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Generate impression based on findings. | Reason: history of hematuria, please evaluate with CT urogram History: hematuria ABDOMEN:LUNG BASES: Redemonstration of extensive centrilobular and paraseptal emphysema. Severe atherosclerosis of the aortic valve and coronary arteries. Sclerotic calcifications of the descending thoracic aorta.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Two large renal cysts in the right kidney. A small renal cyst in the left kidney. No filling defects of the ureters. No evidence of nephrolithiasis. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Penetrating atherosclerotic ulcers of the descending thoracic aorta prior to the aortic hiatus. Extensive atherosclerotic calcification of the descending aorta and bilateral iliac arteries. Ectatic descending aorta with aneurysmal dilation of bilateral iliac arteries with large mural thrombi. Iliac artery aneurysms appear slightly larger in diameter compared to prior exam. Descending aorta and the iliac artery bifurcation is slightly larger in diameter compared to prior exam. The right superficial femoral artery appears to be completely thrombosed.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Bladder diverticula arising from the right bladder wall. No filling defects.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: | 1.Etiology of hematuria is not evident.2.Right large renal cysts.3.Bladder diverticulum arising from the right bladder wall.4.Ectatic descending aorta with interval enlargement of aneurysmal dilatation of bilateral iliac arteries with large mural thrombi.5.Thrombosis of the right superficial femoral artery.6.Redemonstration of severe diffuse atherosclerotic disease.7.Redemonstration of extensive centrilobular and paraseptal emphysema. |
Generate impression based on findings. | Reason: s/p Lap Appy with open abd wound that is now closing, c/o sudden severe abd pain x1 day with elevated blood sugars, assess for abscess/fluid collections History: s/p Lap Appy with open abd wound that is now closing, c/o sudden severe abd pain x1 day with elevated blood sugars, assess for abscess/fluid collections Lack of enteric contrast limits evaluation of GI pathology.ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Dilated small bowel loops measuring up to 3.4 cm with a transition point in the right pelvis. There is mesenteric free fluid without pneumoperitoneum. Status post appendectomy. Moderate wall thickening of the distal ileum.BONES, SOFT TISSUES: Midline laparotomy wound.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: Multiple small wall enhancing loculated fluid collections in the pelvis, which are inseparable from adjacent bowel loops due to lack of enteric contrast. These collections have decreased from the prior exam.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Small bowel obstruction with a transition point in the right pelvis.2.Wall enhancing loculated collections compatible with abscesses, decreased in size compared to the prior exam. |
Generate impression based on findings. | Chronic sinusitis. There is mild to moderate mucosal thickening within the bilateral maxillary sinuses. The bilateral infundibula are partially opacified. There is mild to moderate opacification of the ethmoid sinuses. There is mid mucosal thickening within the left sphenoid sinus. The right sphenoid sinus is clear. The nasal cavity is clear. There is no significant nasal septal deviation. The ethmoid roofs are nearly symmetric and intact. The optic canals and carotid grooves are covered by bone. There are degenerative changes affecting the right temporomandibular joint. The mastoid air cells are clear. The imaged portions of the intracranial structures and orbits are grossly unremarkable. | Mild to moderate scattered paranasal sinus opacification in a sporadic pattern. |
Generate impression based on findings. | Head and Neck cancer follow-up RT and chemo. CHEST:LUNGS AND PLEURA: Reference linear opacity in the right upper lobe measures 19 x 5 mm, previously 18 x 5 mm, not significantly changed (5/23). Right lower lobe nodule is 6 x 6 mm (5/76), previously 7 x 6 mm.Subpleural opacities superior segment right lower lobe unchanged. Bronchial wall thickening and patchy ground glass opacity in the right upper lobe new from previous, likely inflammatory or infectious. Groundglass opacity abutting the mediastinum on the left with adjacent pleural retraction (5/29), unchanged. No pleural fluid.MEDIASTINUM AND HILA: Coronary artery calcifications. Normal heart size. Asymmetric wall thickening of the distal esophagus at the GE junction unchanged dating back to 2011, nonspecific by CT.CHEST WALL: 2-3mm lesion in the left sixth rib laterally with a sclerotic rim (4/142) unchanged dating back to 2011, likely benign.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Subcentimeter hypoattenuating lesions in the liver unchanged, too small to be characterized.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 significant change in index pulmonary lesions. Interval development of bronchial wall thickening and groundglass opacity in the right upper lobe which may be infectious or inflammatory. |
Generate impression based on findings. | 56-year-old male with follicular non-Hodgkin's lymphoma status post chemotherapy CHEST:LUNGS AND PLEURA: Basilar dependent atelectasis. No pleural effusions. No suspicious nodules or masses.Azygos pseudo-lobe.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size is normal without pericardial effusion.CHEST WALL: No axillary lymphadenopathy.ABDOMEN:LIVER, BILIARY TRACT: Left subcentimeter hepatic hypodensity is too small to characterize and unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Left periaortic index node is smaller measuring 1.8 x 1.0 cm (image 119; series 41).BOWEL, MESENTERY: Mesenteric adenopathy redemonstrated. Large mesenteric mass measures 4.4 x 3.1 cm (image 129; series 401), larger than previous. An additional mesenteric index node measures 1.0 x 0.6 (image 121; series 401), equivocally smaller than previous.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Vague soft tissue seen in the left inguinal canal has regressed. | Mixed response. Reference measurements are given above. |
Generate impression based on findings. | Reason: Hx NHL now s/p 4 cycles of RCHOP, eval response to treatment History: chemo, hx nhl CHEST:LUNGS AND PLEURA: No suspicious pulmonary nodules or masses. Mild basilar atelectasis.Left lower lobe subpleural thickening.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size is normal without pericardial effusion. Right chest wall Port-A-Cath tip terminates in the SVC. Small hiatal hernia.CHEST WALL: No axillary lymphadenopathy. Mixed sclerotic/lytic lesion of the T6 vertebral body.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Large infiltrative retroperitoneal mass invades the right kidney and encases the IVC measuring 8.6 x 4.4 cm (axial image 115), previously 8.9 x 5.5 cm. The IVC is attenuated but patent. The right renal artery courses through the mass and is presumed to be patent given that there is symmetric enhancement of the kidneys. The right kidney is atrophic.RETROPERITONEUM, LYMPH NODES: Severe atherosclerosis of the abdominal aorta and its branches.BOWEL, MESENTERY: There is mild extensive mesenteric stranding, unchanged from the prior exam. There are multiple prominent mesenteric lymph nodes. Reference mesenteric lymph node in the left hemi-abdomen measures 1.3 x 1.0 cm (axial image 136), previously 1.3 x 1.1 cm. Diverticulosis without evidence of diverticulitis.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: Prolene plug for right inguinal hernia repair is noted. | 1.Decreasing infiltrative retroperitoneal mass invading the right kidney with encasement of the IVC.2.Misty mesentery with multiple prominent mesenteric lymph nodes without significant interval change.3.T6 vertebral body metastasis, unchanged.4.No new sites of disease in the chest, abdomen, or pelvis. |
Generate impression based on findings. | Clinical question: Personality change, dysphonia. Signs and symptoms: As a ball. Unenhanced head CT:There is no detectable acute intracranial process. CT however is insensitive for detection of acute nonhemorrhagic ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation. Midline is maintained.Unremarkable calvarium and soft tissues of the scalp.Unremarkable images through the orbits.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities remain well pneumatized and unremarkable. | No acute intracranial process. Please see above comments. |
Generate impression based on findings. | Clinical question: Esophageal cancer with brain metastases, check response to WBRT. Enhanced head CT:There is a small focus of parenchymal enhancement in the left said about the measuring at approximately 6 mm in its transaxial dimensions (axial image 8 and sagittal reformatted image 35). This is a new finding since prior exam and suspected for a metastatic lesion.An additional focus of parenchymal enhancement in the right medial temporal lobe measuring at 10 x 7 .2 mm on axial image 10 and consistent with a new metastatic lesion.Additional focus of enhancement in the right mid temporal lobe measuring at 6-mm in transaxial dimensions as visualized on axial image number 11.Additional superficially located enhancing left frontal lobe metastatic lesion measuring at 7.5 times 7-mm (axial image 21 and sagittal reformatted image 35. This lesion however demonstrates subtle surrounding edema.Calvarium demonstrate small focus of bony defect in the diploic space of the left frontal bone as was noted on prior MRI studies. This finding measures approximately 5 mm in size and is entirely within the diploic space and without evidence of associated cortical bony changes. Stable since prior studies. Evidence of left posterior temporal -- occipital small craniotomy for removal of tumor and without evidence of recurrence of disease in the adjacent brain parenchyma. Redemonstration of a small scalp enhancing tissue in exophytic pattern of growth measuring at 11 x 11.7-mm (sagittal reformatted image 46) and the left frontal scalp and with increased size since prior exam (axial image 26).Findings on this exam were discussed by phone with referring clinical physician Dr Victoria Villaflor pager number 8956 at the time of review of study | 1.Examination demonstrates multiple small new enhancing metastatic lesions in bilateral cerebral hemispheres as well as the left cerebellum since prior exam.2.Postoperative changes of left posterior temporal -- occipital craniotomy for removal of tumor and without evidence of recurrence of disease at this site.3.Stable tiny focus of nonocclusive calvarial low-attenuation in the left frontal lobe since prior study.4.Slight interval increase in a exophytic type enhancing lesion in the left frontal scalp superficially and measuring at 11 x 11.7-mm in size. This lesion demonstrates slight interval increased size. |
Generate impression based on findings. | Post inflammatory pulmonary fibrosis. Chronic cough, worsening interstitial opacities on CXR and severely reduced diffusion capacity on PFTs. LUNGS AND PLEURA: Moderate cylindrical and varicoid traction bronchiectasis in the mid and lower lung zones, seen to a lesser extent in the upper lobes. Diffuse mosaic attenuation of the lung parenchyma which persists on the expiration sequence, consistent with airtrapping. Mild thickening of the fissures with peripheral/sub pleural interlobular septal thickening. At the lung bases, intralobular septal thickening is also observed along with mild groundglass opacity. Subtle bronchiolectasis along the fissures and lung periphery(4/51). Mild subpleural reticulation consistent with fibrosis. Mild paraseptal emphysema. Mild honeycombing also consistent with fibrosis within the lingula and right middle and lower lobes.Interval progression of above findings since the 2009 exam.MEDIASTINUM AND HILA: Atherosclerotic calcification of the thoracic aorta and its branches. Native coronary arteries are heavily calcified. Postsurgical findings consistent with prior CABG. Mildly enlarged low right paraesophageal lymph node (3/64). Numerous additional mediastinal lymph nodes bilaterally, upper normal in size.CHEST WALL: Mild gynecomastia. Sternal wires appear intact. Lower thoracic spine anterior flowing osteophyte formation consistent with DISH. Vacuum disk phenomenon in the lower thoracic spine. Mild degenerative changes.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range.Cholelithiasis. | 1.Interval progression of moderate pulmonary fibrosis and bronchiectasis along with evidence of air trapping. This constellation of findings is most consistent with subacute hypersensitivity pneumonitis however the basilar distribution is atypical and superimposed fibrotic NSIP may be considered.2. Interval mild enlargement of a lower paraesophageal lymph node, nonspecific by CT and of unclear clinical significance. Correlate for symptoms of esophageal pathology. |
Generate impression based on findings. | History of Ewing's sarcoma in second remission, respiratory insufficiency secondary to chemo radiation, evaluate for pulmonary metastatic nodules LUNGS AND PLEURA: Bilateral upper lobe predominant linear and subpleural opacities with scarring and traction bronchiectasis appears similar to the prior study. No pleural effusion or pneumothorax.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy. The heart is normal in size and there is no pericardial effusion.CHEST WALL: No axillary lymphadenopathy. Healing left fourth and fifth rib fractures are unchanged. Lytic lesions in the sternum and manubrium are unchanged from the prior study. Pectus excavatum is again noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.Bilateral upper lobe predominant traction bronchiectasis and scarring is unchanged. No new pulmonary nodule.2.Manubrial and sternal lucent lesions are unchanged. Healing left fourth and fifth rib fractures. |
Generate impression based on findings. | Hodgkin's lymphoma stage III S. status post 4 cycles of chemotherapy. Restaging. CHEST:LUNGS AND PLEURA: Scattered calcified granulomas.Dependent atelectasis.MEDIASTINUM AND HILA: Multiple enlarged mediastinal lymph nodes have regressed compared to prior chest CT. The reference low right paratracheal node now measures 2.0 x 1.7 cm (image 27; series 401), previously 3.9 x 2.8 cm. This area was not included on the most recent abdomen and pelvis CT.CHEST WALL: Right chest port.ABDOMEN:LIVER, BILIARY TRACT: Unchanged scattered, hypodensities remain too small to characterize, but likely benign. Fluid density cyst in the right hepatic dome, compatible with a simple cyst.SPLEEN: Previously described splenic lesions are no longer visible.PANCREAS: Subcentimeter cystic lesion in the tail of the pancreas is unchanged.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Stable porta hepatis nodes with a reference, porta hepatis lymph node measures 1.2 x 1.8 cm (image 97; series 401). BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Status post hysterectomy. Adnexa appear unchanged.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Streak artifact from left hip replacement.OTHER: No significant abnormality noted | Resolution of previously described splenic lesions. No substantial interval change in reference lymph nodes in the abdomen. Lymph nodes in the mediastinum have regressed compared to the most recent chest CT of 3/2013. |
Generate impression based on findings. | 68-year-old male with history of bilateral palatine tonsil squamous cell carcinoma and prior metastatic disease to right neck node. Evaluate for recurrence. The partially visualized orbits are normal. Scattered mild paranasal mucosal thickening. The mastoid air cells are clear. Limited view of the intracranial structures are unremarkable. Streak artifact from dental hardware limits evaluation of the oral cavity.Redemonstration of moderate generalized pharyngeal and laryngeal mucosal edema. No solid enhancement or exophytic mass to suggest recurrent or new tumor in the aerodigestive tract. Persistent asymmetric piriform sinuses with greater aeration on the left. Right tonsil calcification is unchanged.The parotid and submandibular glands are unremarkable except for submandibular atrophy. Atrophic appearing thyroid. No lymphadenopathy is noted. The carotid arteries and jugular veins are patent. Atherosclerotic vascular calcification at the left carotid bifurcation without significant stenosis.Bilateral pulmonary linear opacities extending to the pleural surface are unchanged. Bilateral apical pleuroparenchymal scarring. Circumferential esophageal wall thickening which may in part be secondary to underdistention and unchanged. Moderate to severe degenerative changes of the cervical spine are present. Mild grade 1 anterolisthesis of C3 on C4 and C4 on C5. Severe left facet arthropathy present at these levels as well. | 1.No new neck mass or cervical lymphadenopathy to suggest recurrence.2.Bilateral linear lung opacities are unchanged, likely areas of scarring. Please see dedicated CT of the chest from today.3.Moderate to severe degenerative disc disease affects the cervical spine. |
Generate impression based on findings. | Reason: pt with met esophageal ca s/p 4 cycles of chemo History: now needs disease evaluation compare to previous scans and comment CHEST:LUNGS AND PLEURA: Left basilar consolidation/atelectasis slightly more dense than the prior exam.Subpleural nodule in the left lower lobe as well as scattered left upper and lower lobe micronodules not identified on this exam and most likely is inflammatory in origin.Right middle lobe nodule slightly decreased in size and appears more scar like on the current exam.Paramediastinal fibrotic changes may be related to radiation therapy.No pleural effusions.MEDIASTINUM AND HILA: Stable left thyroid lobe hypodensity.No hilar or mediastinal lymphadenopathy.Cardiac size is normal with small pericardial effusion unchanged.Port-A-Cath with its tip in the SVC/RA junction.Mild esophageal wall thickening similar to the prior exam.CHEST WALL: Noted 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: Stable small right renal hypodensity.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Gastrohepatic lymph node (image 78 series 3) measures 10 mm, previously measuring 9 mm.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Jejunostomy catheter unchanged.BONES, SOFT TISSUES: Radiolucent lesion in the L1 vertebral body unchanged. No new osseous lesions identified.OTHER: No significant abnormality noted. | 1.Resolution or decrease in size of previously identified pulmonary micronodules . No new suspicious pulmonary nodules or masses.2.Stable gastrohepatic lymph node.3.No sites of disease identified. |
Generate impression based on findings. | Evaluate for possible disease progression, specifically in the liver. CHEST:LUNGS AND PLEURA: Minimal scarring at the lung bases.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Unchanged left anterior chest wall Port-A-Cath with tip of catheter in the superior vena cava. Right breast skin thickening remains unchanged. Sclerotic expansile lesion unchanged in the right second rib anteriorly, and unchanged. Punctate and nodular lesions sclerotic in nature in the left scapula, T7 and T11 vertebral bodies. No new lesions are identified.ABDOMEN:LIVER, BILIARY TRACT: Large stent remains in position in the common hepatic duct with pneumobilia indicating patency. No dilatation intrahepatic biliary ducts are seen. The small focal reference lesion in inferior right lobe (series 801, image 82) is stable and measures 7 x 4 mm. No new lesions identified.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal nodule, not significantly changed, measuring 1.5 x 1.1-cm (series 801, image 101).KIDNEYS, URETERS: Benign cyst seen in left kidney, unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic metastases are unchanged.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Left adnexal thick-walled cystic lesion again noted is unchanged. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multiple sclerotic metastases appear unchanged.OTHER: No significant abnormality noted. | No substantial interval change compared to prior. Multiple bony metastases. Stable reference measurements. |
Generate impression based on findings. | Female 36 years old Reason: history of parathyroid carcinoma, eval for recurrence. LUNGS AND PLEURA: Resolution of subsegmental atelectasis and focal consolidation in the left costophrenic angle. No new air space abnormality identified. Subpleural nodular density in the right middle lobe unchanged since 2011 and could be a lymph node.MEDIASTINUM AND HILA: Well-circumscribed uniform soft tissue density in the thyroidectomy bed likely representing scarring/postsurgical changes. No definitive evidence of local recurrence. Resolution of pneumomediastinum.No evidence of mediastinal, supraclavicular or hilar lymphadenopathy.Normal heart size and no pericardial effusionCHEST WALL: Enlarged left axillary lymph node not visualized on the prior exam demonstrates a normal fatty hilum, likely benign in etiology.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. | No CT evidence of local recurrence or metastatic disease. |
Generate impression based on findings. | Reason: has lung adenocarcinoma mets to liver, hips, on chemo check response History: pain CHEST:LUNGS AND PLEURA: Status post right lower lobectomy. Apical scarring and bronchiectasis, unchanged. No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: No mediastinal or hilar adenopathy. Heart size is normal. No pericardial effusion. Coronary artery calcification.CHEST WALL: Sclerotic lesion in the T12 vertebral body, unchanged.ABDOMEN:LIVER, BILIARY TRACT: Heterogeneous right hepatic lobe lesion measures 2.1 x 1.7 cm (series 3, image 94), unchanged. Cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: Previously described hypodensity in the pancreatic neck is not seen on the current exam.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right superior pole simple cyst.RETROPERITONEUM, LYMPH NODES: Left paraaortic lymph node measures 1.6 x 0.9 cm (series 3, image 115), unchanged. Atherosclerosis of the abdominal aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Percutaneous gastrostomy tube, unchanged.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.Right hepatic lobe metastasis, unchanged.2.Sclerotic lesion in the T12 vertebral body, unchanged.3.No new sites of disease in the chest, abdomen, or pelvis. |
Generate impression based on findings. | Reason: History of HCC. Staging workup prior to enrollment in a clinical trial. History: na CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Atherosclerotic calcifications of the coronary arteriesCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Liver contour: Cirrhotic morphology.Cholelithiasis.Features of portal hypertension: Portosystemic collaterals around the spleen. Mild to moderate amount of ascites.Portal vein: Thrombosis of the portal vein with cavernous transformation. Hepatic veins: PatentHepatic artery: Patent Right posterior liver lobe lesion evaluation is limited by streak artifact secondary to hardware in the spine. Right posterior lobe liver lesion cavity measures 4.2 x 5.1 cm and does not have arterial enhancement, does not washout, and does not have peripheral rim enhancement.The hepatic lesion in segment 2 measures 2.5 x 2.0 cm with hyperdense foci compatible with chemoembolization material. There is residual arterial enhancement with demonstrable washout on delayed imaging suggestive of residual disease. There is also patchy enhancement with delayed washout inferior to this lesion suggestive of residual disease and questionable involvement of the portal vein.There is redemonstrated of a hyperintense lesion in the peripheral right lobe, segment 7 (series 9, image 15) which does not appear to washout and likely represents a transient hepatic attenuation difference.The caudate lesion measures 2.2 x 1.8 cm and demonstrates early enhancement with washout.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: There is enlargement of the right adrenal gland mass now measuring 5.2 x 4.3 cm. The mass is heterogeneous with no washout on delayed imaging. Left adrenal nodularity is redemonstrated.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Evaluation is significantly limited by streak artifact secondary to spinal hardware. BOWEL, MESENTERY: No significant abnormality noted..BONES, SOFT TISSUES: Thoracic spine hardware..OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Large amount of pelvic ascites. | 1.Segment 1 lesion demonstrates early enhancement with washout compatible with known disease.2.Increase in size of segment 2 lesion with chemoembolization material demonstrating residual peripheral enhancement with washout suspicious for residual disease and inferior extension of disease and questionable portal vein involvement.3.Stable segment 6 lesion without evidence of residual disease.4.Stable segment 7 lesion likely representing transient hepatic attenuation difference.5.Enlargement of right adrenal mass with heterogeneity suspicious for metastatic involvement.6.Moderate to large amount of abdominal and pelvic ascites. |
Generate impression based on findings. | Newly diagnosed SLL with night sweats. Staging. CHEST:LUNGS AND PLEURA: Scarring at both lung apices. There is a 9 x 10 mm nodule at the right lung base medially (image 85; series 4).MEDIASTINUM AND HILA: Multiple small mediastinal lymph nodes. A high left paratracheal node (image 14; series 3) measures 2.0 x 1.7 cm. Coronary artery calcifications.CHEST WALL: Bilateral small axillary lymph nodes; most have fatty hila suggesting benignity.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Scattered retroperitoneal lymph nodes. For reference purposes, there is a right paracaval lymph node (image 126; series 3) which measures 3.1 x 3.2 cm. Additional enlarged pericecal lymph nodes are also noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Scoliosis.OTHER: Infrarenal inferior vena cava filter.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Scattered enlarged pelvic lymph nodes. For reference purposes, a right internal obturator lymph node measures 2.3 x 1.0 cm (image 170; series 3).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Two left iliac vein stents. | 1. Multiple enlarged lymph nodes with reference measurements given above. The largest nodes are located in the right lower quadrant in the pericecal region.2. 1 cm right basilar pulmonary nodule. |
Generate impression based on findings. | Female 63 years old Reason: new stage IV endometrial cancer needs chemo, evaluate metastatic disease History: see above CHEST:LUNGS AND PLEURA: Calcific granulomata right lung and right hilum. No suspicious lung nodules or effusions.MEDIASTINUM AND HILA: Cluster of two or possibly septated hypodense nodules in the left lobe of the thyroid gland.Right hilar calcific granuloma. No pathologic size lymph nodes.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes anterior abdominal wall.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Surgically absent. Prominent vaginal cuff. Small amount of fluid in the cul-de-sac.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. Small amount of fluid in the cul-de-sac. No measurable tumor.BONES, SOFT TISSUES: Surgical changes anterior abdominal wall.OTHER: No significant abnormality noted. | Postsurgical changes. Small amount of fluid in the cul-de-sac. Lungs granulomatous disease. |
Generate impression based on findings. | Male 29 years old Reason: Crohn abd pain History: Abd pain distention.Additional history from pathology report of 7/22/13 indicates that the patient has a history of ileocolonic Crohn's disease has had two resections in the current anastomotic stricture at that time. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Multiple gallstones seen in a collapsed gallbladder and gallbladder neck and possibly cystic duct. No pericholecystic fluid or fat stranding. No biliary dilatation.SPLEEN: 4.1 x 3.3 cm hypodense lesion in the spleen series 2 image 20 consistent with a splenic cyst. Small satellite lesions are also seen which represent cysts or hemangiomas.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Widely patent ileocolic anastomosis about 1.5 cm diameter is seen on coronal image 45/90. No evidence of active Crohn's disease in the region of the anastomosis or distal ileum. No free or loculated intraperitoneal fluid. Small bowel is normal.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: There is mild hyper-enhancement and wall thickening involving the rectum, rectosigmoid area with some mild prominent pericolonic fat. These findings consistent with Crohn's disease, may be chronic in nature. There is no pericolonic fat stranding or fluid to suggest significant disease activity. No sinus tracts or fistulas seen. Mesenteric vasculature enhances normally without evidence of thrombus.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Findings consistent with Crohn's disease involving the rectum, rectosigmoid and sigmoid colon as described.Patent ileocolic anastomosis without evidence of disease activity.Splenic cysts. Cholelithiasis. |
Generate impression based on findings. | Reason: assess for right inguinal mass History: right inguinal mass ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Nonspecific near fluid attenuation lesion lateral to the right spermatic cord measures 2.1 x 2.6 cm (series 3, image 138).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Nonspecific near fluid attenuation lesion lateral to the right spermatic cord may represent a lymphocele or a small amount of peritoneal fluid within a hernia. |
Generate impression based on findings. | Aplastic anemia and neutropenic fever. Rule out sinusitis. The maxillary, ethmoid, frontal, and sphenoid sinuses are clear. The ethmoid roofs are nearly symmetric and appear intact. The carotid grooves and optic canals are intact. The nasal cavity and mastoid air cells are clear. The imaged intracranial structures and orbits are grossly unremarkable. | No evidence of sinusitis. |
Generate impression based on findings. | Clinical question: Rule out intracranial hemorrhage. Signs and symptoms: Difficult to arouse. Nonenhanced head CT:There is no detectable acute intracranial process. CT however is insensitive for detection of acute non-hemorrhagic ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation.Unremarkable calvarium, visualized orbits, paranasal sinuses and mastoid air cells. | Negative nonenhanced head CT. |
Generate impression based on findings. | Clinical question: Brain hemorrhage? Acute stroke. Signs and symptoms: Acute alteration of mental status. Unable to move. Nonenhanced head CT:No detectable acute intracranial process. CT however is insensitive for detection of acute nonhemorrhagic ischemic stroke.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation.Unremarkable calvarium and soft tissues of the scalp.Unremarkable orbits.Unremarkable paranasal sinuses and mastoid air cells. | Unremarkable nonenhanced head CT. |
Generate impression based on findings. | Clinical question: Rule out acute hemorrhage or infarct. Signs and symptoms: History of multiple sclerosis, right-sided weakness and fall. Nonenhanced head CT:There is no detectable acute intracranial process. CT however is insensitive for the touch of acute nonhemorrhagic ischemic strokes.There is prominence of the cerebellar and vermian folia and to a lesser degree of the cerebral cortical sulci for patient's stated age of 59. Mild prominence of supratentorial ventricular system for patient's stated age of 59 is also noted. Correlate with history and risk factors.Very minimal periventricular low attenuation of white matter clips are present changes of demyelinating disease based on given history. Nonenhanced CT cannot differentiate acute or chronic demyelinating plaques.Calvarium and soft tissues of the scalp are unremarkable.Orbits, paranasal sinuses and mastoid air cells are unremarkable. | No accurate intracranial process. Please see above comments. |
Generate impression based on findings. | Concern for polyarteritis nodosum Following observations are made given limitations of an arterial weighted study.ABDOMEN:LUNG BASES: Small bilateral pleural effusions with overlying compressive atelectasis.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Kidneys enhance markedly heterogeneously. Multiple intrarenal microaneurysms are identified. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Probable lower lumbar vertebral body hemangioma.OTHER: Diffuse small vessel vasculitis manifested by innumerable microaneurysms in the terminal arcades of visceral arteries. The finding is consistent with clinical suspicion of polyarteritis nodosa although other small vessel vasculitides could appear similarly in the correct clinical context.The celiac axis, superior mesenteric artery, inferior mesenteric artery are all widely patent. Both renal arteries are widely patent.PELVIS:PROSTATE, SEMINAL VESICLES: Prostatic calcifications compatible with ageBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Diffuse small vessel visceral vasculitis compatible with the suspected clinical history of polyarteritis nodosa. |
Generate impression based on findings. | Clinical question: Breast cancer with brain metastases. Signs and symptoms: Breast cancer with brain metastases. Nonenhanced head CT:Examination demonstrates a focus of decreased attenuation of white matter in right frontal lobe consistent with vasogenic edema. A subtle associated mass effect with the findings. Within this region there is a suspected cystic/necrotic mass measuring approximately 20 x 21 mm in size. Considering provided clinical history of breast cancer this finding should be considered as a possible metastatic lesion to proven otherwise.Lack of intravenous contrast significantly reduces the sensitivity of the exam for better assessment for metastatic lesions.In addition there is a tiny focus of white matter low attenuation in the right inferior frontal lobe which could as well represent peritumoral edema of a small metastatic lesion. Recommend follow up with enhanced imaging and old with an MRI study.Additional small focus of vasogenic edema is also noted in the operculum of right anterior frontal lobe.There is no evidence of mass effect on the ventricular system and midline is maintained. There is no evidence of acute intracranial hemorrhage.Calvarium is intact.Limited images through the orbits, paranasal sinuses and mastoid air cells are unremarkable. | 1.Large focus of vasogenic edema and internal focus of cystic change in high convexity right frontal lobe with subtle associated mass effect highly concerning for a metastatic lesion.2.Two additional small focus of vasogenic edema as detailed and suspected for additional possible foci of metastatic lesions. This is also concerning for peritumoral edema although a metastatic lesion.3.Recommend follow-up with enhanced CT or brain MRI imaging.4.No evidence of any significant mass effect or midline shift. |
Generate impression based on findings. | Concern for polyarteritis nodosum Following observations are made given limitations of an arterial weighted study.ABDOMEN:LUNG BASES: Small bilateral pleural effusions with overlying compressive atelectasis.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Kidneys enhance markedly heterogeneously. Multiple intrarenal microaneurysms are identified. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Probable lower lumbar vertebral body hemangioma.OTHER: Diffuse small vessel vasculitis manifested by innumerable microaneurysms in the terminal arcades of visceral arteries. The finding is consistent with clinical suspicion of polyarteritis nodosa although other small vessel vasculitides could appear similarly in the correct clinical context.The celiac axis, superior mesenteric artery, inferior mesenteric artery are all widely patent. Both renal arteries are widely patent.PELVIS:PROSTATE, SEMINAL VESICLES: Prostatic calcifications compatible with ageBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Diffuse small vessel visceral vasculitis compatible with the suspected clinical history of polyarteritis nodosa. |
Generate impression based on findings. | Female 39 years old Reason: r/o PE History: SOB PULMONARY ARTERIES: Technically adequate study. No evidence of pulmonary embolism.LUNGS AND PLEURA: Small/moderate bilateral pleural effusions with associated compressive atelectasis left greater than right. Perihilar consolidation in the superior segment of the left lower lobe and superior segment of the lingula with associated multifocal patchy ground glass opacities. Bilateral bronchial wall thickening and scattered tree in bud pattern opacities in the periphery of the left lung. These findings are compatible with aspiration or aspiration pneumonia in the appropriate clinical setting.MEDIASTINUM AND HILA: No evidence of mediastinal or hilar lymphadenopathy. The heart size is normal. No pericardial effusion.CHEST WALL: Innumerable nonspecific small cervical, axillary and subpectoral lymph nodes.Mild/moderate body wall edema.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Small volume perihepatic ascites. Partially visualized spleen may be enlarged. | 1. No evidence of pulmonary embolism.2. Pleural effusions, consolidation/atelectasis and groundglass opacities compatible with aspiration or aspiration pneumonia in the appropriate clinical setting.3. Innumerable nonspecific small cervical lymph nodes of uncertain significance. |
Generate impression based on findings. | Male 73 years old; Reason: Pt is 73 yo M with hx of Multiple myeloma and Bil leg weakness and paresthesias History: bil leg weakness and paresthesias. Within the lower lumbar spine, sacrum and pelvis bilaterally there are numerous osteolytic lesions with a permeative cortical destructive pattern noted in the left iliac wing (series 80780, image 65) but no acute fracture. A compression deformity is noted at the superior endplate of L5. There are no discrete soft tissue masses. | Diffuse myelomatous disease, especially involving the left iliac wing, without acute fracture, dislocation or discrete soft tissue lesions. There are no specific findings in the pelvis to account for the bilateral nature of the patient's weakness and paresthesias. |
Generate impression based on findings. | Reason: Pancreatic protocol CT: evidence of exocrine pancreas loss History: low fecal elastase, chronic diarrhea, high fecal fat ABDOMEN:LUNG BASES: Small right pleural effusion.LIVER, BILIARY TRACT: Small punctate calcification at the dome of the right lobe of the liver likely representing granulomata. No evidence of cholelithiasis. No evidence of intrahepatic biliary ductal dilatation. SPLEEN: Splenic vein is thrombosed with multiple collaterals.PANCREAS: Atrophic pancreas with prominent pancreatic duct and parenchymal calcifications.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Scattered retroperitoneal lymph nodes. Mild atherosclerotic calcification of the aorta and bilateral iliac arteries.BOWEL, MESENTERY: Fluid-filled loops of small bowel diffusely. Diffuse thickening of large bowel walls.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Bilateral, mildly prominent inguinal lymph nodes. Scattered mesenteric lymph nodes.BOWEL, MESENTERY: Fluid-filled sigmoid colon with diffuse large bowel wall thickening and surrounding fat stranding.BONES, SOFT TISSUES: Degenerative joint disease at the L5-S1 joint space with bone cyst in the sacrum.OTHER: No significant abnormality noted | 1.Findings consistent with chronic pancreatitis.2.Fluid-filled loops of small and large bowel with diffuse thickening of the large bowel wall compatible with colitis of nonspecific etiology. |
Generate impression based on findings. | Reason: assess for bowel inflammation, sbo History: n/v/bloody diarrhea abd pain ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Diffuse hepatic steatosis.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: Mild left colon and rectal wall thickening and fat stranding, although the colon is nondistended and suboptimally evaluated. No evidence of bowel obstruction. The appendix is normal. Small fat containing umbilical hernia.BONES, SOFT TISSUES: Small fluid containing left inguinal hernia.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.Mild left colon and rectal wall thickening and fat standing suggests colitis of indeterminate etiology.2.Hepatic steatosis. |
Generate impression based on findings. | Reason: r/o obstruction History: intermittent nausea/vomiting x 1.5 wks ABDOMEN:LUNG BASES: Dependent basilar atelectasis bilaterally.LIVER, BILIARY TRACT: No suspicious focal liver lesions. No evidence of cholelithiasis. No intrahepatic or extrahepatic ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Few subcentimeter hypodense lesions in the right kidney likely representing benign renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. No evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Uterus is absent or atrophic.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Sigmoid and descending colon diverticula without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No evidence of small bowel or large bowel obstruction. |
Generate impression based on findings. | Chest pain. Shortness of breath. PULMONARY ARTERIES: Technically inadequate examination for evaluation of the pulmonary arteries to the segmental level. No pulmonary embolus is seen. No evidence of right heart strain.LUNGS AND PLEURA: Mild bibasilar subsegmental atelectasis and scarring, likely secondary to patient's history of asthma. No focal air space opacities or pleural effusions.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Normal sized heart without pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | No evidence of pulmonary embolism. No specific findings to otherwise account for the patient's symptoms. |
Generate impression based on findings. | History of hematuria This study is limited due to lack of IV contrast.ABDOMEN:LUNG BASES: Dependent atelectasis lung bases.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Punctate stone in the right kidney. No evidence of hydronephrosis. Multiple hypodense lesions in both kidneys are again noted. Previously noted right perinephric hematoma has resolved. High density, well defined hypodense lesion at the lower pole of the right kidney measures 2.6 cm on image number 63, series number 3, unchanged. Other hypodense lesions in the left kidney also unchanged. These lesions cannot be optimally characterized to the left of IV contrast.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: Left ovarian cyst. Fibroid uterus.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 | Limited study due to lack of IV contrast. Bilateral hypodense and hyperdense lesions are unchanged but they cannot be optimally characterized due to lack of IV contrast. Follow-up imaging with MRI may be helpful for these lesions. Right nephrolithiasis.Left ovarian cyst. |
Generate impression based on findings. | Reason: r/o low hernia or pelvic mass- R sided History: severe pain to pelvic area and wt loss- h/o hernia repair, and R testicular removal for torsion in 2002 ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Small right hepatic lobe hypodensity is too small to further 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 evidence of bowel obstruction. The appendix is normal. Colonic diverticulosis with mild perisigmoid fat stranding suggests diverticulitis. No pneumoperitoneum or mesenteric free fluid. No drainable fluid collections.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: Status post right orchiectomy. | Findings compatible with uncomplicated diverticulitis. |
Generate impression based on findings. | Cellulitis and abscess. There is a peripherally enhancing fluid collection in the right preauricular region that appears to be located within the superificial lobe of the parotid gland, measuring 13 AP x 12 RL x 17 SI mm. There is stranding of the overlying subcutaneous fat and skin thickening, as well as mild hyperemia of the right parotid gland. There is no evidence of sialolithiasis and the other major salivary glands are unremarkable. There are mildly prominent right level 2B lymph nodes that measure up to 8 x 14 mm. The major cervical vessels are intact. There is a partially calcified lesion within the submucosal tissues of the left hard palate region with smooth remodelling of the adjacent bone, measuring 15 AP x 11 RL x 7 SI mm. There is torus tubarius and torus maxillaris internus. There are carious ADA 11, 13, and 29 as well as periodontal lucencies affecting several other remaining teeth. There is a small retention cyst within the left sphenoid sinus. The imaged portions of the intracranial structures and orbits are grossly unremarkable. | 1. A peripherally enhancing fluid collection in the right preauricular region that appears to be located within the superificial lobe of the parotid gland and measuring up to 17 mm with associated cellulitis and mild reactive adenopathy likely represent a parotid abscess. A superimposed infected first branchial cleft cyst or neoplasm are less likely considerations.2. A partially calcified lesion within the submucosal tissues of the left hard palate region with smooth remodelling of the adjacent bone, measuring up to 15 mm, may represent sialometaplasia, among other possibilities. Direct visualization and MRI of this region may be useful for further characterization 3. Extensive dental disease. |
Generate impression based on findings. | 36-year-old male status-post ileocecal and sigmoid resections, presenting with tachycardia and poor oral intake ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Proximal small bowel loops are dilated measuring up to 6 cm. Distal small bowel loops are decompressed. These findings are consistent with distal small bowel obstruction. Transition is likely at the level of the pelvis. In the lower abdomen there is a large fluid collection measuring 13.4 by 5.8-cm on image number 108, series number 3. Collection also extends to the pelvis. Right lower quadrant ileostomy.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Intra-abdominal large fluid collection and distal small bowel obstruction.Dr. Rodriguez was notified and acknowledged about these findings at the time of dictation. |
Generate impression based on findings. | Fever. History of HIV. Right upper lobe opacity on chest radiograph. LUNGS AND PLEURA: Consolidations in the posterior segment of the right upper lobe, superior segment of the right lower lobe, and superior segment of the left lower lobe, likely representing multifocal pneumonia. No cavitation is evident. There are no pleural effusions.MEDIASTINUM AND HILA: Multiple prominent subcentimeter mediastinal lymph nodes. Normal sized heart with a minimal pericardial effusion. The esophagus is mildly dilated.CHEST WALL: Hypodense right thyroid lobe nodule. Multiple subcentimeter axillary lymph nodes.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Multiple areas of consolidation, likely representing multifocal pneumonia. The dependent locations of these opacities raises the question of aspiration. |
Generate impression based on findings. | Reason: assess for sbo, post op complication, hydro History: abd pain s/p nephrectomy Lack of intravenous contrast limits evaluation of solid organ pathology.ABDOMEN:LUNG BASES: Left basilar subsegmental atelectasis/scarring.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post partial left nephrectomy. Indeterminate collection in the surgical bed at the suture margin is suboptimally evaluated, measuring approximately 2.7 x 2.4 cm (series 3, image 43). There is associated perinephric stranding with near simple fluid tracking inferiorly along the left psoas muscle. No hydronephrosis or nephroureterolithiasis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of bowel obstruction. No pneumoperitoneum. BONES, SOFT TISSUES: Subcutaneous fat stranding in the ventral soft tissues.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. | Status post left partial nephrectomy. Indeterminate collection in the surgical bed with perinephric stranding and fluid tracking along the left psoas muscle. |
Generate impression based on findings. | 58-year-old male status post Whipple surgery, restaging CHEST:LUNGS AND PLEURA: Emphysema, unchanged. There is a subcentimeter left lower lobe nodule on image number 80, series number 4 measuring 4 mm, new from previous study. Other scattered micronodules are stable.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Multiple new hypodense lesions in the liver, suspicious for metastatic disease. Index lesion in the right lobe measures 1 cm on image number 121, series number 4.SPLEEN: No significant abnormality notedPANCREAS: The patient is status post Whipple surgery. There is ill-defined soft tissue encasing the SMV and main portal vein. This soft tissue measures 1.9 x 1.8 cm image number 120, series number 4. Additional infiltrative soft tissue density is present encasing the hepatic artery. Residual pancreas is unremarkable.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Borderline enlarged retroperitoneal lymph nodes and ill-defined soft tissue predominantly in the left paraortic space has increased compared to previous study.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 | Interval progression of disease with interval development of hepatic metastases and new left lower lobe lung nodule. Ill-defined retroperitoneal soft tissue encasing and invading the extrahepatic main portal vein and SMV. |
Generate impression based on findings. | Reason: appy History: RLQ pain ABDOMEN:LUNG BASES: Mild basilar pleural thickening bilaterally.LIVER, BILIARY TRACT: Status post cholecystectomy. No suspicious focal liver lesions. No intrahepatic ductal dilatation. Mild dilatation of the common duct which may be within normal limits given post cholecystectomy status.SPLEEN: Splenule adjacent to spleen.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Small hypodense, subcentimeter lesion in the right kidney likely represents a benign renal cyst.RETROPERITONEUM, LYMPH NODES: Scattered, subcentimeter para-aortic lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: A hypodense left adnexal cyst measuring 2.7 x 1.3 cm likely represents a corpus luteum cyst.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: The appendix is normal in appearance.BONES, SOFT TISSUES: No significant abnormality noted. OTHER: Small amount of fluid in the dependent portions of the pelvis is likely physiologic. | Normal-appearing appendix without evidence for appendicitis. |
Generate impression based on findings. | Painful respiration. History of prior PE/DVT, not on anticoagulation. PULMONARY ARTERIES: Technically inadequate examination for evaluation of the pulmonary arteries to the subsegmental level. No pulmonary embolus is identified. No evidence of right heart strain.LUNGS AND PLEURA: No focal air space opacities or pleural effusions. No suspicious nodules or masses. There is mild bronchial wall thickening, likely secondary to asthma or bronchitis.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Normal sized heart without pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Status post cholecystectomy. No significant abnormality noted. | No evidence of pulmonary embolism. No specific findings to account for the patient's symptoms. |
Generate impression based on findings. | Reason: G tube wound infection History: Abdominal pain ABDOMEN:LUNG BASES: Well-defined basilar pulmonary cysts suggest lymphangioleiomyomatosis (LAM). No pleural effusions. Small hiatal hernia.LIVER, BILIARY TRACT: Right hepatic lobe hypodensity is too small to further characterize but likely benign.SPLEEN: Accessory splenule.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral simple renal cysts.RETROPERITONEUM, LYMPH NODES: Atherosclerosis of a tortuous abdominal aorta and its branches.BOWEL, MESENTERY: Feeding tube tip inflated in the jejunum. Thickening along the subcutaneous tract suggests chronic inflammation. No evidence of bowel obstruction. No pneumoperitoneum or mesenteric free fluid. No drainable fluid collections in the abdomen or pelvis.BONES, SOFT TISSUES: Scoliosis 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: Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Feeding tube tip inflated in the jejunum. Subcutaneous tract thickening likely represents chronic inflammation. . |
Generate impression based on findings. | Reason: 67 female with aplastic anemia, neutropenic fever, lung infiltrate per CXR. Please assess pulmonary infiltrate History: Hypoxia LUNGS AND PLEURA: Patchy interstitial predominant opacities with areas of confluent consolidation throughout both lungs, without pleural effusions.Azygos pseudo-lobe, a normal variant. MEDIASTINUM AND HILA: The ascending aorta is ectatic and the main pulmonary artery is enlarged, the latter consistent with PA hypertension.There is no mediastinal or hilar lymphadenopathy.Moderate coronary artery calcifications are present.Low attenuation of the blood pool is consistent with anemia.CHEST WALL: Moderate degenerative abnormalities affect the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Diffuse pneumonia, the pattern most consistent with pneumocystis although other etiologies including viral infection are in the differential diagnosis, as well as pulmonary hemorrhage or ARDS. |
Generate impression based on findings. | Reason: 71 yr old male with history of t-MDS; post allo SCT History: Evaluate LUNGS AND PLEURA: Residual basilar reticular opacities persist, but there is no evidence of current infection. Minimal bronchiectasis affects the lung bases.Benign-appearing micronodules, some calcified, are unchanged. MEDIASTINUM AND HILA: Calcified lymph nodes from healed infection.No significant lymphadenopathy.Low attenuation of the blood pool is consistent with anemia.Right jugular catheter tip in SVC.CHEST WALL: Degenerative abnormalities affect the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Stable hepatic cyst like hypodensities and cholelithiasis. Nodular left adrenal gland unchanged. Unchanged nodule arising from the posterior gastric wall. | No evidence of new infection with residual interstitial opacities. |
Generate impression based on findings. | Reason: 50 female with chronic myelomonocytic leukemia, recent pneumonia at outside hospital. now with recurrent fevers, assess for infiltrate History: Fever LUNGS AND PLEURA: Consolidation of the medial segment of the right middle lobe consistent with pneumonia possibly simple bacterial.Nonspecific basilar dependent opacities likely dependent atelectasis.There are no pleural effusions.Small nonspecific micronodules are present.Lower lung zone bronchial wall thickening is present. MEDIASTINUM AND HILA: Numerous mediastinal lymph nodes are present, and a small their multiplicity is abnormal.Left subclavian dual chamber pacemaker, leads in appropriate positions.Low attenuation of the blood pool is consistent with anemia. CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Cholecystectomy clips. Splenomegaly, consistent with known CML. | 1. Right middle lobe pneumonia, possibly bacterial.2. Multiple lymph nodes and splenomegaly consistent with known chronic myelomonocytic leukemia. |
Generate impression based on findings. | Reason: R/o Pulm Aspergillosis History: Cystic fibrosis flare - Hx of pulm aspergillosis in the apst LUNGS AND PLEURA: Multiple thin-walled cysts are present in both upper lobes compatible with cystic bronchiectasis, some of which contain a small amount of fluid. Extensive bronchiectasis and tree in bud opacity are present consistent with cystic fibrosis. The findings are generally similar to those on the previous scan, with no specific evidence of consolidation to indicate pneumonia, though some of the cysts are larger (for instance in the left lower lobe,series 5 image 44).MEDIASTINUM AND HILA: Marked mediastinal and hilar lymphadenopathy, unchanged from previous with residual thymic tissue in the anterior mediastinum.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Status post cholecystectomy. | Extensive cystic bronchiectasis consistent with cystic fibrosis. The no evidence of aspergilloma or other specific evidence of Aspergillus infection. |
Generate impression based on findings. | Reason: intrahepatic cholangiocarcinoma please compare index lesions to previous Nadir measurements in May for RECIST History: As above CHEST:LUNGS AND PLEURA: Scattered pulmonary nodules, some of which are calcified, unchanged. No pleural effusions.MEDIASTINUM AND HILA: Reference prevascular lymph node measures 2.0 x 2.0 cm (series 4, image 29), previously 1.9 x 1.7 cm. Calcified hilar lymph nodes. Heart size is normal. No pericardial effusion. Left chest wall Port-A-Cath tip terminates in the SVC.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Index hepatic lesion is ill-defined and difficult to measure. Within this limitation, the lesion measures approximate 4.7 x 3.6 cm (series 4, image 72), previously 4.0 x 3.2 cm. This lesion is contiguous with a larger infiltrative mass invading the central liver with multiple satellite lesions. No evidence of biliary ductal dilatation.SPLEEN: Splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: Upper abdominal and retroperitoneal lymphadenopathy. Reference preaortic lymph node mass measures 5.3 x 2.3 cm (series 4, image 113), previously 5.0 x 2.2 cm.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.Reference hepatic mass is ill-defined and difficult to measure but appears unchanged or slightly increased in size.2.Increasing reference prevascular lymph node.3.Unchanged retroperitoneal lymphadenopathy. |
Generate impression based on findings. | Chronic myelomonocytic leukemia, recurrent fevers. r/o sinusitis. The bilateral maxillary, ethmoid, and sphenoid sinuses are clear. The frontal sinuses are not pneumatized. The right ethmoid roof is 2 mm higher than the left, but these structures are otherwise intact. The optic canals and carotid grooves are covered by bone. There is mild nasal septal deviation to the right. The nasal cavity is otherwise clear. The mastoid air cells are also clear. The facial soft tissues are unremarkable without evidence of abscess. The imaged portions of the intracranial structures are orbits are grossly unremarkable. | No evidence of sinusitis. |
Generate impression based on findings. | Female; 66 years old. Reason: acute aphasia, left MCA stroke, vessel stenosis? History: aphasia CT head:Since the prior CT on 10/3/2013, there has interval appearance of patchy irregular hypoattenuation in the left MCA territory involving the frontal and parietal lobes in a similar distribution as the patchy restricted diffusion seen on MRI from 10/5/2013, compatible with interval evolution of known stroke in this area. No evidence of hemorrhagic transformation. Redemonstration of irregular area of hypoattenuation and encephalomalacia in the left posterior parietal lobe with ex vacuo dilatation of the left lateral ventricle which is consistent with patient's known history of metastatic disease and subsequent stereotactic radiosurgery. Scattered areas of periventricular hypoattenuation is consistent with chronic ischemic small vessel disease and/or postradiation changes. The ventricles and sulci are normal for age. The cisterns are symmetric and unremarkable. There is no mass effect, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. Brain CTA: There is opacification of the distal internal carotid arteries, the distal vertebral arteries, and the proximal, anterior, middle, and posterior cerebral arteries. Mild atherosclerotic plaque causes minimal luminal irregularity of the bilateral cavernous ICAs and up to 10% stenosis of the right supraclinoid segment. A small right A1 segment of the ACA is noted. 3-D post processing images demonstrate an approximately 80% stenosis of the left M1/M2 junction of the MCA with mild post stenosis dilatation. No intracranial aneurysm is evident. | 1.Interval evolution of known stroke seen on the MRI brain examination from 10/5/2013 without evidence of hemorrhagic transformation. A component of underlying acute ischemia within this area cannot be entirely excluded, and an MRI can be obtained as clinically indicated.2.Approximately 80% stenosis of the left M1/M2 junction with mild post stenosis dilatation.3.No intracranial aneurysm is evident. |
Generate impression based on findings. | Reason: Pancreas Cancer: Restaging History: none CHEST:LUNGS AND PLEURA: Reference right apical pulmonary nodule measures 1.7 x 1 .2 cm (series 12 on image 14), previously 1.3 x 1.0 cm.Several other pulmonary nodules appear increased in size.MEDIASTINUM AND HILA: No mediastinal or hilar adenopathy. Heart size is normal without pericardial effusion. Pulmonary artery measures 3.6 cm in diameter suggesting pulmonary arterial hypertension. Left PICC tip terminates in the right atrium. Partially calcified left thyroid lobe nodule.CHEST WALL: Multiple new metastatic lesions in the thoracic spine.ABDOMEN:LIVER, BILIARY TRACT: Increasing hypoattenuating lesions in the right hepatic lobe measuring up to 1.7 cm (axial image 71), previously 1.5 cm. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: Ill-defined hypoattenuating pancreatic mass with associated severe pancreatic ductal dilatation. The mass measures approximately 9.0 x 3.2 cm (series 8, image 148), previously 8.4 x 2.8 cm. The mass attenuates the splenic artery and portal vein. The splenic vein is thrombosed.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: Subcentimeter retroperitoneal lymph nodes.BOWEL, MESENTERY: Multiple mesenteric varices. Left Spigelian hernia. No evidence of bowel obstruction.BONES, SOFT TISSUES: Multiple new metastatic lesions in the lumbar spine. OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Calcified fibroids.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Multiple new osseous metastases.2.Pulmonary nodules, increasing in size.3.Increasing hepatic metastases. |
Generate impression based on findings. | 63-year-old female with esophageal carcinoma CHEST:LUNGS AND PLEURA: Right upper lobe subpleural nodule is unchanged measuring 8 x 6 mm on image number 35 on series number 4.Left upper lobe nodule adjacent to the pulmonary vessels measures 7 mm on image number 31, series number 4. Bilateral small pleural effusions, more on the right compared to the left.MEDIASTINUM AND HILA: Changes secondary to gastric pull through surgery. Enlarged thyroid gland with asymmetrically heterogeneous and enlarged left thyroid lobe, not significantly changed.Index aortopulmonary window lymph node is unchanged measuring two by 1.2-cm image number 40, series number 4. Main pulmonary arteries is again enlarged. Other smaller mediastinal lymph nodes are also unchanged. The pattern of para-aortic lymph node measures 6 mm on image number 48, series number 3, slightly smaller compared to previous study.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis, unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Kidneys are not visualized in their expected locations.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: Partially calcified right adnexal cystic mass is unchanged measuring 6.9 x 4.5 cm image number 169, series number 3.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: Pelvic kidney is again noted. | No significant change from previous study. |
Generate impression based on findings. | Intracerebral hemorrhage. There is continued evolution in the attenuation characteristics, but no significant overall interval change in size of the large intraparenchymal hematoma with associated vasogenic edema centered within the right basal ganglia and thalamus that extends into the ventricular system. However, there is slightly increased hemorrhage tracking along the right transfrontal ventricular shunt track and extension of hemorrhage into the left frontal horn. There is no significant interval change in the small amount of intraparenchymal hemorrhage adjacent to the left transfrontal ventricular catheter. There has been slight interval decrease in size of the bilateral temporal horns of the lateral ventricles. There is no significant interval change in the degree of midline shift to the left, which is approximately 12 mm. There is persistent sulcal effacement, right uncal herniation, subfalcine, and transtentorial herniation. The imaged paranasal sinuses are clear. The extracranial structures are unchanged. | 1. Continued evolution in the attenuation characteristics, but no significant overall interval change in size of the large intraparenchymal hematoma with associated vasogenic edema centered within the right basal ganglia and thalamus with extension into the ventricular system, but slightly increased hemorrhage along the right transfrontal ventricular cathter and into the left frontal horn. 2. No significant interval change in the small amount of intraparenchymal hemorrhage adjacent to the left transfrontal ventricular catheter. 3. Slight interval decrease in size of portions of the lateral ventricles. |
Generate impression based on findings. | 79-year-old male with history of metastatic prostate cancer CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Index supraclavicular lymph node now measures 1.2 by 1.1-cm on image number 9, series number 3, minimally enlarged compared to previous study. Other supraclavicular lymph nodes are also minimally enlarged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Interval development of bilateral hydronephrosis, more on the left side compared to the right side.RETROPERITONEUM, LYMPH NODES: Interval increase in the size and number of the retroperitoneal lymph nodes. Previously measured lymph node now measures 1.4 by 1.1-cm image number 123, series number 3. Small infrarenal abdominal aortic aneurysm is unchanged measuring 2.4 cm on image number 138 on series 3.New left aortic soft tissue density at the level of aortic bifurcation measures 2.2 x 1.2 cm on image number 150, series number 3.BOWEL, MESENTERY: Again noted multiple mesenteric borderline enlarged lymph nodes.BONES, SOFT TISSUES: Multiple sclerotic metastases in the spine, pelvis and femurs are unchanged.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post processed echo.BLADDER: No significant abnormality notedLYMPH NODES: Index pararectal lymph node measures 1.7 x 1.5 cm image number 171, series number 3. Metastatic deposits in the pelvis have increased compared to previous study. Pelvic lymph nodes are also increased.Previously measured mesenteric soft tissue mass now measures 3 x 2.6 cm on image number 171, series number 3, enlarged compared to previous study.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Again noted sclerotic metastatic lesions in the pelvic bones, not significantly changed from previous study.OTHER: No significant abnormality noted | Interval progression of disease with interval development of a bilateral hydronephrosis, more on the left compared to the right side. Interval increase in the size of the retroperitoneal, pelvic and mesenteric adenopathy. Bone metastases are stable. |
Generate impression based on findings. | Reason: 71 yof with h/o breast cancer and R flank pain x3 wks History: R flank pain x3 wks 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: Mild paraseptal emphysematous changes at the bases.LIVER, BILIARY TRACT: No suspicious focal liver lesion. No intrahepatic or intrahepatic biliary ductal dilatation. No evidence of cholelithiasis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Hypodense lesion in the left kidney with retraction of the cortex suggests prior infarct. No evidence of nephrolithiasis. No evidence of hydronephrosis or perinephric fluid collections.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. Appendix is normal appearing.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: Sigmoid and descending colon diverticula without evidence of diverticulitis.BONES, SOFT TISSUES: Degenerative joint disease lower thoracic vertebra with vacuum disk phenomenon of the T11-T12 and T12-L1 and L4-L5.OTHER: No significant abnormality noted | 1.No findings to account for the patient's symptoms.2.No evidence of nephrolithiasis or hydronephrosis. |
Generate impression based on findings. | 62 year old female with history of pancreatic cancer CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Thromboses of the right internal jugular vein, again noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Diffuse fatty infiltration of the liver.SPLEEN: No significant abnormality noted.PANCREAS: Status-post Whipple surgery. The remainder of the pancreas is unremarkable.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left nephrolithiasis.RETROPERITONEUM, LYMPH NODES: Nonspecific fat stranding in the retroperitoneum near the expected area of the pancreatic head, not significantly changed compared to previous study.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: New 1.1-cm nodular soft tissue density in the anterior abdominal wall on the right side on image number 134, series number 7. TheOTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Leiomyomatous uterus,BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No significant change from previous study. |
Generate impression based on findings. | Evaluate for structural change after intracranial EEG lead placement. There are left cerebral electrode grids introduced via hemicraniotomy, which are in unchanged positions. Streak artifact form the hardware obscures regional anatomy. There is an unchanged postoperative air and fluid collection deep to the craniotomy that measures up to 10 mm in width. There is unchanged left cerebral hemisphere sulcal and left lateral ventricle effacement. Likewise, there is unchanged 5 mm of midline shift to the left and medialization of the left uncus. There is no definite evidence of acute intracranial hemorrhage. There is scattered paranasal sinus opacification. The mastoid air cells are clear. There is persistent air and fluid in the scalp overlying the craniotomy. | Stable postoperative findings related to left cerebral hemisphere grid electrode insertion without change in the position of the hardware, 5 mm of midline shift, and no definite evidence of acute intracranial hemorrhage. |
Generate impression based on findings. | Female 77 years old Reason: 77 y.o with hx of Left breast cancer T2 (2.3 cm) N0 s/p mastectomy SLbX now with 2 cm Left axilla node FNA positive History: Left recurrent breast cancer, need to assess for distant mets CHEST:LUNGS AND PLEURA: 7-mm right lower lobe nodule with an ill-defined margin, differential includes primary adenocarcinoma or less likely metastasis. Other scattered solid and ground glass micronodules, some of which are calcified, likely postinflammatory.Minimal basilar scarring and atelectasis.Mild mosaic perfusion pattern compatible with small airways disease.MEDIASTINUM AND HILANo evidence of mediastinal or hilar lymphadenopathy.Normal heart size and no pericardial effusion.Mild coronary artery calcifications..CHEST WALL: Axillary lymphadenopathy, reference left axillary node measures 2.4 cm (image 28, series 80368). Patient is status post left mastectomy..ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Hypodense hepatic segment two focus is incompletely characterized, but likely represents a hepatic cyst.. Cholelithiasis without evidence of cholecystitis.SPLEEN: No significant abnormality noted..ADRENAL GLANDS: No significant abnormality noted..KIDNEYS, URETERS: Multiple bilateral renal cysts..PANCREAS: No significant abnormality noted..RETROPERITONEUM, LYMPH NODES: No significant abnormality noted..BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted..BONES, SOFT TISSUES: Multilevel degenerative changes seen in the thoracic and lumbar spine..OTHER: No significant abnormality noted.. | 1. Indeterminate right lower lobe pulmonary nodule somewhat suspicious for primary lung carcinoma, less likely metastasis. Recommend 6 month CT follow-up to confirm stability.2. Markedly enlarged left axillary lymph node compatible with metastasis. |
Generate impression based on findings. | Seminoma status post orchiectomy ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Stable subcentimeter peripheral segment 4b low-attenuation focus.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Stable negative examination; no evidence for acute, inflammatory, or metastatic process. |
Generate impression based on findings. | Glomus tympanicum tumor in left middle ear. On the right, the external auditory canal is clear and patent. The middle ear and mastoid air cells are well-pneumatized and clear. The ossicular chain is intact. The facial nerve describes a normal course, but may be dehiscent along th tympanic segment. The inner ear structures are unremarkable. On the left, there is a soft tissue mass within the posterior middle ear cavity adjacent to the cochlear promontory and extending into the hypotympanum, which measures approximately 6 AP x 8 RL x 12 SI mm.The lesion also extends into the round window niche and abuts the incudostapedial joints, which is displaced slightly anteriorly, but not eroded. The mastoid air cells are well-pneumatized and clear. The facial nerve describes a normal course, but may be dehiscent along th tympanic segment. The inner ear structures are unremarkable. The left carotid groove may be dehiscent. There is no aberrant or lateralization of the carotid arteries. | A soft tissue mass within the posterior middle ear cavity adjacent to the cochlear promontory and extending into the hypotympanum, which measures approximately up to 12 mm is compatible with a glomus tympanicum. |
Generate impression based on findings. | Rectal carcinoma CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Status post right hepatectomy. Vague low attenuation focus within segment two of the left lobe of the liver best seen on image 82 of series 3 measuring 1.2 x 1.8 cm. This lesion was not appreciated on the most recent noncontrast scan. However, it was present and unchanged since 4/2011.Hepatic vessels patent. No ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable right renal cysts. Stable nonobstructing subcentimeter left renal stonesRETROPERITONEUM, LYMPH NODES: Stable, mildly enlarged portacaval lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small fat-containing parastomal hernia. No bowel obstruction or acute inflammation.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Stable presacral postoperative soft tissue thickening.OTHER: No significant abnormality noted | Stable examination without acute, inflammatory, or metastatic process. |
Generate impression based on findings. | Lung nodule follow up LUNGS AND PLEURA : The groundglass nodule in the right middle lobe adjacent to the major fissure (series 4, image 178) is unchanged in size or appearance, measuring 7 x 8 mm. Multiple additiona calcified and noncalcified micronodules measuring less than 4 mm are unchanged in size and appearance.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Normal sized heart with small inferior pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Subcentimeter hypodense hepatic foci which are too small to characterize, possibly representing cysts. | Stable size and appearance of the nonspecific right middle lobe nodule over 4 months. Given the size of this nodule, follow up CT is recommended in 6 months for monitoring of a possible minimally invasive adenocarcinoma. |
Generate impression based on findings. | Clinical question: Left-sided subdural. Evaluate for change. Signs and symptoms: None, follow-up for resolution. Nonenhanced head CT:Previously noted right sided subdural hematoma demonstrates significant interval decrease since prior exam. Minimal residual subdural anterior to the tip of right frontal lobe measuring approximately 5 mm in thickness remaining. There is also complete resolution of previously noted postprocedural air within the subdural on the right.A small left hemispheric subdural also demonstrate significant interval decrease in its size. It is no longer detected in the left anterior frontal. Small low-density residual subdural is however present in high convexity left posterior frontal left parietal and measuring approximately 6 mm in thickness measured on coronal reformatted image 49. There is no appreciable mass effect with this finding.There is no evidence of new hemorrhage since prior study. The cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation remains within normal for patient of stated age of 83.Calvarium demonstrate changes of a prior right-sided burr hole for drainage of subdural and unremarkable otherwise. Unremarkable images through the orbits, paranasal sinuses and mastoid air cells. | 1.Near complete resolution of reduced amount of the right subdural hematoma. Very small localized residual subdural anterior to the right frontal pole as detailed above.2.Significant interval decrease in size of left hemispheric subdural. A small low-density subdural measuring approximately 6 mm in thickness only in the high convexity left posterior frontal -- parietal region.3.Unremarkable nonenhanced head CT otherwise for patient's stated age of 83. |
Generate impression based on findings. | History of bladder cancer CHEST:LUNGS AND PLEURA: Severe emphysema.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: Nodular left adrenal gland is unchanged.KIDNEYS, URETERS: Bilateral renal cysts are 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: Bladder wall is asymmetrically thickened at the level of the base.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Asymmetric wall thickening involving the base of the bladder. |
Generate impression based on findings. | Reason: history of tonsil cancer with paratracheal recurrence History: history of tonsil cancer with paratracheal recurrence LUNGS AND PLEURA: Bilateral apical post radiation changes. Stable scattered nonspecific micronodules.No suspicious pulmonary nodules or masses.No pleural effusion.MEDIASTINUM AND HILA: Increasing right paratracheal soft tissue at the level of thoracic inlet with a may represent neoplastic involvement.Interval increase in the pre-carinal lymph node (image 42 series 3) measuring 11 mm previously measuring 8 mm.Reference right hilar lymph node (image 45 series 3) is unchanged measuring 13 mm.Cardiac size is normal without evidence of a pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.New increased soft tissue in the high right paratracheal region at the level of the thoracic inlet is suspicious of neoplastic involvement and metastatic disease.2.Stable right hilar lymphadenopathy. Interval increase in an enlarged precarinal lymph node. |
Generate impression based on findings. | Reason: 52 F with metastatic anal cancer s/p chemoRT, please eval for interval change. History: none CHEST: LUNGS AND PLEURA: Scattered pulmonary micronodules, some of which are calcified. No dominant lesion. Basilar scarring/atelectasis. No pleural effusions.MEDIASTINUM AND HILA: No lymphadenopathy. Heart size is normal without pericardial effusion. Left chest wall Port-A-Cath tip terminates in the SVC. Nodular thyroid gland.CHEST WALL: Postoperative change involving the right breast. No axillary lymphadenopathy.ABDOMEN:LIVER, BILIARY TRACT: Reference right hepatic lobe necrotic mass measures 5.3 x 5.0 cm (series 3, image 87), previously 2.6 x 2.3 cm. Increasing bilobar hepatic masses, some of which are new.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: Gastrohepatic lymphadenopathy.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: Rectal wall thickening with perirectal fat infiltration compatible with patient's history of malignancy. Previously described perirectal soft tissue mass has decreased in size and is not measurable on the current exam.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Hepatic metastases increasing in size and number.2.Near interval resolution of perirectal soft tissue mass. |
Generate impression based on findings. | 78-year-old male with history of prostate cancer CHEST:LUNGS AND PLEURA: New, nonspecific, wedge-shaped, vertebral groundglass opacities in the right upper lobe, best seen on image number 34, series number 4. These are nonspecific. Follow-up imaging is recommended for further evaluation.Small left-sided pleural effusion, unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Diffuse bone metastases, unchanged.ABDOMEN:LIVER, BILIARY TRACT: Liver cyst is unchanged. Cholelithiasis, unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal nodule measures 3.1 x 2 cm in image number 102, series number 3, increased in size compared to previous study. The nodule was measured and much smaller on CT dated 4/2012.KIDNEYS, URETERS: Bilateral renal cysts are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Diffuse bone metastases.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Index left iliac chain lymph node measuring 1.2-cm in diameter image number 167, series number 3, not significantly changed from previous study.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Interval increase in the size of the left adrenal nodule. Diffuse bone metastases and index pelvic lymph node are unchanged. New small ground glass opacities in the right upper lobe. Follow-up imaging is recommended. |
Generate impression based on findings. | Reason: Back pain, pelvis mass History: back, groin pain ABDOMEN:LUNG BASES: No significant abnormality noted. Small subcentimeter, soft tissue density lesions in bilateral breasts.LIVER, BILIARY TRACT: Hypodense lesion in the right lobe of the liver, segment 6/7 and another hypodense lesion in the right lobe of the liver, segment 8SPLEEN: 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: Large peripherally calcified and necrotic appearing fibroid within an enlarged uterus wall measuring 9.5 x 8.0 x 8.7 cm.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Scattered mesenteric lymph nodes.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Two hypodense lesions in the right lobe of the liver. Recommend MR liver to further characterize the lesions.2.Large peripherally calcified and necrotic appearing fibroid within an enlarged liver. |
Generate impression based on findings. | Female 69 years old Reason: h/o aortic aneurysm, f/u eval History: none LUNGS AND PLEURA: New upper lobe subpleural nodule, likely post infectious or post inflammatory in etiology. Remainder of scattered micronodules unchanged since 10/7/2010.Basilar scarring unchanged.Apical predominant centrilobular emphysemaMild diffuse mosaic perfusion pattern compatible small airways disease.MEDIASTINUM AND HILA: Fusiform and partially saccular aneurysmal dilatation of the distal aortic arch, unchanged since 10/7/2010.Right hypoattenuating thyroid nodule with incomplete peripheral calcifications unchanged.Cardiomegaly unchanged.Enlarged pulmonary trunk suggestive of pulmonary hypertension.Moderate atherosclerosis of the coronary arteries and aorta.Small sliding type hiatal hernia.CHEST WALL: Moderate degenerative changes of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Multiple hepatic cysts and calcifications unchanged.Marked bilateral renal atrophy. | Fusiform and partially saccular aneurysmal dilatation of the distal aortic arch, unchanged since 10/7/2010 |
Generate impression based on findings. | Reason: copd, pulm htn, lung transplant eval History: as above, shortness of breath. LUNGS AND PLEURA: Increased lung volumes with diffuse marked changes of emphysema.Right upper lobe peripheral pulmonary cyst.New right apical 8mm by 12-mm nodule (image 9 series 4) and adjacent 6 mm x 13 mm thickwalled cyst or cavitary lesion may be neoplastic or infectious/inflammatory in origin.Areas of mosaic attenuation without significant air trapping identified.MEDIASTINUM AND HILA: Large precarinal lymph node (image 34 series 3) measuring 16 mm. Enlarged right paratracheal lymph node (image 22 series 3) measuring 11 mm.Cardiomegaly with mild pericardial effusion/thickening.Enlarged pulmonary artery compatible with pulmonary atrial hypertension.Enlargement of the thyroid gland with extension of the left lobe into the superior mediastinum.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.New right apical nodule and adjacent cavitary/cystic lesion concerning for neoplasia.2.Mediastinal adenopathy.3.Markedly increased lung volumes and severe diffuse emphysema. |
Generate impression based on findings. | Reason: Pancreas Cancer: Restaging History: none CHEST: LUNGS AND PLEURA: Scattered pulmonary micronodules. No dominant lesion. No pleural effusions. Bibasilar atelectasis.MEDIASTINUM AND HILA: Left paratracheal lymph node measures 1.9 x 1.1 cm (series 11, image 12), previously 1.8 x 1.1 cm. No additional lymphadenopathy. Filling defect in the distal SVC, unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Reference left hepatic lobe heterogeneous lesion measures 5.9 x 3.9 cm (series 11, image 79), previously 3.9 x 2.8 cm. Increasing right hepatic lobe hypoattenuating lesions.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic head mass measures 3.5 x 1.8 cm (series 11, image 100), previously 4.1 x 3.2 cm.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Thickening of the gastric fundus and duodenum, unchanged.BONES, SOFT TISSUES: Right anterior abdominal wall soft tissue nodules are new from the prior exam. 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. Increasing hepatic metastases.2. New right anterior abdominal wall soft tissue nodules are nonspecific, but may represent metastatic foci.3. Stable left paratracheal lymph node.4. Pancreatic mass, slightly small in size. 5. Persistent SVC thrombus. |
Generate impression based on findings. | Microscopic hematuria and abdominal pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: 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: No significant abnormality noted | Within the limitations of a noncontrast study, negative for acute, inflammatory, or neoplastic process. No GU related abnormality noted. |
Generate impression based on findings. | 44-year-old female with history Avandamet short cancer CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Ill-defined soft tissue density in the anterior mediastinum, more prominent compared to previous chest CT dated 3/6/2013. This likely represents thymus, however, mediastinal adenopathy cannot be excluded. For reference purposes, anterior mediastinal focal soft tissue density measures 2.2 x 3 cm image number 21, series number 3.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Hepatomegaly, unchanged.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: Small amount of fluid and fat stranding in the anterior abdominal wall adjacent to small bowel loops is again noted. No evidence of collection.BONES, SOFT TISSUES: Small amount of inflammation along the incision in the subcutaneous fat.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Bladder wall is diffusely thickened.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Interval increase in the anterior mediastinal soft tissue density compared to previous chest CT. This may represents thymus, however, adenopathy cannot be excluded. Follow-up imaging is recommended.Thickwalled bladder. |
Generate impression based on findings. | Reason: Evaluate for progression of metastatic disease; compare to previous scan History: dyspnea CHEST:LUNGS AND PLEURA: Status post left lower lobectomy with paramediastinal radiation reaction.Multiple right lung nodules compatible with metastases.The reference right lower lobe nodule is now obscured by adjacent radiation reaction and atelectasis, and not accurately measurable, though it has probably increased in size.A large right upper lobe mass measures 39 x 47 mm (series 4 image 37) increased from 29 x 36 mm previously.A second right upper lobe nodule measures 22 mm in diameter, increased from 19 mm previously (series 4 image 44).MEDIASTINUM AND HILA: Moderate right hilar lymphadenopathy unchanged.Severe coronary artery calcification.Mildly enlarged main pulmonary artery which raises the question of pulmonary hypertension.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Possible small calculi in the gallbladder.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Renal cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Interval growth of pulmonary metastases. |
Generate impression based on findings. | Hodgkin's lymphoma CHEST:LUNGS AND PLEURA: Stable right middle lobe referenced nodule best seen on image 76 of series 5 measuring 1 x 1 cm.MEDIASTINUM AND HILA: Stable mediastinal confluent adenopathy. Reference prevascular focus seen on image 38 of series 3 measures 3.8 x 1.3 cm.CHEST WALL: Stable reference left supraclavicular node best seen on image 8 of series 3 and measures 1.5 by 0.8ABDOMEN: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: Stable nonobstructing right subcentimeter renal stone.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. | Stable examination. No new adenopathy. |
Generate impression based on findings. | 74-year-old male with history of gastric cancer CHEST:LUNGS AND PLEURA: Focal area of ground glass opacity in the right upper lobe appears less dense on today's study. Scattered micronodules are 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: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts are unchanged.RETROPERITONEUM, LYMPH NODES: Gastrohepatic and porta hepatis lymph nodes areBOWEL, MESENTERY: Right omental mass measures 4.1 x 1.8 cm on image number 116, series number 3, not significantly changed from prior CT. Small ascites, unchanged. Peritoneal nodularity is unchanged.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: The prostate is enlarged.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Pelvic, peritoneal soft tissue representing carcinomatosis, not significantly changed from previous study.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No significant change in the peritoneal carcinomatosis and lymph nodes..Focal area of groundglass opacity in the right upper lobe appears less dense. |
Generate impression based on findings. | 35-year-old female with abdominal swelling ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: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 | Unremarkable study. |
Generate impression based on findings. | 73-year-old male with history of chronic lymphoid leukemia This study is limited due to lackCHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Index right superior posterior mediastinal lesion measures 1.3 by 0.7-cm in image number 12, series number 4, not significantly changed from previous study. More inferior index lesion now measures 1.8 by 0.8-cm image number 49, series number 4, not significantly changed.CHEST WALL: Index left axillary lymph node measures 1.9 x 1.3 cm on image number 10, series number 4, not significant changed. Other axillary lymph nodes are also stable.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: Left aortic lymph node measures 2.5 by 1.9-cm image number 106, series number 4, smaller compared to previous study.Midline mesenteric lymph node measures 1.4 by 0.8-cm image number 127, series number 3, significantly smaller compared to previous study.BOWEL, MESENTERY: Other mesenteric lymph nodes are also decreased in size compared to previous study.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Right operator index lymph node measures 3.1 x 0.8 cm in image number 174, series number 4, not significantly changed compared to previous study. Index right inguinal lymph node measures 1.8 by zero .9-cm on image number 189, series number 4.BOWEL, MESENTERY: Index lymph node in the central pelvis measures 9-mm in diameter image number 152, series number 4, unchanged.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Slight interval decrease in the size of the abdominal lymph nodes. Chest and pelvis lesions are stable. |
Generate impression based on findings. | Clinical impression: Evaluate for hemorrhage. Signs and symptoms: Head trauma two days ago, on Coumadin, positive loss of consciousness. Nonenhanced head CT:Examination demonstrate no evidence of an acute intracranial process in particular hemorrhage is detected. CT however is insensitive for detection of acute nonhemorrhagic ischemic strokes.Examination demonstrates approximately 4 mm herniation of cerebellar tonsils through the foramen magnum with partial effacement of subarachnoid space.The cerebral cortex, cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation is within normal.Unremarkable calvarium, soft tissues of the scalp, paranasal sinuses, mastoid air cells and middle ear cavities. Unremarkable limited images through the orbits. | 1.No detectable acute intracranial process.2.4-mm ectopia of cerebellar tonsils through the foramen magnum and unremarkable nonenhanced head CT otherwise. |
Generate impression based on findings. | History of stomach cancer and atypical cells in the peritoneal washings CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Borderline enlarged mediastinal lymph nodes. Index node measures 1.3 by 1 cm image number 31, series number 3 the pretracheal space.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic right kidney. Simple right renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Thickened gastric wall consistent with patient's on history of stomach cancer. The mass likely extends into the perigastric fat. Pericardial nodularity in the immediate vicinity of the mass is noted. No other CT evidence of peritoneal carcinomatosis.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. | Large gastric wall mass likely extending into the perigastric fat and associated with focal pericardial nodularity locally. |
Generate impression based on findings. | 36-year-old male for pre-kidney transplant evaluation ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral kidneys are not visualized.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Left lower quadrant calcification likely representing an old graft. Right lower quadrant calcifications are also suggestive of fremitus on previous graft. Clinical correlation is recommended. No evidence of atherosclerotic calcifications.PELVIS: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: Rectum is not well opacified, therefore cannot be optimally evaluated. However, there is a 2.4 x 2.6 cm collection adjacent to the rectum. This may represent an abscess.Changes secondary to a arteriovenous fistula in the right lower extremity. | Possible perirectal abscess. Clinical correlation and if necessary confirmation with a pelvic MRI may be helpful.These findings are communicated with Dr. Thistlethwaite`s office at the time of dictation. |
Generate impression based on findings. | 32-year-old male with history of lymphoma CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM 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: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable sclerotic bone lesions.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No significant change from previous study. |
Generate impression based on findings. | 91 year-old female with abdominal pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: 9 x 9 mm hypodense lesion in the of the pancreas, incompletely characterized with this single phase CT. M.R.C.P. maybe helpful for further evaluation.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Extensive diverticulosis without evidence of diverticulitis.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 acute abdominal pain.Nonspecific small cystic lesion in the head of the pancreas. M.R.C.P. may helpful for further evaluation of this lesion. |
Generate impression based on findings. | Reason: History of metastatic breast cancer on treatment, evaluate for response and extent of disease History: History of metastatic breast cancer on treatment, evaluate for response and extent of disease CHEST:LUNGS AND PLEURA: Left basilar scarring/discoid atelectasis. Stable scattered nonspecific micronodules.No new suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Right precarinal reference lymph node (image 35 series 3) continues to decrease in size now measuring 5 mm previously measuring 7 mm.Right hilar enlarged lymph node unchanged.No new lymphadenopathy.Small pericardial effusion unchanged.CHEST WALL: Skin thickening of the breast bilaterally, left greater than right similar appearance to prior exam.Right chest port with its catheter in the SVC.Interval decrease in right axillary lymph node now measuring 8 mm there is a measuring 12 mm.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Stable appearance of a central hepatic hypodense poorly defined mass measuring 19 mm x 19 mm previously measuring 20 mm x 18 mm.Stable hepatic cysts right lobe vascular malformation.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. | 1.Continued interval decrease in mediastinal and right axillary lymphadenopathy.2.Stable hepatic lesion.3.Noted sites of disease identified. |
Generate impression based on findings. | 76-year-old male with history of bladder cancer CHEST:LUNGS AND PLEURA: Stable right micronodules. Stable calcified plaques.MEDIASTINUM AND HILA: Ectatic ascending aorta measuring 4.6-cm.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Patient's known left adrenal mass measures 2.9 x 2.4 cm on image number 102, series number 7, not significantly changed from previous study.KIDNEYS, URETERS: Mild left hydronephrosis persists. Left perinephric soft tissue is unchanged. Atrophic right kidney.RETROPERITONEUM, LYMPH NODES: Index left retrocrural lymph node measures 1.6 x 1.3 cm on image number 103, series number 7. Not significantly changed.Index left aortic lymph node measures 1.8 x 1.7 cm on image number 127, series number 7, unchanged.Index iliac bifurcation lymph node measures 1.4 by 0.9 cm on image number 145, series number 7, slight smaller compared to previous study. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post cystoprostatectomy.BLADDER: No significant abnormality notedLYMPH NODES: Index right external iliac lymph node is smaller now measuring 1.6 x 2 cm in image number 176, series number 7.Index left external iliac lymph node measures 2.2 x 1.6 cm image number 183, series number 7, smallAn index perirectal developed, however has increased in size and now measures 2.6 x 1.5 cm image number 183, series number 7.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Mixed response to the referenced lesions as detailed above. |
Generate impression based on findings. | Clinical question: Please evaluate pituitary for central hypogonadism, cannot do MRI due to pacemaker. Signs and symptoms: Central hypogonadism. Pre-and post-enhanced head CT:Limited evaluate scan for precise assessment of the pituitary gland.Examination demonstrates normal size and overall morphology of sella, normal appearing dorsum sella and sphenoid sinus and bilateral cavernous sinuses. Pituitary gland appears normal in size and bleed uniform enhancement. The particular stalk is identified and remains unremarkable. The suprasellar visual complex remains unremarkable.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF cisterns/spaces and gray -- white matter differentiation.The post enhanced images demonstrate no detectable abnormal parenchymal or leptomeningeal enhancement. There is normal enhancement of intracranial major arterial branches as well as all venous sinuses.Unremarkable images through the orbits.Unremarkable calvarium and soft tissues of the scalp.Unremarkable paranasal sinuses with the exception of a small retention cyst in the dependent portion of left maxillary sinus.Mild nasal septum deviation to the left and a bony septal spur of 6-mm length projecting to the left is noted. Bilateral mastoid air cells and middle ear cavities remain well pneumatized. | 1.Negative pre-and post enhanced head CT.2.Based on this exam there is no detectable abnormality of the pituitary gland/pituitary stalk/sella, cavernous sinuses, skull base or suprasellar cistern. |
Generate impression based on findings. | Colon carcinoma off therapy CHEST:LUNGS AND PLEURA: Interval increase in size and number of numerous bilateral subcentimeter nodules, worrisome for metastatic foci. The reference right lower lobe nodule best seen on image 63, series 5, now measures 4 mm in diameter; this is in comparison to 2 mm on 8/14/2013. A representative new nodule within the right upper lobe as seen on image 27 of series 5, measures 2 mm in diameter.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Interval increase in size of the previously noted bilobar hepatic metastatic lesions. The reference left lobe segment two mass best seen on image 80 of series 3, now measures 1.8 x 1.4 cm; this is in comparison to 1.2 x 1.1 cm on 8/14/2013.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Stable nodular right adrenalKIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Stable retrocrural adenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Interval increase in size of right abdominal wall mass best seen on image 121 of series 3, now measuring 6.1 x 6.2 cm; this is in comparison to 4.7 x 4.1 cm on 8/14/2013.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Uterus absent or atrophicBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Trace ascites. Stable perisigmoid soft tissue nodularityBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Interval appearance of multiple bilateral subcentimeter pulmonary nodules, worrisome for new metastatic foci. Associated with interval increase in size of bilobar hepatic metastases and right abdominal wall metastatic mass. |
Generate impression based on findings. | Fever, congestion, r/o sinusitis. There is right maxillary sinus retention cyst that measures up to 15 mm and mild mucosal thickening medially. There is also mild mucosal thickening within the bilateral frontoethmoid recesses. The other paranasal sinuses are clear. The nasal cavity is clear and there is no significant nasal septal deviation. The mastoid air cells are clear. The overlying facial soft tissues are unremarkable without evidence of abnormal fluid collections. The imaged intracranial structures are orbits are grossly unremarkable. | No evidence of acute sinusitis. |
Generate impression based on findings. | Clinical question: Evaluate for acute intracranial process. Signs and symptoms: Possible seizure, + LOC Nonenhanced head CT:There is no evidence of acute intracranial process. CT however is insensitive for detection of acute nonhemorrhagic ischemic strokes.There are moderate periventricular and subcortical patchy foci of white matter low-attenuation also nonspecific but often represent age indeterminate small vessel ischemic strokes. There are no prior exams for comparison.Cerebral cortex, cortical sulci, ventricular system and CSF spaces remain within normal. Gray -- white differentiation and midline is preserved. Calvarium and soft tissues of the scalp are unremarkable.All paranasal sinuses are visualized and demonstrate mild chronic pansinusitis. Bilateral mastoid air cells and middle cavities are well pneumatized. Unremarkable images through the orbits. | 1.No detectable acute intracranial process. CT however is insensitive for detection of acute nonhemorrhagic ischemic strokes.2.Mild age indeterminate small vessel ischemic strokes.3.Mild chronic pansinusitis. |
Generate impression based on findings. | Chronic lymphocytic leukemia diagnosed in 2006. There is no significant interval change in the size of previously cervical lymph nodes.For reference, the following measurements are provided:* Left level 1B lymph node measures 12 x 9 mm (series 4, image 30), previously 12 x 9 mm.* Left level 2A lymph node measures 11 x 9 mm (series 4, image 27), previously 12 x 9 mm.* Right level 3 lymph node measures 12 x 7 mm (series 4, image 36), previously 13 x 7 mm.Right level 5 lymph node measures 12 x 10 mm (series 4, image 51), previously 13 x 7 mm.There are stable postoperative findings in the left submental region. The major salivary and thyroid glands appear unremarkable. The nasopharynx, oropharynx, oral cavity, hypopharynx, larynx, and subglottic airway remain patent. There is unchanged moderate degenerative spondylosis without suspicious osseous lesions. The paranasal sinuses and mastoid air cells are normally pneumatized. The imaged intracranial contents and orbits are unremarkable. Please refer to dedicated chest CT dictation for additional details. | No significant interval change in the lymphadenopathy related to treated leukemia. However, assessment is limited due to lack of IV contrast. |
Generate impression based on findings. | Clinical question: History of nasal congestion and postnasal drip, evaluate sinus. Signs and symptoms: As above. Medtronic fusion sinus CT:Frontal sinuses are poorly developed and remains small however without evidence of disease.Ethmoid sinuses are well pneumatized and without evidence of disease.Sphenoid sinus is well pneumatized and with patent bilateral sphenoethmoidal recess.Maxillary sinuses demonstrate minute mucosal thickening along the dependent portion and unremarkable otherwise/patent bilateral ostiomeatal units.Nasal cavity demonstrate mild nasal septum deviation and unremarkable otherwise.Images through the orbits are unremarkable.Bilateral mastoid air cells and middle ear cavities remain well pneumatized. | No evidence of acute or chronic sinusitis. |
Generate impression based on findings. | Reason: Cholangiocarcinoma please compare to previous scan to determine response to chemo please provide index leison measurements for RECIST History: As above CHEST:LUNGS AND PLEURA: Multiple nonspecific pulmonary nodules are unchanged.MEDIASTINUM AND HILA: Small supraclavicular lymph nodes. No mediastinal or hilar lymphadenopathy. Heart size is normal without pericardial effusion. CHEST WALL: Right chest wall Port-A-Cath tip terminates in the SVC.ABDOMEN:LIVER, BILIARY TRACT: Innumerable heterogeneous lesions, many necrotic, replace the left hepatic lobe. Reference lesion in segment IVA measures 3.6 x 2.9 cm (series 3, image 89), previously 3.3 x 3.0 cm. Reference lesion in segment II measures 4.6 x 3.5 cm (series 3, image 27), previously 4.3 x 4.2 cm. Nonvisualization of the main or left portal veins compatible with thrombosis. The SMV and splenic veins are patent. No biliary ductal dilatation. SPLEEN: Accessory splenule.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Nodular left adrenal gland, unchanged.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Reference portacaval lymph node measures 2.1 x 1.6 cm (series 3, image 107), previously 2.2 x 1.8 cm. Reference paraesophageal lymph node measures 1.0 cm (series 3, image 79), previously 1.0 cm.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. | Cholangiocarcinoma and portal vein thrombosis without significant interval change in reference measurements. |
Generate impression based on findings. | Female 68 years old Reason: on therapy for lung abscess; monitoring response to therapy History: cough LUNGS AND PLEURA: Large right upper lobe cavitary lesion measuring 6.1 x 8.0 cm (image 35, series 4) with predominately dependent and adhered nodular partially calcified material within the cavity suggestive of an aspergilloma/fungus ball. Prominent associated bronchiectasis with a small amount of adjacent consolidation.Multifocal basilar predominant mostly subpleural areas of consolidation, likely infectious/post infectious in etiology. Innumerable pulmonary nodules likely post infectious/post inflammatory in etiology. Diffuse moderate bronchiectasis.Severe centrilobular and paraseptal emphysema with mild basilar predominant architectural distortion compatible with minor underlying fibrosis. MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy.Moderate/severe atherosclerosis of the coronary arteries and thoracic aorta. CHEST WALL: Nonspecific enlarged subpectoral lymph nodes.Multilevel degenerative the thoracic and lumbar spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Multiple left simple renal cysts. Minimal nonspecific intrahepatic biliary ductal dilatation. | 1. Large right upper lobe cavitary lesion with dependent calcified material compatible with aspergilloma/fungus ball.2. Multifocal areas of subpleural consolidation and nodules likely infectious or post infectious in etiology.3. The above two could be all the result of mycobacterial infection, although not necessarily TB.4. Severe centrilobular and paraseptal emphysema with underlying minimal basilar predominant fibrosis. |
Generate impression based on findings. | Reason: evaluate for appendicitis History: RLQ pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No suspicious focal liver lesions. No intrahepatic or dilatation. Evidence of cholelithiasis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Scattered retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Heterogeneously enhancing, bulbous uterus. Engorged pelvic vessels surrounding the uterus.BLADDER: No significant abnormality notedLYMPH NODES: Scattered inguinal lymph nodes bilaterally.BOWEL, MESENTERY: Focal wall thickening of the proximal appendix with mild fat stranding. BONES, SOFT TISSUES: Soft tissue scarring over the pubis consistent with history of prior C-section.OTHER: No significant abnormality noted | 1.Focal wall thickening of the proximal appendix with mild surrounding fat stranding. Early appendicitis cannot be excluded. No abscess, perforation, or bowel obstruction.2.Heterogeneously enhancing, bulbous uterus. This may be due to postoperative changes or uterine fibroids. Please correlate clinically. |
Generate impression based on findings. | History of bladder cancer CHEST:LUNGS AND PLEURA: Severe emphysema.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: Nodular left adrenal gland is unchanged.KIDNEYS, URETERS: Bilateral renal cysts are 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: Bladder wall is asymmetrically thickened at the level of the base.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Asymmetric wall thickening involving the base of the bladder. |
Generate impression based on findings. | 76-year-old male with history of bladder cancer CHEST:LUNGS AND PLEURA: Stable right micronodules. Stable calcified plaques.MEDIASTINUM AND HILA: Ectatic ascending aorta measuring 4.6-cm.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Patient's known left adrenal mass measures 2.9 x 2.4 cm on image number 102, series number 7, not significantly changed from previous study.KIDNEYS, URETERS: Mild left hydronephrosis persists. Left perinephric soft tissue is unchanged. Atrophic right kidney.RETROPERITONEUM, LYMPH NODES: Index left retrocrural lymph node measures 1.6 x 1.3 cm on image number 103, series number 7. Not significantly changed.Index left aortic lymph node measures 1.8 x 1.7 cm on image number 127, series number 7, unchanged.Index iliac bifurcation lymph node measures 1.4 by 0.9 cm on image number 145, series number 7, slight smaller compared to previous study. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post cystoprostatectomy.BLADDER: No significant abnormality notedLYMPH NODES: Index right external iliac lymph node is smaller now measuring 1.6 x 2 cm in image number 176, series number 7.Index left external iliac lymph node measures 2.2 x 1.6 cm image number 183, series number 7, smallAn index perirectal developed, however has increased in size and now measures 2.6 x 1.5 cm image number 183, series number 7.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Mixed response to the referenced lesions as detailed above. |
Generate impression based on findings. | Gross hematuria and left flank pain ABDOMEN:LUNG BASES: Bilateral small pleural effusions and dependent atelectasis.LIVER, BILIARY TRACT: Well-defined hypodense lesion the right lobe of the liver measuring 2-cm in image number 35, series number 8, likely representing a simple cyst.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left kidney demonstrates persistent nephrogram with no pyelogram at 15 minutes. Left ureter is slightly dilated throughout its course. Its obscured by ill-defined soft tissue at the segment just superior to the level of the left UVJ.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Free air and fat stranding in the subcutaneous tissues of the pelvis.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Not visualized.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Free air and fat stranding in the subcutaneous tissues of the pelvis.OTHER: No significant abnormality noted | CT findings suggestive of distal left ureteral injury. Persistent nephrogram with lack of contrast excretion of the left kidney. Postsurgical changes in the pelvis.Gynecology resident on call (pager #8142) while not defined in a pouch about the above findings at the time of dictation. |
Generate impression based on findings. | Non-Hodgkin's lymphoma CHEST:LUNGS AND PLEURA: Stable micronodulesMEDIASTINUM AND HILA: Stable bilateral thyroid nodulesCHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Interval decrease in size of right renal low attenuation infiltrative mass and perinephric soft tissue. Reference lesion best seen on image 91 of series 3, now measures 2.6 x 1.3 cm; this is in comparison to 3.9 x 3 cm on 7/11/2013RETROPERITONEUM, LYMPH NODES: Relatively stable retroperitoneal adenopathyBOWEL, MESENTERY: Stable mesenteric adenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Stable fibroid uterus.BLADDER: No significant abnormality noted.LYMPH NODES: Slight interval decrease in size of bulky right inguinal adenopathy. Reference right inguinal lymph node, best seen on image 180 of series 3, now measures 2.2 x 1.4 cm; this is in comparison to 2.7 x 1.6 cm on 7/11/2013.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Interval decrease in size of right renal infiltrative mass and perinephric soft tissue. Slight interval decrease in size of bulky right inguinal adenopathy. Retroperitoneal and mesenteric adenopathy relatively stable. No new adenopathy. |
Generate impression based on findings. | Male 65 years old Reason: baseline eval prior to starting new systemic targeted therapy History: hx of metastatic thyroid cancer CHEST:LUNGS AND PLEURA: Biapical scarring/fibrosis compatible with prior radiation unchanged.Right lower lobe reference nodule measures 7 mm (image 27, series 4), previously 6 mm. Remainder of pulmonary nodules unchanged. No new suspicious pulmonary nodules identified.Mild basilar predominant centrilobular emphysema.MEDIASTINUM AND HILA: Patient status post thyroidectomy, cervical lymph node dissection and tracheostomy. No evidence local recurrence within thyroidectomy bed.Necrotic subcarinal reference lymph node now measures 20 mm (image 56 of series 3), previously 16 mm. Interval enlargement of pretracheal and right hilar nodes.Heart size is normal and no pericardial effusion is present. Moderate coronary artery calcifications.CHEST WALL: Multiple lytic osseous lesions in the thoracic and lumbar spine; the lesions in the vertebral bodies, pedicles and spinous processes of L1 and L5, unchanged; left scapular lesion enlarged.Right lateral eighth rib healing fracture. ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Innumerable hypodense variably sized lesions are seen scattered throughout the hepatic parenchyma are increased in size and number and are compatible with hepatic metastasis. Reference lesion measures 3.5 x 2.3 cm (image 118, series 3), previously measuring 3.1 x 2.1 cm SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Renal cysts unchanged.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Moderate/severe calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Multiple lytic osseous lesions in the thoracic and lumbar spine; the lesions in the vertebral bodies, pedicles and spinous processes of L1 and L5, unchanged.OTHER: No significant abnormality noted. | 1. Unchanged non-specific pulmonary nodules. 2. Increasing mediastinal lymphadenopathy and hepatic metastases.3. Osseous metastasis unchanged except for progression in the left scapula, refer to nuclear medicine bone scan from the same day for further evaluation. |
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