suggest loculated collections. Scattered, subcentimeter mesenteric lymph nodes. For reference, a loculated fluid collection in the left gutter measures 4.1 x 4.1 cm (series 3, image 120).BONES, SOFT TISSUES: Surgical staples over the mid abdomen noted. Sclerotic focus in the T2 vertebral body. Sclerotic focus in the L4 vertebral body.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Collapsed and not well-visualized.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Rectal balloon. Patient is status post colectomy with ileocolostomy. Contrast is seen within the rectum and extravasating from the anastomosis site. Multiple fluid collections are seen in the dependent portions of the pelvis. There is free intraperitoneal air. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Extravasation of contrast from the ileocolostomy anastomosis.2.Diffuse, scattered fluid collections throughout the peritoneum and pelvis, some of which appear loculated.3.Loculated fluid collection in the soft tissue of the the right chest may represent a seroma. There are no signs of infection but CT is limited in the characterization of fluid collections.4.Bibasilar air space consolidation of the lung bases, right greater than left.5.Stable lesion in the superior pole of the left kidney is poorly defined due to the screening nature of the study. A follow up with dedicated kidney CT is recommended.Results were discussed with the primary surgery service, Dr. Barrreto-Andrade (pager 2941) over the phone at 10:49p.m. on 10/07/2013 by Dr. Michael Veronesi. |
Generate impression based on findings. | Reason: 51 M with hx of myoepithelial carcinoma of L palate s/p XRT with recurrence s/p salvage maxillectomy and graft. Please evaluate for residual tumor, possible skull base invasion. History: L face pain. Dysphagia. LUNGS AND PLEURA: Stable, nonspecific micronodules the right apex. No evidence of pleural or pulmonary metastases.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. No mediastinal or hilar lymphadenopathy.CHEST WALL: No axillary lymphadenopathy.UPPER ABDOMEN: Scattered hepatic hypodensities do not appear to be simple cysts,but could represent hemangiomas. Interval placement of a percutaneous gastrostomy tube.No significant abnormality noted. | Nonspecific, stable micronodular right apex. No specific evidence of intrathoracic metastases. |
Generate impression based on findings. | 62-year-old female with left flank pain -- evaluate for kidney stone ABDOMEN: Within the limits of a non-IV contrast enhanced examination limiting evaluation of abdominal parenchymal organs and vascular structures, the following observations can be made: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: Both kidneys are of normal size and morphologic appearance. Vascular calcification is seen in the left kidney, but no other parenchymal calcifications are seen. No hydronephrosis. No perinephric fluid collections. No masses are identified, however, with out IV contrast, cannot exclude small and moderate-sized masses.Ureters are nondilated and no calcifications are seen in their course other than adjacent vascular calcifications.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No abnormality seen in the stomach, large and small bowel in the abdomen. See pelvis discussion below.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 evidence of bowel obstruction. Small bowel appears intrinsically normal. There is extensive diverticular change seen in the sigmoid colon. There is adjacent infiltrating changes in the mesenteric root superior to these diverticular changes of uncertain significance. This may represent inflammatory changes without frank fluid collection, but is nonspecific in its appearance. No old studies are built for comparison to confirm that this is an acute finding.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Extensive diverticular changes in the sigmoid colon without wall thickening or adjacent fluid collections. 2. Slight increased haziness to the mesenteric just superior to the sigmoid colon, which may be adjacent inflammation related to diverticular disease or be independent. Nonspecific in nature. |
Generate impression based on findings. | Male, 51 years old, history of myoepithelial carcinoma of the left palate, status post radiation with recurrence status post salvage maxillectomy and graft. Presenting with left face pain and dysphagia. Evaluate for residual tumor, possible skull base invasion. Since the prior examination, patient has undergone left maxillectomy with resection of the left maxillary sinus, left hard palate and left inferior turbinate. The inferior orbital wall has been reconstructed and fixed with sideplates and screws, using either bone graft or native maxillary bone. A myocutaneous flap has been placed with in the surgical defect. The muscular component seems to enhance similarly to skeletal muscle elsewhere and is likely normal. It blends with more hypodense muscle within the infratemporal fossa.Within the left masticator space, at the posterior lateral margin of the myocutaneous flap, adjacent to the vascular pedicle, there is a rim enhancing, centrally hypodense lesion measuring 3.6 x 2.2 cm (image 44 series 5). No lesion is seen at this location on the prior exam.Subtly enhancing soft tissue containing flecks of calcific material is present more medially along the posterior margin of the myocutaneous flap (see image 38 series 5). Very subtle enhancement with scattered calcific flecks extends from here inferiorly into the residual pterygoid musculature (see image 43 series 5). Given that tumor was present at these locations on the prior examination, and that it demonstrated similar imaging characteristics, the possibility that these findings represent infiltrative residual or recurrent tumor should be considered.The pterygoid plates on the left are deformed likely secondary to both tumor and surgical change. The pterygopalatine fossa on the left is mildly widened, and its inferior aspect is infiltrated by soft tissue. This is a nonspecific finding which may reflect scarring or potentially tumor invasion. Just anterior to the pterygopalatine fossa, there is a small fluid level layering within the residual maxillary sinus with some minimal enhancement of the immediately adjacent myocutaneous flap. Again, the findings are of uncertain significance.Within the limitations of CT, no other evidence of skull base invasion is demonstrated. Foramen ovale and foramen rotundum are not eroded or widened. The cavernous sinus and Meckel's cave are within normal limits.Elsewhere in the neck, no mass lesion or pathologic adenopathy is detected. The fascial planes of the left neck are infiltrated compatible with therapy. The left submandibular gland is absent. The residual salivary glands and thyroid are within normal limits. Cervical vessels remain patent. Lung apices show no significant abnormality. Except as above, no bony lesions are demonstrated. The left mastoid air cells are newly opacified when compared to the prior exam. | Extensive postsurgical change, new from the prior examination, including left maxillectomy and reconstruction with a myocutaneous flap.There is a peripherally enhancing, centrally hypodense lesion along the left posterior lateral margin of the graft, adjacent to the vascular pedicle, which is highly concerning for a focus of recurrent tumor. Vague enhancing tissue is also seen more medially along the posterior margin of the graft, extending down into the residual pterygoid musculature. As the tumor noted on prior exam was located in this vicinity and demonstrated similar imaging characteristics, the possibility of infiltrative tumor in these locations cannot be excluded.The left pterygopalatine fossa is mildly widened and there is some degree of soft tissue infiltration of the inferior aspect. This is nonspecific and may represent postsurgical scarring or tumor invasion. Elsewhere, no definite evidence of skull base tumor invasion is seen within the limitations of CT. |
Generate impression based on findings. | MVC. Rule out bleed. Head: No intracranial mass, fluid collection, hemorrhage, hydrocephalus or CT evidence of acute ischemia. Gray-white differentiation is maintained bilaterally and the midline is intact. Max/face/sinus: There are no visualized facial or mandibular fractures. There is a very small amount of soft tissue density within the maxillary sinuses representing mucosal thickening or secretions. Orbits are unremarkable. | No visualized sequelae of trauma. A small amount of maxillary sinus secretion could potentially imply early/mild sinusitis. |
Generate impression based on findings. | Reason: eval for biliary pathology, SBO History: epigastric pain ABDOMEN:LUNG BASES: Multiple basilar pulmonary micronodules measuring up to 4 mm (series 4, image 19). LIVER, BILIARY TRACT: Peripherally enhancing left hepatic lobe mass compatible with a hemangioma. Right hepatic lobe cyst and parenchymal calcifications. Mild intrahepatic biliary ductal dilatation. The common bile duct is prominent. No CT evidence of gallstones.SPLEEN: No significant abnormality noted.PANCREAS: Infiltrative changes of the pancreatic head with peripancreatic stranding. There is a papillary lesion protruding into the duodenal lumen at the level of the ampulla (coronal image 59) with eccentric medial duodenal wall thickening.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: No evidence of obstruction. The appendix is normal. No pneumoperitoneum or mesenteric fluid. BONES, SOFT TISSUES: Small fat containing umbilical hernia.OTHER: Surgical clips are noted along the left diaphragmatic crus and GE junction.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Findings compatible with an ampullary lesion and possible subsequent pancreatitis. MRCP should be considered for further evaluation.2.Nonspecific basilar pulmonary micronodules. |
Generate impression based on findings. | Reason: 58yoM with head and neck cancer, checking for recurrence and extent History: head/neck ca LUNGS AND PLEURA: Right apical opacities favor that of radiation reaction. Dependent groundglass, mild bronchial wall thickening with subsegmental atelectasis raising the question of aspiration. Focus of consolidation at the medial basal segment left lower lobe may be a focus of resolving infection. It is contiguous with subsegmental atelectasis and pleural thickening and a small left pleural effusion within the posterior costophrenic angle; the differential diagnosis includes rounded atelectasis.Pulmonary cyst lateral left major fissure.No suspicious pulmonary nodules. MEDIASTINUM AND HILA: Heart size is within limits of normal. Mild coronary artery calcification. Density within the proximal right coronary artery favors that of a stent.Mildly enlarged lymph node at the midline, immediately inferior to the thyroid and isthmus (series 3 image 12) measuring 12 mm. Mild aortopulmonary lymphadenopathy. Reference lymph node in measures 22 mm in short axis (series 3 image 33).CHEST WALL: Degenerative changes of the glenohumeral joints. UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Hypodensities within liver too small to characterize but may represent cysts or hemangiomas. Small hiatal hernia. | 1. Apical opacities favor that of radiation reaction.2. Dependent opacities subsegmental atelectasis. Consolidation medial basal segment left lower lobe, consider infection related to aspiration or round atelectasis with associated small pleural effusion.3. Mild mediastinal lymphadenopathy.4. No evidence of pulmonary metastases. |
Generate impression based on findings. | 57-year-old male with abdominal pain and fevers -- rule-out abscess. CHEST:LUNGS AND PLEURA: No masses, nodules or infiltrates. No pleural effusions.MEDIASTINUM AND HILA: No adenopathy, masses or abnormal fluid collections. Intubation tube traverses through the esophagus into the stomach.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Liver parenchyma appears homogeneous. Pneumobilia is seen indicating patent larger. Biliary stents, unchanged in position through to the duodenum. Air is seen in the gallbladder to be expected in a patient with stent without other abnormality seen in gallbladder.SPLEEN: No significant abnormality notedPANCREAS: In tail of pancreas again appear normal in appearance. Head and uncinate process are pertinent again posteriorly and medially where the prior noted large fluid collection abuts the pancreas and discrimination between fluid collection and involvement of the uncinate process cannot be differentiated. These changes appear stable.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left kidney appears normal with a single simple benign cyst medially. Right kidney shows normal parenchyma, but slightly increasing hydronephrosis. This most likely indicates an element of obstruction from the inflammatory process. More medially and anteriorly located. Extensive perinephric fluid collections are seen described. Under retroperitoneum, below.RETROPERITONEUM, LYMPH NODES: The extensive abnormal fluid collections throughout the right retroperitoneum, and in circling the right kidney and extending into the right posterior chest wall and right psoas muscle are again noted. There has been interval insertion of a large draining through the right flank posterior to the kidney and extending up towards the uncinated process. The diffuse collections seen previously has slightly decreased in size subjectively and now have air within them most likely introduced by the large drain. Fluid collection reference measurements as compared to prior are as follows:Fluid collection posterior to the uncinate process and extending to the inferior vena cava and right kidney (series 3, image 124) now measures 10.1 by 5.0-cm compared with prior 10.5 x 4.7 cm.Inferior-most component of fluid in the right pelvis (series 3. Count, image 164) now measures 3.9 x 1.8 cm compared with 4.5 x 2.8 cm..The degree of involvement in the right flank wall musculature and psoas muscle cannot directly be compared because the large bore drain extends through this area and obscures details.No new fluid collections are identified. BOWEL, MESENTERY: Orally administered contrast traverses through normal appearing stomach, and, as described for the duodenum is effaced by the large adjacent fluid collections. Intubation tube extends past this region into the proximal small bowel. Small bowel to the right lower quadrant is opacified by oral contrast and appears normal. The colon shows no abnormalities and is fluid and feces filled. No free mesenteric fluid is seen.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: Orally administered contrast traverses through normal appearing jejunum and ileum to the right lower quadrant. The colon shows no abnormalities and is fluid and feces filled. No free mesenteric fluid is seen.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Number one good interval insertion of large right flank catheter into retroperitoneum. 2. Minimal, change in measured size of fluid collections throughout retroperitoneum, but subjectively slightly smaller. 3. No abnormality seen in chest. 4. No new fluid collections identified. |
Generate impression based on findings. | Male; 45 years old. Reason: eval subdural History: bilat evac sdh with drains, level of drains decreased 10/7 Redemonstration of bilateral subdural hematomas with postoperative pneumocephalus. When measured at the same locations as in the comparison study, both collections are not significantly changed in size. The right measures up to 11 mm (previously 11 mm) and the left 12 mm (previously 10 mm) (image 38, series 80256). The right drain has retracted in position and now has its tip approximately 2-cm from the calvarium; the catheter tip remains in the subdural space. The left drain is stable in position.Ventricles are stable in size and configuration. Status sulcal effacement from the bilateral subdural collections. No new hemorrhage or overt hematoma formation.Accompanying overlying calvarial and soft tissue changes are noted, expected postprocedural findings. Orbits, paranasal sinuses, and mastoid air cells are unremarkable. | 1. No significant interval change in bilateral subdural fluid and air collections. No new hemorrhage or overt hematoma formation.2. Right-sided subdural drain is retracted when compared to prior study with its tip within the subdural space approximately 2 cm from the calvarium. |
Generate impression based on findings. | Female 61 years old; Reason: new serous uterine cancer, evaluate metastatic disease preop History: see above CHEST:LUNGS AND PLEURA: No dominant lung lesions. The pleural spaces are clear. The central airways are patent.MEDIASTINUM AND HILA: Heart size is normal. There are enlarged mediastinal lymph nodes with a prevascular node measures 1.7 x 0.7 cm (image 25/series 3). There are enlarged left axillary lymph nodes.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Liver contour is smooth. Well marginated fluid hypoattenuating right hepatic lobe lesion most likely represents a cyst. Smaller hypodense hepatic lesions are too small to characterize.Hepatic and portal veins are patent.Multiple noncalcified gallstones within a nondistended gallbladder. No intra-or extrahepatic ductal dilatationSPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cyst. No hydronephrosis or nephrolithiasisRETROPERITONEUM, LYMPH NODES: Calcific arteriosclerotic disease of the aorta. Small retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Enlarged left adnexa measuring 1.4 x 4.4 cm. Thickening of the endometrial cavity.BLADDER: No significant abnormality noted.LYMPH NODES: Small pelvic lymph nodes. Left pelvic sidewall node measures 2.2 x 0.6 cm (image 153/series 3). BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Post operative changes in the anterior abdominal wall.OTHER: No pelvic ascites. | 1.Enlarged left adnexa possibly to spread of disease to the left adnexa.2.Cholelithiasis.3.Mildly enlarged mediastinal lymph node and left axillary nodes |
Generate impression based on findings. | cerebral hemorrhage/Intracerebral hemorrhageIntracerebral hemorrhage There is a redemonstration of a large right basal ganglia hematoma currently measuring 48 x 84 mm axial dimensions and previously measuring 71 x 41 mm axial dimensions. It appears to have enlarged along its medial aspect and superior aspect. Coronal imaging and currently measure 71 x 44 mm and previously measured 61x40 mm. The patient is status post drainage catheter placement within this hematoma. A small amount of blood is adjacent to the drainage catheterThe punctate hematoma measuring 8 x 5 mm axial dimensions is redemonstrated in the right thalamus and is unchangedThe patient is also status post ventriculostomy tube placement coursing to the left frontal lobe into the left lateral ventricle with tip in the frontal horn of the left lateral ventricle in the region of foramen of Monro. A small amount of blood is present adjacent to the ventriculostomy tube. The prior examination the lateral ventricles have decreased in size. The sulci are completely effaced now. The septum pellucidum is shifted 18 mm to the left of midline and previously was 13 mm.There is uncal herniation, subfalcine and transtentorial herniation.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.There is redemonstration and enlargement of a large right basal ganglia hematoma associated with significant mass-effect with sulcal effacement which has progressed. There is an associated uncal herniation, subfalcine and transtentorial herniation. Midline shift has progressed . There is a extensive intraventricular blood in the lateral and third ventricles as well as a small hemorrhage in the right thalamus. 2.status post hematoma drainage tube which is in stable position3.Status post left-sided ventriculostomy tube in stable position. |
Generate impression based on findings. | MVA. Right-sided neck pain. Rule out fracture. There is straightening of the cervical spine which could be on the basis of position/neck brace or muscle spasm. Vertebral body and intervertebral disk heights are maintained. There are no visualized fractures. There is no prevertebral soft tissue swelling. The odontoid is intact. | No visualized fracture or abnormality of the cervical spine. |
Generate impression based on findings. | Male 57 years old Reason: mets lung ca, EGFR +, on Metmab and Erlotinib now, s/p cycle 18, pls c/w previous study and evaluate tx response. History: lung ca CHEST:LUNGS AND PLEURA: Right apical pleural thickening and traction bronchiectasis unchanged. Perihilar bronchial thickening, bronchiectasis and fibrosis unchanged. Findings are compatible with postsurgical scarring and radiation reaction.Small right pleural effusion unchanged.No new suspicious nodules identified.MEDIASTINUM AND HILA: Hypoattenuating thyroid nodules unchanged. No evidence of mediastinal or hilar lymphadenopathy. Rightward mediastinal shift unchanged.CHEST WALL: Mild multilevel degenerative changes of the thoracic and lumbar spine.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Multiple small hypoattenuating lesions appear more conspicuous, possibly due to contrast phase. Non-reference hepatic segment 4a lesion appears larger, but this may be related to differences in contrast phase. Reference right hepatic lobe lesion measures 6 x 6 mm (image 99, series 4), previously measuring 6 x 6 mm.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts unchanged. Bilateral punctate calcifications in the renal sinus compatible with nonobstructive nephrolithiasis. Resolution of left perinephric inflammatory changes.PANCREAS: Distal pancreatic atrophy and pancreatic ductal dilatation unchanged. Ill-defined hypodense lesion in the proximal pancreatic body now measures 9 mm in diameter (image 110, series 4), previously 8 mm.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Mild multi-level degenerative changes of the thoracic and lumbar spine.OTHER: No significant abnormality noted. | 1. Increased conspicuity of hepatic lesions, likely related to contrast phase, with possible increase in size of segment 4a lesion.2. Otherwise, no significant interval change or new lesions identified. |
Generate impression based on findings. | Reason: Cirrhosis protocol eval liver lesions, masses, ascites rising AFP 1194 History: cirrhosis, HCV, rising AFP 1194 CHEST:LUNGS AND PLEURA: Basilar atelectasis.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. No lymphadenopathy.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology. Solitary arterially enhancing lesion in segment 6 measures 2.3 x 2.6 cm (coronal image 49), and demonstrates washout on portal venous and delayed images. In retrospect, this lesion was faintly appreciable on the prior exam. The portal vein is patent. There is increasing ascites.SPLEEN: Splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Nonobstructive right upper pole calculus. RETROPERITONEUM, LYMPH NODES: Prominent upper abdominal and retroperitoneal lymph nodes are nonspecific in the setting of chronic liver disease.BOWEL, MESENTERY: No evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Upper abdominal varices.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: Distended.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.Increasing right hepatic lobe mass compatible with HCC.2.Portal vein is patent.3.Increasing ascites.4.Cirrhosis with evidence of portal hypertension. |
Generate impression based on findings. | Follow-up ventriculomegaly. Ventriculostomy catheter is demonstrated traversing the right frontal lobe with its tip in the right frontal horn. There is hypoattenuation along the catheter tract which slightly more prominent than on the examination one day prior. The ventricular diameter has been unchanged since the prior examination and there is demonstration of interval partial resolution of intraventricular blood products layering at the right trigone.The multiple bilateral mixed attenuating lesions known to represent metastatic disease are demonstrated in super and infratentorial compartments as well as at the pineal region. There is associated vasogenic edema demonstrated within the cerebellum and most prominently associated with a lesion at the left posterior frontal convexity. The there is local mass effect associated with the frontal lesion with more pronounced mass effect in the posterior fossa -- there is effacement of the prepontine cistern and crowding of the foreman magnum without frank herniation. There is some upward deviation of the tentorium at its midpoint. There is no evidence of ischemia. There are no aggressive appearing bony lesions demonstrated. | Unchanged ventricular diameter and stable position of ventriculostomy catheter with interval partial resolution of intraventricular blood demonstrated previously. Unchanged presence/effect of multiple bilateral supra- and infratentorial metastatic lesions. Mass effect within the posterior fossa without frank herniation. |
Generate impression based on findings. | Male 56 years old; Reason: lymphoma History: lymphoma CHEST:LUNGS AND PLEURA: Cyst in the right upper lobe with subcentimeter nodules adjacent to it. No dominant or suspicious lung lesion. Pleural spaces are clear.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. There are borderline enlarged mediastinal lymph nodes.CHEST WALL: Enlarged thoracic inlet, subpectoral and axillary nodes reference left axillary lymph node measures 2.3 x 1.3 cm (image 14/series 3). OTHER: ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Spleen is enlarged measuring approximately 15 cm.PANCREAS: No significant abnormality notedADRENAL GLANDS: Right adrenal lesion which appears hypodense and may represent an adrenal adenoma however, it cannot be characterized on this single phase CT. It will be best evaluated on a noncontrast CT or MRI.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes. Left para-aortic node measures 1.5 x 0.9 cm (image 127/series 3). 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: Enlarged pelvic lymph nodes. Right pelvic side wall node measures 4.1 x 2.1 cm (image 176/series 3). BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Axillary, subpectoral and thoracic inlet adenopathy.2.Splenomegaly.3.Pelvic lymphadenopathy4.Indeterminate right adrenal lesion. |
Generate impression based on findings. | Reason: 71M w/ complicated diverticular disease now POD 25 s/p ex lap, subtotal colectomy, creation of end ileostomy, left ureteral stent placement; c/b bladder and left ureteral injury s/p vesicular /ureteral repair and abdominal wall reconstruction with biologic mesh placement History: abdominal wall cellulitis, also eval for vesicular leak, fluid collection ABDOMEN:LUNG BASES: Moderate pleural effusions bilaterally, left greater than right, with atelectasis. Stable micronodule in the right lung (series 4, image 4).LIVER, BILIARY TRACT: Small subcentimeter hyperdense lesion in the right lobe of liver, segment 5. Status post cholecystectomy. No evidence of intrahepatic or extrahepatic ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Horseshoe kidneys. Calcific focus in the superior pole of the right kidney. There is excretion of contrast into the pelvis but no contrast visualized within the ureters and bladder. RETROPERITONEUM, LYMPH NODES: There is scattered, subcentimeter retroperitoneal lymph nodes.BOWEL, MESENTERY: Dilated loops of small bowel with air-fluid levels suggestive of small bowel structure, with mild improvement compared to prior exam. Status post colectomy.BONES, SOFT TISSUES: Surgical drain within a loculated fluid collection in the anterior mid abdomen, significantly improved compared to prior exam. Soft tissue fat stranding at the ileostomy site with interval improvement of adjacent loculated fluid collection measuring 3.4 x 1.7 cm (series 3, image 112). There is a new phlegmon, adjacent to the ileostomy that enhances and measures 2.2 cm.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: The bladder wall is thickened and accentuated by collapse. Although there are no fluid collections around the vast majority of the bladder, there are some ill-defined densities around the distal ureter and the dome of the bladder. Without contrast filling the bladder and ureters, a leak cannot be completely excluded. LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Status post subtotal colectomy with residual Hartmann's pouch and end ileostomy.BONES, SOFT TISSUES: Evidence of right hip replacement. Degenerative disease of the L4-L5 vertebral bodies with vacuum disk phenomenon. OTHER: No significant abnormality noted | 1.Interval improvement of multiple anterior fluid collections.2.Although there are no fluid collections around the vast majority of the bladder, there are some ill-defined densities around the distal ureter and the dome of the bladder. Without contrast filling the bladder and ureters, a leak cannot be completely excluded. 3.Horseshoe kidneys with calcified, nonobstructing stone in the right upper pole. 4.Slight interval improvement of small bowel dilation.5.Bilateral pleural effusions with atelectasis, stable.6.Status post subtotal colectomy with residual Hartmann's pouch and end ileostomy |
Generate impression based on findings. | 86-year-old female with abdominal distention and vomiting. Concern over small bowel obstruction. ABDOMEN:LUNG BASES: Bibasilar pleural effusions, left greater than right. Left basilar atelectasis.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Benign cortical cysts in left kidney -- no other significant abnormality.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: NG tube traverses the esophagus into the stomach. Stomach appears distended, but otherwise normal. Small bowel loops are distended and the proximal and mid small bowel loops show disproportionate dilatation compared to collapsed distal ileal small bowel most consistent with small bowel obstruction. No abnormal masses are seen to suggest neoplastic obstruction and etiology most likely is adhesions.There is ascites dependent in the lateral flanks and pelvis -- obstruction with the presence of ascites may be a risk for ischemia.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Pelvic floor relaxation with the neck of the bladder slipping lower in the pelvis.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Small bowel loops are distended and the proximal and mid small bowel loops show disproportionate dilatation compared to collapsed distal ileal small bowel most consistent with small bowel obstruction. No abnormal masses are seen to suggest neoplastic obstruction and etiology most likely is adhesions. The colon is filled with feces and other than postsurgical changes in the sigmoid colon with anastomosis shows no other abnormalities.There is ascites dependent in the lateral flanks and pelvis -- obstruction with the presence of ascites may be a risk for ischemia.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Marked disproportionate plane proximal and mid small bowel versus collapsed distal small bowel indicative of bowel obstruction. 2. Presence of ascites can be associated with ischemic changes from obstruction. |
Generate impression based on findings. | Reason: CT guided aspiration of ICH History: left sided weakness There is a redemonstration of a large right basal ganglia hematoma currently measuring 71 x 41 mm and 61x40 mm coronal dimensions. The patient is status post drainage catheter placement within this hematoma. A small amount of blood is adjacent to the drainage catheterThe punctate hematoma measuring 8 x 5 mm axial dimensions is redemonstrated in the right thalamus and is unchangedThe patient is also status post ventriculostomy tube placement coursing to the left frontal lobe into the left lateral ventricle with tip in the frontal horn of the left lateral ventricle in the region of foramen of Monro. A small amount of blood is present adjacent to the ventriculostomy tube. The prior examination the lateral ventricles are mildly dilated but stable since the prior exam. The sulci are completely effaced now. The septum pellucidum is shifted 13mm to the left of midline .There is uncal herniation, subfalcine and transtentorial herniation.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.Examination was not performed for CT guidance so that the referring service could place a drainage catheter in the right basal ganglia hematoma.2. There is redemonstration and enlargement of a large right basal ganglia hematoma associated with significant mass-effect with sulcal effacement. There is an associated uncal herniation, subfalcine and transtentorial herniation and midline shift. There is a extensive intraventricular blood in the lateral and third ventricles as well as a small hemorrhage in the right thalamus. 3.Status post left-sided ventriculostomy tube in stable position. |
Generate impression based on findings. | Male 72 years old; Reason: Rectal cancer please assess and provide index lesions and evaluate for any possible metastatic disease prior to chemo/radiation/surgery History: As above CHEST:LUNGS AND PLEURA: Left upper lobe pulmonary nodule measures 10-mm on image 24/series 5 previously, 11-mm and is unchanged allowing for technique differences. No new pulmonary lesions. The pleural spaces are clear.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: Liver morphology is normal. Scattered subcentimeter hypodense lesion in the liver are too small to characterize including a 8mm mildly hypodense lesion in the left hepatic lobe (image 80/series 4). No new lesions. Hepatic and portal veins are patent.Cholelithiasis within a nondistended gallbladder.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts. Right kidney upper pole cyst with a thin calcified septation. No nodular enhancement is evident.RETROPERITONEUM, LYMPH NODES: Calcific arteriosclerotic disease of aorta. No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Small but abnormal lymph node in the right pelvis outside the mesorectal fascia measuring 1.1 x 0.7 cm (image 191/series 3), unchanged from prior. There are multiple other small pelvic lymph nodes.BOWEL, MESENTERY: Circumferential rectal thickening with infiltration of the perirectal fat represents the primary malignancy.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.No change in the left upper lobe nodule.2.Circumferential rectal mass with small malignant appearing lymph nodes outside the mesorectal fascia on the right3.Minimally complex right renal cyst. |
Generate impression based on findings. | Female 56 years old; Reason: pt history met. breast ca currently receiving treatment. please eval for response/progression using measurements if applicable and compare with previous History: see above CHEST:LUNGS AND PLEURA: Bilateral interstitial opacities and scattered areas of ground-glass opacities. Some of the pulmonary parenchymal abnormalities are more solid.The pleural spaces are clear.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Right chest wall postsurgical abnormality measures 3.1 x 2.2 cm (image 47/series 3) previously, 3.0 x 2.1 cm.ABDOMEN:LIVER, BILIARY TRACT: Right hepatic lobe lesion now measures 3.9 x 2.3 cm (image 61/series 3) previously remeasured, 3.9 x 2.7 cm. No new lesions are evident. Hepatic and portal veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small calcification left renal hilum representing either vascular or small nonobstructive calculi. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Extensive osseous metastatic disease.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: Extensive sclerotic metastases.OTHER: No significant abnormality noted. | 1.No significant size change in the right hepatic lobe lesion.2.Pulmonary parenchymal ground-glass opacities appear more solid.3.Osseous metastatic disease |
Generate impression based on findings. | Reason: Pt with Tongue Ca s/p CRT in July 2012. please re-eval and compare top prior exams History: as above Within the suprahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated. Within the infrahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated.A right level 2 neck lymph node measures 9 x 5 mm and stable. A left level 2 lymph node measures 12 x 7 mm and is stableSome mild infiltration of the fat planes of the soft tissues of the neck is likely posttreatment related.Within the visceral space the thyroid gland appears intact.The airway appears patent.The visualized intracranial structures which include the posterior fossa are intact. The visualized portions of the orbits are intact. The paranasal sinuses demonstrates some mucus retention cysts in the right maxillary sinus as well as extension of roots of molar density maxillary sinuses. The mastoid air cells are clear.The parotid and the submandibular glands appear intact.The visualized lung apices appear clear.The carotid and vertebral vasculature visualized on this exam appears intact.The cervical vertebral bodies in general are intact with no evidence for canal stenosis. There are endplate and uncovertebral osteophytes present at C5-6 and C6-7 with narrowing of the neural foramina bilaterally at C5-6 and narrowing the spinal canal at C5-6 and C6-7 | 1.No evidence for local recurrence or neck lymphadenopathy on the basis of CT size criteria for lymphadenopathy |
Generate impression based on findings. | Male, 53 years old, intracerebral hemorrhage. Extensive parenchymal hemorrhage is demonstrated in the right greater than left frontal lobes, and the right greater than left anterior temporal lobes. Parenchymal edema is seen surrounding the areas of hemorrhage, particularly on the right. This results in significant generalized mass effect with effacement of the suprasellar cistern and a variable midline shift to the left of between 1.0 to 1.5 cm.The blood is also evident tracking within the subdural spaces along the interhemispheric falx and the tentorium. Scattered subarachnoid hemorrhage is also seen, right side more than left. There is a small amount of layering blood product within the left occipital horn. The right lateral ventricle is completely effaced, but there appears to be some dissection of blood product into the right frontal horn area and at the level of the right foramen of Monro. The left lateral ventricle is mildly dilated consistent with developing obstruction. The third ventricle is minimally prominent. The fourth ventricle is within normal limits.Left-sided cranial deformities are seen most suggestive of prior surgery. Motion artifact degrades evaluation, but within this limitation, no definite evidence of acute bony fracture is seen. | Extensive parenchymal hemorrhage involving the right worse than left frontal lobes and right worse than left temporal lobes. Subdural, subarachnoid and intraventricular blood is also present.There is significant generalized mass effect with effacement of the suprasellar cistern and a midline shift to the left of between 1 to 1.5 cm. |
Generate impression based on findings. | 63 yo F with CHF and recent AVR/MVR complicated by loculated pleural effusion/hemothorax. Please quantify the area of hemothorax vs. prior. LUNGS AND PLEURA: The endotracheal tube has been removed. Mild interval decrease in size of mixed density right pleural effusion which is partially loculated anteriorly. Small left pleural effusion and basilar compressive atelectasis are stable. No focal airspace opacity.MEDIASTINUM AND HILA: Postsurgical changes compatible with aortic valve replacement. The previously seen loculated substernal fluid collection appears to have slightly decreased in size given the limitations of this nonenhanced study. It now measures approximately 3.3 x 1.9 cm, previously 4.5 x 1.9 cm (series 3, image 25). Prominent mediastinal and hilar lymph nodes are likely reactive. Cardiomegaly with small pericardial effusion. Enlarged main pulmonary trunk diameter is compatible with pulmonary arterial hypertension. Nodular thyroid is again noted.CHEST WALL: Body wall anasarca. Median sternotomy hardware is unchanged. Mild multilevel degenerative disease affects the visualized spine. Right central venous catheter tip in distal SVC.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Cirrhotic liver morphology. Moderate perihepatic and perisplenic ascites is not significantly changed. Nonspecific but unchanged gallbladder wall thickening. Feeding tube tip in the stomach. | 1.Mild interval decrease in size of partially loculated mixed density right pleural effusion which likely contains blood products.2.Loculated substernal fluid collection also appears slightly decreased in size given the limitations of this noncontrast study, and may represent a resolving abscess, hematoma, or seroma.3.Findings compatible with pulmonary arterial hypertension.4.Cirrhotic liver and abdominal ascites, not significantly changed. |
Generate impression based on findings. | Reason: eval for parastomal varices History: gi bleed The phase of intravenous contrast is optimized for evaluation of arterial system. Evaluation of solid organ pathology is limited.ABDOMEN:LUNG BASES: Motion artifact limits evaluation of the lung bases. Basilar atelectasis/scarring.LIVER, BILIARY TRACT: Cholelithiasis.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: Mild atherosclerosis of the abdominal aorta and its branches without aneurysmal dilatation. The celiac axis, SMA, and IMA are patent.BOWEL, MESENTERY: Left lower quadrant ostomy with large wide-mouthed parastomal hernia containing mesenteric fat, vessels, and bowel loops without evidence of strangulation. Small supraumbilical hernia containing omentum and vessels. Small fat containing umbilical hernia. No evidence of bowel obstruction. Multiple parastomal varices draining into the bilateral iliac/femoral veins. No hematoma.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Wide-mouthed left lower quadrant parastomal hernia containing mesenteric fat, vessels, and bowel loops without evidence of strangulation. No evidence of bowel obstruction.2.Parastomal varices draining into the bilateral iliac/femoral veins. No hematoma.3.Mild atherosclerosis of the abdominal aorta and its branches, which are patent. |
Generate impression based on findings. | Male, 53 years old, intracerebral hemorrhage. Bilateral, right worse than left, frontal lobe hematomas, and bilateral, right worse than left, temporal lobe hematomas are redemonstrated. Accurate measurements are difficult due to the irregular nature of the hemorrhage, but no definite significant interval changes are seen. At worst, the hematomas have expanded by 1 or 2 mm.Also unchanged is subdural hemorrhage along the interhemispheric falx and scattered areas of subarachnoid hemorrhage.Parenchymal edema surrounding the areas of hemorrhage appears similar to the prior examination. There is a stable, significant generalized mass effect which results in effacement of the suprasellar cistern and a midline shift to the left of between 1.0 to 1.5 cm.A small amount of dependent hemorrhage is again seen in the occipital horn of the left lateral ventricle. The left lateral ventricle remains mildly dilated compatible with obstruction. The right lateral ventricle is completely effaced and there is evidence of some intraventricular dissection of hemorrhage in the region of the right frontal horn and foramen of Monro. | Extensive parenchymal hematomas are stable to most 1 or 2 mm larger. Subdural, subarachnoid and intraventricular hemorrhage is also grossly unchanged. Associated mass effect is stable as well. |
Generate impression based on findings. | 20 year-old female. Desaturation, chest pain. Evaluate for PTLD in the chest, abdomen, and pelvis. PULMONARY ARTERIES: No pulmonary embolism identified. LUNGS AND PLEURA: Trace left pleural effusion. Left lower lobe dependent atelectasis/consolidation with adjacent nodular opacities. Scattered bilateral upper lobe groundglass opacities. MEDIASTINUM AND HILA: ETT tip is at the carina/right mainstem bronchus. No mediastinal or hilar lymphadenopathy. Moderate pericardial effusion, increased from prior exam. No cardiomegaly. Left and right central line tips are in the SVC. Left upper extremity PICC tip is in the SVC.CHEST WALL: No axillary lymphadenopathy.ABDOMEN:LIVER, BILIARY TRACT: Three nonspecific hypoattenuating foci in the right hepatic lobe, new from prior exam. The largest measures 1 x 0.8 cm (series 9, image 50). No biliary ductal dilatation. Cholecystectomy clips. Hepatomegaly measures 20 cm, similar to prior exam.SPLEEN: Multiple new peripheral, wedge shaped hypoattenuation within the spleen, probably representing infarcts. Splenic vein is patent. Splenomegaly measures 23.3 cm. PANCREAS: Normal morphology and enhancement.ADRENAL GLANDS: Normal appearance of the adrenal glands.KIDNEYS, URETERS: Heterogeneous enhancement of the kidneys. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: G-tube tip terminates in a markedly distended stomach. No small or large bowel dilatation.BONES, SOFT TISSUES: Unchanged cortical defect in the ninth right rib. Lucencies in the iliac wing, likely from prior bone marrow biopsies.OTHER: Large amount of abdominopelvic ascites. Small amount of anasarca.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Distended bladder.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No small or large bowel dilatation.BONES, SOFT TISSUES: Dystrophic calcifications along the cortex of the femurs and acetabula, increased from prior exam.OTHER: Large amount of abdominopelvic ascites. | 1. No evidence of pulmonary embolism.2. No evidence of PTLD. 3. ETT tip is at the carina/right mainstem bronchus.4. Left lower lobe atelectasis/consolidation. Scattered left basilar nodular opacities and upper lobe groundglass opacities may represent aspirate and/or infection.5. New splenic infarcts. 6. Moderate pericardial effusion, increased in size from prior exam.7. Nonspecific 1 cm and smaller hypoattenuating foci in the right hepatic lobe. 8. Large amount of abdominopelvic ascites.9. Markedly distended stomach. |
Generate impression based on findings. | Reason: HCV cirrhosis, HCC screening History: HCV cirrhosis ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver contour: The liver has widened fissures.Features of portal hypertension: None Portal vein: Patent Hepatic veins: PatentHepatic artery: Conventional hepatic arterial anatomy.Lesions: No suspicious focal lesions. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Upper abdominal lymphadenopathy is nonspecific in the setting of chronic liver disease.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Chronic liver disease without evident HCC. |
Generate impression based on findings. | Male; 57 years old. Reason: patient with a right lung mass; questionable endobronchial obstruction; long standing, 10years?; OSH films available (7/23/13) History: cough; dyspnea on exertion. LUNGS AND PLEURA: There is a right suprahilar soft tissue mass that measures approximately 4.7 x 3.4 cm and is hypermetabolic on outside PET imaging (series 3, image 39). The mass encircles and nearly obliterates the lumen of the right upper lobe bronchus, causing post-obstructive atelectasis of the inferior segment of the right upper lobe (series 80291, image 21). The right middle and lower lobes are well aerated. Diffuse centrilobular nodules and surrounding ground glass opacities in the right upper lobe are most compatible with post-obstructive bronchiolitis. There are no pleural effusions. Minimal right apical scarring. Scattered calcified granulomas but no suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Mild cardiomegaly with biatrial and left ventricular chamber dilatation. No pericardial effusion. Scattered calcified mediastinal and hilar lymph nodes compatible with prior granulomatous infection. Mild coronary and aortic arch calcifications. Air-fluid level in the esophagus is indicative of reflux. Reference right supraclavicular lymph node measures 7 mm (series 3, image 13). CHEST WALL: Mild multilevel degenerative changes and DISH affect the visualized spine. No axillary lymphadenopathy. UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Hypodense right hepatic lobe lesion with irregular margins is difficult to measure but is approximately 17 x 11 mm (series 3, image 82). While incompletely characterized, this lesion is suspicious for metastasis. A second subcapsular lesion in the right hepatic lobe favors a benign cyst (series 3, image 98). Splenic granulomata. There are also small periaortic and paracaval lymph nodes, with a reference periaortic node measuring 7 mm (series 3, image 101). Mildly enlarged reference gastrohepatic lymph node measures 13 mm in short axis (series 3, image 90). | 1.Right suprahilar soft tissue mass which encases and nearly obliterates the lumen of the right upper lobe bronchus, causing post-obstructive atelectasis of the inferior segment of the right upper lobe and disseminated right upper lobe bronchiolitis. 2.Small mediastinal and upper abdominal lymph nodes, with reference measurements given above. Irregular hypodense right hepatic lobe lesion is incompletely characterized but suspicious for metastatic disease. Triple-phase dedicated liver CT or hepatic MRI can be considered for further evaluation. |
Generate impression based on findings. | Male 62 years old; Reason: eval fluid collections, pleural effusions History: s/p lap chole c/b bile leak, pleural effusions s/p IR drain placements CHEST:LUNGS AND PLEURA: Patchy areas of ground-glass opacity involving the right lung with basilar subsegmental atelectatic regions.Small left pleural effusion occupying approximately 20% of the left hemithorax. Trace right pleural effusion.MEDIASTINUM AND HILA: Heart size is normal. Small mediastinal lymph nodes.CHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: The scattered intrahepatic pneumobilia. A metallic stent is in the common bile duct.Right perihepatic fluid collection measures 9.1 x 1.8 cm (image 75/series 3) previously, 11.5 x 2.1 cm.Status post cholecystectomy. There is some gas and hyperdense material in the gallbladder fossa.SPLEEN: Spleen is normal in size. Peri-splenic collection measures 8.4 x 4.9 cm (image 84/series 3) previously, 11.7 x 6.8 cm.PANCREAS: Pancreas enhances homogeneously. Metallic stent in the common bile duct. No pseudocyst formation. Splenic vein and portal vein are patent.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Calcific arteriosclerotic disease of the aorta.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: Fluid collection anterior to the rectum measures 5.3 x 2.7 cm (image 175/series 3) previously, 9.6 x 6.3 cm. | 1.Decrease in the size of the perihepatic abscess with a drain.2.Decrease in the size of the peri-splenic and pelvic abscess which do not have drains. |
Generate impression based on findings. | Reason: evolution of RLQ mass History: Asymptomatic now; ? periappendiceal abscess seen in earlier study. Rx medically Lack of intravenous contrast limits evaluation of solid organ pathology.ABDOMEN:LUNG BASES: Right lower lobe fissural micronodule is unchanged (series 3, image 2).LIVER, BILIARY TRACT: Left hepatic lobe peripheral calcification.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of bowel obstruction. No pneumoperitoneum.BONES, SOFT TISSUES: Status post lumbosacral fusion. 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: No significant abnormality noted.BOWEL, MESENTERY: Interval decrease in periappendiceal inflammatory changes and fluid. The proximal appendix is normal in caliber and demonstrates intraluminal contrast and air. Sigmoid diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Significant interval decrease in periappendiceal inflammatory changes and fluid. |
Generate impression based on findings. | Male, 58 years old, history of head and neck cancer, evaluate for recurrence and extent. 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. Note is made of prominent venous structures in the bilateral temporal fossae.An enhancing hypopharyngeal mass is demonstrated centered at the level of the piriform sinuses. The lesion causes partial effacement of both piriform sinuses and abuts the aryepiglottic folds from which it is difficult to separate. From here, tumor extends superiorly along the left posterior aspect of the pharynx nearly to the level of the palatopharyngeal arch. The lesion measures 3.7 x 1.7 cm in the transverse plane (image 58 series 6), and 4.3 cm in the sagittal plane (image 57 series 80317).At the level of the free edge of the epiglottis, there is some suggestion of spread of enhancing tissue into the adjacent left carotid space versus contiguous, ill-defined adenopathy (see image 50 series 6). Otherwise, no evidence of pathologic adenopathy is seen in the neck.The salivary glands are small and fatty replaced but free of focal lesions. The thyroid is within normal limits. Cervical vessels remain patent. Scarring is present in both lung apices. Small bilateral pleural effusions are suspected. No concerning bony lesions are seen. | 1. Bilateral hypopharyngeal tumor centered at the level of the piriform sinuses which extends in infiltrative fashion superiorly, along the left posterior pharynx, to the level of the palatopharyngeal arch.2. No discrete pathologic adenopathy is identified in the neck. However, there is the suggestion of contiguous tumor spread into the left carotid space at the level of the free edge of the epiglottis. |
Generate impression based on findings. | 64-year-old male with history of left partial nephrectomy, February, 2012. Evaluate kidney post partial nephrectomy. 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: Left kidney shows postsurgical changes without distortion of the renal contour to suggest residual or recurrent mass. Lack of IV contrast limits ability to detect small or moderate size renal masses. Right kidney morphology appears normal as well. No abnormal calcifications are seen and no hydronephrosis is present.RETROPERITONEUM, LYMPH NODES: No adenopathy or other significant abnormality noted. Atherosclerotic calcification noted diffusely throughout the aorta.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: Right inguinal hernia containing only mesenteric fat. Degenerative changes in the bony spine and pelvis without focal abnormality to suggest metastasis.OTHER: No significant abnormality noted | 1. Postoperative changes seen about the left kidney -- no evidence for recurrent or residual disease seen, however, lack of IV contrast limits evaluation of renal parenchyma. |
Generate impression based on findings. | Male 82 years old; Reason: Pt is an 82 y/o male with prostate cancer, PSA rising, evaluate for met disease, compare to last year's imaging History: prostate cancer CHEST:LUNGS AND PLEURA: Subcentimeter nodule adjacent to the minor fissure, unchanged. No suspicious bony lesions. The pleural spaces are clear.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. Small mediastinal lymph nodes.CHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: Liver has a smooth contour. No suspicious hepatic lesions. Hepatic and portal veins are patent. No intra-or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal gland is mildly nodular, unchanged. Right gland is normal in morphology.KIDNEYS, URETERS: No hydronephrosis in either kidney. Left upper pole renal cyst, unchanged.RETROPERITONEUM, LYMPH NODES: Reference aortocaval lymph node measures 1.6 x 0.8 cm (image 136/series 3) previously, 2.2 x 0.8 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostate is enlarged.BLADDER: No significant abnormality notedLYMPH NODES: Right external iliac lymph node has decreased in size measuring 1.1 x 0.8 cm (image 169/series 3) previously, 1.6 x 1.6 cm.Left internal iliac lymph node has decreased in size measuring 1.1 x 0.8 cm (image 175/series 3) previously, 1.6 x 1.2 cm.New right pelvic sidewall lesion adjacent to the prostate measures 2.6 x 2.1 cm (image 186/series 3). BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Postsurgical changes from hernia repair.OTHER: No significant abnormality noted | 1.Decrease in the size of the reference lesions.2.New 2.6cm right lymph node adjacent to the prostate. |
Generate impression based on findings. | 59-year-old male with history of bladder cancer. Status post cystectomy with neobladder. Evaluate for recurrent/metastatic disease. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Diffuse fatty infiltration throughout the liver is seen. Presence of fat can obscure visualization of underlying solid parenchymal liver lesions. Punctate calcification is seen from prior granulomatous disease. No other parenchymal abnormalities are seen. Vessels all appear normal.Cholelithiasis without complication again seen.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Simple left renal cyst, unchanged -- no other significant abnormality noted in renal parenchyma. Prompt and symmetric excretion of contrast material into normal pyelo- calyceal systems is noted bilaterally. No abnormalities are seen in the urothelial tracks, including the, ureters, which are moderately well opacified with only small skip areas of nonopacification.RETROPERITONEUM, LYMPH NODES: No enlarged retroperitoneal lymph nodes seen. Clusters of small lymph nodes again seen, largest of which, together measure 1.2 x 0.9 cm, compared with previous 1.4 x 1.1 cm.. No new foci of lymph node enlargement identified. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post cystoprostatectomy without other abnormality seen.BLADDER: Patient is status post cystectomy with continent neobladder unchanged from prior examination.LYMPH NODES: No adenopathy identified.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes seen throughout the thoracolumbar spine without focal abnormality seen to suggest metastasis.OTHER: No significant abnormality noted | 1. Status post cystoprostatectomy with continent neobladder stable in appearance. 2. Small reference left retroperitoneal, periaortic lymph node, slightly decreased in size. 3. No evidence of metastatic disease. |
Generate impression based on findings. | Reason: sepsis w/unknown source History: sepsis w/unknown source ABDOMEN: Streak artifact from cardiac hardware limits evaluation of the upper abdomen.LUNG BASES: Basilar ground-glass opacities and consolidation compatible with aspiration/infection. Calcified right basilar pulmonary nodule. Four chamber cardiomegaly with partially visualized ICD leads and LVAD.LIVER, BILIARY TRACT: Trace perihepatic ascites. Gallbladder sludge in the fundus.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left upper pole renal cyst.RETROPERITONEUM, LYMPH NODES: Atherosclerosis of the abdominal aorta and its branches without aneurysmal dilatation.BOWEL, MESENTERY: Air fluid levels and fluid filled colon without bowel wall thickening compatible with a diarrheal state. No evidence of bowel obstruction. No drainable fluid collections.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small amount of free fluid in the pelvis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Fluid-filled colon compatible with a diarrheal state, which may represent an early colitis.1.Basilar ground-glass opacities and consolidation compatible with infection/aspiration.2.No drainable fluid collections in the abdominal cavity.3.Gallbladder sludge.4.CT chest dictated separately. Please see final report for findings. |
Generate impression based on findings. | Clinical question: Subarachnoid hemorrhage, want to a reevaluate prior to anticoagulation. Signs and symptoms: As above. Unenhanced head CT:Previously noted residual subarachnoid hemorrhage in the right sylvian fissure and right frontal cortical sulci demonstrate interval decreased size and density. There is however a new small focus of subarachnoid hemorrhage more superiorly in the right frontal region (axial images 20 through 23). Which is suspicious for a small focus of new hemorrhage however less likely possibility of redistribution cannot be entirely excluded.Stable and unremarkable unenhanced head CT otherwise.Findings on this exam were discussed by phone with the referring clinical physician from anesthesia and critical care with pager number 4428 at the time of review of study. | 1.There is interval decreased size and density of previously noted hemorrhage in the right sylvian fissure and right frontal cortical sulci.2.There is a small new focus of subarachnoid hemorrhage more superiorly in the right frontal cortical sulci suspicious for new hemorrhage however less likely possibility of redistribution cannot be entirely excluded. |
Generate impression based on findings. | Male; 55 years old. Reason: Pt with Tongue Ca s/p CRT in July 2012. please re-eval and compare top prior exams. CHEST:LUNGS AND PLEURA: Mild apical fibrosis likely secondary to radiation treatment but no suspicious pulmonary nodules or masses. There is no focal airspace opacity or pleural effusion. Scattered pulmonary micronodules are unchanged. MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. No mediastinal or hilar lymphadenopathy. Anterior mediastinal soft tissue is stable and most consistent with rebound thymic hyperplasia.CHEST WALL: Vertebral body wedge deformity of T8 and associated thoracic kyphosis are unchanged.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No suspicious hepatic lesions or biliary ductal dilatation.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: The pancreas is enlarged and the pancreatic head is thickened to a maximum diameter of 3.4 cm, previously 3.5 cm and not significantly changed (series 3, image 131). The contour of the pancreatic head is also abnormal. While imaging findings cannot exclude an occult pancreatic head lesion, recent MRCP showed a prominent pancreas without focal pancreatic lesion.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 evidence of osseous metastatic disease.OTHER: No significant abnormality noted. | No evidence of metastatic disease. |
Generate impression based on findings. | Reason: Evaluate for progression of metastatic disease; compare to previous scan History: none0 CHEST:LUNGS AND PLEURA: Bilateral perihilar scarring, architectural distortion, bronchiectasis, and left lower lobe postsurgical changes similar in appearance compared to multiple prior exams.No new suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Stable enlarged prevascular lymph node (image 29 series 3) measuring 17 mm in its short axis.Calcified left hilar lymph nodes compatible with prior granulomatous disease.No new mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Scattered punctate calcifications unchanged.SPLEEN: Calcifications compatible with prior granulomatous disease.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Degenerative changes in the lumbar spine.OTHER: No significant abnormality noted. | No interval change without evidence of recurrent metastatic disease. |
Generate impression based on findings. | Reason: h/o HNC, CRT, compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: Scattered benign-appearing pulmonary micronodules and intrapulmonary lymph nodes are stable.There is no evidence of pulmonary or pleural metastases.MEDIASTINUM AND HILA: There is no evidence of mediastinal or hilar lymphadenopathy, except for a stable 11 mm right cardiophrenic lymph node image 85 series 10817. Very small hiatal hernia.CHEST WALL: Degenerative abnormalities affect the thoracic spine. ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Subcentimeter poorly defined hypodensity in hepatic segment III image 97 series 10817 is slightly hyperdense on prior contrast studies and likely a hemangioma.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No evidence of metastases, or other significant finding. |
Generate impression based on findings. | Clinical question: Left-sided weakness, history of prior stroke. Signs and symptoms: As above. Nonenhanced head CT:There is no detectable acute intracranial process. CT however is insensitive for detection of acute nonhemorrhagic ischemic strokes.There are moderate periventricular and subcortical low attenuation of white matter which considering patients age likely representing age indeterminate small vessel ischemic strokes. In addition there is a small focus of cortical and subcortical low attenuation a right posterior parietal consistent with a chronic ischemic cortical stroke. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation otherwise. | 1.No detectable acute intracranial process. CT however is insensitive for detection of acute nonhemorrhagic ischemic strokes.2.Moderate age indeterminate small vessel ischemic strokes and a chronic right parietal cortical stroke as detailed. |
Generate impression based on findings. | Female; 64 years old. Reason: r/o PE History: resp failure. PULMONARY ARTERIES: No evidence of pulmonary embolus. Main pulmonary artery is dilated, measuring 36 mm transverse.LUNGS AND PLEURA: There are diffuse ground glass opacities extending throughout both lungs. Associated basilar atelectasis/consolidation and pleural effusions, all of which are new since the prior CT. Findings favor pulmonary edema. In addition, there is a cavitary lesion in the peripheral right upper lobe measuring 2.5 x 2.7 cm (series 11, image 72), with internal soft tissue component. This is suggestive of a cavitary infection, possibly the result of interval septic embolus. ET tube tip terminates 2 cm above the carina.MEDIASTINUM AND HILA: Stable severe cardiomegaly with left ventricular and biatrial chamber dilatation. There is a prosthetic mitral valve. No pericardial effusion. Prominent mediastinal lymph nodes. There are mild coronary and aortic vascular calcifications. The outflow cannula of the LVAD is not visualized from the lateral right ventricular wall to the left ventricular apex. There is no phlegmon around the LVAD driveline. CHEST WALL: Left AICD and leads are in place. Median sternotomy hardware with well-approximated sternal fragments.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Significant streak artifact from LVAD limits visualization of the left upper abdomen. Reflux of contrast into a dilated suprahepatic IVC, the infrahepatic IVC, and the hepatic veins is suggestive of right heart failure with possible concominant tricuspid regurgitation. Feeding tube tip in the stomach. Left upper pole renal cyst is unchanged. High density left upper pole cyst is also stable. Thickened left adrenal gland is again noted and unchanged. | 1. No evidence of pulmonary embolus.2. New right upper lobe cavitary lesion, suggestive of a cavitary infection, possibly the result of interval septic embolus. No evidence of infection involving the LVAD driveline. 3. Diffuse ground glass opacities and bilateral atelectasis/consolidation compatible with pulmonary edema. |
Generate impression based on findings. | Reason: lung nodule, compare to previous, super D protocol History: cough/dyspnea LUNGS AND PLEURA: Interval appearance of posterior pleural based nodular consolidation measuring 15 x 18 mm involving the superior segment of the left lower lobe (high resolution series 5 image 94).Previously referenced ground glass nodule within the posterior left lower lobe is ill-defined (series 5 image 172), without measurable component. There is surrounding increased ground glass within the superior segment of the left lower lobe which may be post inflammatory.Linear band favoring subsegmental atelectasis involving the left upper lobe is new. Associated nodular component (series 5 image 55) measures 5 x 9 mm which is nodular on the coronal view (series 80280 image 52). This may represent additional new nodule; continued follow up is recommended.Biapical pleural parenchymal scarring unchanged. Extensive centrilobular and apical paraseptal emphysema is unchanged.MEDIASTINUM AND HILA: Heart size remains stable. No pericardial effusion.No mediastinal or hilar lymphadenopathy.CHEST WALL: No axillary lymphadenopathy.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Hypodense lesion in the left kidney is unchanged, likely a simple cyst. Nonspecific hypodensities throughout the hepatic parenchyma remain too small to characterize; however, these are unchanged from the prior exams.Hiatal hernia stable. | 1. Interval appearance of posterior pleural based nodular consolidation measuring 15 x 18 mm involving the superior segment of the left lower lobe (high resolution series 5 image 94).2. Previously referenced ground glass nodule posterior left lower lobe is ill-defined without measurable component. There is surrounding increased ground glass within the superior segment of the left lower lobe which may be post inflammatory.3. Linear band favoring subsegmental atelectasis involving the left upper lobe is new. Associated nodular component 5 x 9 mm, somewhat nodular on the coronal view. This may represent additional new nodule; continued follow up is recommended. |
Generate impression based on findings. | Reason: Hx of breast cancer, lymphoma, and t-AML admitted for fever + c.diff c/b liver failure and AMS History: *Pls do with PO contrast but NO IV contrast.* Distended abdomen and pain - pls assess for signs of obstruction 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 a large right pleural effusion and moderate left pleural effusion.LIVER, BILIARY TRACT: Redemonstration of the right lobe hypodense lesion, which cannot be further characterized due to lack of IV contrast. No evidence of intrahepatic or extrahepatic biliary ductal dilatation. Status post cholecystectomy. Liver at cirrhotic morphology.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal lesion with fat density suggestive of a lipid rich adrenal adenoma.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Fluid around the liver and the right paracolic gutter, likely ascites, grossly unchanged compared to prior exam. No dilation of bowel loops.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: Stable moderate amount of pelvic ascites. Collapsed distal colon.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.No evidence of small or large bowel obstruction.2.Redemonstration of a large right pleural effusion and moderate left pleural effusion.3.Moderate amount of abdominal and pelvic ascites.4.Redemonstration of nonspecific, hypodense hepatic lesion. |
Generate impression based on findings. | Reason: r/o diverticulitis History: LUQ abd pain ABDOMEN:LUNG BASES: Mild emphysematous changes of bilateral lung bases.LIVER, BILIARY TRACT: No evidence of cholelithiasis. No intrahepatic or extrahepatic ductal dilatation. No suspicious focal hepatic lesion.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple hypodense lesions in bilateral kidneys, likely representing renal cysts. Mild cortical scarring of bilateral kidneys.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: Diverticula of the sigmoid colon and descending colon. There is fat stranding and focal wall thickening of the mid descending colon suggestive of acute diverticulitis. There is no evidence of fluid collection or abscess.BONES, SOFT TISSUES: Degenerative disease involving L3-L4 and L4-L5 as well as T12-L1 with vacuum disk phenomenon.OTHER: No significant abnormality noted | Focal, acute diverticulitis of the mid descending colon without evidence of fluid collection or abscess. |
Generate impression based on findings. | 50 year-old female with breast cancer and renal cell carcinoma. Evaluate for recurrence of renal cell carcinoma, status post nephrectomy. CHEST:LUNGS AND PLEURA: Fibrotic changes at the left apex, unchanged. No new nodules, masses or infiltrates. No pleural abnormality seen.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Fluid collection in the left breast, unchanged with surgical clips about it. Normal-appearing bony skeleton without evidence for metastatic disease.ABDOMEN: Lack of IV contrast limits ability to evaluate solid parenchymal organs and vascular structures -- within these limitations, the following observations can be made:LIVER, BILIARY TRACT: Diffuse fatty infiltration is again seen throughout the liver -- the presence of fat can obscure hepatic parenchymal mass lesions and if liver lesions are of concern, ultrasound or MR examination would be recommended. Morphology of the liver with widening of the fissures raises question of underlying cirrhosis. Development. Patient is status post cholecystectomy. No intrahepatic or extra hepatic biliary duct dilatation is seen.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Right adrenal gland is normal. Left adrenal gland not visualized, presumably surgically removed.KIDNEYS, URETERS: Left nephrectomy. Morphology of the right kidney shows only a low-attenuation presumed benign cyst at the upper pole, unchanged. No abnormal calcifications are seen. Lack of IV contrast limits ability to see small and moderate-sized renal parenchymal mass lesions.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted -- no adenopathy seen.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Calcified fibroid -- no other abnormalities seen.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes seen in the lumbar spine and pelvis, but without focal abnormality to suggest metastatic disease.OTHER: No significant abnormality noted. | 1. Left nephrectomy without evidence of residual or recurrent tumor seen. 2. No evidence of metastatic disease. 3. Diffuse fatty infiltration of the liver -- presence of fat can obscure the presence of parenchymal liver masses. 4. Morphology of the liver raises question of cirrhotic changes. |
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. | 1.No evidence for acute intracranial hemorrhage mass effect or edema.2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 3.CT is insensitive for the early detection of nonhemorrhagic CVA |
Generate impression based on findings. | Clinical question: Evaluate intracranial hemorrhage. Signs and symptoms: Intracranial hemorrhage, status post mistie catheter placement. Unenhanced head CT:There is no convincing evidence of any significant interval change in the size of very large and very irregular in shape hemorrhage in the right basal ganglia/thalami and with extension inferiorly into the right temporal lobe. Multiple measurements of hematoma appear identical to prior exam at the current levels. There is surrounding vasogenic edema without significant change since prior exam. There is a catheter entering from right frontal burr hole entering the anterior aspect of hematoma and extending to the hematoma similar to prior exam.There is evidence of extensive hemorrhage in the supratentorial ventricular system similar to prior exam. No evidence of extension in the fourth ventricle similar to prior exam. There is midline shift of approximately 18 mm to the left which is also stable since prior exam. A left-sided ventricular catheter entering from left frontal bur hole and tip in the left frontal horn of lateral ventricle similar to prior exam. There is small amount of hemorrhage along the track of the left ventricular catheter as well as the right sided catheter similar to prior exam.Near complete effacement of all cortical sulci and effacement of right upper cerebellopontine angle cistern remain similar to prior study. No evidence of interval increased size of ventricular system. | 1.Stable large and very irregular dissecting hematoma of right basal ganglion with intraventricular extension of hemorrhage since prior study.2.Stable right-sided catheter entering from the right frontal burr hole and extending to the hematoma similar to prior exam.3.Stable extensive supratentorial intraventricular hemorrhage since prior study.4.Stable midline shift of approximately 18 mm to the left.5.Stable size of ventricular system and a left frontal approach ventricular catheter. |
Generate impression based on findings. | 48-year-old male with history of kidney and pancreatic transplant with perforation of graft duodenum this study is limited due to lack of IV contrast ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Cholelithiasis with distended gallbladder and multiple stones associated with pericholecystic fluid consistent with acute: Cystitis. There is a calcified stone in the distal common bile duct. Mild intrahepatic biliary dilatation is present.SPLEEN: No significant abnormality notedPANCREAS: Atrophic pancreas.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral atrophic kidneys.RETROPERITONEUM, LYMPH NODES: ABOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Transplanted pancreas is noted within the mid lower abdomen. No evidence of free air or fat stranding surrounding the transplanted pancreas.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Transplanted kidney in the pelvis is unremarkable. There is also a calcified graft in the left lower pelvis, unchanged from previous study. AOTHER: No significant abnormality noted | Cholelithiasis and cholecystitis with choledocholithiasis. |
Generate impression based on findings. | Reason: h/o HNC, CRT, compare to previous, measurements pls History: none There is redemonstration of infiltration of the soft tissues of the right neck more than the left associated with thickening of the platysma muscle right more than left. All this is likely post treatment related.Within the suprahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated. Within the infrahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated.Within the visceral space the thyroid gland appears intact.The airway appears patent.The visualized intracranial structures which include the posterior fossa are intact. The visualized portions of the orbits are intact. The paranasal sinuses are clear. The mastoid air cells are clear.The parotid and the submandibular glands appear intact.The visualized lung apices appear clear.The carotid and vertebral vasculature visualized on this exam appears intact.The cervical vertebral bodies in general are intact with no evidence for canal stenosis. There are endplate and uncal vertebral osteophytes present at C5-6 and C6-7 with neural foramina encroachment stable since the prior exam | 1.No evidence for local recurrence or neck lymphadenopathy on the basis of CT size criteria for lymphadenopathy2.please note that the lack of intravenous contrast decreases the sensitivity for CT soft tissues of the neck |
Generate impression based on findings. | Pancreas cancer CHEST:LUNGS AND PLEURA: Micronodular image number 64 of series number 3, unchanged. No new nodules.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Previously measured index lesion in the liver is very difficult to differentiate from the surrounding liver and measures 6 cm on image number 102, series number 3.SPLEEN: Thrombosed splenic vein, unchanged.PANCREAS: Patient's known pancreatic cancer in detail is very difficult to differentiate from the surrounding normal pancreas and measures 2.4 by 1.6-cm in image number 104, series number 3, slightly smaller compared to previous study.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right renal cyst, unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Lytic lesions seen there iliac bones predominantly on the right side.OTHER: No significant abnormality noted | Interval decrease in the size of the patient's known tail mass. |
Generate impression based on findings. | Male 66 years old; Reason: 66 yo male with metastatic sigmoid colon cancer to liver. Palliative sigmoid colon resection to be done on 10/16/13. Need to evaluate extent of disease prior to resection History: Abdominal Pain CHEST:LUNGS AND PLEURA: Calcified right middle lobe granuloma. Few scattered micronodules are changed. No dominant lung lesion. The pleural spaces are clear.MEDIASTINUM AND HILA: Heart size is normal. Extensive coronary artery calcifications. No mediastinal lymphadenopathy.CHEST WALL: Left central venous catheter terminates at the cavoatrial junction.OTHER: ABDOMEN:LIVER, BILIARY TRACT: Diffuse fatty infiltration of the liver. There are multiple hepatic lesions. The segment two lesion measures 2.6 x 2.4 cm (image 76/series 3) previously, 2.5 x 2.4 cm.Multiple gallstones. No ductal dilatation.Hepatic and portal veins are patent.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy. Reference peripancreatic node measures 1.9 x 1.3 cm (image 93/series 3) previously, 1.6 x 1.4 cm.BOWEL, MESENTERY: Upper abdominal omental and peritoneal nodularity without ascites.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: Circumferential thickening of the sigmoid colon with infiltration of the pericolonic fat. Small mesenteric lymph nodes persists. The peritoneal nodularity persists. No ascites.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.No evident change in the size of the hepatic metastases.2.Peritoneal carcinomatosis. |
Generate impression based on findings. | Reason: assess for ich, cause for seizure History: seizure The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Periventricular and subcortical white matter hypodensities of a moderate degree are present.Atherosclerotic calcifications are present along the distal internal carotid arteries.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The left eyeball lens is thin. | 1.No evidence for acute intracranial hemorrhage mass effect or edema.2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 3.CT is insensitive for the early detection of nonhemorrhagic CVA. |
Generate impression based on findings. | Reason: TxN3 HNSCC-completed 5/5 DFHX completed 3/9/12. please re-eval for recurrence History: as above CT neck:The patient is status post right radical neck surgery it is infiltration of the fat planes in the right neck surrounding the right carotid space from the level of the clavicle to the level of the C1 vertebral body. This appears stable when compared to prior exam. There is superimposed infiltration of mass effect which is adjacent and medial to the right carotid space associated with some mass effect extending from the level of thyroid cartilage to the C2 vertebral body level which when compared to prior exam and appears stable . The airway and larynx are tilted towards the leftWithin the suprahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated. Within the infrahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated.Within the visceral space the thyroid gland appears intact. The right lobe of the thyroid appears visually contiguous with infiltration along the right neck.The airway appears patent. The airway and larynx are tilted towards the leftThe parotid and the submandibular glands appear intact.The visualized lung apices appear clear.The carotid and vertebral vasculature visualized on this exam appears intact. Atherosclerotic calcifications are present at the carotid bifurcations.The cervical vertebral bodies in general are intact with no evidence for canal stenosis.CT head:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No acute intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening also seen on the prior exam. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.No convincing evidence for local recurrence or neck lymphadenopathy on the basis of CT size criteria for lymphadenopathy2.There are some infiltrative changes associated with mass effect present along the right neck which appear stable when compared to the prior exam suggesting this is likely post treatment effect. Continued follow-up will help confirm this.3.No evidence for brain metastases. |
Generate impression based on findings. | Reason: Pt with hx of HNC; please re-eval and compare to prior exams History: as above CHEST:LUNGS AND PLEURA: Mild reticulonodular/tree in bud opacities and bronchial wall thickening previously noted at right lung base have decreased. However, similar findings within the right middle and left lower lobes have increased with new patchy consolidation involving the posterior basal segment of the left lower lobe. A focus of groundglass opacity is new within the lingula. The consolation of findings favors that of recurrent aspiration.Numerous, scattered, nonspecific pulmonary micronodules appear grossly unchanged since2010. No suspicious pulmonary nodule is identified. No pleural effusion or pneumothoraxis identified.MEDIASTINUM AND HILA: Small amount of mucus is present within the right bronchus intermedius.Heart size remains normal. No pericardial effusion. Evidence of prior coronary artery revascularization in the setting of severe native coronary artery calcification.CHEST WALL: Left AICD with stable position of electrodes.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: Bilateral renal hypodensities similar to the prior study, likely cysts.PANCREAS: Stable prominence of the pancreatic duct with pancreatic calcifications.RETROPERITONEUM, LYMPH NODES: Dilated left lumbar vein stable.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Percutaneous gastrostomy tube with balloon seen within the gastric lumen.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Multiple sutures approximate the anterior abdominal wall. | 1. Stable scattered pulmonary micronodules without specific evidence of metastaticdisease.2. Bronchial wall thickening with reticulonodular and tree in bud opacities within the bilateral lower lobes, lingula and right middle lobe. Associated consolidation posterior basal segment left lower lobe. Mucus within the bronchus intermedius. Findings consistent with recurrent aspiration. |
Generate impression based on findings. | Reason: TxN3 HNSCC-completed 5/5 DFHX completed 3/9/12. please re-eval for recurrence History: as above CHEST:LUNGS AND PLEURA: Stable benign appearing left lower lobe subpleural nodule (image 80 series 5).Upper lobe predominant paraseptal and central lobular emphysema.No new suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Stable minimally prominent mediastinal lymph nodes without hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of the pericardial effusion.Severe coronary artery calcification.CHEST WALL: Degenerative changes in the thoracic spine with stable T11 sclerotic focusABDOMEN: 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.Fat containing ventral hernia unchangedBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No interval change without evidence of metastatic disease. |
Generate impression based on findings. | History of hepatocellular carcinoma, status post resection CHEST:LUNGS AND PLEURA: Nonspecific, scattered micronodules unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Ablation defect in segment 8 measures 5-mm in diameter image number 91, series number 12. Post resection defect in segment 5 measures 2.1 x 1 cm image number 104, series number 12.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: Postsurgical changes secondary to spinal fusion in the lumber vertebral bodiesOTHER: 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 | Slight interval decrease in the size of the posttreatment lesions in the liver |
Generate impression based on findings. | 58 year-old female with GIST -- restaging ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Multiple lesions are seen throughout the liver in a pattern of distribution and size, unchanged from 10/23/12. These lesions show different imaging characteristics, some been most characteristic of benign cysts and near fluid density, other showing peripheral nodular enhancement and others being nonspecific. The lesions measured in reference in the past are as follows:Segment 4 A. : 0.8 x 0.7 cm (series 7, image 16) slightly smaller, previously measuring 1.1 x 0.7 cm.Segment 5: 3.9 x 3.0 cm (series 7, image 31) previously 4.0 x 3.0Segment 7: 2.3 x 1.6 cm (series 7, image 26 previously 2.3 x 1.3 cm).It should be noted that these measurements are provided as reference lesions throughout, but the lack of change in particular, the peripheral, nodular enhancement in the segment 5 lesion suggests that these may not be metastatic lesions and I would favor segment 5 for example being a hemangioma even though it is slightly increased since 2008. SPLEEN: No significant abnormality noteddPANCREAS: No significant abnormality noteddADRENAL GLANDS: No significant abnormality noteddKIDNEYS, URETERS: No significant abnormality noteddRETROPERITONEUM, LYMPH NODES: No significant abnormality noted..BOWEL, MESENTERY: Anterior abdominal wall ventral hernia slightly more prominent than on prior examinations, containing, small bowel, without complicationBONES, SOFT TISSUES: No significant abnormality noteddOTHER: No significant abnormality noteddPELVIS:UTERUS, ADNEXA: No significant abnormality noteddBLADDER: No significant abnormality noteddLYMPH NODES: No significant abnormality noteddBOWEL, MESENTERY: No significant abnormality noteddBONES, SOFT TISSUES: No significant abnormality noteddOTHER: No significant abnormality notedd | Stable examination -- the numerous hepatic lesions of varying appearances all appear stable. Reference measurements are provided, although these may not represent metastases. No other abnormality seen. |
Generate impression based on findings. | 35-year-old female with history of microscopic hematuria ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Liver is enlarged. Diffuse fat infiltration is present. There are multiple hyperdense lesions throughout the liver. The index lesion in the right lobe measures 3.5 x 3.3 cm on image number 37, series number 3.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No evidence of renal stones or focal renal lesions except for a simple renal cyst in the right lower pole.. No evidence of 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 | No CT findings to explain patient's hematuria.Fat infiltration of the liver with hepatomegaly. Multiple hyperdense liver lesions. Their etiology is unknown but likely represents multiple adenomas or focal nodular hyperplasia. MRI of the liver with focal nodular hyperplasia protocol is recommended for further evaluation. |
Generate impression based on findings. | 77-year-old male with history of metastatic urothelial cancer This study is limited due to lack of IV contrastCHEST:LUNGS AND PLEURA: Right upper lobe spell with opacity is unchanged and likely represents scarring. It measures 9 x 7 mm and number 14, series number 5. Right lower lobe focal pasty measures 5-mm in diameter image number 42, series number 5, unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Status post left adrenalectomyKIDNEYS, URETERS: Status post left nephrectomy. Hypodense lesion in the right kidney is unchanged but could not be optimally characterized due to lack of IV contrast. Right nephrolithiasis is unchanged.RETROPERITONEUM, LYMPH NODES: Infrarenal abdominal aortic aneurysm measuring 4.5-cm in largest AP dimension is unchanged inBOWEL, MESENTERY: Unremarkable.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: Fat-containing right-sided inguinal herniaOTHER: A | Limited study due to lack of IV contrast. No significant change from previous study. 4.5-cm infrarenal abdominal aortic aneurysm is also unchanged. |
Generate impression based on findings. | History of bladder cancer, status post cystectomy CHEST:LUNGS AND PLEURA: 5-mm nodule in the right lower lobe image number 6, series number 7. Chest CT is recommended for further evaluation.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left renal simple cysts. No evidence of hydronephrosis or focal lesions in the kidneys.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: Status post cystectomy. Right lower quadrant ileostomy.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No evidence of metastatic disease or recurrence. |
Generate impression based on findings. | Reason: evaluate ILD History: cough sob fibrosis LUNGS AND PLEURA: Subpleural reticular opacities with a mildly basilar predominance, traction bronchiectasis and bronchiolectasis, but little specific evidence of honeycombing. No groundglass opacities are present.The patient has undergone several wedge biopsies on the right.Scattered punctate calcified micronodules are benign in appearance.Expiration series fail to reveal significant air trapping.MEDIASTINUM AND HILA: Scattered mediastinal lymph nodes are not significantly enlarged.Severe coronary artery calcifications are present.The heart size is normal. CHEST WALL: Degenerative abnormalities affect the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Vascular calcifications and marked right hemidiaphragm elevation. | Moderate interstitial lung disease, a pattern consistent with possible UIP. Marked right hemidiaphragm elevation is present as well. |
Generate impression based on findings. | Reason: h/o met thyroid ca, compare to previous, measurements pls CT neck:There is redemonstration of total thyroidectomy and left neck dissection with apparent sacrifice of the left internal jugular vein and partial resection of the left submandibular gland. There is no discrete residual or recurrent tumor/mass in the sites of prior dissection. There is infiltration of the fat planes along the left than the which remains stable. There is asymmetry at the nasopharynx which is stable compared to prior examWithin the suprahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated. Within the infrahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated.The previously noted right paratracheal lymph node is stable to slightly smaller and only measured to 5 mm diameter on the priorThe airway appears patent.The parotid glands appear intact. The left submandibular gland is smaller than the right submandibular gland.The visualized lung apices appear clear.The carotid and vertebral vasculature visualized on this exam appears intact. Atherosclerotic calcifications are present at the carotid bifurcations.The cervical vertebral bodies in general are intact with no evidence for canal stenosis. There are multilevel degenerative changes in the cervical spine mainly in the form of endplate and uncovertebral osteophytes with neural foramen encroachment stable since the prior exam from 9/20/11There is a subdural effusions present in the posterior fossa which were also present on prior exams and are likely related to atrophy.CT head:There is a small posterior fossa subdural effusion which has been present on prior exam and remains unchanged and is likely related to atrophy.Atherosclerotic calcifications are present along the distal internal carotid arteries.No abnormal enhancing mass lesions are appreciated intracranially. No acute intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the orbits are intact. The paranasal sinuses demonstrate a right maxillary sinus mucus retention cyst in the right sphenoid sinus mucus retention cyst. The mastoid air cells are clear. The eyeball lenses are thin. | 1.No evidence for local recurrence or neck lymphadenopathy on the basis of CT size criteria for lymphadenopathy2.No evidence for brain metastases. |
Generate impression based on findings. | Male 61 years old; Reason: prostate cancer History: prostate cancer ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver has a smooth contour. There are least 3 hepatic lesions over 1 cm. A right hepatic lobe segment 5 lesion measures 3.4 x 2.2-cm (image 53/series 3. Lesion has peripheral nodular enhancement and most likely represents a hemangioma. The smaller hepatic lesions are too small to characterize.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:PROSTATE/SEMINAL VESICLES: Status post prostatectomy.BLADDER: No significant abnormality noted.LYMPH NODES: Small right common iliac lymph node measures 8 x 6 mm on image 114/series 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Small right common iliac lymph node.2.Probable hepatic hemangiomata. |
Generate impression based on findings. | Clinical portion: Evaluate for sinusitis in patient with complaint of headache. Signs and symptoms: Patient with CF and long history of sinusitis. Sinus cultures negative. Medtronic fusion sinus CT:Frontal sinuses demonstrate interval improvement and read on a trace knee coastal thickening in the dependent portion of right frontal sinus is noted.Ethmoid sinuses demonstrate significant interval improvement of bilateral ethmoid sinus disease. Evidence of bilateral ethmoidectomies. Residual mucosal thickening (right greater than left) in the anterior bilateral ethmoids are noted.Sphenoid sinus also demonstrate interval improvement of chronic sinus disease and without detectable acute or chronic sinus disease. There is evidence of prior surgical intervention and removal of the anterior wall of left chamber of sphenoid sinus and widening of the right sphenoethmoidal recess.Right maxillary sinus demonstrate evidence of prior endoscopic functional sinus surgery with patent column were compromised sinonasal window secondary to diffuse mucosal thickening of right maxillary sinus. There is interval worsening of findings since prior study. Left maxillary sinus also demonstrate postoperative changes of endoscopic functional sinus surgery with widely patent sinonasal window. There is significant interval decreased mucosal thickening of the left maxillary sinus with minimal residual.The nasal cavity demonstrate increased soft tissue density/mucosal thickening on the right right exam. There is improvement of mucosal thickening on the left nasal passages since prior exam.Unremarkable orbits. | 1.Interval improvement of frontal, sphenoid and bilateral ethmoid sinusitis since prior exam.2.Interval improvement of chronic sinus disease in the left maxillary sinus with widely patent sinonasal window.3.Interval worsening of right maxillary sinusitis with resultant decreased size of right sinonasal window.4.Evidence of bilateral ethmoidectomies and endoscopic functional surgery of bilateral maximum sinuses. |
Generate impression based on findings. | Male 78 years old; Reason: Pt is a 78 y/o male with met prostate cancer, evaluate for worsening disease History: met prostate cancer, pain CHEST:LUNGS AND PLEURA: Right lower lobe pulmonary nodule measures 0.8 x 0.7 cm (image 83/series 4) previously, 0.8 x 0.8 cm.Sub pleural calcifications and pleural thickening are stableAzygous fissure.MEDIASTINUM AND HILA: Calcified right hilar lymph nodes. No mediastinal lymphadenopathy. Sclerotic rib lesions.CHEST WALL: Enlarged left thyroid lobe.OTHER: ABDOMEN:LIVER, BILIARY TRACT: Reference left hepatic lobe lesion measures 2.2 x 0.9 cm (image 85/series 3) previously, 2.1 x 0.8 cm.Segment 5 lesion measures 1.5 x 0.8 cm (image 100/series 3), unchanged since 7/6/2010.Smaller hypodense lesions are too small to characterize.Mild intrahepatic biliary ductal dilatation.Status post cholecystectomy.SPLEEN: Calcified splenic granulomata.PANCREAS: Subcentimeter cystic lesion in the head of the pancreas (image 126/series 3) is unchanged. This may represent a small side branch type IPMNADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left renal cysts.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes. Left para-aortic node measures 1.1 x 0.8 cm (image 132/series 3) previously, 1.0 x 0.9 cm.Inferior left para-aortic lymph node measures 0.8 x 0.5 cm (image 141/series 3) previously, 0.9 x 0.7 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Sclerotic osseous metastatic disease. Left ilium sclerotic lesion measures 1.0 x 0.7 cm (image 183/series 3) previously, 0.9 x 0.8 cm.OTHER: No significant abnormality noted | 1.Stable size measurements of the reference lesions.2.Sclerotic osseous metastatic disease, better evaluated on the concurrent bone scan. |
Generate impression based on findings. | Reason: 28M w UC s/p robo completion proctectomy, IPAA, DLI on 10/2 discharge 10/7, here w nausea, vomiting History: nausea, vomiting ABDOMEN:LUNG BASES: Basilar 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: No significant abnormality noted.BOWEL, MESENTERY: Status post proctocolectomy with ileoanal anastomosis and right lower quadrant diverting loop ileostomy. Dilated proximal small bowel loops measuring up to 3.2 cm with inspissated stool in a bowel loop immediately proximal to the ileostomy (series 3, image 85). The distal small bowel loops are disproportionately smaller in caliber. Pneumoperitoneum is likely postoperative. There is a small amount of mesenteric fluid without drainable fluid collections.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Enteric tube terminates in the stomach.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Moderate free fluid in the pelvis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Dilated small bowel loops with a transition point at the level of the loop ileostomy compatible with a partial small bowel obstruction. 2.Pneumoperitoneum and mesenteric fluid are likely postoperative. |
Generate impression based on findings. | Reason: evaluate ILD History: sob LUNGS AND PLEURA: Surgical sutures are identified in the left lower lobe and left apex.Focal subpleural areas of clustered small cysts and surrounding groundglass opacity are noted in the right apex and posteriorly in the superior segments of the lower lobes bilaterally.Basilar groundglass opacities and minimal fibrosis with possible early honeycombing at the right lung base.No pleural effusions.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of a pericardial effusion.Mild amount of residual thymic tissue in the intermediastinum.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Focal areas of subpleural clustered cysts and surrounding groundglass with mild basilar fibrosis, possible early honeycombing , and ground glass opacities in a patient of this age group raises the question of pulmonary fibrosis secondary to mixed connective tissue disease. Chronic hypersensitivity pneumonitis is a diagnostic consideration although less likely. |
Generate impression based on findings. | Reason: 73yo F with 15 pack year history, RA, chronic DOE. Eval for pulm abnormalities History: chronic DOE LUNGS AND PLEURA: Multifocal and discontinuous regions of peripheral fibrosis with minimal groundglass that persist on prone imaging, extending from the apices to the bases. Although this is predominantly posterior in location, there are subpleural regions in the anterior medial right upper lobe and anterolateral left upper lobe. In the setting of known rheumatoid arthritis, this favors findings secondary to mixed connective tissue disorder.Evidence of apical predominant minimal centrilobular emphysema.There is a tubular opacity in the left upper lobe (high resolution series 5 image 7) that favors bronchocele. There is a subpleural micronodule measuring 3 mm in the left upper lobe.No suspicious pulmonary nodules or pleural effusions.MEDIASTINUM AND HILA: Heart size is upper limits of normal. There is evidence of prior coronary artery revascularization with moderate native coronary artery and aortic valvular calcification. No pericardial effusion. Mild mediastinal lymphadenopathy. The largest representative lymph node in the high right parabronchial location is 13 mm in short axis (series 3 image 34).Several calcified mediastinal lymph nodes are indicative of prior granulomatous disease.CHEST WALL: The sternum is well approximated by wires.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Peripheral fibrosis with minimal groundglass. Mild associated mediastinal lymphadenopathy. In the setting of known rheumatoid arthritis, this favors findings secondary to mixed connective tissue disorder. |
Generate impression based on findings. | 9/25/2013 CHEST:LUNGS AND PLEURA: New basilar predominant ground glass opacities are seen with interlobular septal and bronchial wall thickening likely representing pulmonary edema. Bibasilar consolidation is again seen, likely related to aspiration/infection.Scattered pulmonary micronodules are again noted with several new nodules in the upper lobes. New ill-defined opacities are also seen throughout the lungs which are nonspecific, however may be due to multifocal infection versus hemorrhage.Previously referenced left upper lobe nodule measures 5 mm (image 39, series 5). Residual linear/nodule opacity in left lower lobe is unchanged.MEDIASTINUM AND HILA: Left subclavian central venous catheter tip lies at the cavoatrial junction. Several prominent right paratracheal lymph nodes are unchanged in size. No hilar lymphadenopathy. The heart is normal in size and there is no pericardial effusion.CHEST WALL: No axillary lymphadenopathy.ABDOMEN:LIVER, BILIARY TRACT: No focal liver lesion or intrahepatic delayed ductal dilation is seen. Gallbladder wall edema and periportal edema are unchanged.SPLEEN: No focal splenic lesion.PANCREAS: The pancreas appears normal.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The kidneys enhance homogeneously and symmetrically without perinephric stranding or hydronephrosis.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No loculated fluid collection.PELVIS:UTERUS, ADNEXA: Small amount of pelvic free fluid is again noted.BLADDER: No significant abnormality notedLYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No loculated fluid collection. | 1.Bibasilar consolidation again seen and may be related aspiration/infection. New ill defined opacities and pulmonary nodules may also be due to infection.2.New bilateral pleural effusions. New pulmonary edema.3.No loculated fluid collection to suggest abscess formation. |
Generate impression based on findings. | 52-year-old female with history of renal calculus ABDOMEN: Within the limitations of a non-IV contrast enhanced examination which limits evaluation of solid organ parenchyma and vascular structures, the following observations can be made:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple nonobstructing calcified renal stones bilaterally largest measuring 5 mm in diameter. No evidence of hydronephrosis bilaterally. No perinephric fat stranding. RETROPERITONEUM, LYMPH NODES: Scattered subcentimeter perirenal and retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Bulbous uterus cannot be further characterized.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Multiple nonobstructing nephrolithiasis bilaterally. |
Generate impression based on findings. | Male 86 years old Reason: h/o met thyroid ca, compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: Innumerable basilar predominant bilateral pulmonary nodules compatible with metastatic disease, increased in size and number from the prior exam, and markedly increased from the exam dated 3/20/2013. Reference left upper lobe lesion now measures 6 mm (image 39, series 5), previously 5 mm. Reference lingula lesion now measures 12 x 9 mm (series 5, image 61), previously 12 x 9 mm.MEDIASTINUM AND HILA: Ectatic ascending aorta and associated calcification of the aortic valve. Moderate/severe coronary artery and moderate thoracic aortic calcifications.Numerous small mediastinal lymph nodes unchanged. Calcified left hilar and subcarinal lymph nodes unchanged.Postoperative changes compatible thyroidectomy.CHEST WALL: Moderate/severe multilevel degenerative changes of the thoracic spine. ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis without evidence of cholecystitis. Multiple punctate calcifications in the hepatic parenchyma consistent with prior granulomatous disease.SPLEEN: Multiple punctate calcifications in the splenic parenchyma consistent with prior granulomatous disease.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cyst again seen, unchanged.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Severe atherosclerosis of the abdominal aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Hyperattenuating lesion adjacent to the lesser curvature of the stomach consistent with aneurysmal dilatation of the left gastric artery measures 15 x 12 mm (series 3, image or), previously 15 x 14 mm. Multiple small mesenteric and retroperitoneal lymph nodes, unchanged.BONES, SOFT TISSUES: Severe multilevel degenerative changes of the lumbar spine. Lucencies scattered throughout the bilateral iliac crests suggestive of osteopenia, unchanged.OTHER: No significant abnormality noted. | 1. Slight interval increase in size and number of miliary pulmonary metastasis. 2. Stable aneurysmal dilatation of the left gastric artery. |
Generate impression based on findings. | Reason: evaluate for stroke History: hypertension, unsteadiness There is redemonstration of a focus of encephalomalacia along the right occipital lobe centered in the cuneus. There is another focus of encephalomalacia involving the left lingual gyrus extending to the fusiform gyrus associated with ex vacuo effect along the adjacent left lateral ventricle.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. The eyeball lenses are thin. | 1.No evidence for acute intracranial hemorrhage mass effect or edema.2.CT is insensitive for the early detection of nonhemorrhagic CVA3.Redemonstration and no change in encephalomalacia in the right and left occipital lobes. |
Generate impression based on findings. | Female 76 years old; Reason: metastatic colon cancer s/p microwave thermoablation of 3 hepatic tumors in august 2013. evaluate for interval change of disease History: colon cancer CHEST:LUNGS AND PLEURA: Right upper lobe pulmonary nodule has increased in size measuring 0.8 x 0.7 cm (image 20/series 4) previously, 0.6 x 0.5 cm.Calcified left basilar nodule and right lung nodule adjacent to the diaphragm are unchanged. The pleural spaces are clear.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion.CHEST WALL: Status post right mastectomy. Post operative changes in the right axilla.ABDOMEN:LIVER, BILIARY TRACT: Hepatic metastases have progressed. The lesion in the superior portion of the caudate measures 3.9 x 2.3 cm (image 76/series 3) previously, 3.1 x 1.6 cm.The right hepatic lobe lesion measures 4.2 x 3.7 cm (image 89/series 3) previously, 2.9 x 2.0 cm.Status post partial hepatic resection and ablation.Residual hepatic and portal veins are patent.SPLEEN: Spleen is normal in size. There are multiple venous collaterals.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: Thoracolumbar scoliosis.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: Thoracolumbar scoliosis.OTHER: No significant abnormality noted. | 1.Increase in the right upper lobe pulmonary nodule.2.Increase in the size of the hepatic lesions. |
Generate impression based on findings. | Reason: pre-op planning History: parkinsons Examination was performed for the purpose of stereotactic guidanceThe 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.Examination was performed for the purpose of stereotactic guidance. No evidence for acute intracranial hemorrhage mass effect or edema.2.Metallic artifact in partially obscures visualization of the intracranial structures. This may obscure subtle abnormalities |
Generate impression based on findings. | Reason: Pancreas cancer please compare to previous scan and provide index measurements for RECIST History: As above CHEST:LUNGS AND PLEURA: Scattered micronodules without significant interval change. No dominant pulmonary lesion. No pleural effusions. MEDIASTINUM AND HILA: Right chest wall Port-A-Cath tip terminates at the cavoatrial junction. Heart size is normal. No pericardial effusion. No lymphadenopathy.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Hypoenhancing mass in the pancreatic body measures 3.3 x 2.5 cm (series 3, image 103), previously 3.5 x 2.6 cm. There is upstream pancreatic atrophy. The splenic vein is patent and the gastrosplenic varices are less prominent compared to the prior exam.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerosis of the abdominal aorta and branches. Subcentimeter retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Pancreatic body mass without significant interval change. 2.Patent splenic vein.3.Nonspecific pulmonary micronodules without significant interval change. |
Generate impression based on findings. | 57-year-old male with poorly differentiated neuroendocrine carcinoma of the pancreas. CHEST: LUNGS AND PLEURA: Stable 1 cm nodule in the anterior right middle lobe (series 9, image 31).MEDIASTINUM AND HILA: Scattered subcentimeter, benign-appearing lymph nodes in the mediastinum. Atherosclerotic vascular calcifications.CHEST WALL: Scattered, subcentimeter axillary lymph nodes bilaterally.ABDOMEN:LIVER, BILIARY TRACT: Stable subcentimeter, hypodense lesion in segment two. Heterogeneous lesion in the posterior right lobe of the liver (series 7, image 102) measures 3.9 x 3.2 cm, previously measuring 3.5 x 2.8 cm. There is interval enlargement of an additional hypodense lesion adjacent to the reference lesion in the posterior right lobe of the liver. There is a new lesion in the left lobe of the liver, segment two, measuring 3.3 x 2.6 cm.Gallbladder is normal. No intrahepatic or extrahepatic biliary ductal dilatation. SPLEEN: No significant abnormality notedPANCREAS: Interval enlargement of large pancreatic head mass measuring 8.0 x 7.5 cm previously measuring 6.6 x 6.0 cm and in addition to size increase there is substantial increase in the peripheral soft tissue nodular component of the mass around the prior demonstrated necrosis..There is mass effect on the adjacent vessels. There is now 360 degree encasement of the SMA. There is 180 degree encasement of the SMV with narrowing proximal to confluence, both of which have increased since prior exam. Remainder of the pancreas appears normal with no pancreatic duct dilatation.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable right mid pole benign cyst.RETROPERITONEUM, LYMPH NODES: Left periaortic lymph nodes looked larger.Relatively stable enlarged reference lymph node in the portacaval space(series 7, image 106) measuring 2.4 x 1.7 cm. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Increase in size of pancreatic anterior pancreatic mass with increased soft tissue nodular component around necrosis. Interval worsening of encasement of SMA.2.Posterior right lobe liver mass is slightly increased in size3.New left lobe liver mass is suspicious for metastasis.4.Mild increase in periaortic lymph nodes.5.Stable right middle lobe lung nodule. |
Generate impression based on findings. | Male 86 years old; Reason: hx UCC and lung nodule, evaluate for growth History: hx UCC CHEST:LUNGS AND PLEURA: Upper lung predominant emphysematous changes. A rounded superior peripherally located upper lobe mass measures 3.0 x 2.9 cm (image 18/series 4) previously, 3.0 x 2.9 cm.Spiculated left upper lobe mass measures 4.3 x 2.5 cm (image 34/series 4) previously, 4.2 x 2.6 cm.The right upper lobe opacity is unchanged.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. Extensive coronary calcification.Left chest wall pacer leads terminate in the heart.CHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. Geographic area of poor enhancement involving the right hepatic lobe. There are additional areas of patchy hypo-attenuation most likely representing fatty infiltration. No discrete hepatic lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right ureter is normal in caliber. The left ureter is dilated up to its insertion into the ileal conduit. Focal hyper enhancing tissue at the left ureter to conduit anastomosis. Non obstructive bilateral renal calculi.RETROPERITONEUM, LYMPH NODES: Calcific arteriosclerotic disease of the aorta with mild lesion of the infrarenal abdominal aorta measuring 2.7-cm in AP dimension.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: CystoprostatectomyBLADDER: CystoprostatectomyLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Postoperative in the ileum.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Mild persistent dilatation of the left ureter with small amount of soft tissue near its anastomosis may represent area of stenosis or small soft tissue lesion.2.Hypoattenuating areas in the liver are unchanged. |
Generate impression based on findings. | Reason: eval progression of saccular aneurysm of distal thoracic aorta History: hx of open AAA repair, saccular aneurysm of thoracic aorta LUNGS AND PLEURA: Moderate upper lobe predominant paraseptal emphysema.Mild basilar scarring/discoid atelectasis unchanged.Scattered calcified and noncalcified micronodules.No suspicious pulmonary nodules or masses.No pleural effusions.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of the pericardial effusion.Small saccular aneurysm of the proximal descending aorta unchanged over multiple exams. However, the exam is limited without the use contrast.CHEST WALL: Stable sclerotic focus in the right seventh rib. The changes in the thoracic spine..UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Multiple surgical clips of the right renal fossa with atrophy the right kidney. Status post left nephrectomy. Surgical clips in the region of the head of the pancreas. | No interval change with redemonstration of a small saccular aneurysm of the proximal descending aorta. |
Generate impression based on findings. | Reason: pancreatic cancer restaging History: pancreatic cancer restaging CHEST:LUNGS AND PLEURA: Multiple pulmonary nodules increasing in size and number. Reference right lower lobe pulmonary nodule measures 8 mm (series 4, image 45), previously 6 mm. Reference left lower lobe pulmonary nodule measures 7 mm (series 4, image 39), previously 5 mm. MEDIASTINUM AND HILA: Calcified mediastinal and hilar lymph nodes without lymphadenopathy. Heart size is normal. No pericardial effusion.CHEST WALL: Reference right axillary lymph node measures 1.9 x 1.2 cm (series 3, image 24), unchanged.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: The mass in the pancreatic body measures 1.7 x 1.4 cm (series 3, image 82), previously 1.8 x 1.4 cm. Streak artifact from adjacent metal limits optimal evaluation and measure of the mass. The splenic vein is thrombosed, unchanged from prior exam. There are multiple gastrosplenic varices, unchanged.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: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Multiple pulmonary nodules, increase in number and size.2.Pancreatic mass is not discretely measurable but appears unchanged.3.Splenic vein thrombosis, unchanged.4.Reference right axillary lymph node is unchanged. |
Generate impression based on findings. | Male 23 years old Reason: patient with histoplasmosis and hemoptysis History: hemoptysis LUNGS AND PLEURA: The cavitary portion of the right middle lobe nodule has subsequently filled in with soft tissue, now measuring 14 x 10 mm (image 55, series 5), previously measuring 14 x 8 mm. There has been marked interval decrease in size of the right upper lobe nodule, now measuring 9 x 4 mm (image 49, series 5), previously measuring 14 x 6 mm. The clustered right upper and left lower node nodules are unchanged. These findings are compatible with patient's history of histoplasmosis.MEDIASTINUM AND HILA: Bulky subcarinal and hilar lymphadenopathy, with associated calcifications appear grossly unchanged. The confluent lymphadenopathy results in severe narrowing of the right bronchus intermedius as well as less pronounced narrowing of the right mainstem and upper lobe bronchi. The degree of of narrowing is unchanged. These findings are compatible with fibrosing mediastinitis secondary to prior histoplasmosis. CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. Interval filling in of the right middle lobe cavitary lesion, which is unchanged in size.2. Confluent bulky mediastinal and hilar lymphadenopathy resulting in severe narrowing of the bronchus intermedius compatible with fibrosing mediastinitis, unchanged.3. Remainder of pulmonary findings compatible with histoplasmosis unchanged. |
Generate impression based on findings. | 50 year-old male with lymphoma -- pre-stem cell transplant evaluation. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Anterior mediastinal reference lymph node mass (series 701, image 31) measures 2.6 x 1 .6 cm, previously 3.5 x 2.0 cm. other small subcentimeter lymph nodes appear unchanged. Nonocclusive superior vena cava thrombus again seen in the supra-atrial location.CHEST WALL: Prior reference left supraclavicular lymph node has continued to decrease in size and now measures 0.6 x 0.4 cm (series 701, image 3) compared with 1.0 x 0.8 cm previously. No other areas of adenopathy are seen.ABDOMEN: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: Continued decrease in size of the peripancreatic lymph node mass (series 701, image 106), which now measures 3.3 x 2 .2 cm, compared with previous 4.0 by 3.8-cm. other retroperitoneal lymph nodes remain small and subcentimeter in appearance not significantly changed from prior examination.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: Only. Subcentimeter lymph nodes are seen diffusely throughout the pelvis and unchanged from prior examination. The referenced prior right common iliac lymph node (series 701, image 144) measures 0.8 x 0.6 cm, previously 0.8 x 0.6 cm.Slightly prominent inguinal lymph nodes bilaterally seen most of which have fatty hila, typical of benign appearing lymph nodes. These have not changed in size or appearance.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Continued decrease in size of anterior mediastinal lymph nodes as measured above with no change in the, predominately small, subcentimeter lymph nodes seen in the abdomen and pelvis. 2. No new evidence of disease or progression. 3. No change in nonocclusive superior vena cava thrombus. |
Generate impression based on findings. | Reason: metastatic thyroid ca, eval for dz progression History: as above The patient is status post laryngectomy and thyroidectomy.There is a small nodule present in the right thyroid bed measuring 5 mm in size which is unchanged since prior examSince the prior exam the patient has developed a lytic lesion in the right clavicle associate with a fracture.Within the suprahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated. Within the infrahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated.The airway appears patent.The visualized intracranial structures demonstrate a punctate enhancing lesion in the left occipital lobe and one in the right parietal lobe which were seen better on an MRI from 4/23/13.. The visualized portions of the orbits are intact. The paranasal sinuses demonstrate a mucus retention cyst in right maxillary sinus.. The mastoid air cells are clear.The parotid and the submandibular glands appear intact.The visualized lung apices appear clear.The carotid and vertebral vasculature visualized on this exam appears intact.The cervical vertebral bodies in general are intact with no evidence for canal stenosis. | 1.New pathologic fracture involving the right clavicular head is suspicious for metastatic disease .2.Small nodules in the right parietal lobe and left occipital lobe are better seen on a recent MRI of the brain and are suspicious for metastatic disease |
Generate impression based on findings. | Reason: lung cancer History: lung cancer CHEST:LUNGS AND PLEURA: Left sided volume loss, postsurgical changes, and a loculated hydropneumothorax unchanged from the prior exam.There is marked attenuation and narrowing of the left descending pulmonary artery.Azygos pseudo-lobe noted on the right.Mild pleural thickening on the right.MEDIASTINUM AND HILA: Enlarged right paratracheal lymph node (image 35 series 401) unchanged from the prior exam. Stable enlarged precarinal lymph node (image 41 series 41).Large right hilar lymph node (image 46 series 41) measures 2.9 cm.Subcarinal lymphadenopathy stable.Cardiac enlargement without evidence of pericardial effusion.Severe coronary artery calcification.Evidence of previous CABG.Paraspinal soft tissue at the level of the proximal descending aorta (image 37 series 4) may be metastatic or inflammatory in origin .CHEST WALL: Status post median sternotomy. Old fracture deformities of the right hemithorax. Status post left thoracotomy.Degenerative changes in the thoracic spine.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Severe atherosclerotic changes of aorta and its branches with aneurysmal dilatation of the distal abdominal aorta and a prominent eccentric mural thrombus.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Severe degenerative changes of the lumbar spine.OTHER: No significant abnormality noted. | 1.Postsurgical changes and volume loss in the left lung with a loculated hydropneumothorax.2.Right hilar and mediastinal lymphadenopathy.3.Left paraspinal soft tissue at the level of the proximal descending aorta probably representing a metastatic focus although inflammatory etiology cannot be excluded. |
Generate impression based on findings. | 24 year-old male. Undifferentiated sarcoma, assess for pulmonary disease. LUNGS AND PLEURA: No suspicious nodules or masses identified.MEDIASTINUM AND HILA: Normal heart size. No hilar or mediastinal lymphadenopathy is identified.CHEST WALL: Left humeral prosthesis with adjacent surgical clips. Few Schmorl's nodes are present in the lower thoracic vertebral bodies. UPPER ABDOMEN: Punctate calcification along the right medial hemidiaphragm is unchanged. No abnormality is seen in the superior aspects of the liver, kidneys and spleen. | No evidence of intrathoracic metastasis. |
Generate impression based on findings. | 66-year-old male with resected renal cell carcinoma and enlarging lymph nodes. CHEST:LUNGS AND PLEURA: No parenchymal lung nodule seen. Reference left upper lobe parenchymal nodule (series 6, image 32) has slightly increased in size, measuring 2.0 x 1 .9 cm, previously 1.8 x 1.6 cm.MEDIASTINUM AND HILA: Again noted are diffusely enlarged anterior mediastinal lymph nodes with slight increase in size. The reference lymph node (series 4, image 35) measures 2.9 x 1.7 cm.. No new foci of lymph node enlargement is seen.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No change in scattered small subcentimeter hypodensities, most likely benign. No new lesions are seen. Contracted gallbladder again seen. No intrahepatic or extrahepatic biliary duct dilatation noted.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Postsurgical changes from prior partial resection seen in the left kidney without change. Cortical benign cyst anteriorly in left kidney. No evidence of tumor recurrence or residual tumor. Right kidney appears normal.RETROPERITONEUM, LYMPH NODES: Diffuse retroperitoneal, periaortic adenopathy has slightly increased in size. Prior referenced left para-aortic lymph node (series 4, image 126) measures 3.8 x 2.7, previously 3.2 x 2.6 cm.BOWEL, MESENTERY: Diffuse mesenteric adenopathy is slightly increased in size without new foci seen. Prior reference lymph node (series 4, image 149) now measures 4.2 x 3 .5 cm, compared with 4.0 x 3 .4 cm, previously.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Scattered subcentimeter lymph nodes unchanged. Slightly prominent inguinal lymph nodes, mostly, with normal-appearing fatty hila are unchanged.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Right inguinal hernia containing only mesenteric fat.OTHER: No significant abnormality noted | 1. No new foci of involvement, however, slight increase in reference lymph node measurements in chest and abdomen. 2. Slightly increasing size of pulmonary nodule. |
Generate impression based on findings. | Reason: Does patient have pyogenic pyelonephritis or abdominal abscess or other etiology of suprapubic pain? History: hematuria, dysuria, frequency, SUPRAPUBIC PAIN ABDOMEN:LUNG BASES: Basilar atelectasis.LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis or evident nephrolithiasis. No renal mass or perinephric collection.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of obstruction. No pneumoperitoneum or mesenteric fluid. No drainable fluid collections.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Thickened bladder wall with enhancing mucosa compatible with cystitis. No pelvic fluid collections.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Bladder wall thickening with enhancing mucosa compatible with cystitis. No pelvic fluid collections. |
Generate impression based on findings. | Status post thoracic aneurysm repair with new left upper quadrant pain ABDOMEN:LUNG BASES: Patient's known descending thoracic aorta aneurysm is again noted. There is a stent in place. The aneurysm measures 7.7 x 5.1 cm number 3 series number 9. The thoracic aneurysm is incompletely imaged on this abdominal pelvic CT. There are no evidence of extravasation of contrast into the aneurysm sac. LIVER, BILIARY TRACT: Multiple hyperdense lesions in the liver and simple cysts are unchanged from previous study. Near etiology is unknown.SPLEEN: Splenic cyst is unchanged.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral atrophic kidneys with hypodense lesions likely representing cysts unchanged.RETROPERITONEUM, LYMPH NODES: Torturous abdominal aorta. Atherosclerotic changes involving the abdominal aorta and its major branches. New focal dissection involving the right common iliac artery extending to the right external iliac artery.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 | Posterior denting changes involving the descending thoracic artery aneurysm. The aneurysm is incompletely imaged with this abdominopelvic CT. Chest CT maybe helpful for better evaluation of the aneurysm clinically indicated.New focal dissection involving the right external iliac and right common iliac arteries.Multiple hepatic hypodense lesions of unknown etiology, not significantly changed from previous study. |
Generate impression based on findings. | Right lower quadrant pain This study is limited due to lack of IV contrastABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Previously described hypodense lesions in the liver are not seen. Lack of IV contrast limits optimal evaluation of the liver.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: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Interval placement of a percutaneous drainage catheter into patient's known abscess. Fluid collection decreased in size within the interval. | Limited study due to lack of intravenous contrast.Interval decrease in the size of the pelvic fluid collection following percutaneous drainage.Patient's known liver lesions cannot be evaluated due to lack of IV contrast. |
Generate impression based on findings. | Metastatic pancreas cancer CHEST:LUNGS AND PLEURA: Scarring and atelectasis in the lung bases, not significantly changed from previous study. Nonspecific nodular densities in both lungs. Index lesion measures 5 mm image number 41, series number 5. Follow-up imaging is recommended.MEDIASTINUM AND HILA: Mediastinal adenopathy. Index pretracheal lymph node measures 1.2 by 0.8-cm image number 22, series number 3. Borderline enlarged right hilar lymph node.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Pneumobilia secondary to metallic stent in the common bile duct. Intrahepatic biliary tree is slightly prominent.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic ductal dilatation within prop narrowing at the pancreatic head without a discernible mass is unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Borderline enlarged retroperitoneal lymph nodes. There is some soft tissue fullness around the celiac trunk and in the lesser sac. This is unchanged from previous study. An index paraceliac lymph node measures 1.8 x 1.1 cm image number 99, series number 3, unchanged from previous study.BOWEL, MESENTERY: Mild nodularity of the omentum is unchanged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of fluid in the pelvis. | No significant change from previous study.Nonspecific right lung nodule. Follow-up with chest CT is recommended. |
Generate impression based on findings. | Ascending aortic aneurysm CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: There is a ascending thoracic aortic aneurysm measuring up to 4.5-cm in its greatest AP dimension. Aortic arch and descending thoracic aorta are unremarkable. An enlarged thyroid extending retrosternally.CHEST WALL: No significant abnormality noted | Ascending aortic aneurysm.Retrosternal goiter. |
Generate impression based on findings. | Clinical question: History of arteriovenous malformation in the basal ganglia/thalamus, seizure disorder. Signs and symptoms: Seizures. Nonenhanced head CT:There is no evidence of acute intracranial process. CT however is insensitive for detection of acute nonhemorrhagic ischemic strokes.Fairly extensive punctate and linear calcification in the left basal ganglia/thalamus and with inferior extension into the left cerebral peduncle appears fairly similar to two prior studies from 2009 and 2011 and consistent with patient's known arteriovenous malformation. There is no evidence of hemorrhage or surrounding vasogenic edema or any mass effect with the findings. This is a similar observation is prior study. There is also stable small focus of calcification in the right posterior thalamus.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF cisterns and gray to white matter differentiation otherwise. | 1.No evidence of acute intracranial process.2.Stable extensive punctate and linear vascular calcification in the left basal ganglia/thalamus consistent with patient's known arteriovenous malformation.3.Stable punctate focus of calcification in the right posterior thalamus. |
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