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Generate impression based on findings. | 50-year-old male with respiratory distress. Evaluate for pneumonia versus pulmonary edema. LUNGS AND PLEURA: Bilateral scattered patchy and groundglass opacities with septal thickening, more prominent dependently and at the lung bases. The left lower lobe is collapsed secondary to compression by the heart. There is a trace left pleural effusion. The airway and bronchi are patent bilaterally.MEDIASTINUM AND HILA: Multiple prominent subcentimeter mediastinal lymph nodes. Cardiomegaly, without pericardial effusion. Prominent main pulmonary artery, suggestive of pulmonary hypertension. LVAD device in place. AICD leads in the right atrial appendage, right ventricular apex, and posterior left ventricular wall. CHEST WALL: Sternotomy fixation hardware intact. Left internal jugular catheter tip in the SVC.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. Mild pulmonary edema. No specific evidence of pneumonia.2. Left lower lobe compressive atelectasis. |
Generate impression based on findings. | Right flank 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: Status post left nephrectomy. Solitary right kidney. Multiple hypodense lesions arising from the right kidney. These cannot be characterized due to lack of IV contrast. No evidence of renal stones. No evidence of recurrence in the left nephrectomy bed.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Large ventral hernia containing nonobstructed bowel segments.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: New degenerative changes involving the thoracic spine.OTHER: No significant abnormality noted | Solitary right kidney. No evidence of recurrence in the left nephrectomy bed.No evidence of nephrolithiasis, however, multiple hypodense lesions in the right kidney cannot be optimally evaluated due to lack of IV contrast. |
Generate impression based on findings. | Abdominal pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Nonspecific hypodense lesion in the right lobe of the liver measuring 9 mm, most likely benign. No other focal lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: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 | Unremarkable study. |
Generate impression based on findings. | Reason: 88F with history hep C and hepatocellular ca, treated with RT, surveillance scan and stable AFP History: no symptoms CHEST:LUNGS AND PLEURA: No suspicious pulmonary nodules or masses. No pleural effusions.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology. Reference arterially enhancing left hepatic lobe lesion measures 1.6 x 1.6 cm (series 11, image 76), previously 1.9 x 1.9 cm. New arterially enhancing lesion in segment V without definite washout measures 7 mm (series 9, image 21). The portal vein is patent. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small renal cysts.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy. Atherosclerosis of the abdominal aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Surgically absent.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.New arterially enhancing lesion without definite washout is nonspecific. Special attention should be paid to this area on future exams.2.Reference left hepatic lobe lesion is unchanged. |
Generate impression based on findings. | Colon carcinoma CHEST:LUNGS AND PLEURA: Multiple bilateral pulmonary nodules. A representative right lower lobe nodule best seen on image 55, series 4, measures 0.6 x 0.4 cm. A left lower lobe nodule best seen on image 60 of series 4, measures 5 mm in diameter.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Fatty infiltration of the liver. Multiple, bilobar hepatic metastatic lesions. A representative segment 5 right lobe lesion best seen on image 96 of series 3 measures 1.9 x 1.3 cm. A segment 4a left lobe lesion best seen on image 75 of series 3 measures 1.8 x 2.8 cm. Hepatic vessels patent. No ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No 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. | Multiple bilateral pulmonary nodules, worrisome for metastatic foci. Bilobar hepatic metastatic lesions; reference measurements provided. Fatty infiltration of the liver. |
Generate impression based on findings. | Reason: further eval abd wall abscess, please give contrast through G tube. History: further eval abd wall abscess ABDOMEN:LUNG BASES: Interval increase in left pleural effusion. Basilar atelectasis bilaterally.LIVER, BILIARY TRACT: Status post cholecystectomy. No focal liver lesions. No intrahepatic or extra hepatic ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Percutaneous gastrostomy tube within the stomach. No no evidence of enteric contrast extravasation. Interval worsening of back stranding around the gastrostomy tube with foci of air suggestive of developing abscess. No evidence of loculated fluid collections. No evidence of free intraperitoneal air. No evidence of bowel obstruction. BONES, SOFT TISSUES: Ventral hernia contains transverse colon without evidence of incarceration or strangulation.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Redemonstration of heterogeneous right adnexal mass.BLADDER: Air within the bladder likely secondary to the Foley catheter manipulation.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Heterogeneous right adnexal mass is again seen. Further workup of this mass is recommended.2.Percutaneous gastrostomy tube with interval worsening of surrounding subcutaneous fat stranding and air foci is suggestive of an early abscess. No drainable fluid collections is noted.3.No evidence of bowel obstruction. |
Generate impression based on findings. | Non-Hodgkin's lymphoma CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Stable reference left paratracheal lymph node, best seen on image 19 of series 5, measuring 1 x 0.6 cm.CHEST WALL: Stable reference right axillary lymph node as seen on image 25 of series 5, measuring 0.4 cm in short axis.ABDOMEN:LIVER, BILIARY TRACT: Stable bilobar cysts.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: Previously mentioned referenced left mesenteric lymph node is no longer visualized.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Stable enlarged prostateBLADDER: No significant abnormality notedLYMPH NODES: Stable reference right femoral lymph node seen on image 190 of series 5, with a short axis measurement of 0.6 cm.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Reference mesenteric lymph nodes no longer visualized. Otherwise, stable examination. No new adenopathy. |
Generate impression based on findings. | Female; 65 years old. Reason: Eval for post op hemorrhage History: headache CT head:Postsurgical changes from left pterional approach left MCA aneurysm clipping. There is diffuse brain edema with sulcal effacement, likely due to immediate postoperative state. There is small amount of subarachnoid hemorrhage in the inferior left temporal lobe and and within the left cerebral convexity; a small amount of subdural hemorrhage overlying the right tentorium is noted. There are small bifrontal epidural collections containing air, fluid, and small amount of hemorrhage. No intraparenchymal hemorrhage. No significant midline shift.There is mild ill-defined hypodensity in the low left parietal lobe in the region of the pre-or postcentral gyrus extending to the gray matter, which may be postsurgical though may also be due to acute ischemia (series 5, images 43-47).A nasal airway is partially visualized. There is partial opacification of the ethmoidal air cells; otherwise, the visualized portions of the paranasal sinuses and mastoid air cells are clear. The orbits are unremarkable.Incidental note is made of a partial fusion of C1 and C2. The left peroneal craniotomy demonstrates overlying subcutaneous soft tissue swelling and emphysema.Brain CTA: There is opacification of the distal internal carotid arteries, the distal vertebral arteries and the proximal, anterior, middle, and posterior cerebral arteries.There is an interval surgical clipping of left MCA aneurysm at the mid M1 segment. Contrast opacification through the the proximal M1 segment is normal. However, about the mid to distal M1 segment, opacification is impossible to evaluate due to streak artifact from surgical clips. There is filling seen in the left M2, M3, and M4 segments.There is fetal origin of the left posterior cerebral artery with an infundibulum at its origin. The right vertebral artery is hypoplastic.The anterior communicating artery and the posterior communicating arteries are identified and are intact. | 1. Interval postsurgical changes of left pterional approach left MCA aneurysm clipping.2. Mild subarachnoid and extraaxial hemorrhage, likely within expected immediate postsurgical findings. No intraparenchymal hemorrhage.3. Mild, ill-defined hypoattenuation extending to the gray matter in the low left parietal lobe, which may be postsurgical or due to acute ischemia. Follow-up imaging can be obtained as clinically warranted.4. Normal contrast opacification through the left proximal left M1 segment. Evaluation of opacification in the mid to distal M1 segment is impossible due to streak artifact. There is filling seen of the left M2, M3, and M4 branches. |
Generate impression based on findings. | Reason: acute abd pain, r/o acute abd changes History: abd pain ABDOMEN:LUNG BASES: Basilar atelectasis.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small hypodense focus abutting the posterior margin of the stomach may represent a small gastric diverticulum or possibly a duplication cyst. No evidence of bowel obstruction. The appendix is not definitively seen. No pneumoperitoneum or mesenteric free fluid. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No acute intra-abdominal abnormality. |
Generate impression based on findings. | Reason: eval for progression History: metastatic rcc, worsening back pain 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:CHEST:LUNGS AND PLEURA: Scattered micronodules in the right lower lobe.MEDIASTINUM AND HILA: Atherosclerotic calcification of the aortic arch.Stable reference paraesophageal lymph node measuring 1.2 x 0.8 cm (series 5, image 43) previously measuring 0.9 x 0.8 cm.Calcified hilar lymph nodes are again seen. Scattered subcentimeter, normal-appearing lymph nodes in the mediastinum. Borderline thickening of the esophageal wall.CHEST WALL: Expansile, lytic lesion with soft tissue component in the right posterior 11th rib now measures 6.5 x 3.3 cm (series 5, image 100), previously measuring 2.7 x 5.7 cm. No new bony lesions are noted.ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology remains unchanged. Multiple punctate calcifications suggestive of prior granulomatous disease. No evidence of cholelithiasis.SPLEEN: Multiple punctate calcifications consistent with prior granulomatous disease.PANCREAS: Atrophic pancreas without significant abnormality.ADRENAL GLANDS: Stable right adrenal mass measuring 3.2 x 2.6 cm (series 5, image 91).KIDNEYS, URETERS: Status post left nephrectomy. No evidence of recurrent mass. Right kidney unchanged in appearance. No abnormal perinephric findings seen. No evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Scattered diverticula in the large colon without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy.BLADDER: No significant abnormality notedLYMPH NODES: Reference left iliac lymph node (series 5, image 154) is likely decreased in size. No enlarged lymph nodes seen.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Relatively stable left iliac lytic bone lesion is unchanged. Adjacent lucent changes in sacrum also appear unchanged.OTHER: No significant abnormality noted | 1.Slight interval increase in size of right posterior 11th rib lytic lesion with soft tissue component.2.Stable paraesophageal reference lymph node.3.Slight decrease in size of left iliac reference lymph node.4.Stable right adrenal mass.5.Stable left iliac bone lytic lesion. |
Generate impression based on findings. | Reason: peritoneal cancer with carcinomatosis compare to last CT History: pre chemo CHEST:LUNGS AND PLEURA: No suspicious pulmonary nodules or masses. No pleural effusions.MEDIASTINUM AND HILA: Right chest wall Port-A-Cath tip terminates at the superior cavoatrial junction. Heart size is normal without pericardial effusion. No mediastinal or hilar lymphadenopathy.CHEST WALL: Small left chest wall soft tissue nodule, unchanged.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Indeterminate left adrenal nodule is unchanged in size.KIDNEYS, URETERS: Bilateral nephroureteral scans. Left greater than right hydronephrosis, improved from the prior exam.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post omentectomy and partial small bowel resection. Peritoneal soft tissue nodule in the left anterior pelvis measures 2.5 x 1.4 cm (series 3, image 155), previously 2.2 x 1.4 cm. Subcentimeter peritoneal nodules at the level of the hepatic flexure, unchanged from the prior exam. No evidence of bowel obstruction, pneumoperitoneum, or mesenteric free fluid.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Peritoneal nodularity compatible with carcinomatosis without significant interval change.2.Left greater than right hydronephrosis, improved from the prior exam. |
Generate impression based on findings. | Papillary thyroid carcinoma s/p total thyroidectomy on 1/21/11. There are postoperative findings related to total thyroidectomy. There is no mass lesion in the resection bed. There is no significant cervical lymphadenopathy. The oral cavity. oropharynx, nasopharynx, hypopharynx, and larynx are unremarkable. The major salivary glands are unremarkable. There is mild atherosclerotic plaque at the bilateral carotid bifurcations. There are right maxillary sinus retention cysts. The mastoid air cells are clear. The imaged portions of the intracranial structures are orbits are grossly unremarkable. There is biapical pulmonary fibrosis. | No evidence of locoregional tumor recurrence or significant cervical lymphadenopathy. |
Generate impression based on findings. | Pre-renal transplant evaluation of vasculature 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 change in retroperitoneal adenopathy.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: Distal end of peritoneal dialysis catheter coiled within the pelvic mesentery without loculated collection. Trace free ascites.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Central right femoral vein central line. No significant calcification involving distal aorta, common iliac, or external iliac branches bilaterally. | No significant arterial calcification involving distal aorta, iliac, or external iliac branches bilaterally. Stable retroperitoneal adenopathy. |
Generate impression based on findings. | Male 73 years old Reason: left true vocal cord paralysis. evaluate entire length of recurrent nerve in neck and chest. suspect related to lymphadenopathy previously identified LUNGS AND PLEURA: Left upper lobe cavitary lesion with associated consolidation, atelectasis, architectural distortion, volume loss and extensive associated bronchiectasis, unchanged. This lesion is compatible with a necrotic chronic bacterial infection. Lingular nodular opacities unchanged. New right lower lobe nodular opacities and tree-in-bud pattern opacities compatible endobronchial mucous plugging. Right apical interstitial thickening with internal bronchiectasis compatible with scarring unchanged.Severe basilar predominant centrilobular emphysema unchanged.MEDIASTINUM AND HILA: There is extensive consolidation and scarring adjacent to the left apex; however, no mass or significant lymphadenopathy found to account for the patient's vocal cord paralysis. Enlarged precarinal lymph node now measures 1.2 cm (image 37, series 7) previously 1.3 cm, likely reactive. Remaining calcified mediastinal and hilar lymph nodes unchanged.Severe atherosclerosis of the coronary arteries and thoracic aorta.Normal heart size and no pericardial effusion.CHEST WALL: Cachexia unchanged.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Hepatic segment 8 subcentimeter hyperattenuating focus is incompletely characterized but likely represents a flash filling hemangioma.Renal cysts unchanged. | 1. Consolidation and scarring adjacent to the left apex, but no specific etiology found to explain the patient's vocal cord paralysis; refer to report of CT neck the same day for further information.2. Left upper lobe necrotic cavitary lesion, bronchiectasis and nodular opacities not significantly changed and compatible with mycobacterial or other chronic bacterial infection.2. Severe centrilobular emphysema. |
Generate impression based on findings. | 40 year-old female with history of fall, neck pain, and seizures. Evaluate for fracture and intracranial hemorrhage. Head:The ventricles and sulci are normal for age. The cisterns are symmetric and unremarkable. The gray-white matter differentiation is preserved. There is no mass effect, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. C-spine:Loss of normal cervical lordosis likely due to positioning versus muscle spasm. The cervical vertebral bodies are appropriate in overall alignment and height. No fractures or subluxations identified. No significant compromise to the spinal canal or neural foramina.The prevertebral soft tissues are within normal limits. | 1.No acute intracranial normality.2. No evidence for cervical spine fracture or subluxation. |
Generate impression based on findings. | Non-Hodgkin's lymphoma CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Stable bilobar heterogeneous enhancing foci; favor benign etiology, such as hemangiomas. Hepatic vessels patent. No ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable bilateral renal cysts are previously noted subcentimeter nonobstructing proximal right ureteral stone now absent.RETROPERITONEUM, LYMPH NODES: Stable vena caval filterBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No change in enlarged prostate.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Stable right inguinal hernia without bowel involvementOTHER: No significant abnormality noted | Stable examination. No new adenopathy. |
Generate impression based on findings. | Reason: 3 weeks of subacute abdominal pain and distention History: had incomplete colonoscopy and now has inability to have BM ABDOMEN:LUNG BASES: Basilar scarring/atelectasis.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of bowel obstruction. Desiccated stool throughout the colon. No bowel wall thickening or fat stranding. No pneumoperitoneum or mesenteric free fluid.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No acute intra-abdominal abnormality. |
Generate impression based on findings. | Left parotid tumor s/p parotidectomy complicated by hematoma. There are postoperative findings related to interval left parotidectomy and neck dissection. There is ill-defined intermediate attenuation fluid compatible with hemorrhage as well as scattered foci of gas located in the left parotidectomy bed that extends inferiorly towards the supraclavicular region and medially to the carotid sheath. Over all, the hematoma measures approximately 4.3 AP x 3.1 RL x 11.0 SI cm. There is no definite evidence of residual parotid mass. There is diffuse thickening of the adjacent platysma and sternocleidomastoid. There is no evidence of airway compromise. The major cervical arteries appear to be intact without discernable pseudoaneurysm. However, the cervical portions of the left interval jugular vein is not identified and may have been ligated or perhaps compressed by the hemorrhage. The remaining major salivary glands are unremarkable. There is no significant cervical lymphadenopathy. The thyroid gland is unremarkable. The osseous structures are unremarkable. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear. | Interval left parotidectomy with hemorrhage in the resection bed that measures up to 11 cm in length without evidence of airway compromise, discernable pseudoaneurysm, or abscess. |
Generate impression based on findings. | 66 year old female status post wedge resection of liver lesion CHEST:LUNGS AND PLEURA: Scattered micronodules, unchanged.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: There is a new hypodense lesion with air fluid levels measuring 4.7 x 3 cm image number 77, series number 12 suspicious for an abscess. Pneumobilia secondary to metallic stent, unchanged.SPLEEN: Subcentimeter splenic lesion, unchanged.PANCREAS: Dilated pancreatic duct, unchanged. Masslike enhancement of the pancreas, smaller in size and now measures 2.7 x 2.4 cm on image number 114, series number 12.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 in the midline.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. | Interval development of an intrahepatic fluid collection with air-fluid level suspicious for biloma/abscess.Dr. Polite was paged about these findings at the time of dictation. |
Generate impression based on findings. | Left true vocal cord paralysis. There is medialization of the posterior left vocalis muscle, which is otherwise atrophy, compatible with paralysis. The larynx is otherwise unremarkable. The thyroid gland is unremarkable. There is no significant cervical lymphadenopathy. There is no evidence of mass lesions in the neck. There is mild degenerative spondylosis at C5-6. The major cervical vessels are intact. The skull base and imaged intracranial structures are unremarkable. There are extensive bilateral upper lung opacities. Refer to the concurrent separate chest CT report for additional details. | 1. Findings compatible with left vocal cord paralysis by no evidence of mass lesions in the neck or skull base. 2. Extensive bilateral upper lung opacities. Refer to the concurrent separate chest CT report for additional details. |
Generate impression based on findings. | Possible left renal mass seen on outside ultrasound. 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 noted. Specifically, no evidence for mass lesion, acute inflammation, stone, or hydronephrosis. Unremarkable collecting systems bilaterally.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: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 | Negative for acute, inflammatory, or neoplastic process. Specifically, no GU related abnormality. |
Generate impression based on findings. | History of colon cancer CHEST:LUNGS AND PLEURA: Nonspecific subcentimeter nodule in the left lower lobe, measuring 5 mm number 65, series number 5.MEDIASTINUM AND HILA: No significant abnormality noted.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: 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: Postsurgical changes involving the sigmoid colon. A very small collection is present adjacent to the anastomosis measuring 1.7 x 1.8 cm image number 137, series number 3.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No evidence of metastatic or recurrent disease. Small collection near the anastomosis, adjacent to the sigmoid colon |
Generate impression based on findings. | Reason: r/o infection in LUL, immunosuppressed host History: cough, nausea, tremors LUNGS AND PLEURA: Subpleural scarring left upper and right lower lobes, but no specific evidence of active infection.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.Status post heart transplant.CHEST WALL: Median sternotomy for heart transplant.Mild degenerative abnormalities affect the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. 23-mm hepatic segment IVa hypodensity, attenuation greater than expected for a cyst but in a patient with no known malignancy most likely hemangioma. | No evidence of lung infection with scarring from prior infection or infarction. Probable hepatic hemangioma. |
Generate impression based on findings. | Cough. Follow-up micronodules. LUNGS AND PLEURA: Few scattered micronodules, similar to the prior exam in 2010. No new nodules or masses seen. Minimal bibasilar subsegmental atelectasis. No focal airspace opacities or pleural effusions.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Normal sized heart without pericardial effusion. Moderately severe coronary artery calcifications in the right and left systems. Aortic arch calcifications.CHEST WALL: Severe degenerative changes in thoracic spine, similar to the prior exam.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. No specific findings to account for the patient's symptoms. 2. Stable pulmonary micronodules, which may be secondary to prior infection or intrapulmonary lymph nodes. No further follow-up is recommended for this finding. |
Generate impression based on findings. | Possible left renal mass seen on outside ultrasound. 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 noted. Specifically, no evidence for mass lesion, acute inflammation, stone, or hydronephrosis. Unremarkable collecting systems bilaterally.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: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 | Negative for acute, inflammatory, or neoplastic process. Specifically, no GU related abnormality. |
Generate impression based on findings. | Male 56 years old Reason: 56 male with ALL, needs methotrexate, but must rule out pleural effusion before chemotherapy History: ALL LUNGS AND PLEURA: Focal scarring of the lingula unchanged.Diffuse bronchial wall thickening unchanged and suggestive of chronic bronchitis or asthma.MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy.The two coronary artery stents unchanged in position.Calcifications of the aortic valve appear unchanged.Bilateral PICC lines with the right catheter tip in the distal SVC and the left catheter tip in the cavoatrial junction.CHEST WALL: Multilevel degenerative changes of the thoracic spine unchanged.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Nonspecific enlarged peripancreatic node. | 1. No evidence of pleural effusions as clinically questioned.2. Diffuse bronchial thickening suggestive of chronic bronchitis or asthma. |
Generate impression based on findings. | Female 73 years old; Reason: OSH CT without contrast (uploaded to PACS under MRN 255619) with report that showed possible soft tissue mass with lymphadenopathy, unclear on location of mass. Please rule out mass. PELVIS:UTERUS, ADNEXA: Absent or atrophicBLADDER: Gas within the urinary bladder which is decompressed by a Foley catheter.LYMPH NODES: No pelvic lymph adenopathy.BOWEL, MESENTERY: Colonic diverticulosis.BONES, SOFT TISSUES: Bilateral sacral insufficiency fractures which are in near-anatomic alignment.Bilateral parasymphysial fractures with erosive changes of the pubic symphysis which may be due to fracture healing. There is calcification of the right adductor musculature which may represent heterotopic ossification.The right piriformis muscle is thickened. Post operative changes of the lower lumbar spine with pedicle and screw fusion.OTHER: No pelvic ascites. | 1.Bilateral sacral insufficiency fractures with parasymphysial fractures. There are erosive changes about the pubic symphysis which may be due to fracture healing.2.No evident pelvic mass.3.Findings discussed with Dr. Press at 4.50pm by Dr.Thomas |
Generate impression based on findings. | Clinical question: Hemorrhage. Signs and symptoms: Right-sided headache, dizziness and nausea after MVC. Nonenhanced head CT:There is no detectable acute posttraumatic intracranial, calvarial or soft tissues of the scalp findings.There are very subtle some cortical foci of low-attenuation in bilateral cerebral hemispheres which are nonspecific however and could represent age indeterminate to small vessel ischemic strokes. Recommend follow-up with MRI exam for better assessment and to exclude other possible white matter pathologies.Unremarkable cerebral cortex, cortical sulci, ventricular system and gray-white matter differentiation otherwise.Unremarkable calvarium and soft tissues of the scalp.Unremarkable orbits.There is evidence of complete opacification of left maxillary sinus with noticeable thickening of the sinus wall suggestive of long-standing chronic sinus disease. The rest of visualized paranasal sinuses are unremarkable. | 1.No acute posttraumatic intracranial, calvarial or soft tissues of the scalp findings.2.Subtle subcortical low-attenuation white matter is a nonspecific finding and recommend follow up with MRI for better assessment.3.Complete opacification of left maxillary sinus with thickening of sinus walls consistent with long-standing chronic sinusitis. |
Generate impression based on findings. | Clinical question: Evaluate intracranial process. Signs and symptoms: Intoxication, battery. Nonenhanced head CT:No detectable acute posttraumatic intracranial, calvarial or soft tissues of the scalp findings.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation.Unremarkable visualized paranasal sinuses.Images through the orbits demonstrate a chronic blow out fracture of left lamina papyracea and unremarkable otherwise.Mastoid air cells and medullary cavities are well pneumatized and unremarkable. | 1.No acute posttraumatic findings.2.Unremarkable intracranial contents.3.Chronic small blowout fracture of left lamina papyracea. |
Generate impression based on findings. | Clinical question: Rule out stroke. Signs and symptoms: Left foot drop. Nonenhanced head CT: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.Unremarkable calvarium.There is a small region of subgaleal hemorrhage in the left posterior parietal scalp measuring at 11 x 30 1 mm.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells but | 1.No acute intracranial or calvarial findings.2.Left posterior parietal scalp hematoma.3.Unremarkable nonenhanced head CT otherwise. |
Generate impression based on findings. | Clinical question: Rule out intracranial hemorrhage, history of seizure D./O. Signs and symptoms: Patient had seizure shortly after MVA. Nonenhanced head CT:There is no evidence of 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.Unremarkable calvarium and soft tissues of the scalp.Unremarkable orbits, visualized paranasal sinuses and mastoid air cells. | Unremarkable nonenhanced head CT. |
Generate impression based on findings. | Clinical question: Evaluate for intracranial abnormalities. Signs and symptoms: Confusion, hallucination. Nonenhanced head CT:There is no detectable acute intracranial process. CT however is insensitive for detection of acute non-hemorrhagic ischemic strokes.There is prominence of cortical sulci and supratentorial ventricular system however likely within normal range for patient stated age of 78. Subtle underlying parenchymal volume loss cannot be excluded.There are subtle periventricular no attenuation of white matter suspected for age indeterminant small vessel ischemic strokes.Calvarium and soft tissues of the scalp are unremarkable.All paranasal sinuses, mastoid air cells and middle ear cavities are well pneumatized.Unremarkable images through the orbits. | 1.There is no detectable acute intracranial process. CT however is insensitive for detection of acute non-hemorrhagic ischemic strokes.2.Minimal age indeterminate small muscle ischemic stroke is suspected. |
Generate impression based on findings. | Male 41 years old Reason: eval for pe History: tachycardia PULMONARY ARTERIES: Technically limited study, without evidence of pulmonary emboli or right heart strain.LUNGS AND PLEURA: Triangular soft tissue lesion in the left costophrenic angle may be pleural or intraparenchymal, measuring 29 x 11 mm (image to 213, series 8), of unclear etiology but new from the previous exam.New bibasilar subsegmental atelectasis with minimal associated consolidation and small pleural effusions. Mild bronchial wall thickening without evidence of mucus plugging. MEDIASTINUM AND HILA: Evidence of mediastinal or hilar lymph adenopathy.Normal heart size, no evidence of pericardial effusion.Hypodense left thyroid nodule unchanged from prior.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Hypodense lesion in the left hepatic lobe is incompletely characterized but likely a hepatic cyst. | 1. No evidence of acute pulmonary emboli, but somewhat technically limited study.2. Nonspecific lesion in the left costophrenic angle of unclear etiology possibly post infectious or a subacute subsegmental infarct. Recommend follow-up CT in 6 weeks to exclude the remote possibility of a metastasis, though this is considered unlikely.3. Bibasilar atelectasis with associated small pleural effusions consistent with postoperative atelectasis.These findings were discussed with Gina Bradley APRN at 10:35 on 10/11/2013. |
Generate impression based on findings. | Reason: evaluate renal vasculature for bleeding History: hematuria ABDOMEN: Limited exam due to poor contrast bolus.LUNG BASES: Stable micronodule in the left lung base (series 4, image 9). Atherosclerotic calcification of the descending thoracic aorta. Mural thrombus of the descending and ectatic thoracic aorta.LIVER, BILIARY TRACT: Mildly dilated intrahepatic and extrahepatic biliary ducts without evidence of obstructing stone. Status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: Atrophic pancreas with calcified splenic artery.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right ureteral stent. Left nephrostomy catheter. There are bilateral hypoplastic renal arteries. There is calcification at the origin of the right renal artery. Bilateral atrophic kidneys with poor parenchymal enhancement. No evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: IVC filter. Aortobiiliac stent graft. Aneurysmal aorta with mural thrombus measuring 4.7 cm. Right common iliac with aneurysmal dilation measuring up to 2.9 cm.BOWEL, MESENTERY: Moderate amount of free air within the peritoneum. Several distended and angulated loops of proximal small bowel in the midabdomen with small bowel feces sign and air fluid levels suggesting partial obstruction.BONES, SOFT TISSUES: Diffuse moderate degenerative joint disease of the thoracic and lumbar spine.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Enlarged uterus with calcified fibroids. Evaluation is limited as fat planes between uterus and bladder are obliterated.BLADDER: Collapsed bladder with Foley catheter and right nephroureteral stent. No evidence of active bleeding or hematoma.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Fat stranding of the lower abdominal wall.BONES, SOFT TISSUES: Diffuse moderate degenerative joint disease of the thoracic and lumbar spine.OTHER: No significant abnormality noted | 1.Moderate amount of free air within the peritoneum. Bowel perforation versus recent surgery--the service was notified of this finding at the time of dicatation.2.Bilateral atrophic kidneys with hypoplastic renal arteries. No evidence of hemorrhage. No evidence of hydronephrosis bilaterally.3.Right ureteral stent and left nephrostomy tube.4.Aortic aneurysm with mural thrombus.5.Aneurysmal dilatation of right common iliac artery.6.Dilated loops of small bowel in the midabdomen suggestive of partial small bowel obstruction.7.Enlarged uterus with fibroids.Findings were discussed with service (pager 4039) over the phone at 9:30 a.m. on 10/11/2013 by Dr. Funaki. |
Generate impression based on findings. | Reason: stone? History: L flank pain, additional history includes lupus nephritis Lack of IV contrast limits evaluation of solid organ pathology.ABDOMEN:LUNG BASES: 4 mm micronodule at the left base (series 4, image 23).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: Atrophic kidneys with bilateral indeterminate lesions. No hydronephrosis or nephrolithiasis.RETROPERITONEUM, LYMPH NODES: Nonspecific prominent retroperitoneal lymph nodes. Left paraaortic lymph node measures 1.7 x 1.0 cm (series 3, image 65).BOWEL, MESENTERY: No evidence of bowel obstruction. The appendix is normal. No pneumoperitoneum or mesenteric free fluid.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Atrophic kidneys with bilateral indeterminate lesions, which can not be characterized without intravenous contrast. 2.Nonspecific retroperitoneal lymphadenopathy. |
Generate impression based on findings. | Chest pain, shortness of breath PULMONARY ARTERIES: Technically adequate examination. There is a large acute-appearing pulmonary embolus in the right middle lobar pulmonary artery with smaller emboli seen in the right upper lobe. LUNGS AND PLEURA: Low lung volumes with basilar atelectasis. Stable moderately severe predominantly apical centrilobular and paraseptal emphysema. The reference right upper lobe nodule measures 4 mm (10/43), unchanged since 2009 and almost certainly benign. No new suspicious nodules or masses are seen. There are no pleural effusions.MEDIASTINUM AND HILA: Subcentimeter mediastinal lymph nodes. No mediastinal or hilar lymphadenopathy. Normal sized heart without pericardial effusion. Mild to moderate coronary artery and aortic calcifications.CHEST WALL: Moderate degenerative changes affect the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Hepatic hypodensities, which are too small to characterize though likely representing simple cysts, are unchanged.Atherosclerotic plaques in the abdominal aorta with mural thrombus, unchanged compared to 9/20/2012. | Acute pulmonary embolism at the lobar level and further distally, with emboli in the right upper and middle lobes. |
Generate impression based on findings. | 10 year-old male. Abdominal pain, bilateral hydronephrosis. Evaluate for obstruction or any intraabdominal pathology. ABDOMEN:LUNG BASES: Lung bases are clear.LIVER, BILIARY TRACT: No biliary ductal dilatation. Normal hepatic contour. No focal hepatic lesion.SPLEEN: Normal appearance of the spleen.PANCREAS: Normal appearance of the pancreas.ADRENAL GLANDS: Normal appearance of the adrenal glands.KIDNEYS, URETERS: No focal renal lesion is identified. Normal corticomedullary differentiation. Bilateral mild hydronephrosis.RETROPERITONEUM, LYMPH NODES: No retroperitoneal adenopathy.BOWEL, MESENTERY: Normal caliber of the bowel. No abnormal bowel wall thickening, mesenteric fluid, or loculated fluid collection.BONES, SOFT TISSUES: Normal appearance of the bones.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Incompletely distended bladder.LYMPH NODES: No pelvic lymphadenopathy. BOWEL, MESENTERY: Normal caliber of the bowel. No abnormal bowel wall thickening, mesenteric fluid, or loculated fluid collection.BONES, SOFT TISSUES: Normal appearance of the bones.OTHER: Small amount of free fluid in the proximal inguinal canals, right greater than left. | Mild bilateral hydronephrosis. Small amount of free fluid in the proximal inguinal canals. |
Generate impression based on findings. | Fall from monkey bars, dried blood in auditory canal. Rule out skull fracture. 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. No temporal bone fracture is identified. The facial nerve describes a normal course. The inner ear structures are unremarkable, without evidence of pneumolabyrinth. On the left, there is linear soft tissue density within the lumen of the external auditory canal approximately 12 mm deep to the meatus, which likely corresponds to the dried blood apparent on clinical exam. The middle ear and mastoid air cells are well-pneumatized and clear. The ossicular chain is intact. No temporal bone fracture is identified. The facial nerve describes a normal course. The inner ear structures are unremarkable, without evidence of pneumolabyrinth. are unremarkable. | 1. Linear soft tissue density within the lumen of the left external auditory canal approximately 12 mm deep to the meatus likely corresponds to the dried blood apparent on clinical exam.2. No evidence of temporal bone fracture or ossicular chain disruption. |
Generate impression based on findings. | Reason: Abd pain, h/o Hep C cirrhosis w/ worsening LFT's, slightly elevated lipase, rule out gallstones/pancreatitis History: Abd pain, h/o Hep C cirrhosis w/ worsening LFT's, slightly elevated lipase, rule out gallstones/pancreatitis ABDOMEN:LUNG BASES: Basilar atelectasis.LIVER, BILIARY TRACT: Liver contour: The liver contour is nodular compatible with cirrhosis.Features of portal hypertension: None Portal vein: Patent Hepatic veins: PatentHepatic artery: Conventional hepatic arterial anatomyLesions: 1.7 x 1.5 cm arterially enhancing segment III lesion with persistent portal venous enhancement is unchanged from the prior exam and compatible with a portal venous -- hepatic venous shunt. Veins from both systems are seen coursing through the lesion.No suspicious focal hepatic lesions. No ascites.Status post cholecystectomy with mildly prominent extrahepatic biliary ductal dilatation. No CT evidence of CBD stone.SPLEEN: Calcified splenic artery without aneurysmal dilatation.PANCREAS: Heterogeneous and enlarged pancreatic head with mild peripancreatic fat stranding. Nonspecific 4-mm cystic lesion in the pancreatic body and a 3-mm cystic lesion in the pancreatic tail.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left lower pole calculus measures 1.2-cm (series 7, image 75). No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Moderate atherosclerosis of the abdominal aorta and its branches. Mildly prominent upper abdominal and retroperitoneal lymph nodes are nonspecific in the setting of chronic liver disease.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Enlarged pancreatic head with mild peripancreatic fat stranding. Differential considerations include pancreatic mass and acute pancreatitis. Recommend endoscopic ultrasound for further evaluation. 2.No CT evidence of gallstones. 3.Cirrhosis. Vascular segment III lesion is unchanged. Findings discussed with Dr. Yashar by telephone at 9:41 a.m. on 10/11/2013. |
Generate impression based on findings. | Head injury and neck pain. Head: There is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is a small right maxillary sinus retention cyst. The mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. Cervical Spine: The vertebral column alignment is within normal limits, without spondylolisthesis. There is no evidence of cervical spine fracture. The vertebral body and disc space heights are preserved. The craniocervical junction is intact. The prevertebral and paravertebral soft tissues are unremarkable. The imaged portions of the lungs are clear. | 1. No evidence of intracranial hemorrhage or skull fracture.2. No evidence of cervical spine fracture or spondylolisthesis. |
Generate impression based on findings. | Male 67 years old Reason: 67M w myeloma, h/o prior TB exposure, multiple nodules seen on prior CT, pls eval for progression/resolution History: 67M w myeloma, h/o prior TB exposure, multiple nodules seen on CT, please eval for progression/resolution LUNGS AND PLEURA: Significant interval decrease in size and extent of multiple bilateral basilar predominant nodular opacities. Given the brisk improvement an infectious etiology is favored over intraparenchymal plasmacytomas. Biapical scarring/calcifications are unchanged.Mild/minimal basilar predominant centrilobular emphysemaMEDIASTINUM AND HILA: Calcified mediastinal lymph nodes unchanged. Nonspecific small hypoattenuating lesions in the thyroid gland.Moderate atherosclerosis of the thoracic aorta and coronary arteries. Normal heart size and no pericardial effusion. Small sliding type hiatal hernia.CHEST WALL: Innumerable lytic lesions of variable size scattered throughout the thoracolumbar spine, sternum, right scapula and multiple ribs.Bilateral mild gynecomastia.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. Significant interval decrease in size of bilateral lung nodules favoring resolving infection. Additional CT follow-up in 4 to 6 weeks is suggested.2. Lytic lesions affecting the skeleton compatible with given history of multiple myeloma. |
Generate impression based on findings. | Reason: rule out hydronephrosis History: UTI Lack of intravenous contrast limits evaluation of solid organ pathology.ABDOMEN:LUNG BASES: Basilar atelectasis/scarring. Small pleural effusions.LIVER, BILIARY TRACT: Gallstones.SPLEEN: Calcified splenic granulomata.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic kidneys with bilateral renal cysts. No hydronephrosis or nephrolithiasis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small umbilical hernia containing a small bowel loop.BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate. Indeterminate soft tissue lesion adjacent to the prostate can not be further characterized without IV contrast (series 4, image 99).BLADDER: Suprapubic catheter. LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Bilateral renal cysts . No evidence of hydronephrosis. |
Generate impression based on findings. | Coumadin, fall down 3 stairs. Head: There is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There are postoperative findings related to right uncinectomy and partial internal ethmoidectomy. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. Cervical Spine: The vertebral column alignment is within normal limits, without spondylolisthesis. There is no evidence of cervical spine fracture. There is a sclerotic focus within the left C5 vertebral body, which measures up to 9 mm. The vertebral body and disc space heights are preserved. The craniocervical junction is intact. There is no significant spinal canal stenosis. The prevertebral and paravertebral soft tissues are unremarkable. The imaged portions of the lungs are clear. | 1. No evidence of intracranial hemorrhage or skull fracture.2. No evidence of cervical spine fracture or spondylolisthesis.3. A sclerotic focus within the left C5 vertebral body that measures up to 9 mm may represent an enostosis. |
Generate impression based on findings. | Male, 70 years old, status post aortic aneurysm repair, now with right sided weakness. Examination is significantly limited due to suboptimal positioning with streak and motion artifact. Within these limitations, the following observations are made.Areas of hypoattenuation are seen within the posterior left parietal lobe, the left parieto-occipital junction, and perhaps the left temporal lobe. There may be additional areas of hypoattenuation as well, but these are not definitive given study limitations.No evidence of large parenchymal hematoma or extra-axial fluid collection. Please note that small amounts of blood product likely would not be detected. The ventricular system does not appear to be dilated. | Scattered areas of left hemispheric ischemia are highly suspected, at least subacute if not acute. When the patient's condition allows, repeat CT imaging in the radiology department, or MRI, would better delineate these abnormalities.Findings discussed with Dr. Gaudet at 0900 hrs on 10/11/13. |
Generate impression based on findings. | Reason: evaluate for malignancy, retroperitoneal hematoma History: abd distention, bruising Lack of intravenous contrast limits evaluation of solid organ pathology.ABDOMEN:LUNG BASES: Basilar interlobular septal thickening with ground-glass opacities compatible with edema. More dense consolidation at the right base. Small right pleural effusion. Cardiomegaly. Pacer leads are partially visualized.LIVER, BILIARY TRACT: Intra-abdominal ascites. Cholelithiasis. Ring-like calcification inferior to the liver is of indeterminate etiology.SPLEEN: No significant abnormality noted.PANCREAS: Mild peripancreatic fat stranding.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Nonspecific upper abdominal and retroperitoneal lymphadenopathy. Left paraaortic lymph node 2.2 x 1.8 cm (series 3, image 61). No evidence of retroperitoneal hematoma.BOWEL, MESENTERY: No evidence of bowel obstruction. No pneumoperitoneum.BONES, SOFT TISSUES: Diffuse body wall anasarca.OTHER: No significant abnormality noted.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.No evidence of retroperitoneal hematoma. 2.Nonspecific upper abdominal and retroperitoneal lymphadenopathy. 3.Probable CHF with ascites and body wall anasarca. |
Generate impression based on findings. | Reason: eval prior inguinal mesh hernia repair, acute intraabd process History: L>R inguinal swelling/pain, hx CKD 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: Moderate centrilobular emphysematous changes. Atherosclerotic calcification of the descending thoracic aorta. Small pleural effusions bilaterally.LIVER, BILIARY TRACT: Punctate calcifications consistent with granulomata. No evidence of cholelithiasis. No intrahepatic or extrahepatic ductal dilatation.SPLEEN: Punctate calcifications consistent with granulomata. Severe calcification of the splenic artery.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Vascular calcifications of bilateral renal arteries. No evidence for hydronephrosis. No evidence of hydroureter.RETROPERITONEUM, LYMPH NODES: Severe calcification of the descending aorta and bilateral iliac arteries. Ectatic infrarenal aorta and bilateral iliac arteries. Aneurysmal left iliac artery.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Collapsed bladder with Foley catheter.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diverticula the sigmoid colon and descending colon without evidence of diverticulitis.BONES, SOFT TISSUES: Right inguinal hernia with collection of fluid and air foci measuring 5.0 x 4.2 cm. The inguinal hernia containing mesenteric fat, small bowel and collection of fluid and air foci. Fluid collection measures 5.6 x 3.1 cm. There is proximal small bowel dilatation with air-fluid levels indicating partial obstruction. OTHER: No significant abnormality noted | 1.Bilateral inguinal hernias, left greater than right. Left hernia appears to be obstructive of small bowel. Early ischemia cannot be excluded.2.Bilateral fluid collections adjacent to inguinal hernias with air foci suggestive of abscesses.3.Extensive vascular calcifications and ectasia of the infrarenal abdominal aorta and aneurysmal left common iliac artery.Findings communicated to service by RROC at time of study. |
Generate impression based on findings. | Clinical question: Evaluate for hemorrhage. Signs and symptoms: Headache. Nonenhanced head CT:Examination demonstrates no evidence of any new intracranial hemorrhage since prior study.Previously seen left-sided subarachnoid hemorrhage in the left sylvian fissure and left frontal -- parietal and occipital cortical sulci appears nearly identical to prior study. Minimal extra-axial hemorrhage along the superior surface of tentorium and falx remains also identical to prior study.Postoperative changes of left anterior temporal and frontal craniotomy and cranioplasty remains stable. There is mild parenchymal low attenuation of the immediate peri surgical site/aneurysm clip in the left anterior temporal and frontal lobes which appears slightly more conspicuous since prior exam and representing edema.There is no change in the normal size of ventricular system and no midline shift.Slight interval decrease in the expected postoperative pneumocephalus. | 1.No evidence of any new hemorrhage since prior exam. 2.Stable minimal subarachnoid hemorrhage and hemorrhage along the superior surface of tentorial leafs (right greater than left) since prior exam.3.Subtle parenchymal edema in the left anterior temporal and frontal in the immediate surgical site of left sylvian fissure aneurysm clips.4.Stable normal size of ventricular system and maintained midline.5.Slight interval decrease of post operative pneumocephalus. |
Generate impression based on findings. | Reason: h/o RUE fistula evaluate venous outflow History: h/o RUE fistula evaluate venous outflow CHEST:LUNGS AND PLEURA: Scattered pulmonary micronodules. No suspicious pulmonary nodules or masses. Basilar atelectasis/scarring.MEDIASTINUM AND HILA: No lymphadenopathy. Heart size is normal without pericardial effusion. Mild coronary arterial calcification.VASCULATURE: Right Brescia-Cimino fistula with arterial inflow stenosis (series 81512, image 17). Arterial outflow to the hand is preserved. There is aneurysmal dilatation of the venous limb. Multiple venous stenoses are present involving the SVC at the origin of the left innominate vein as well as the right internal jugular and subclavian veins. There are scattered chest wall collateral vessels. No evidence of thrombus. CHEST WALL: Right arm and chest wall edema. Degenerative changes of the thoracolumbar spine. UPPER ABDOMEN: Atrophic kidneys. | 1.Right Brescia-Cimino fistula with inflow vein stenosis near the AV anastomosis, which would be amenable to angioplasty. Arterial outflow to the hand is preserved. Aneurysmal dilatation of the venous limb.2.Multiple venous stenoses involving the SVC, right internal jugular vein and subclavian veins.3.Right arm and chest well edema secondary to impaired venous return. |
Generate impression based on findings. | 25 year-old female with end-stage renal disease, cardiomegaly, multiple autoimmune disorders, now with subacute worsening shortness of breath and unresponsive to antibiotics. Evaluate for possible ILD. Please note that sensitivity is limited by patient motion.LUNGS AND PLEURA: Moderate subpulmonic left pleural effusion with overlying subsegmental atelectasis. There are scattered patchy air space opacities in the right lung, most prominent in the right upper lobe. These most likely represent infection and less likely hemorrhage. There is no evidence of fibrosis, air trapping, or nodules to suggest interstitial lung disease. There is bronchial wall thickening, suggestive of asthma or bronchitis. There is no significant component of edema based on clear costophrenic angles with no effusion or septal lines..MEDIASTINUM AND HILA: Enlarged mediastinal lymph nodes, measuring up to 1.1 cm in short axis (3/21). No hilar lymphadenopathy. Cardiomegaly with small pericardial effusion.CHEST WALL: Enlarged axillary lymph nodes, measuring up to 1.6 cm in short axis (3/20).UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. Scattered right lung patchy air space opacities, most likely representing infection.2. No specific evidence of diffuse interstitial lung disease or pulmonary edema.3. Moderately large left subpulmonic pleural effusion.4. Bronchial wall thickening, suggestive of asthma or bronchitis.5. Moderate mediastinal and axillary lymphadenopathy. |
Generate impression based on findings. | Clinical question: Intracranial hemorrhage. Signs and symptoms: Intracranial hemorrhage. Unenhanced head CT:The examination redemonstrates a very large, irregular and dissecting right basal ganglial, thalamic hemorrhage without convincing evidence of any significant interval change since prior exam from 10 -- 10 -- 13. Surrounding vasogenic edema and age overall associated mass effect also remains very similar to prior exam. No change in the position of a right frontal approach catheter which traverses the right hemispheric hematoma in the AP axis.No change in the position of the left frontal approach ventricular catheter with the tip in the left frontal horn. Stable minimal hemorrhage along the course of left frontal catheter. Midline leftward shift of approximately 11 mm is very similar to prior exam. Extensive intraventricular hemorrhage in the third ventricle and left lateral ventricle remains also similar to prior study. Partially collapsed right lateral ventricle and intraventricular hemorrhage is similar to prior exam.Mildly dilated left lateral ventricle remains similar to prior exam. | 1.No evidence of new hemorrhage or increased size of patient's known large right hemispheric hematoma.2.Stable mass effect of hematoma/surrounding edema with resultant 11-mm leftward midline shift.3.No change in the size of ventricular system (mildly dilated left lateral ventricle) and intraventricular hemorrhage since prior exam.4.No change in the position of catheter with the tip within the hematoma and left ventricular catheter. |
Generate impression based on findings. | Reason: GIST s/p resection, on adjuvant Gleevec, eval EOD History: none ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Scattered punctate calcifications suggestive of granulomata. No suspicious focal liver lesions. No evidence of intrahepatic ductal dilatation. Mild prominence of the common duct. No evidence of cholelithiasis. SPLEEN: No significant abnormality notedPANCREAS: Status post partial pancreatectomy. Cystic lesion adjacent to the remaining pancreatic body remains stable in size measuring 1.4 x 1.3 cm (series 8, image 42).Cystic lesion in the pancreatic head remains unchanged compared to prior exam. Pancreatic duct is unremarkable.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post partial gastrectomy.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Heterogeneously enhancing 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 | 1.Stable cystic lesion adjacent to the pancreatic body.2.Stable exam without evidence of metastatic disease. |
Generate impression based on findings. | Reason: ICH History: ICH Since the prior examination a left hemispheric hematoma has increased in size from 59 x 48 mm axial dimensions to 71 x 66 mm in axial dimensions. Midline shift has progressed with shift of septum pellucidum approximately 20 mm in the right middle and current exam and 10 mm on the prior exam. There is redemonstration of intraventricular blood as well as enlargement of the lateral ventricles. Blood extends into the fourth and third ventricles. There is redemonstration of uncal herniation as well as transtentorial herniation and subfalcine herniation.There is redemonstration of subarachnoid blood.Since the previous exam a ventriculostomy tube is in place which course of the right frontal lobe into the right lateral ventricle with tip in the body of the right lateral ventricle.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.Interval significant progression of left hemispheric hematoma with progression of midline shift, uncal herniation, transtentorial herniation and subfalcine herniation. There is associated intraventricular and subarachnoid blood.2.there is redemonstration of ventriculomegaly. The ventricles are low but smaller on the current exam but remain dilated3.Status post recent ventriculostomy tube placement |
Generate impression based on findings. | Reason: f/u ICH History: f/u ICH Brain CTA: Findings are compatible with CTA spots sign along the left frontal lobe subcortical white matter at the superior aspect and anterior aspect of the hematoma. Please see image number 186 to 220 axial 2-mm cuts and image 417 of 511 of series 8, image 159 of 394 of the sagittal .9 mm slices series 80830 and .9 mm coronal image 238 of 491 series 80829. This is "spot sign" can be traced back to a branch of the left middle cerebral arteryThere is opacification of the distal internal carotid arteries, the distal vertebral arteries and the proximal anterior middle and posterior cerebral arteries. No intracranial stenosis is appreciated.The anterior communicating artery and the posterior communicating arteries are identified and are intact.CT head:Since the prior exam the patient has developed a new hematoma measuring 59 x 48 mm axial dimensions in the left hemisphere which is centered in the left centrum semiovale and subcortical white matter and is associated with intraventricular extension into the lateral, third and fourth ventricles as well as posterior fossa subarachnoid space and ventriculomegaly. There is associated uncal herniation and subfalcine herniation and shift of the brainstem towards the right. The septum pellucidum is shifted approximately 10 mm to the right of midlineThe visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.The patient has developed a large left-sided hemispheric hematoma centered in the centrum semiovale and subcortical white matter associated with significant mass effect with midline shift subfalcine herniation and uncal herniation as well as a compression of the brainstem towards the right and ventriculomegaly . This represents a higher risk for an oval progression of the patient's hematoma. It is likely related to a left middle cerebral artery branch.2.findings are compatible with CTA spots sign along the left frontal lobe subcortical white matter at the superior aspect and anterior aspect of the hematoma. This is considered high risk for progression of the hematoma.3.No evidence for cerebrovascular occlusive disease |
Generate impression based on findings. | NPH status post ventricular shunt insertion. There has been interval insertion of a right transfrontal ventricular shunt catheter that terminates in the right lateral ventricle. There is a small amount of subdural pneumocephalus in the anterior right frontal region. There is marked dilatation of the lateral and third ventricles out of proportion to the fourth ventricle and sulci, which is not significantly changed. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. There is no midline shift or herniation. There is left frontal sinus osteoma that measures up 20 mm. The skull and extracranial soft tissues are otherwise unremarkable. | No significant interval change in the degree of triventricular dilatation related to normal pressure hydrocephalus status post right transfrontal ventricular shunt insertion, without evidence of acute intracranial hemorrhage. |
Generate impression based on findings. | Reason: h/o HNC, s/p CRT, compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: Apical radiation fibrosis unchanged.Benign-appearing nodules some calcified, unchanged.Left basilar groundglass opacity improved consistent with aspiration.No sign of pulmonary or pleural metastases.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.Calcified right hilar nodes are from a prior granulomatous infection.Moderate coronary calcifications are present.A left jugular catheter terminates in the SVC region.CHEST WALL: Only mild degenerative abnormalities affect the thoracic spine.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left extrarenal pelvis.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. | Improving left base groundglass opacity likely from prior aspiration, and no evidence of metastases. |
Generate impression based on findings. | Reason: uip History: UIP/PSS LUNGS AND PLEURA: Peripheral and basilar reticular opacities have worsened since the prior study and there is now subtle honeycombing deep in the costophrenic sulci.Traction bronchiectasis and bronchiolectasis is present.No significant groundglass disease is present. Calcified and noncalcified benign-appearing micronodules are evidence of healed granulomatous disease.There is no significant air trapping on expiration series. MEDIASTINUM AND HILA: The esophagus is dilated consistent with the patient's history of scleroderma.Calcified left hilar nodes are present, but there is no significant mediastinal or hilar lymphadenopathy. CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Numerous calcified splenic granulomata are likely from prior histoplasmosis. | Worsening interstitial lung disease in a UIP pattern. Healed granulomatous disease probably histoplasmosis. |
Generate impression based on findings. | Female, 60 years old, left neck fullness. A left level 2 lymph node is identified measuring 9 x 9 mm (image 26 series 3) which may correspond to the patient's palpable abnormality. No prior dedicated neck imaging is available for comparison. However, when comparison is made to coronal images from a prior neck MRA, there has been no significant interval change in size.A borderline enlarged left supraclavicular lymph node is also seen measuring 16 x 11 mm (image 56 series 3). Again, this lesion was very likely present on the prior MRI and does not seem to have changed, but it is less clearly seen on that study.Neither of the above nodes demonstrates aggressive features. No additional pathologic adenopathy is seen.The aerodigestive mucosa is within normal limits. The salivary glands and thyroid are within normal limits. The cervical vessels are patent. The lung apices are clear.Lucency is evident within the right posterior mandible, perhaps correlating to a site of dental extraction. Correlation with history suggested. No additional concerning bony lesions are seen. Extensive degenerative disk disease is evident through the cervical spine with vertebral body auto-fusion from C4 to C6. Incidental note is made of a metallic device, partially visualized and within the soft tissues of the left breast. | 1. 9 x 9 mm left level 2 lymph node, stable when compared to a prior examination from 2011.2. 16 x 11 mm left supraclavicular lymph node, probably also stable when compared to the prior exam. |
Generate impression based on findings. | Reason: pt with lung ca s/p treatment h/o pelvic mass too History: doing fairly well now needs disease evaluation compare to previous scans and outside one too CHEST:LUNGS AND PLEURA: Postsurgical changes in the right hemithorax. No suspicious pulmonary nodules or masses. Centrilobular emphysema.MEDIASTINUM AND HILA: Reference high right paratracheal lymph node measures 5 mm (series 4, image 12), previously 9 mm. Heart size is normal without pericardial effusion.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Left hepatic lobe hypodensity in segment IV A is too small to further characterize, but is unchanged and likely benign.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Reference high right paratracheal lymph node is smaller.2.Status post right upper lobectomy.3.No new sites of disease in the chest, abdomen, or pelvis. |
Generate impression based on findings. | Male 55 years old; Reason: lung cancer a/p 39 cycles of chemo. please evaluate for disease and compare with previous scans using same target lesions. History: lung cancer CHEST:LUNGS AND PLEURA: Decrease in the left hemithoracic volume due to circumferentialpleural thickening. Pleural thickening adjacent to the mediastinum medially measures 11 mm (image 32/series 3), unchanged.The pleural nodularity along the left major fissure measures 2.3 x 1.6 cm (image 40/series 5) previously, 2.4 x 1.8 cm.There are multiple left lung nodules. Loculated pleural effusion at the left lung base is unchanged in volume.MEDIASTINUM AND HILA: Heart size is normal. The reference left pericardiophrenic node measures 10-mm (image 73/series 3), changed.CHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: Since hypodense hepatic lesions are too small to characterize, unchanged. No suspicious hepatic lesions. Hepatic and portal veins are patent.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Right adrenal gland is atrophic and calcified ; left adrenal gland is unremarkable.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Small bowel is normal in caliber. The colon is unremarkable.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.No evident change in the left hemithorax pleural thickening. |
Generate impression based on findings. | Lung cancer. CHEST:LUNGS AND PLEURA: Postsurgical and postradiation changes, with left lung volume loss and apical opacities, appear similar to prior exam. Centrilobular emphysema. No pleural effusions.The left upper lobe focal nodular opacities are decreased. No new nodules or masses.MEDIASTINUM AND HILA: Interval decrease in size of the reference anterior mediastinal lymph node, measuring 6 mm in short axis (3/32), previously 11 mm. interval decrease in size of the reference right paratracheal lymph node, measuring 8 mm in short axis (3/27), previously 13 mm.The previously seen low attenuation along the left atrial appendage (3/51) suggestive of thrombus, appears unchanged. The chronic appearing thrombus in the left main pulmonary artery appears unchanged.Persistent thickening of the mid to distal esophagus is again seen.CHEST WALL: Mild to moderate degenerative changes of the thoracic spine. Right chest Port-A-Cath with tip at the superior cavoatrial junction.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Stable hypoattenuating lesion in the right hepatic lobe compatible with an hemangioma. Status post cholecystectomy.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable centimeter hypodense lesion in the left kidney which is too small to characterize.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Marked atherosclerosis of the abdominal aorta and its branches, without aortic aneurysm.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. Decreased size of the left upper lobe nodules and mediastinal lymph nodes. No evidence of disease progression.2. Stable appearance of the suspected left atrial appendage thrombus. |
Generate impression based on findings. | Reason: metastatic bladder cancer evaluation of disease after chemotherapy treatment History: bladder cancer post chemo LUNGS AND PLEURA: Scattered pulmonary micronodules.MEDIASTINUM AND HILA: New prominent left supraclavicular lymph node measures 1.3 x 1.0 cm (series 5, image 10). Heart size is normal without pericardial effusion. CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Hepatic hemangiomas measuring up to 8.1 x 5.7 cm (series 5, image 93), previously 7.7 x 5.4 cm. 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: New retroperitoneal lymphadenopathy. Paraaortic lymph node mass measures 2.7 x 3.1 cm (series 5, image 133).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy.BLADDER: Status post cystectomy.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Lytic lesions in the iliac bones are unchanged.OTHER: No significant abnormality noted. | New left supraclavicular and retroperitoneal lymphadenopathy. |
Generate impression based on findings. | Reason: history of bladder cancer, please evaluate for mets with delayed imaging History: none ABDOMEN:LUNG BASES: Bochdalek hernia is again demonstrated.LIVER, BILIARY TRACT: Hyperdense focus in the right lobe of liver, segment 4/8 measuring 1.5 x 1.3 cm (image 22; series 7) is isodense to liver parenchyma on delayed imaging and may represent hemangioma. Cholelithiasis without evidence of cholecystitis. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Apparent enlargement of a nodule just distal to the left ureter-small bowel anastomosis which measures 9 mm (image 100; series 10). The prior examination, this measured 6 mm. This nodule was present as far back as 10/2009 and probably is benign.RETROPERITONEUM, LYMPH NODES: Subcentimeter retrocrural lymph node. Subcentimeter scattered retroperitoneal lymph nodes.BOWEL, MESENTERY: Postoperative changes to small bowel.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Penile prosthesis.BLADDER: Neobladder reconstruction.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Scattered surgical clips. Diverticula of the sigmoid colon without evidence of diverticulitis.BONES, SOFT TISSUES: Subcutaneous lymph nodes in the left lower abdominal wall remain unchanged. Sclerotic focus in the L1 vertebral body.OTHER: No significant abnormality noted | Hyperdense focus in the right lobe of the liver is most likely a hemangioma. Suggest continued follow-up .1.Subcentimeter nodule distal in the ileal conduit (slightly distal to anastomosis with left ureter) to the neobladder appears to have enlarged slightly compared to the most recent prior examination. Given this finding was present on 10/2009 CT examination, its probably benign, possibly representing a mucosal fold. |
Generate impression based on findings. | Reason: lung cancer, please evaluate for disease and compare with previous scan done in July 2013. Patient can't get MRI because of pacemaker History: lung cancer evaluate for brain mets. The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of a mass along the superior aspect of the vermis measuring 16 x 13 mm coronal dimensions on the current exam and 13 x 12 mm on the prior exam. On sagittal imaging the solid component previously measured 7 x 9 mm and currently measures 12 x 12 millimeters. This mass is now associated with a larger cyst measuring 20 x 15 mm coronal dimensions. This is associated cyst was not present on the prior exam.A linear focus of enhancement along the right frontal lobe represents a vascular structure and can be identified on the prior MRIAtherosclerotic calcifications are present along the distal internal carotid arteries.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. Only the very most superior aspect the orbits are included on this exam. | 1.Since the prior exam the mass in the vermis has enlarged and developed a cystic component and is now a cyst and mural nodule lesion. Given the patient's clinical history, metastasis is the most likely consideration. |
Generate impression based on findings. | Clinical question: Ventriculogram, service to inject 2 cc of Omnipaque 180 prior to scan. Injection will be performed at patient's bedside prior to head CT. Signs and symptoms: Hydrocephalus/headache. Nonenhanced head CT:Examination is performed after referring clinical service injected 2 cc of Omnipaque 180 through the ventricular catheter prior to CT. The initial head CT examination (planes at 10:01: 21 a.m.).Previously noted extensive subarachnoid contrast has entirely cleared.This examination demonstrates contrast within the left lateral ventricle in the temporal and occipital horns as well as trigone of left lateral ventricle. There is no detectable contrast in the left frontal horn, 3rd ventricle, 4th ventricle, right sided ventricular system or the subarachnoid space.Compared to prior exam a left sided approach ventricular catheter appears to have been pulled back minimally and the tip remains across the midline in the right hemisphere (not certain of the exact location of tip of the catheter).Nonenhanced head CT:A follow-up second head CT is performed at 10:07: 35 a.m. after pt was asked by the clinical service to move/rotate head prior to repeat CT.Examination redemonstrates contrast within the left lateral ventricle and in the left occipital horn, temporal horn and trigone. There is no evidence of extension of contrast into the left frontal horn, right lateral ventricular system, third ventricle or the fourth ventricle. There is also no detectable contrast in the subarachnoid space. This is a similar observation is prior study. | 1.Interval complete resolution of previously noted extensive contrast within the subarachnoid space since prior study.2.Approximately 2 cc of Omnipaque 180 was injected by two the ventricular catheter by the referring clinical service is immediately prior to head CT.3.The initial exam demonstrate inject the contrast confined to the left lateral ventricle without extension into the left frontal horn as detailed. There was no detectable contrast in the other ventricular system or in the subarachnoid space.4.A repeat second exam was performed after clinical service was asked the patient to/rotate head. Examination was performed approximately 7 minutes after the initial study. This follow up exam again reveals concentration of contrast entirely within the left lateral ventricle however without extension into the left frontal horn. Similar to initial study there is no evidence of extension of contrast into any of the other ventricles or the subarachnoid space.5.Compared to prior exam from 10 -- 9 -- 13 it appears the tip of the left-sided approach ventricular catheter has moved slightly more posteriorly but still remains in the right hemisphere however uncertain of exact location of the tip. |
Generate impression based on findings. | Carcinoid tumor resected two years prior LUNGS AND PLEURA: Postsurgical changes are again seen in the right lung, compatible with previous resection. No new suspicious nodules or masses are seen. The diffuse interstitial lung disease appears similar to the prior exam, with diffuse subpleural reticulation, apical nodules, and lower lobe fibrosis and traction bronchiectasis. MEDIASTINUM AND HILA: Prominent mediastinal and hilar lymph nodes, similar to the prior exam. Severe coronary artery calcifications. Normal sized heart without pericardial effusion.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. No evidence of tumor recurrence.2. Stable appearance of the diffuse interstitial lung disease, compatible with atypical UIP. |
Generate impression based on findings. | Reason: lung cancer History: lung cancer s/p LLL lobectomy and LUL wedge resection LUNGS AND PLEURA: Interval increase in a nodule adjacent to left apical suture line, now 13 mm in diameter compared to 8 mm previously, highly suspicious for recurrence.7-mm irregularly marginated subpleural nodule in the right lower lobe, increased from about 3 mm previously. This remains indeterminate but somewhat suspicious for a primary carcinoma and a follow-up scan is recommended in approximately 3 months.Diffuse centrilobular emphysema with chronic fine reticulonodular opacity and bronchial thickening, unchanged.MEDIASTINUM AND HILA: Enlarged high anterior mediastinal lymph node, unchanged.Pre-vascular hyper attenuating lymph node measuring 12 mm in short axis, not significantly changed.Moderate coronary artery calcifications. Small hiatal hernia.Bilateral pleural calcification suggestive of asbestos exposure.CHEST WALL: Postsurgical rib deformities on the left.Partial collapse of the L1 vertebral body, unchanged.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Right renal cyst. | 1.Further interval growth of left upper lobe nodule adjacent to suture line highly suspicious for tumor recurrence.2. Increased 7 mm subpleural nodule in the right lower lobe which is also moderately suspicious though still indeterminate, and further follow up is recommended. |
Generate impression based on findings. | Clinical question: Evaluate acute intracranial process. Signs and symptoms cord slurred speech and weakness. Nonenhanced head CT:There is no detectable acute intracranial process. CT however is insensitive for detection of acute nonhemorrhagic ischemic strokes.There are very subtle subcortical low attenuation of white matter in bilateral cerebral hemispheres without any gross interval change since prior exam from August of this year and likely representing age indeterminate moderate small vessel ischemic strokes. Unremarkable head CT otherwise and stable since prior exam. | 1.There is no detectable acute intracranial process. CT however is insensitive for detection of acute nonhemorrhagic ischemic strokes.2.Moderate age indeterminate small vessel ischemic strokes grossly similar to prior exam from August of this year. |
Generate impression based on findings. | Non-small cell lung cancer status post 4 cycles of chemotherapy CHEST:LUNGS AND PLEURA: The right upper lobe mass involving invading the lateral chest wall is increased in size, measuring 4.9 x 3.6 cm (8023/28), previously 4.3 x 3.1 cm on axial images. The left upper lobe subpleural mixed groundglass and solid-appearing opacity abutting the fissure is unchanged.Upper lobe predominant centrilobular emphysema.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy. Unchanged left-sided AICD. Normal sized heart without pericardial effusion. Moderate coronary artery calcifications.No large central pulmonary embolus is seen.CHEST WALL: Stable subcentimeter right internal mammary chain and right axillary lymph nodes. The reference of right subpleural lymph node measures 11 mm in short axis (8023/11), previously 12 mm. Unchanged hypodense left thyroid noduleABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: The hepatic metastasis has increased in size, measuring 6.0 x 5.2 cm (8023/108), previously 4.5 x 4.1 cmSPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Ectopic left kidney, located in the pelvis.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic changes of aorta and iliac arteries.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. Increased sizes of the right upper lobe mass invading the chest wall 2. Increased size of the hepatic metastasis.3. Stable appearance of the left lung mixed solid and ground glass opacity, which may represent an additional site of primary malignancy. |
Generate impression based on findings. | Clinical question: Rule out stroke. Signs and symptoms: Altered mental status. Nonenhanced head CT:No meniscal acute intracranial process. CT however insensitive for the detection of acute nonhemorrhagic ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation.Unremarkable calvarium, paranasal sinuses, mastoid air cells and partially visualized orbits are | Negative nonenhanced head CT. Please see above comments. |
Generate impression based on findings. | Hemoptysis, history of lupus, evaluate for pulmonary embolus PULMONARY ARTERIES: Right lower lobe segmental pulmonary embolus is seen. Groundglass opacities in the right lower lobe.LUNGS AND PLEURA: Ground glass opacities in the right lower lobe likely represents pulmonary hemorrhage. Ground glass opacities anomaly in the lower lobes with bronchial wall thickening and interlobular septal thickening likely represents pulmonary edema. There is a small right pleural effusion.MEDIASTINUM AND HILA: Left central venous catheter tip lies in the right atrium. The main pulmonary artery is dilated and there is reflux of contrast into the hepatic veins. No mediastinal or hilar lymphadenopathy is seen. The heart is normal in size and there is no pericardial effusion.CHEST WALL: No axillary lymphadenopathy.UPPER ABDOMEN: No significant abnormality noted. | 1.Right lower lobe segmental pulmonary embolus.2.Pulmonary edema with small right pleural effusion.These findings were discussed with Dr. Heilbrunn at 11:00 a.m. 10/11/2013 |
Generate impression based on findings. | Reason: eval for cause of Left sided abdominal pain, distension, bloating, History: Left sided abdominal pain, bloating ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Subcentimeter cyst in the right lobe liver (series 3, image 41) is too small to further characterize. No intrahepatic or extrahepatic biliary ductal dilatation. No 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: Air in nondistended loops of small bowel is abnormal but nonspecific. No distended loops of bowel.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Thickened uterine wall with cystic lesions with thin septa involving bilateral adnexa is likely normal appearance in a premenopausal state.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Normal-appearing appendix.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No finding to explain patient's stated symptoms. |
Generate impression based on findings. | Male 68 years old; Reason: history of metastatic prostate cancer to lungs, LN, bones post chemo History: prostate cancer with metastasis CHEST:LUNGS AND PLEURA: Interval development of numerous bilobar metastatic deposits. The right lower lobe lung lesion measures 2.2 x 1.6 cm (image 70/series 6) previously, 1.5 x 1.1 cm.No pleural effusions.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion.Extensor no mediastinal lymphadenopathy. A right paratracheal necrotic node measures 2.7 x 2.1 cm (image 21/series 4). CHEST WALL: Sclerotic osseous metastatic disease.OTHER: ABDOMEN:LIVER, BILIARY TRACT: New bilobar hepatic metastases. A segment 6 lesion measures 1.2 x 1.1 cm (image 99/series 4). No biliary ductal dilatation. The hepatic and portal veins are patent.SPLEEN: No significant abnormality notedPANCREAS: Pancreatic parenchymal atrophy.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral percutaneous nephrostomy catheters. No hydronephrosis or perinephric collections in either kidney.RETROPERITONEUM, LYMPH NODES: New retroperitoneal lymphadenopathy. Multiple new para-aortic and aorta caval lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Decrease in the size of the pelvic lymph nodes. Left pelvic mass measures 3.9 x 1.6 cm (image 172/series 4) previously, 4.7 x 2.7 cm.Right iliac node measures 1.4 x 0.9 cm (image 166/series 3) previously, 1.7 x 1.3 cm.BOWEL, MESENTERY: No significant abnormality noteddBONES, SOFT TISSUES: Osseous metastatic disease.OTHER: No significant abnormality notedd | Disease progression with a decrease in the size and number of the pulmonary lesions.1.New mediastinal and hepatic disease.2.Decrease in the size of the reference pelvic lesion following radiation. |
Generate impression based on findings. | Female 72 years old Reason: mets lung ca, ALK+, mets to mediastinum LAD and anterior abdominal subcutaneous lesion. Pls c/w previous study and evaluate tx response. History: lung ca, w/ abd SQ mets. CHEST:LUNGS AND PLEURA: Stable circumferential necrotic appearing nodular pleural based tumor in the right hemithorax. The right diaphragmatic pleural-based mass has decreased slightly in size.Reference paramediastinal tumor adjacent to the brachiocephalic vein measures 5 mm (series 3, image 38), previously 5 mm. Second reference pleural-based nodule in the right upper lobe measures 9 mm (series 3, image 51), previously 9 mm.Loculated right pleural effusion and associated enhancing pleura unchanged. Previously described peripheral centrilobular micronodules and mucoid impaction in the right middle lobe has decreased.MEDIASTINUM AND HILA: The reference a subcarinal lymph node measures 5 mm (series 4, image 51), previously 5 mm. No evidence mediastinal or hilar lymphadenopathy.Hypoattenuating cystic thyroid lesion unchanged. The heart size is normal and there is no pericardial effusion or thickening.Moderate coronary artery calcifications unchanged.Unchanged circumferential esophageal wall thickening.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Nodular thickening along the right hepatic dome compatible with peritoneal implants, unchanged.SPLEEN: Multiple punctate calcifications in the splenic parenchyma compatible with prior granulomatous disease.ADRENAL GLANDS: Previously described left adrenal nodule not identified on today's exam.KIDNEYS, URETERS: Right renal cyst.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Moderate atherosclerosis of the abdominal aorta and its branches. No evidence of retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Stable anterior abdominal wall subcutaneous metastasis now measuring 7 mm x 6 mm (image 25, series 4), previously 7 mm x 6 mm. Sclerotic focus in the T4 vertebral body unchanged. Multilevel degenerative changes of the thoracic and lumbar spine unchanged.OTHER: No significant abnormality noted. | Stable right pleural-based tumor and nodules, as well as stable mediastinal lymph nodes and subcutaneous metastasis. |
Generate impression based on findings. | Three months after bronchoscopy, left robotic video-assisted thoracoscopy, left superior segment of lower lobe resection with a wedge excision of left lower lobe for metastatic clear cell renal carcinoma LUNGS AND PLEURA: Moderate volume of loculated pleural fluid on the left with a thickened rim and internal heterogeneity consistent with septations and internal debris. Postoperative volume loss consistent with left lower lobe superior segmentectomy and wedge resection. Consolidation abutting the suture line and adjacent to the loculated pleural fluid collection is nonspecific in appearance. No suspicious pulmonary nodules in the aerated portion of the left lung.10-mm right middle lobe nodule (5/67) increased in size compared to earlier examinations, suspicious for an indolent metastasis.Poorly defined subcentimeter lesion in the posterior segment of the right lower lobe increased in size from the 5/2/13 exam, also suspicious for a metastasis. There was a nodule in this location on the earlier exams of 2008 and 2007 which was larger; query history of interval therapy.Mild subpleural emphysema. Additional subcentimeter micronodules are nonspecific in appearance. MEDIASTINUM AND HILA: Atherosclerotic calcifications of the aorta and its branches. Normal heart size. No visible lymphadenopathy.CHEST WALL: Periosteal thickening along left mid ribs may be posttraumatic.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Left nephrectomy bed is incompletely visualized. Two poorly defined hypoattenuating hepatic lesions (3/88, 3/80). Lesion left hepatic lobe appear to have been present in 2007 | 1. Moderate volume of loculated pleural fluid on the left with a nonspecific surrounding rind and internal septations. Although the appearance is what is expected postoperatively, empyema may have similar radiographic appearance, correlate for signs of infection.2. Two nodules in the right lung suspicious for metastases. 3. Indeterminate hepatic lesions, please refer to outside PET report. |
Generate impression based on findings. | Previous subarachnoid hemorrhage and PRES and treatment related AML presents with tachypnea and change in mental status. Please evaluate for intracranial bleed or mass. There is no evidence of intracranial hemorrhage, mass, or cerebral edema. There is minimal white matter hypoattenuation with interval decrease in the abnormality related to PRES, accounting for differences in technique. The ventricles and basal cisterns are stable in size and configuration. There is no midline shift or herniation. There is mild opacification of the right mastoid air cells. There is a small right maxillary sinus retention cyst. The skull and extracranial soft tissues are unremarkable. There is a partially imaged enteric tube. | No evidence of acute intracranial hemorrhage, mass, or cerebral edema. There is minimal white matter hypoattenuation with interval decrease in the abnormality related to PRES, accounting for differences in technique. However, CT is not sensitive for non-hemorrhagic infarcts or mild PRES and MRI is recommended for further evaluation if clinically indicated. |
Generate impression based on findings. | Reason: history of bladder cancer, please eval with CT urogram History: none ABDOMEN:LUNG BASES: Chronic interstitial changes at the lung bases. No suspicious pulmonary nodules or masses.LIVER, BILIARY TRACT: Predominantly left hepatic lobe intrahepatic ductal dilatation and common bile duct dilatation are unchanged. Status post cholecystectomy. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cyst.RETROPERITONEUM, LYMPH NODES: Subcentimeter retroperitoneal lymph nodes. Mild atherosclerosis of the abdominal aorta and its branches.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: Nodularity along the posterior wall the bladder is unchanged. Enhancing mucosa with mild perivesicular fat infiltration suggests cystitis.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Engorged left gonadal vein and ovarian varices suggest pelvic congestion syndrome. | 1. Persistent nodularity along the posterior bladder wall is compatible with patient's history of malignancy.2. No evidence of metastasis.3. Nonspecific hypodense lesion in the left atrium. Echocardiogram is recommended for further evaluation.4. Biliary ductal dilatation is unchanged.Findings discussed with Nisha Kumar, NP urology at 11:40 a.m. on 10/11/2013. |
Generate impression based on findings. | Lymphadenopathy. History of ALL CHEST:LUNGS AND PLEURA: Few scattered nonspecific micronodules, appearing similar to the prior study. MEDIASTINUM AND HILA: Subcentimeter mediastinal lymph nodes. No mediastinal or hilar lymphadenopathy. Normal sized heart without pericardial effusion..CHEST WALL: No axillary lymphadenopathy. Right PICC with tip at the superior cavoatrial junction.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cirrhotic liver morphology. No focal hepatic lesions seen. Small amount of perihepatic ascites which is decreased.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Unchanged indeterminate right adrenal nodule, measuring 1.6 x 1.4 cm (series 3, image 11).KIDNEYS, URETERS: The previously seen exophytic right renal lesion (series 3, image 131) displays no enhancement, likely representing a cyst.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Prominent peripancreatic, gastrohepatic, and porta hepatis lymph nodes are again seen. The reference gastrohepatic lymph node measures 1.0 x 0.9 cm (series 3, image 100), previously 1.1 x 1.1 cm. The reference porta hepatis lymph node measures 2.6 x 1.2 cm (series 3, image 107), previously 2.7 x 1.5 cm.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: Decreased abdominal ascites. | Upper abdominal lymphadenopathy, with minimal change as described above. |
Generate impression based on findings. | Reason: h/o HNC and CRT, compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: Benign-appearing nodules and micronodules, some calcified. No evidence of pulmonary or pleural metastases. MEDIASTINUM AND HILA: Mild coronary calcification.No mediastinal or hilar lymphadenopathy noted. CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Small accessory splenule.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No evidence of metastases, or other significant abnormality. |
Generate impression based on findings. | Hypoxia. History of breast cancer. PULMONARY ARTERIES: Technically adequate examination. No evidence of pulmonary embolism.LUNGS AND PLEURA: Moderate-sized bilateral pleural effusions with overlying atelectasis, most prominent at the left lower lobe. No suspicious pulmonary nodules or masses are seen in the aerated lung parenchyma. Apical predominant centrilobular emphysema. Pleural and subpleural nodules one the left mediastinum anteriorly.Severe bronchial wall thickening with associated atelectasis in the right middle lobe. Minimal dependent edema.MEDIASTINUM AND HILA: Large necrotic para-aortic mediastinal mass in the region of the thymic bed, measuring 4.3 by 3cm (7/163). This mass is inseparable from the pericardium posteriorly, the chest wall anteriorly where it encases the left internal mammary vasculature focally on series 7 image 152 and the parietal pleural surface of the mediastinum laterally. Mediastinal fat invasion anteriorly noted. There are multiple subcentimeter mediastinal and hilar lymph nodes, which are abnormal in attenuation, likely nodal metastases. Moderate cardiomegaly with a moderate-sized pericardial effusion. Small right cardiophrenic lymph nodes. Nonspecific low subcentimeter nodules in the left costophrenic angle may be metastatic.CHEST WALL: Peripherally enhancing nodule right breast resection site suspicious for recurrence. Multinodular thyroid gland. Postsurgical changes in the breasts bilaterally. Left subclavian catheter tip in the SVC. Diffuse subcutaneous fat stranding and skin thickening of the anterior chest wall, right greater than left. Numerous solid subcutaneous and intramuscular nodules anterior chest wall suspicious for metastases.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. Phase of contrast is not adequate to assess for his organ metastases | 1. No evidence of pulmonary embolism.2. Findings consistent with tumor recurrence and metastases in the right chest wall. 3. Mass in the thymic bed invading the mediastinum and left pleura with potential chest wall invasion anteriorly most likely represents a metastasis. A primary thymic tumor could have a similar radiographic appearance but is considered less likely.4. Large bilateral pleural effusions with overlying atelectasis. Segmental right middle lobe atelectasis, bronchial wall thickening and mild edema.5. Moderate sized pericardial effusion |
Generate impression based on findings. | Reason: s/p bilateral pleural thickening and calcification of his pleura History: f/u CHEST:LUNGS AND PLEURA: Emphysema and extensive bilateral pleural thickening and calcification consistent with asbestos exposure.Round atelectasis posteriorly at the right base, unchanged.Pleural thickening at the right base posterolaterally measures 8 mm, not significantly changed from previous allowing for slight differences in section level and patient position.Small loculated right pleural effusion, unchanged.MEDIASTINUM AND HILA: : Postsurgical changes consistent with prior CABG. Dense metallic foreign body at the base of the heart adjacent to the diaphragm (coronal image 73) is presumably related to prior surgical procedure and unchanged in position.Aortic valve and severe native coronary artery calcifications.CHEST WALL: Sternal fixation wires with sternal synthesis.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Extensive abdominal aortic and iliac artery atherosclerosis with mural thrombus and penetrating ulcers as previously described.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Multiple colonic diverticula.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Extensive chronic abnormalities with stable pleural thickening and no specific evidence of neoplasm. |
Generate impression based on findings. | Right upper lobectomy for lung cancer. LUNGS AND PLEURA: Right upper lobectomy. No signs of localized recurrence at the resection site. Nonspecific thickening within a band of atelectasis or scarring in the right lower lobe measuring up to 6 mm in the AP dimension (5/55). Subpleural nodular densities in the right middle lobe too small to characterize however have an appearance most consistent with intrapulmonary lymph nodesSubpleural emphysema left upper lobe. No pleural fluid or pneumothorax.MEDIASTINUM AND HILA: Atherosclerotic calcification of the aorta and its branches. Scattered calcifications and he tracheal wall along with discontinuous areas of nodularity noted. Saber sheath appearance of the trachea. No significant lymphadenopathy. Moderate coronary artery calcifications. Ossifications of the aortic valve. No pericardial fluid.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. 7-mm hypoattenuating lesion in the right hepatic lobe which measures density of simple fluid, present previously, favoring a cyst though it is incompletely assessed. Atherosclerotic calcification of the aorta and its branches. | No signs of localized recurrence and no conclusive signs of metastases. Area of nonspecific parenchymal thickening and atelectasis can be followed on subsequent exams but is most likely of benign etiology. |
Generate impression based on findings. | Acute mental status change, status post recent right retrosigmoid craniotomy for resection of meningioma. There are postoperative findings related to right suboccipital craniotomy and cranioplasty with a right posterior fossa resection cavity filled with fluid and a small amount of pneumocephalus, but no evidence of acute intracranial hemorrhage. Evaluation for residual tumor is limited on this non-contrast CT. There are mild nonspecific cerebral white matter hypoattenuating foci that are better depicted on the prior MRI. The ventricles appear to be stable in size and configuration. There is mild residual right parieto-occipital scalp swelling but no definite evidence of pseudomeningocele. | Expected postoperative findings related to recent right suboccipital craniotomy without evidence of acute intracranial hemorrhage. However, evaluation for residual tumor is limited on this non-contrast CT. Likewise, non-contrast CT is not sensitive for non-hemorrhagic acute infarct. MRI may be useful for further evaluation if clinically indicated. |
Generate impression based on findings. | Reason: eval of distal esophageal adenocarcinoma History: esophageal adenocarcinoma CHEST:LUNGS AND PLEURA: Left upper lobe 14-mm sharply marginated nodule, unchanged since at least 6/13/2013.An associated tubular component suggestive of a bronchocele has largely resolved.Interval clearing of right lower lobe groundglass opacities compatible with aspiration.No new nodules.MEDIASTINUM AND HILA: Interval decrease in an AP window/prevascular lymph node now 4 mm in short axis diameter.Severe coronary artery calcifications.Thickening of the distal esophagus and patulous distal esophagus or small sliding hiatal hernia.CHEST WALL: Degenerative disease in the spine.Lipoma in the right flank.ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Small left adrenal nodule, unchanged and likely benign.KIDNEYS, URETERS: Nonobstructing bilateral calculi.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Aortoiliac stent graft.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.Stable left upper lobe nodule with partial resolution of an associated bronchocele, favoring a benign etiology, though further follow-up is recommended.2. No new findings. |
Generate impression based on findings. | Abnormal radiograph. No S.O.B. at baseline, no DOE. History of COPD, tobacco use and chronic organizing pneumonia. Last CT with questionable interval progression, reevaluate. LUNGS AND PLEURA: Bilateral areas of subpleural curvilinear scarring consistent with multifocal organizing pneumonia in various stages of healing. Previously seen large focus of consolidation in the lingula has nearly resolved, with residual scar (5/52). Chronic traction bronchiectasis with volume loss and consolidation in the anterior left lower lobe unchanged. Within this area there is a 6-mm nodule (5/71) which has been stable over the last two studies and is decreased from patient's baseline exam of 2005.Posterior right upper lobe lesion contains a new subcentimeter solid component medially (5/37). Right upper lobe lesion abutting the minor fissure with a mixed response. The bandlike area of consolidation seen previously is thinner and spreads over a large area of the lung suggesting healing. However, the solid component seen on the prior examination is minimally larger. There is a new subcentimeter nodule in the right middle lobe abutting the minor fissure (5/47). Chronic traction bronchiectasis with volume loss and focal consolidation in the right lower lobe unchanged.No pleural fluid. Mild centrilobular emphysema.MEDIASTINUM AND HILA: Mild atherosclerotic calcification of the thoracic aorta and its branches. Upper normal heart size. Small pericardial fluid collection anterior to the left ventricular apex, minimally larger. CHEST WALL: Solid nodule in the left inferior breast measures 7 x 14 mm, present previously dating back to 2005 where it was larger, previously measuring 16 x 9 mm, favoring a benign lesion though it remains nonspecific by CT. Left fifth rib focal sclerosis unchanged, favoring a benign lesion.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. Focal area of hypoattenuation in the right hepatic lobe (4/82) has been present since 2005 and is unchanged. | Multifocal organizing pneumonia with mixed response. While some areas have resolved with residual scarring, new or larger nodules are present in the right lung. Please note that malignancy cannot be differentiated radiographically and if there is clinical concern, FDG-PET maybe obtained for verification. Otherwise, 6 month follow up suggested. |
Generate impression based on findings. | Clinical question: Evaluate for sinus polyps or sinus disease. History of anosmia. Signs and symptoms: Disturbance of sensation of smell and taste. Nonenhanced head CT:Examination demonstrates no evidence of acute intracranial process. CT however is insensitive for detection of acute nonhemorrhagic ischemic strokes.The cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation remains within normal.Calvarium and soft tissues of the scalp are unremarkable.Images through the orbits are unremarkable.Bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization.Visualized paranasal sinuses demonstrate no evidence of acute or chronic sinus disease. There is evidence of prior bilateral endoscopic functional sinus surgery is draped widely patent bilateral sinonasal windows. Bilateral ethmoidectomies.CT of maxillofacial:Examination demonstrates post operative changes of bilateral endoscopic functional sinus surgery with widely patent bilateral sinonasal windows. No detectable acute or chronic sinusitis.Images through the nasal passage demonstrate expected postoperative changes and unremarkable otherwise. Mild mucosal thickening along the nasal septum without convincing evidence of a polyp on the CT exam.No detectable bony changes at the level of the skull base.Bilateral mastoid air cells and middle ear cavities are well pneumatized and unremarkable.Unremarkable images through the orbits. | 1.Unremarkable nonenhanced head CT.2.Nonenhanced maxillofacial CT demonstrate expected postoperative changes of sinus surgery without evidence of acute or chronic sinus disease. Images through the nasal passage as well demonstrate postop changes and without convincing evidence of a mass or polyp. Bilateral mastoid air cells and middle ear cavities remain well pneumatized. Partially visualized orbits are unremarkable. |
Generate impression based on findings. | Reason: mesothelioma, s/p 6 cycles of chemo. please evaluate for disease and compare with previous scans using the same target lesions History: mesothelioma CHEST:LUNGS AND PLEURA: Diffuse pleural thickening and subpleural consolidation anteriorly in the left hemithorax consistent with mesothelioma.Nonspecific interstitial opacity in the left lung particularly in the left lower lobe, unchanged from previous. Small loculated left pleural effusion.Right lower lobe micronodule (arrow) unchanged.Reference measurements as follows:1. At the level of the aortic arch (series 3 image 26): At the 9 o'clock position, 0 mm. At the 7 o'clock position 2 mm not significantly changed.2. At the level of the left main pulmonary artery (series 3 image 31): At 12 o'clock position, no measurable pleural thickening but extensive subpleural pulmonary consolidation. At the 3 o'clock position, 3 mm, not significantly changed.3. At the level of the intraventricular septum (series 3 image 49): 4 mm at the 5 o'clock position, unchanged.4 mm at the 7 o'clock position, unchanged. MEDIASTINUM AND HILA: No significant lymphadenopathy.Moderately severe coronary artery calcification.No pericardial effusion.CHEST WALL: Healed sternotomy incision.Elevated left hemidiaphragm.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Hepatic cysts, unchanged.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cyst.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No significant change and no specific evidence of residual tumor. |
Generate impression based on findings. | Female 58 years old; Reason: stage 4 colon cancer s/p chemotherapy with complete response, eval EOD, compare to previous History: non3 CHEST:LUNGS AND PLEURA: No new lung lesions. The pleural spaces are clear. The central airways are patent.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. No mediastinal lymphadenopathy.Ascending thoracic aorta measures 3.3-cm in AP dimension and is mildly ectatic.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Liver has a smooth contour. Hypodense lesion adjacent to falciform is unchanged and likely represent perfusional phenomenon or focal fat. No suspicious hepatic lesions. Hepatic and portal veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No bowel obstruction.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: Post operative changes in the rectosigmoid.BONES, SOFT TISSUES: The bones are demineralized in the pelvis.OTHER: No significant abnormality noted. | 1.Stable exam without evident metastatic disease. |
Generate impression based on findings. | Newly diagnosed oral cancer evaluate for metastases. Smoker. LUNGS AND PLEURA: Nonspecific 2 to 3-mm micronodules and scattered areas of endobronchial debris in the peripheral airways. Subcentimeter nodules in the periphery of the left lower lobe measuring up to 5-mm (4/207, 4/153, 149). These nodules measure lipid attenuation and could be post inflammatory.Similar, smaller micronodules are seen in the posterior right lower lobe.Mild bronchial wall thickening.MEDIASTINUM AND HILA: 8mm nodule in the posterior aspect of the left thyroid gland, nonspecific by CT.Mildly enlarged right inferior interlobar lymph node could be post inflammatory the patient has had recent episode of aspiration.7-mm lymph node adjacent to the suprahepatic IVC (3/78), not normally visible. Other mediastinal lymph nodes are nonspecific in appearance.Mild coronary artery calcifications.CHEST WALL: Mild degenerative change of the spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. Focal subcentimeter area of hypoattenuation in the spleen (3/99) too small to characterize, most likely benign. | 1. Indeterminate pulmonary nodules are more likely to be post inflammatory than metastatic based on their density and lack of mediastinal lymphadenopathy. Enlarged lymph nodes in the lower aspect of the right hilum could be postinflammatory, not in the expected distribution of metastases. Six week follow-up chest CT is suggested to assess for resolution to exclude metastatic lesions.2. Nonspecific solid-appearing 8mm nodule in the left thyroid gland. Further characterization may be made with ultrasound if clinically warranted. |
Generate impression based on findings. | Reason: s/p 8 mo after completion of induction therapy followed by left pneumonectomy for an initial T4N1M0 stage IIIB squamous cell carcinoma with residual TIN0M0 disease in the specimen History: f/u LUNGS AND PLEURA: Interval left pneumonectomy with the small amount of fluid in the pneumonectomy space. Right apical nodularity similar in character when compared to CT Chest 7/30/12. Additional pulmonary micronodules in the right are nonspecific. No suspicious pulmonary nodules or right pleural effusion.MEDIASTINUM AND HILA: Leftward mediastinal shift into the left hemithorax.The heart size remains normal. No interval pericardial effusion.No mediastinal or right hilar lymphadenopathy.CHEST WALL: Multilevel degenerative changes of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Stable left adrenal nodule nodularity right adrenal body also unchanged. Pancreatic calcifications with associated atrophy. Stable porta hepatis lymphadenopathy. | 1. Interval left pneumonectomy with associated leftward mediastinal shift.2. Pulmonary micronodules on the right are unchanged. No suspicious right-sided nodules or interval pleural effusion. |
Generate impression based on findings. | 88-year-old man with diverticular bleed. Please localize. ABDOMEN:LUNG BASES: Trace effusions with overlying compressive-type atelectasis.LIVER, BILIARY TRACT: Innumerable presumed hepatic cysts were present previously have not changed substantially since the prior examination. No enhancing liver lesions identified or evidence of intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Numerous colonic diverticula. No evidence of active extravasation.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Replaced right hepatic artery is a normal variant.PELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate is unchanged.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Right corona mortise variant. Right common iliac artery aneurysm measures 3 cm (which meets size threshold for prophylactic treatment). | No evidence of active gastrointestinal hemorrhage. 3-cm right common iliac artery aneurysm. These findings were communicated to the clinical service (pager 2619) at the time of dictation |
Generate impression based on findings. | Reason: r/o mets. compare to prior CT scan. History: thyroid cancer with lung mets LUNGS AND PLEURA: Innumerable pulmonary nodules in both lungs compatible with metastases, of some of which have slightly reduced in size. No new suspicious focal nodules identified. No interval effusion.MEDIASTINUM AND HILA: Heart size remains normal. No interval pericardial effusion or mediastinal lymphadenopathy. Prominent thymic tissue may represent rebound hyperplasia.CHEST WALL: No axillary lymphadenopathy.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Multiple bilateral pulmonary nodules compatible with metastases, some of which appear slightly smaller at this time. No new suspicious nodule. |
Generate impression based on findings. | Male 74 years old; Reason: Pt is a 74 y/o male with met RCC, evaluate for progression on pazopanib History: met rcc CHEST:LUNGS AND PLEURA: No dominant pulmonary lesions. The pleural spaces are clear.MEDIASTINUM AND HILA: Heart size is normal with extensive coronary artery calcifications.AP window node measures 1.7 x 1.0 cm (image 36/series 4) previously, 2.2 x 1.4 cm. The nodes shows central decreased enhancement.CHEST WALL: Dilated right subpectoral veins possibly from a right arm dialysis graft.OTHER: ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. There are multiple hypodense hepatic lesions. The reference segment IVb lesion measures 2.1 x 1.8 cm (image 102/series 4) previously, 2.2 x 1.9 cm.The hepatic and portal veins are patent.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Poor enhancement of the kidneys compatible with severe renal parenchymal dysfunction.Right lower pole mostly exophytic renal mass measures 5.5 x 4.4 cm (image 122/series 4) previously, 5.8 x 4.9 cm. Bilateral renal cysts.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Extensive retroperitoneal adenopathy, appears similar to prior.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No change in the lytic right L4 pedicular lesionOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No active adenopathy with left iliac chain nodes appear similar to prior.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Sclerotic sacral and left iliac wing lesions.OTHER: No significant abnormality noted | 1.Extensive disease in the chest, abdomen and pelvis with stable to slight decrease in the size measurements of the reference lesions. |
Generate impression based on findings. | CT scan following treatment for pseudomonas. Cough. LUNGS AND PLEURA: Slight improvement in diffuse bronchiolitis pattern, the right lung is affected more than the left. Subsegmental atelectasis abutting the right minor fissure anteriorly has improved. Peribronchial wall thickening, right greater than left. No pneumothorax.MEDIASTINUM AND HILA: Mediastinal lymph nodes, some of which are slightly improved in size. Severe coronary artery calcifications. Calcification of the apex of the left ventricle is unchanged.Left subclavian ICD in place.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Atherosclerotic calcification of the aorta and its branches. | Moderate residual bronchiolitis pattern with slight improvement since the previous scan. Serial CT follow-up to complete radiographic resolution is recommended as endobronchial spread of mucinous adenocarcinoma may have an identical radiographic appearance. |
Generate impression based on findings. | Headache. There is no evidence of acute intracranial hemorrhage. There is unchanged encephalomalacia in the right MCA territory. There is also unchanged patchy scattered cerebral white matter hypoattenuation consistent with age indeterminate small vessel ischemic disease. The ventricles are stable in size and morphology with diffuse cerebral volume loss. There is no midline shift. The skull and extracranial structures are unchanged. The paranasal sinuses and mastoid air cells are clear. | 1. No acute intracranial hemorrhage. 2. Chronic right MCA infarct and small vessel ischemic disease of indeterminate age. Please note that CT is insensitive to early detection of nonhemorrhagic CVA. |
Generate impression based on findings. | Recurrent sinus infections, right sided sinus pain/pressure, PND and chronic cough. There are right maxillary sinus retention cysts that measure up to 15 mm in width. The right maxillary sinus is clear and the infundibula are patent. There is a 4 mm left sphenoid sinus retention cyst. The right sphenoid, bilateral ethmoid, and frontal sinuses are clear. There is tinning and perhaps dehiscence of the left carotid groove. There is minimal nasal septal deviation. The nasal cavity is clear. The ethmoid roofs are symmetric and intact. The optic nerves are covered by bone. The lamina papyracea are intact. There is a left maxillary alveolus bone island. The mastoid air cells are clear. The imaged portions of the intracranial structures and orbits are unremarkable. | Right maxillary sinus retention cysts that measure up to 15 mm in width and a 4 mm left sphenoid sinus retention cyst, but otherwise clear paranasal sinuses and nasal cavity. |
Generate impression based on findings. | Female 48 years old; Reason: epigastric pain History: known pancreatic ca, untreated ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver is normal morphology. There is a new segment 5 lesion measuring 2.8 x 2.1 cm. The lesion is located peripherally. There is mild intrahepatic biliary ductal dilatation and expected pneumobilia. Metallic stent in the distal common bile duct. There is gas within the gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic duct involving the body and tail are dilated up to a hypodense pancreatic mass measuring 3.2 x 3.2 cm (image 37/series 3) previously, 3.1 x 2.5 cm. The mass is increased from prior. It now extends an compresses the porta splenic confluence. The proximal portal vein is nearly thrombosed.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Portacaval and peripancreatic lymph nodes persist.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: Trace pelvic ascites. | 1.Slight increase in the size of the pancreatic mass which now causes further narrowing of the portal vein.2.Hypodense segment 5 lesion. Differential considerations include a new hepatic metastasis or possibly infection. |
Generate impression based on findings. | Reason: HNSCC. Post induction evaluation. History: as above CHEST:LUNGS AND PLEURA: Upper lobe predominant centrilobular emphysema. Right apical pleural parenchymal scarring, unchanged. Nonspecific scattered pulmonary micronodules. No suspicious pulmonary nodule or pleural effusion.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion.No mediastinal or left hilar lymphadenopathy. The right hilar nodal tissue measures up to 9 mm (series 9 image 41).CHEST WALL: Mildly enlarged left axillary lymph node measuring 8 mm (series 3 image 19), slightly smaller than 10 mm on the prior study.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Small hypodensity left hepatic lobe too small to characterize but stable.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: Mild enlargement left periaortic lymph nodes, stable.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. | Scattered pulmonary micronodules are nonspecific. No suspicious pulmonary nodules.Left axillary lymph node is slightly smaller, 8 mm at this time. No mediastinal lymphadenopathy. |
Generate impression based on findings. | Panorex dated 10/9/13. There is a defect in the enamel and dentin along the mesiobuccal aspect of ADA 17. There is minimal associated perinodal lucency without evidence of abscess or osteomyelitis. There are small left maxillary sinus retention cysts. The mastoid air cells are clear. The orbits are unremarkable. The major salivary glands and overlying soft tissues are unremarkable. The intracranial structures are also grossly unremarkable. | Carious ADA 17 with minimal associated perinodal lucency and no evidence of abscess or osteomyelitis. |
Generate impression based on findings. | Recent diagnosis of SCCA to BOT infiltrating right tonsil with bilateral spread to cervical lymph nodes, status post induction chemotherapy. Streak artifact emanating from dental amalgam obscures surrounding structures. Within this limitation, there has been marked interval decrease in size of the ill-defined mass centered in the right base of tongue, which now measures approximately 20 AP x 15 RL x 15 mm, previously up to approximately 35 mm. The mass still appears to traverse the midline and extends into the right tonsillar fossa, but the soft palatine involvement is now virtually inconspicuous. There is also marked interval decrease in the right suprahyoid lymphadenopathy. For example, a right level 1A lymph node now measures 11 x 10 mm, previously 21 x 20 mm and a right level 2A lymph node now measures 13 x 8 mm, previously 23 x 20 mm. There is no air way compromise. The is sclerosis of the right arytenoid, which can be a normal variant. The larynx is otherwise unremarkable. The major salivary gland and thyroid are unremarkable. The major cervical vessels are patent. The imaged portions of the intracranial structures and orbits are grossly unremarkable. There is mild degenerative spondylosis , but no lytic or blastic lesions. There is a 4 mm wide skin excrescence in the left nasolabial fold. There is a small retention cyst within the right maxillary sinus. There is moderate pulmonary emphysema. | Marked interval decrease in size of the ill-defined mass centered in the right base of tongue, which now measures up to approximately 20 mm, previously up to approximately 35 mm and marked interval decrease in size of the right suprahyoid lymphadenopathy indicated response to the induction chemotherapy. |
Generate impression based on findings. | 66 year old male with metastatic renal cell cancer -- ablation of liver lesion; restaging. The following observations are made given the limitations of an unenhanced study.CHEST:LUNGS AND PLEURA: Innumerable pulmonary parenchymal nodules are unchanged. Reference left lower lobe nodule (series 5, image 74) measures 3.0 x 2.0 cm, stable. The right lung are reference nodule (image 83; series 5) measures 0.7 cm by 0.7 cm, unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Old healed left proximal rib fractures unchanged. No evidence of lytic lesion seen to suggest metastatic disease. Gynecomastia.ABDOMEN:LIVER, BILIARY TRACT: Multiple bilobed are metastases appear stable or decreased in size. The right hepatic lobe reference lesion which had undergone ablation on 11/13/12 measures 3.7 x 2.5 cm (image 94; series 3), unchanged. The reference lateral segment lesion (series 3; image 104) measures 2.0 x 1 .7 cm, smaller compared to prior. Vascular structures in the liver appear normal. Gallbladder and biliary tract appear normal.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Prior right nephrectomy. No evidence of recurrence in the surgical bed is seen. No significant mass lesions are seen in the left kidney a small subcentimeter cortical presumed cysts again seen.RETROPERITONEUM, LYMPH NODES: Multiple left periaortic lymph nodes are unchanged. The reference left periaortic lymph node (series 3; image 119) measures 1.0 x 0.8 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate without other significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Lucent lesion in the right femoral neck with sclerotic rim is unchanged and has a benign morphology. No other abnormalities are seen the could suggest metastatic disease.OTHER: No significant abnormality noted | Stable lung lesions. Decrease in one of two reference liver lesions. Stable small lymph nodes. |
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