instruction stringclasses 1 value | input stringlengths 6 8.98k | output stringlengths 5 3.11k |
|---|---|---|
Generate impression based on findings. | Recurrent uveitis, arthritis evaluate for sarcoid LUNGS AND PLEURA: Right apical micronodule, most likely a granuloma.MEDIASTINUM AND HILA: No paratracheal or hilar lymphadenopathy. Normal heart size. Calcified right hilar lymph node, consistent with healed granulomatous infection.CHEST WALL: Nonspecific calcification in the upper left breast (3/16), correlate with recent breast imaging reports.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. Calcified granulomas in the spleen. Cholesterol gallstones. No lymphadenopathy. | No specific evidence of sarcoidosis. Calcified right hilar lymph node, calcified micronodules in the spleen and a calcified right lung micro-nodule are most consistent with healed granulomatous infection. |
Generate impression based on findings. | Female 64 years old Reason: 64 year old woman with history of RLL NSCLC treated with SBRT 9 months ago. Please evaluate for interval change and compare to most recent CT scan as well as initial CT History: History of lung cancer for surveillance CHEST:LUNGS AND PLEURA: Multiple bilateral basilar predominant thin-walled pulmonary cyst consistent with lymphangioleiomyomatosis, unchanged. There is less than 25% pulmonary parenchymal involvement compatible with stage I disease.Subpleural spiculated right lower lobe nodule measures 2.1 x 1.4 cm (image 53, series 5), previously 2.0 x 1.4 cm. This nodule appears to be contiguous with the pleura along its lateral margin and there is adjacent architectural distortion, interstitial thickening and pleural retraction, which appears increased and is likely secondary to radiation therapy. Metal artifact superior and medial to the mass unchanged.Nodular opacity along the right inferior major fissure not significantly changed and compatible with atelectasis/scarring. Right pleural based nodule unchanged, likely representing an intrapulmonary lymph node (image 60, series 5); however, there is increased adjacent scarring. Left lower lobe nodule not significantly changed (image 72, series 5).No pleural effusion or pneumothorax.MEDIASTINUM AND HILA: Reference right hilar lymph node measures 12 mm (image 46, series 4), previously 11 mm. A more peripheral centrally necrotic right hilar lymph node appears to have increased in size as well as a left hilar lymph node, with the remainder of the mediastinal lymphadenopathy unchanged.Normal heart size and no pericardial effusion. Moderate/severe atherosclerosis of the coronary arteries and thoracic aorta and its branches. There is a focus of arterial wall calcification at the ostial LAD.CHEST WALL: No evidence of supraclavicular, axillary or subpectoral lymphadenopathy.Healing fractures of the lateral fifth and sixth rib. Right anterior chest wall soft tissue density compatible with prior thoracotomy.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Small hypodense lesions in the left hepatic lobe incompletely characterized and likely hepatic cysts.Mild intra and extra hepatic biliary ductal dilatation unchanged, likely related to prior cholecystectomy.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Subcentimeter left adrenal nodule too small to characterize.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: 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: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Minimal enlargement of the subpleural spiculated right lower lobe nodule.2. Enlarged right and left hilar lymph nodes, but otherwise stable lymphadenopathy.3. No new metastatic focus identified.4. Stage I lymphangioleiomyomatosis, unchanged. |
Generate impression based on findings. | Reason: Hx of Bladder Cancer s/p cystectomy with neobladder. Eval for recurrent/metastatic disease History: See above ABDOMEN:LUNG BASES: Basilar emphysema.LIVER, BILIARY TRACT: Right hepatic lobe hypodensity is too small to further characterize, unchanged and likely benign. Calcified granulomata.SPLEEN: Calcified granulomata. Accessory splenules.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mild bilateral hydronephrosis. The kidneys demonstrate symmetric parenchymal enhancement and contrast excretion. Multiple left upper pole cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of bowel obstruction. Small bowel containing ventral hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy.BLADDER: Status post cystectomy with ileal pouch.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Resolution of left lower quadrant fluid collection. | No evidence of disease recurrence. Resolution of left lower quadrant fluid collection. |
Generate impression based on findings. | Reason: LAD on CT chest History: cough LUNGS AND PLEURA: Dependent groundglass opacities favoring subsegmental atelectasis. No suspicious pulmonary nodule or pleural effusion. A few scattered pulmonary micronodules are nonspecific.MEDIASTINUM AND HILA: Supraclavicular lymphadenopathy with a representative lymph node measuring 8 mm (image 3 series 80375). Prevascular lymphadenopathy with representative node measuring 13 mm (series 80375 image 18). Aortopulmonary, paratracheal, subcarinal and bihilar lymphadenopathy. A representative measurement in the subcarinal location on series 80375 image 41 is 26 mm in short axis. Lymphoma is a consideration. This is atypical for sarcoidosis.The heart size is normal. Minimal, discontinuous pericardial thickening. Moderate hiatal hernia.CHEST WALL: Anterior degenerative changes of the superior thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Focal hypodensity in segment 4 A. it is unchanged, most compatible with a cyst. Porta hepatis lymphadenopathy is stable, with a representative lymph node measuring 14 mm in short axis (80375 image 85). | Diffuse mediastinal and hilar lymphadenopathy without significant pulmonary abnormality. The distribution is slightly atypical for sarcoidosis. Lymphoma is a consideration. |
Generate impression based on findings. | Reason: hx of microscopic hematuria for several years, please evaluate with delayed imaging History: microscopic hematuria ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Gallstones.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis or nephrolithiasis. The kidneys demonstrate symmetric parenchymal enhancement and contrast excretion. The distal ureter is not opacified, but this finding may reflect peristalsis, and can not be further evaluated.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No evident cause of patient's hematuria. |
Generate impression based on findings. | Sinonasal polyp. There is a left conchae bullosa. There is a 3 mm defect in the cartilaginous nasal septum, which is deviated mildly to the right. Otherwise, the nasal cavity is clear without evidence of sinonasal polyposis. There is a 7 mm wide right maxillary sinus retention cyst and mild mucosal thickening along the superior aspect of the maxillary sinuses. The paranasal sinuses are otherwise clear. The carotid grooves and optic nerve canals are covered by bone. The ethmoid roofs are symmetric and intact. The orbits are unremarkable without evidence of orbita wall defects. There is diffuse brain parenchymal volume loss and patchy cerebral white matter hypoattenuation that likely represents microangiopathy. | 1. Left conchae bullosa and a 3 mm defect in the cartilaginous nasal septum, which is deviated mildly to the right. Otherwise, the nasal cavity is clear without evidence of sinonasal polyposis. 2. diffuse brain parenchymal volume loss and patchy cerebral white matter hypoattenuation that likely represents microangiopathy. |
Generate impression based on findings. | Two breast cancers now with elevated CEA 19-9 rule-out recurrence/metastasis. CHEST:LUNGS AND PLEURA: New 8-mm dependent groundglass nodular density superior segment right lower lobe (6/36). Unchanged nodular groundglass subpleural nodule left upper lobe (6/39).Subpleural fibrosis anterior right lung consistent with prior radiation therapy to the chest wall. No pleural fluid.MEDIASTINUM AND HILA: Heterogeneous wall thickening of the proximal thoracic esophagus with areas of enhancement. Soft tissue stranding in the anterior mediastinal fat with opacification of numerous collateral vessels. Normal heart size. Small right cardiophrenic angle collateral vessel opacification.CHEST WALL: Bilateral mastectomies and breast reconstructions. Nonspecific soft tissue stranding about the right breast prosthesis. Axillary dissection clips with nonspecific soft tissue stranding presumably representing scarring. No dominant masses or nodules are appreciated. Small low cervical lymph node on the right appears flat on the axial imaging, unlikely to be of clinical significance but please refer to PET report.Apparent narrowing of the right subclavian vein as it crosses over the first rib.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Hypoattenuating lesion in the right hepatic lobe adjacent to the IVC unchanged at 1.1-cm (series 701, image 65).SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Interval decrease in size of complex cystic lesion arising from the anterolateral aspect of the left kidney with internal septations containing calcifications and nodularity, now measuring 6.4 x 5.7 cm (series 701, image 86) compared to 8.9 x 6.6 cm previously. Two nodular areas are identified along the internal septa near the apex of the lesion on images 82 and 80 of the standard axial series.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Poorly defined 8 millimeter nodular density in the superior segment of the right lower lobe. Metastasis cannot be excluded though the appearance is atypical. Short-term follow-up in 2-3 months suggested. Though this occurs outside the expected radiation field, a post therapeutic area of fibrosis is a possibility.2. Subcentimeter left upper lobe ground glass nodule unchanged compared to 1/4/12 but new from 3/26/08. Lack of growth favors a postinflammatory nodule over a metastasis.3. Hypoattenuating lesion in the right hepatic lobe is unchanged.4. Interval decrease in overall size of left renal complex cyst however two nodular components arising from internal septations are new, indeterminate for primary renal malignancy. Further assess and may be made with dedicated renal imaging when feasible.5. Abnormal appearance of the proximal thoracic esophagus with wall thickening and enhancement which could be post inflammatory if the patient's radiation portal covered there region. I also suspect that some of the areas of enhancement may be due to vascular opacification given the extent of collateral vasculature present elsewhere in the mediastinum.6. Unable to exclude thoracic outlet syndrome on the right with apparent narrowing of the right subclavian vein as it courses over the the first rib when the patient's upper extremities are elevated. |
Generate impression based on findings. | Reason: 80F metastatic parathyroid ca with mediastinal metastasis and rising PTH. Please evaluate for growth, size, local extension, distant disease History: Rising PTH, dysphagia CHEST:LUNGS AND PLEURA: Near complete resolution of previous tree and bud opacities within the inferior right upper lobe of resolving infection.The previous right posterior reference nodule is no longer present, a focus of groundglass remains in its place (series 5 image 39). Previously noted right sided posterior pleuralbased nodule in the right upper lobe is no longer visualized.On the left, the lingular pleural nodule has been resected with surgical staples in post wedge resection scarring remaining (series 5 image 56). While these reference nodules have decreased in size, others are new. For example, there is a new peripheral right upper lobe nodule measuring 5 x 8 mm (series 5 image 43). A nodule in the right lower lobe is now present, measuring 11 x 12 mm (series 5 image 73). There are nodules that extend into the medial right upper lobe, arising from paramediastinal tumor (series 5 image 29).Paraseptal emphysema unchanged. Stable scattered micronodules.Diffuse groundglass involving the bases, extending into the posterior costophrenic sulci,with interlobular septal thickening thickening, bronchiectasis unchanged.MEDIASTINUM AND HILA: Asymmetric soft tissue density along the left thyroid cartilage hasnot significantly changed. Previously described soft tissue posterior to the trachea in the superior mediastinum isbetter delineated with intravenous contrast. There is an enhancing nodular component thatextends into the posterior wall of the trachea (series 3 image 10) that remains stableapproximately 14 by 17 mm.Soft tissue mass in the anterior superior mediastinum, immediately anterior to the leftbrachiocephalic vein, has increased, now 24 mm in short axis (series 3 image 26) as compared to 20 mm. this has extended inferiorly along the right mediastinum.Slightly posterior and inferior to this level, a soft tissue nodule has increased in size(series 3 image 28), measuring 18 x 21 millimeters, as compared to 10 x 11 mm.Significant interval enlargement of a right cardiophrenic lymph node (series 3 image 76).Stable size of the mediastinal and hilar lymph nodes which are not significantly enlarged.Heart size remains normal without interval pericardial effusion. Extensive coronaryarterial, aortic valvular and atherosclerotic calcifications within the aorta.CHEST WALL: Progressive callus related to fracture posterior right 11th rib.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Low attenuation liver lesions remain stable.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Progressive enlargement of the left adrenal gland suggestive of metastasis, 21 mm transverse, as compared to 18 millimeters.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Small periaortic lymphadenopathy unchanged.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Severe multi-level degenerative changes concentrated in the lumbar spine. Multi-focal lucencies throughout the vertebral bodies, most prominent in the T1 vertebral body unchanged. No interval compression fractures. While most of this does appear degenerative, assessment for metastases with a bone scan may be considered.OTHER: No significant abnormality noted. | While several reference pleural based nodules are no longer visualized, there are several new pulmonary nodules. In addition, the superior right paramediastinal soft tissue tumor has enlarged. Progressive enlargement of the left adrenal gland suggestive of metastases. Diffuse lucencies in the vertebral bodies; although unchanged, consider or bone scan to exclude osseous metastases. |
Generate impression based on findings. | Clinical question: CVA. Signs and symptoms: CVA. Nonenhanced head CT:Examination demonstrates no evidence of an acute intracranial process. CT however is insensitive for detection of acute nonhemorrhagic ischemic strokes.The cerebral cortex demonstrate normal density and unremarkable.The cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation remains within normal. Midline is maintained. Unremarkable images through posterior fossa. Unremarkable calvarium and soft tissues of the scalp.Unremarkable images through the orbits.All visualized paranasal sinuses and bilateral mastoid air cells, middle ear cavities remain well pneumatized. | Negative nonenhanced head CT. |
Generate impression based on findings. | Metastatic thyroid cancer. CHEST:LUNGS AND PLEURA: The previously seen right middle lobe micronodule is unchanged compared to 5/7/13. A new 4-mm nodule is seen in the right middle lobe (series 8, image 44). Basilar subsegmental atelectasis obscures the previously described 4-mm left basilar nodule.MEDIASTINUM AND HILA: Evaluation of the superior mediastinum is limited by streak artifact secondary to a left shoulder prosthesis.No visible mediastinal or hilar lymphadenopathy. The calcified subcarinal lymph node is unchanged. Mild coronary artery calcifications. Normal sized heart without pericardial effusion.CHEST WALL: The left ninth rib destructive lesion is increased in size, measuring 5.9 x 2.1 cm (series 6, image 67), previously 4.3 x 1.6 cm. Focal sclerosis affecting the left lateral sixth rib is unchanged. No new lytic or sclerotic lesions are seen.Moderate to severe degenerative changes of 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: Unchanged nodular thickening of the left adrenal gland.KIDNEYS, URETERS: The ill-defined soft tissue lesion in the midpole region of the right kidney measures 1.1 x 1.0 cm (series 6, image 90), previously 1.2 x 1.2 cm. Additional centimeter hypodense lesions are too small to characterize, though unchanged and possibly representing cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Asymmetric atrophy of the right psoas muscle, similar to prior. Atherosclerotic calcifications of the abdomina aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small fat-containing ventral wall hernia is again seen.. | 1. Increased size of the destructive left ninth rib lesion.2. New nonspecific right middle lobe nodule. Continued follow-up is recommended.3. Stable ill-defined right renal lesion. |
Generate impression based on findings. | Metastatic DTC on the cediranib + lenalidomide, held since 6.7.13. Head: There is no evidence of intracranial masses or abnormal enhancement. There is stable moderate cerebral white matter hypoattenuation that is likely related to microangiopathy. Mild prominence of the ventricular system is unchanged. The skull and regional extracranial structures are unchanged. Neck: Streak artifact related to dental amalgam and a left shoulder prosthesis obscures surrounding structures. There are postsurgical findings related to thyroidectomy. There is no significant change in the soft tissue in the right surgical bed that measures 10 x 6 mm. There is no significant cervical lymphadenopathy. The airways are patent. The hypopharynx and larynx are unremarkable. The major salivary glands are unchanged. There are mild atherosclerotic calcifications at the carotid bifurcations. The carotid arteries and jugular veins are otherwise patent. There is unchanged degenerative spondylosis. The osseous structures are otherwise unremarkable. The imaged portions of the lungs are clear. | 1. Unchanged nonspecific soft tissue within the right thyroidectomy bed. Otherwise, no evidence of locoregional tumor recurrence or significant cervical lymphadenopathy.2. No evidence of intracranial metastases. |
Generate impression based on findings. | Reason: mets lung ca, bone mets, T790M, s/p 2 cycles of AP26113, pls c/w previous study to evaluate tx response. History: lung ca CHEST:LUNGS AND PLEURA: Right lower lobe mass measures 5.4 x 4.8 cm (series 5, image 50), previously 5.4 x 4.6 cm.There is extensive surrounding nodularity which may represent additional tumor. No pleural effusions.MEDIASTINUM AND HILA: Index right hilar lymph node measures 1.6 x 0.8 cm (series 3, image 52), previously 2.0 x 1.2 cm. Heart size is normal without pericardial effusion.CHEST WALL: Left chest wall Port-A-Cath tip terminates at the cavoatrial junction.ABDOMEN:LIVER, BILIARY TRACT: Nonspecific left hepatic lobe hypodensity 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: Reference gastrohepatic lymph node measures 1.4 x 1.0 cm (series 3, image 74), unchanged. Reference paraaortic lymph node measures 1.0 x 0.7 cm (series 3, image 97), previously 1.1 x 0.9 cm.BOWEL, MESENTERY: Reference soft tissue density anterior to the esophagus measures 2.7 x 1.7 cm (series 3, image 80), previously 2.6 x 1.6 cm.BONES, SOFT TISSUES: Tiny sclerotic lesions throughout the thoracolumbar spine, unchanged.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic lesion in the left superior acetabulum and right ischium are not significantly changed.OTHER: No significant abnormality noted. | 1.Right lower lobe mass without significant interval change.2.Mesenteric soft tissue density anterior to the esophagus is unchanged.3.Reference lymph nodes without significant interval change in size.4.Sclerotic osseous lesions are unchanged. |
Generate impression based on findings. | Reason: tube position abd pain History: abd pain 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: Air space disease of bilateral lung bases suggesting consolidation from aspiration pneumonia. Atherosclerotic calcification of the descending thoracic aorta. Atherosclerotic calcification of the coronary arteries.LIVER, BILIARY TRACT: Status post cholecystectomy. Interval improvement in intrahepatic and extrahepatic biliary ductal dilatation.Stable hepatic cyst in the right lobe of the liver.SPLEEN: No significant abnormality notedPANCREAS: Interval resolution of pancreatic duct dilatation.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Relatively stable right and left renal lesions although noncontrast study limits characterization of these lesions. RETROPERITONEUM, LYMPH NODES: Stable atherosclerotic calcifications of the descending aorta and bilateral iliac arteries. Aortobiiliac stents are again seen.BOWEL, MESENTERY: Gastric tube balloon within the stomach lumen and the tube loops on itself in the stomach with tip in the first portion of the duodenum. Mildly dilated loops of small bowel with air. BONES, SOFT TISSUES: Partially visualized, stable appearing soft tissue mass in the proximal posterior left thigh.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Bulbous uterus with calcified fibroid. BLADDER: Foley catheter within bladder. Air within the bladder is likely due to Foley catheter manipulation. LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diverticula of the sigmoid and descending colon without evidence of diverticulitis. Contrast within the rectum.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Gastric tube looped within the stomach and with tip in the first portion of the duodenum. The tube should be repositioned in Interventional Radiology.2.Mildly dilated loops of small bowel with air is abnormal but nonspecific. Contrast within the rectum represents proper bowel motility.3.Right lower lobe airspace consolidation may represent aspiration pneumonia. |
Generate impression based on findings. | Clinical question: Evaluate atrophy. Signs and symptoms: Dementia. Unenhanced head CT:There is no detectable acute intracranial process.Very subtle low-attenuation in subcortical white matter is nonspecific however could represent age indeterminate small vessel ischemic strokes considering patient's stated age of 86.The cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation remains within normal for patient stated age. There is no convincing evidence of atrophic changes of brain.No appreciable vascular calcification of cavernous carotid or vertebral arteries is present.Unremarkable images through the orbits.Unremarkable calvarium and soft tissues of the scalp.All visualized paranasal sinuses and bilateral mastoid air cells/middle cavities remain well pneumatized. | 1.Very minimal age indeterminate small muscle ischemic stroke is suspected.2.Unremarkable exam otherwise for patient's stated age and in particular no evidence of atrophy as is questioned clinically. |
Generate impression based on findings. | Chest pain question PE. PULMONARY ARTERIES: Adequate infusion quality. No filling defects suggest the presence of an acute pulmonary embolus.LUNGS AND PLEURA: Small pleural fluid collections with dependent tree in bud opacities and atelectasis in a pattern most consistent with aspiration.MEDIASTINUM AND HILA: Interval development of mediastinal adenopathy with a high right paratracheal lymph node measuring 11 mm (11/63) and enlarged left lower paratracheal lymph node also noted. Mid thoracic esophagus is patulous, mildly dilated with air just below the level of the aortic arch. Thoracic aorta is highly tortuous and has atherosclerotic calcifications throughout its length. The mid to distal left subclavian artery is stenotic, present previously. Moderate cardiomegaly. Extrinsic compression of the left atrium by the descending thoracic aorta as it passes from left to right over the vertebral column. Calcification of the aortic valve leaflets. Severe coronary artery calcifications. Ascending aorta appears mildly ectatic however accurate measurements cannot be obtained by this technique.CHEST WALL: Previously measured area of hypoattenuation in the region of the left thyroid is not identified on the current study.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Gastrostomy tube retention device partially visualized gastric lumen. Nonspecific hypoattenuating lesion in the posterior right hepatic lobe unchanged. Intrahepatic biliary ductal dilatation is slightly more prominent and could be related to prior cholecystectomy. The extrahepatic bile ducts appears dilated. Atherosclerotic calcification of the aorta, celiac axis and superior mesenteric artery. The SMA appears stenotic with approximately the half of its lumen occupied by atherosclerotic plaque, poorly assessed by this technique. Hypoattenuating soft tissue mass in the apex of the left kidney measures up to 2.2 x 3.2 cm (11/263) present since 2009 where it measured up to 3.1 x 2.3 cm at a similar level on 12/3/09. However, the craniocaudal dimension has increased from 3.3-cm to 4-cm (coronal image 28) since this time. | 1. No evidence of acute pulmonary embolus.2. Left renal mass suspicious for renal cell carcinoma.3. Interval development of mild mediastinal lymphadenopathy, possibly post inflammatory or post infectious however of unclear etiology given the presence of renal mass.4. Signs of moderate aspiration in the dependent lung fields, with significant atelectasis and bronchiolitis..5. Small pleural fluid collections.6. Dilatation of the mid thoracic esophagus, likely result of the patient's anatomy but potentially could result in chest discomfort. |
Generate impression based on findings. | Male 72 years old Reason: evaluation of right upper lobe poorly differentiated adenocarcinoma; hx of resection LUL History: eval of RUL lung cancer LUNGS AND PLEURA: Right upper lobe perihilar lesion adjacent to the upper lobe anterior segmental bronchus measures 25 mm (image 55, series 4), previously 27 mm. Metallic foci are seen in the region of this lesion compatible with new endoscopy clips. Small right upper lobe peripheral nodule (image 47, series 4) in the vicinity of the right hilar mass unchanged and compatible with an intrapulmonary lymph node. Remaining scattered pulmonary micronodules unchanged.Left upper lobe bronchiectasis, architectural distortion and interstitial thickening compatible with scarring unchanged and likely related to prior infection.Mild/minimal centrilobular and paraseptal emphysema.MEDIASTINUM AND HILA: No evidence of mediastinal or hilar lymphadenopathy.Severe coronary artery calcifications. Normal heart size and no pericardial effusion. There is prominence of the papillary heads seen on the axial images; however, these appear normal in appearance on the sagittal and coronal views.CHEST WALL: Nonspecific enlarged left axillary lymph node with normal fatty hilum, unlikely representing metastasis.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Bilateral simple renal cysts. | 1. Stable left perihilar lesion compatible with given diagnosis of lung cancer.2. No evidence of lymphadenopathy or metastatic disease. |
Generate impression based on findings. | Reason: 63 yo w/ abdominal distension RLQ pain, concern for possible partial BO. Please give IV and oral contrast. History: RLQ pain,abdominal distension, nausea ABDOMEN:LUNG BASES: Right Bochdalek hernia.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. Enteric contrast is present in the right colon. The appendix is normal. No pneumoperitoneum or mesenteric free fluid.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Heterogeneous and enlarged prostate with irregular margins.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 evidence of bowel obstruction or other acute intraabdominal abnormality. |
Generate impression based on findings. | Reason: lung cancer s/p 3 months on Tarceva. please evaluate for disease and compare with previous scans History: lung cancer CHEST:LUNGS AND PLEURA: Interval increase size of right suprahilar mass that now extends along the superior mediastinum to the apex. Reference measurement is 3.2 by 7.0 centimeters (series 3 image 24), as compared to 4.6 x 2.3 cm. Right pleural effusion has increased, now moderate in size. Associated progressive pleural nodularity.Progressive fine nodularity involving the fissures, inter and intralobular septa within the right upper and middle lobes, suggestive of lymphatic spread of tumor. Increasing ground glass opacity suggestive of impaired lymphatic and venous drainage.Innumerable micronodules in a random distribution involving the left lung, concentrated in the left upper lobe.MEDIASTINUM AND HILA: Diffusely reference right paratracheal lymph node has increased in size, 11 mm (series 3 image 27, previously 7 mm.The heart size remains stable. No interval pericardial effusion. CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Interval increase size of right suprahilar mass that now extends along the superior mediastinum to the apex, 3.2 by 7.0 cm. Right pleural effusion has increased, now moderate in size. Associated progressive pleural nodularity.Progressive fine nodularity involving the fissures, inter and intralobular septa within the right upper and middle lobes, suggestive of lymphatic spread of tumor. Increasing ground glass opacity suggestive of impaired lymphatic and venous drainage. |
Generate impression based on findings. | Male, 84 years old, rhinorrhea, postnasal drip, history of dental abscess. Frontal sinuses and frontoethmoidal recesses are clear. Minimal patchy opacification through the ethmoid air cells. Sphenoid sinuses and sphenoethmoidal recesses are clear.Moderate peripheral mucosal thickening is seen in the left maxillary sinus. The wall of the left maxillary sinus is thickened and sclerotic. The left maxillary outflow pathway is largely obstructed by soft tissue thickening.Minimal peripheral mucosal thickening within the right maxillary sinus. The walls of the right maxillary sinus are not significantly thickened or sclerotic. The right maxillary outflow path is clear.The nasal septum is intact but the anterior cartilaginous portion deviates to the left. The nasal cavity is clear. Pneumatization of the middle nasal turbinates is noted. | Findings suggestive of chronic sinusitis in the left maxillary sinus. No significant disease is seen in the remaining paranasal sinuses. |
Generate impression based on findings. | Female, 38 years old, status post lumbar drain, evaluate for CSF leak. Laminectomy has been performed at the L4 level. A lumbar catheter enters the spinal canal at the L3-4 level coursing superiorly within the right lateral aspect of the thecal sac. Catheter tip terminates at the L1 level. No kink or discontinuity is identified.No evidence of a fluid collection is seen within the paraspinal soft tissues or along the catheter course at any point.Spinal alignment is anatomic. Vertebral body heights are preserved. No destructive osseous lesions are seen. A large right paracentral disk protrusion is identified at L5-S1 appearing similar to the prior MRI accounting for differences in technique. This results in a generalized spinal canal stenosis, particularly affecting the right subarticular zone. | No evidence of paraspinal fluid collection is seen to suggest CSF leak. |
Generate impression based on findings. | Reason: persistent nausea. SBFT, gastric emptying study, and EGD negative. Please eval for portal vein thrombosis. History: persistent nausea, dry heaving ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No suspicious focal liver lesions. Status post cholecystectomy. No evidence of portal vein thrombosis. Patent hepatic veins.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: Postoperative changes to small and large bowel. Focal area of dilated loop of small bowel correlates with small bowel follow-through study findings of possible adhesions in the left upper quadrant.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Bilateral adnexal cysts are nonspecific on CT but likely represent functional cysts given patients premenopausal status. BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Severe edema of the ascending colon and proximal transverse colon. Descending and sigmoid colon are collapsed and also appear edematous. Scattered mesenteric lymph nodes.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Patchy areas of edematous colon representative of colitis, presumably related to patient's provided history of Crohn's disease. |
Generate impression based on findings. | Reason: metastatic breast cancer - baseline prior to starting new treatment regimen History: metastatic TNBC CHEST:LUNGS AND PLEURA: Multiple pulmonary metastases. Right lower lobe pulmonary nodule measures 2.2 x 2.1 cm (series 5, image 62). Left upper lobe pulmonary nodule measures 1.8 x 1.7 cm (series 5, image 32).MEDIASTINUM AND HILA: Anterior mediastinal triangular soft tissue density compatible with residual thymus. Hilar and mediastinal lymphadenopathy. Left hilar lymph node measures 4.2 x 2.5 cm (series 3, image 40). Subcarinal lymph node measures 2.2 x 1.6 cm (series 3, image 50).CHEST WALL: Bilateral breast prostheses. No axillary lymphadenopathy. Bone erosion of the anterior T5 vertebral body.ABDOMEN:LIVER, BILIARY TRACT: Heterogeneous segment 6 lesion measures 2.6 x 2.5 cm (series 3, image 124).SPLEEN: Accessory splenule.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. Pulmonary metastases.2. Hepatic metastasis.3. Hilar and mediastinal lymphadenopathy.4. Destructive T5 vertebral body lesion. |
Generate impression based on findings. | Head and neck cancer status post CRT CHEST:LUNGS AND PLEURA: Mild subpleural fibrosis in the lung periphery. No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: 18-mm left inferior pulmonary ligament lymph node increased from previous size of 16mm (3/57). Mild high left paratracheal chain lymphadenopathy , also subtly larger. When comparing back to 1/17/13 both of these lymph nodes are significantly larger, now consistent with indolent metastases. Numerous small subcarinal region lymph nodes and mildly enlarged bilateral interlobar region lymph nodes. Heart size is upper normal. There is mild pericardial thickening versus depended pericardial fluid adjacent to the left atrium and free wall the left ventricle.CHEST WALL: T10 superior endplate depression. Mildly enlarged left low cervical lymph node, please refer to neck CT report for significance.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Subcentimeter hypoattenuating lesion in the left hepatic lobe is unchanged. Cholelithiasis without signs cholecystitis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.PANCREAS: Pancreatic atrophy and fatty replacement.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Gastrostomy tube retention device in the stomach.BONES, SOFT TISSUES: Chronic compression fracture of L2.OTHER: No significant abnormality noted. | Progressive enlargement of a left inferior pulmonary ligament lymph node and a high left paratracheal lymph node are now consistent with indolent nodal metastases. |
Generate impression based on findings. | Female 64 years old Reason: adenocarcinoma of lung, ? surgically resectable History: wheezing CHEST:LUNGS AND PLEURA: There is a 25 x 15 mm (image 40, series 4) left lower lobe nodule adjacent to the left superior segment bronchus and abutting nearly 90 degrees of the aorta with preservation of the intervening fat plane. This nodule corresponds to an FDG avid focus seen on the outside PET scan and is compatible with the given history of adenocarcinoma of the lung. The nodule is approximately 6-cm from the carina.There are multiple solid pleural based nodules in the left hemithorax compatible with metastases , the largest measuring 27 x 22 mm (image 39, series 3) corresponding to the previously biopsied nodule. No evidence of pleural effusion.MEDIASTINUM AND HILA: Abnormally attenuating periaortic prevascular node measures 9 mm (image 30, series 3), and subcentimeter left hilar region lymph nodes are suspicious for metastases.Normal heart size and no evidence of pericardial effusion.Small sliding type hiatal herniaCHEST WALL: Multilevel degenerative changes of the thoracic and lumbar spine without evidence of metastatic disease.Tiny left internal mammary chain lymph nodes are visible.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Hypodense lesions in the left and right hepatic lobes are not fully characterized, the left is indeterminate and the right hepatic lesion is suspicious for metastasis. Status post cholecystectomy.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral indeterminant lesions in the interpolar regions of the kidneys could be complex cysts but metastasis cannot be excluded.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Multiple nonspecific slightly enlarged porta hepatis lymph nodes.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. Left lower lobe perihilar mass abutting approximately 90 degrees of the aorta and compatible with patient's given history of adenocarcinoma of the lung.2. Numerous pleural based metastases in the left hemithorax.3. Enlarged para-aortic and left internal mammary chain lymph nodes suspicious for nodal metastases. Non-enlarged left hilar lymph nodes with abnormal attenuation also suspicious for metastases.4. Indeterminate lesions in the liver and kidneys |
Generate impression based on findings. | Metastatic breast cancer CHEST:LUNGS AND PLEURA: Postradiation changes in the right lung with apical and anterior ground glass, volume loss, and traction bronchiectasis. Stable size of the loculated right pleural effusion. Right lower lobe scar like opacities are unchanged. Bibasilar subsegmental atelectasis. No new suspicious pulmonary nodules or masses are evident.Enhancing nodules at the right costophrenic angle are consistent with pleural metastases.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Normal size heart without pericardial effusion.There is a nodular focus at the wall of the mid esophagus, suspicious for an enlarged para-esophageal lymph node however artifact occurs at this region and this cannot be confirmed (series 4, image 43). Additional prominent subcentimeter para-esophageal lymph nodes are seen inferiorly, suspicious for metastatic disease.CHEST WALL: The right chest wall mass is unchanged at 6.9 x 4.2 cm (series 4, image 40).Tracheostomy tube position is unchanged. Left chest Port-A-Cath tip at the superior cavoatrial junction. Subcentimeter axillary lymph nodes.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted within the liver. Status post cholecystectomy.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: There are new enlarged peri-portal and pericaval lymph nodes, the larger of which measures 2.5 cm in short axis (series 4, image 70). BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted. | 1. Unchanged size and appearance of the reference right chest wall mass. 2. New enhancing pleural nodules in the right lung, consistent with metastases.3. Upper abdominal lymphadenopathy compatible with metastatic disease. |
Generate impression based on findings. | Female 28 years old; Reason: stones History: stones ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Kidneys are normal in morphology. 5-mm right lower pole nonobstructive renal calculus. No hydronephrosis or kidney. No perinephric fluid collections.No evident calculi in the left kidney.The imaged portions of the ureters are normal in caliber.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 distal ureteral or bladder calculi.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Nonobstructive 5-mm right lower pole renal calculus. |
Generate impression based on findings. | Head and neck cancer (hypopharynx, pyriform sinus), follow-up after chemotherapy and RT. LUNGS AND PLEURA: No suspicious pulmonary nodules or masses. Interval resolution of previously seen ground glass opacities.MEDIASTINUM AND HILA: Coronary artery calcifications. Normal heart size. No suspicious lymphadenopathy. Physiologic volume of pericardial fluidCHEST WALL: Posterior sebaceous cyst in the midline. Skin thickening at the site of prior port catheter, presumably scarring.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. Cholecystectomy clips noted. | No evidence of metastatic disease to the chest. |
Generate impression based on findings. | Male, 72 years old, status post fall with tenderness along C-spine. Images are degraded by motion artifact. Within this limitation, the following observations are made.Periventricular hypoattenuation noted, right side more than left, compatible with age indeterminate ischemic change. A chronic appearing right basal ganglia infarct is also demonstrated.No evidence of parenchymal or extra-axial hemorrhage is seen within limitations of the study. No mass effect is detected. The right lateral ventricle is larger than the left, probably reflecting ex vacuo dilatation.No calvarial fractures seen. There may be mild left frontal scalp swelling.Hyperdense material is evident tracking through the subcutaneous tissues of the suboccipital region and to a lesser degree along the midline at lower cervical levels.No cervical spine fractures are seen. There is extensive degenerative disk disease with resultant endplate irregularity and mild degenerative loss of vertebral body height. Bulky anterior osteophytes are evident at lower levels. There are disk osteophyte complexes at all levels of the cervical spine most conspicuously C3-4, C5-6 and C6-7. These do not appear to significantly encroach upon the spinal canal. Neural foraminal narrowing is evident at all levels but worse on the left. | 1. Age indeterminate right worse than left periventricular small vessel ischemic disease. Chronic appearing right basal ganglia lacunar infarct. No definite acute intracranial abnormalities.2. Hyperdense material tracking within the subcutaneous tissues of the suboccipital region may represent hematoma. Correlation for mechanism of injury and site of pain is suggested. MRI would be able to confirm this finding and would better assess the other soft tissue and ligamentous structures.3. Extensive degenerative changes without evidence of acute cervical spine fracture. |
Generate impression based on findings. | 63 year old man with chest pain. He has a history of CABG (LIMA to LAD; SVG to diagonal artery; and SVG to PDA to RPL to OM3).CPT Code: 75574 Coronary artery bypass grafts:LIMA to LAD. The LIMA to LAD is patent. The distal runoff vessel has non-obstructive atherosclerosis.SVG to diagonal artery is occluded.SVG to PDA to RPL to OM3. The SVG to PDA portion of the graft has a large burden of atheroma in the mid portion of the graft but there is no significant associated stenosis. The native PDA runoff vessel has non-obstructive, calcified plaque. The segment of the SVG in between the PDA and RPL (right posterolateral) is patent and the distal runoff RPL is without significant stenosis. The segment of the SVG graft in between the RPL and OM3 is patent. The native OM3 run-off vessel is free of obstructive disease.Coronary arteries: LM: The left main coronary artery arises normally from the left sinus of valsalva and bifurcates into the left anterior descending and left circumflex coronary arteries. There is partially calcified, non-obstructive plaque in the mid-body of the left main.LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove, supplying the diagonal and septal branches. There is a large, low attenuation plaque in the proximal to mid LAD (over-riding the ostium of the major diagonal artery) resulting in a 50-70% stenosis. There are multiple non-obstructive calcified plaques in the remainder of the mid LAD. The mid LAD is also involved in a myocardial bridge. The distal LAD has non-obstructive atherosclerosis and is anastomosed to the LIMA. The mid portion of the above mentioned major diagonal artery is occluded.LCx: The left circumflex coronary artery is non-dominant. It courses normally in the left AV groove. It gives rise to the obtuse marginal branches. There are several non-obstructive calcified plaques throughout the proximal and mid portions of the vessel. There is a non-obstructive, non-calcified plaque in the distal LCx. OM1 and OM2 are without significant stenosis. OM3 is occluded (but bypassed as described above).RCA: The right coronary artery is large and arises normally from the right sinus of valsalva. It is the dominant coronary artery supplying a posterior descending artery and a posterolateral branch. There is a non-obstructive calcified plaque in the proximal RCA. There is a non-calcified, low attenuation plaque in the mid RCA resulting in a 25-50% stenosis. There are several densely calcified plaque in the distal RCA precluding assessment of several portions of the distal RCA lumen. The PDA and RPL are patent distal to their respective anastomosis sites.Left Ventricle: The left ventricular late diastolic volume is normal (LV volume 85ml).Right Ventricle: Visually the right ventricular late diastolic volume is within normal limits.Left Atrium: Visually, the left atrial volume appears to be normal in size. There are four distinct pulmonary veins which drain normally into the left atrium. There is no evidence of left atrial appendage thrombus.Right atrium, vena cavae, and coronary sinus: The right atrial volume appears to be normal in size. The superior and inferior vena cavae are grossly normal. The coronary sinus is normal in size. Valves: There is minimal calcification on the aortic valve. No mitral valve calcification.Great vessels: The visualized portions of the thoracic aorta demonstrate no evidence of dissection or aneurysm. The left subclavian artery has a non-obstructive (<25% stenosis) plaque at its ostium. The main pulmonary artery is normal in size.Pericardium: The pericardium is normal in thickness. There is no pericardial effusion. | 1. LIMA to LAD patent. SVG to diagonal artery occluded. SVG to PDA to RPL to OM3 is patent. 2. The distal runoff vessels to each of the patent bypass grafts are free of obstructive disease. 3. There is severe native coronary artery disease as detailed above. Importantly, the major diagonal artery supplies a relatively large territory of myocardium. It originates at the site of a significant proximal to mid LAD stenosis and is occluded in the mid portion of the vessel. The vessel was likely the previous target of the occluded SVG graft described above.This portion of the report pertains to the heart and great vessels only. The remaining soft tissues of the thorax and upper abdomen will be interpreted by the attending chest radiologist and included as an addendum to this report. |
Generate impression based on findings. | Male 65 years old Reason: shortness of breath and chest pain x 2 weeks History: none new PULMONARY ARTERIES: Technically adequate study. No evidence of pulmonary embolism or right heart strain.LUNGS AND PLEURA: Trace dependent atelectasis. No focal airspace opacity or pneumothorax.MEDIASTINUM AND HILA: Nonspecific prominent right paratracheal node.Normal heart size and no evidence of pericardial effusion. Minimal coronary artery atherosclerosis.CHEST WALL: Mild multilevel degenerative changes of the thoracic spine. No evidence of acute rib fracture.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Hypodense lesion in the right hepatic lobe is too small to characterize. | 1. No evidence of pulmonary emboli. 2. No etiology found to explain the patient's symptomatology. |
Generate impression based on findings. | Female 19 years old Reason: r/o PE or R sided pulm pathology History: 19 yr old on OCPs with cough and SOB, previous temp, with HR 150s, O2 sat 96%, R sided wheeze.+d-dimer today. PULMONARY ARTERIES: Technically adequate study with no evidence of pulmonary embolism or right heart strain.LUNGS AND PLEURA: Area of confluent consolidation in the superior segment of the right lower lobe containing air bronchograms with surrounding patchy consolidation and ground glass opacities compatible with pneumonia.No evidence of pleural effusion or pneumothorax.MEDIASTINUM AND HILA: Enlarged right hilar lymph nodes likely reactive in nature.Normal heart size and no evidence of pleural effusionCHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. No evidence of pulmonary emboli.2. Superior segment right lower lobe pneumonia without evidence of pleural effusion. |
Generate impression based on findings. | Female 82 years old Reason: acute R heart strain with apical ballooning History: acute R heart strain with apical ballooning PULMONARY ARTERIES: Technically adequate study with no evidence of pulmonary emboli. LUNGS AND PLEURA: 6-mm right lower lobe nodule (image 166, series 8) contains a small peripheral calcification consistent with a granuloma; however, CT surveillance in 6 to 12 months recommended to confirm stability.Right upper lobe clustered subpleural nodules with a bronchovascular distribution compatible with mucous plugging, possibly sequela from aspiration or bronchitis.Mild paraseptal/central lobular emphysema.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.Cardiomegaly with associated biatrial enlargement.Severe coronary artery atherosclerosis with associated atherosclerosis of the ostial LAD. Prominent aortic valve calcification. Moderate calcifications of the thoracic and abdominal aorta, and its branches.CHEST WALL: New compression fracture of the T6 vertebral body. Moderate multilevel degenerative changes of the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Status post cholecystectomy. Nonspecific clustered retroperitoneal, peripancreatic and porta hepatis lymph nodes. Vascular calcifications of the splenic hilum | 1. No evidence of pulmonary emboli.2. Cardiomegaly with associated biatrial enlargement.3. 6-mm right lower lobe nodule with peripheral calcification suggestive of granuloma; however, CT surveillance in 6 to 12 months recommended to confirm stability. 4. New compression fracture of the T6 vertebral body. |
Generate impression based on findings. | Male 74 years old Reason: eval for PE/ eval for aortic pathology History: cp PULMONARY ARTERIES: Technically adequate study without evidence of pulmonary embolus. Upper normal pulmonary artery size may represent right heart mild strain. Pulmonary micronodule in the right middle lobe.LUNGS AND PLEURA: Assessment of the pulmonary parenchyma degraded by patient motion. Biapical scarring right greater than left. No evidence of pleural effusion.MEDIASTINUM AND HILA: No evidence of mediastinal or hilar lymphadenopathy.Cardiomegaly secondary to left ventricular hypertrophy. Axial images were acquired in systole with a closed mitral valve; however, there is asymmetrical septal hypertrophy; morphology consistent with chronic hypertension or less likely hypertrophic cardiomyopathy. Evidence of prior cardiac vascular graft, and vascular clips are seen in the anterior cardiophrenic angle.Severe atherosclerosis of the coronaries as well as the thoracic aorta and its branches.No definitive hematoma or aneurysmal dilatation of the thoracic aorta; however, lack of contrast and ECG gating significantly diminishes the sensitivity of this examination to detect aortic pathology.CHEST WALL: Streak artifact from the patient's pacemaker limits assessment of the thoracic inlet.Mild wedge deformity of the T11 vertebral body may represent degenerative changes or compression fracture. Sclerotic lesion of the superior aspect of the mid thoracic vertebral body likely benign in etiology. Diffuse osteopenia.Sternal fixation hardware with sternum well aligned. Left subclavian dual lead pacemaker, leads in appropriate position.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Small sliding type hiatal hernia. | 1. No evidence of pulmonary embolus.2. Cardiomegaly with morphology suggestive of chronic hypertension or less likely hypertrophic cardiomyopathy, consider cardiac echo to further evaluate as clinically warranted.3. Mild wedge deformity of the T11 vertebral body compatible with degenerative changes/mild compression fracture.4. Severe atherosclerosis of the thoracic aorta, but no gross evidence of hematoma or aneurysm; however, this study is not optimized to evaluate the aorta. |
Generate impression based on findings. | Reason: r/o bleed, infection. hx PCKD known liver/pancreatic/renal cysts History: fever, white count ABDOMEN:LUNG BASES: Eventration of the left hemidiaphragm. Mild basilar atelectasis bilaterally.LIVER, BILIARY TRACT: Multiple hepatic cysts, grossly unchanged compared to prior exam. No evidence of intrahepatic or extrahepatic ductal dilatation. No evidence of cholecystitis.SPLEEN: No significant abnormalities noted.PANCREAS: Multiple pancreatic cysts, grossly unchanged compared to prior exam.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple bilateral renal cysts, grossly unchanged compared to prior exam.RETROPERITONEUM, LYMPH NODES: Scattered subcentimeter retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diverticulosis of the sigmoid colon and descending colon without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.No acute intra-abdominal processes.2.No evidence of infection in the abdomen or pelvis. |
Generate impression based on findings. | Reason: pancreatitis History: abdominal pain ABDOMEN:LUNG BASES: Mild left basilar atelectasis.LIVER, BILIARY TRACT: No suspicious focal liver lesions. No intrahepatic or hepatic duct dilatation. No evidence of cholelithiasis. Moderate to large amount of presumed blood surrounding the liver.SPLEEN: No significant abnormality noted. Moderate amount of presumed blood around the spleen.PANCREAS: Hypoattenuation of the midportion of the body of the pancreas with a large amount of surrounding fluid in the lesser sac with density suggestive of acute hemorrhage. There is a hyperdense linear structure anterior to the body of the pancreas (series 3, images 52-58) which may be vascular but are concerning for active contrast extravasation. Splenic vein and artery appear patent. No evidence of pseudoaneurysm of the splenic artery.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. Moderate amount of fluid surrounds the small and large bowel.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: Abdominal fluid and presumable blood tracks down into the dependent portions of the pelvic cavity. | Hemorrhagic pancreatitis with hemoperitoneum and findings suggestive of active extravasation of blood. No evidence splenic artery pseudoaneurysm or splenic vein thrombosis. |
Generate impression based on findings. | Female 19 years old Reason: r/o PE History: LLE swelling, tachycardia PULMONARY ARTERIES: Injection was repeated as the first exam was technically inadequate. Repeat examination was also suboptimal. Given this technical limitation, no large central or lobar pulmonary emboli identified. LUNGS AND PLEURA: Low lung volumes and minimal dependent basilar atelectasis, but no focal consolidation, pneumothorax or pleural effusion.MEDIASTINUM AND HILA: No evidence of mediastinal or hilar lymphadenopathy.Normal heart size and no pericardial effusion.CHEST WALL: Severe obesity.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Technically limited study, but no large central or lobar pulmonary emboli identified. |
Generate impression based on findings. | Reason: abdominal pain History: abdominal pain 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: Cardiomegaly.LIVER, BILIARY TRACT: Enlarged, fatty liver with no suspicious focal liver lesions. No evidence of cholelithiasis.SPLEEN: Multiple round soft tissue nodules adjacent to the spleen likely represent splenules.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the aorta and bilateral iliac arteries.BOWEL, MESENTERY: Mildly prominent loops of proximal jejunum without discrete transition point. Contrast continues to the rectum indicating functioning bowel motility.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diverticula of the sigmoid and descending colon without evidence of diverticulitis. Gas collection in the pelvis may represent gaseous distention of the sigmoid colon or giant diverticulum. Evidence of surrounding inflammation.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Moderate amount of free fluid in the dependent portion of the pelvis. | 1.Moderate amount of free fluid in the dependent portion of the pelvis.2.Diverticulosis of the sigmoid and descending colon without evidence of diverticulitis. |
Generate impression based on findings. | Female 40 years old Reason: PE? History: atypical chest pain, syncope PULMONARY ARTERIES: Technically adequate study with no evidence of pulmonary embolism right heart strain.LUNGS AND PLEURA: Proximal bronchial wall thickening unchanged and compatible with chronic bronchitis. Scattered pulmonary micronodules unchanged.Minimal dependent basilar atelectasis, but no evidence of consolidation or pleural effusions.MEDIASTINUM AND HILA: Nonspecific enlarged right hilar lymph node unchanged, but otherwise no mediastinal or hilar lymphadenopathy.Residual thymic tissue unchanged. Small sliding type hila hernia.Upper normal heart size and no evidence of pericardial effusion. CHEST WALL: Bilateral nonspecific enlarged subpectoral nodes unchanged.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. No evidence of pulmonary embolism.2. Proximal bronchial wall thickening compatible with chronic bronchitis.3. Nonspecific enlarged right hilar lymph node and bilateral subpectoral nodes are unchanged. |
Generate impression based on findings. | Female 28 years old Reason: PE? History: tachycardic and desalts PULMONARY ARTERIES: Technically limited study due to patient respiratory motion artifact. No definitive pulmonary embolism identified. LUNGS AND PLEURA: Diffuse ground glass opacities and pleural effusions with associated body wall edema suggestive of pulmonary edema; atypical infection or hemorrhage are considered less likely.Dependent basilar predominant atelectasis with associated areas of possible consolidation. Superimposed infection cannot be excluded, correlate clinically.MEDIASTINUM AND HILA: No evidence of mediastinal or hilar lymphadenopathy.Heart size is the upper limit of normal. Trace pericardial effusion.CHEST WALL: Moderate body wall edema. Nonspecific increased bone density.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Enteric feeding tube with tip in the gastric body. Hydropic gallbladder without definitive evidence of cholelithiasis. Mild subhepatic and parasplenic ascites. Haziness of the mesentery compatible with edema. Thickened left adrenal gland unchanged. | 1. Suboptimal study, but no evidence of pulmonary embolism.2. Diffuse ground glass opacities, septal thickening and small pleural effusions compatible with pulmonary edema.3. Dependent basilar atelectasis with possible superimposed infection, correlate clinically4. Minimal subhepatic and perisplenic ascites, likely related to fluid status. |
Generate impression based on findings. | Male 68 years old Reason: eval for e/o worse pna History: fever, chills, hx heart transplant with aspergillus LUNGS AND PLEURA: New patchy consolidation with air bronchograms and surrounding ground glass opacities in the posterior segment of the right upper lobe compatible with pneumonia.New basilar atelectasis with associated tree in bud opacities and ground glass opacities right greater than left suggestive of aspiration; however, no evidence of debris is seen within the bronchi.Apical predominant mild centrilobular emphysema. Left basilar pleural thickening unchanged.Previously described pulmonary nodules unchanged.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.Adhesions and pericardial thickening of the anterior mediastinum with the heart adherent to the anterior mediastinum. Retrosternal adhesion/scarring unchanged. Findings compatible with prior orthotopic heart transplant.Moderate atherosclerosis of the coronary arteries and thoracic aorta and its branches.Left PICC line with tip in the left innominate vein.CHEST WALL: Sternal fixation hardware in place, sternum well aligned. Presternal loop recorder position unchanged. Surgical clips in the left axilla.Short metallic structure arises off the proximal subclavian, unchanged. There is a second structure which appears to be a vascular conduit with the terminal portion in the left subclavian artery and the proximal portion buried in the left subpectoral fat.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Severe atherosclerosis of the abdominal aorta. Status post cholecystectomy. Small sliding-type hiatal hernia. | 1. New right upper lobe posterior segment pneumonia.2. Findings suggestive of mild aspiration.3. unchanged likely post infectious pulmonary nodules. 4. Unchanged postoperative mediastinal changes. |
Generate impression based on findings. | Female 59 years old Reason: further characterize pleural effusion on CXR History: sob, cough LUNGS AND PLEURA: Large left-sided pleural effusion which tracks into the major fissure and measures simple fluid density. There is prominent associated compressive atelectasis. There is nodularity and non-dependent fluid at the medial aspect of the pleural surface near the left hilum at the level of the carina, which is suspicious for a possible underlying pulmonary nodule.There is a 15 mm x 8 mm (image 61, series 4) subpleural spiculated nodule in the right lower lobe suspicious for malignancy. Other nonspecific pulmonary micronodules are also identified.Severe apical predominant centrilobular/paraseptal emphysema.MEDIASTINUM AND HILA: Enlarged right hilar, left aortopulmonary window, left costophrenic and enhancing left paraesophageal lymph nodes suspicious for malignancy.Multinodular goiter.Normal heart size and no evidence of pericardial effusion.CHEST WALL: No evidence of axillary, supraclavicular or subpectoral lymphadenopathy.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Multiple small hypodense foci scattered throughout the liver are too small to characterize. Two well circumscribed fluid density lesions in the visualized left kidney suggestive of simple renal cysts. Bilateral adrenal thickening is incompletely characterized on this examination. No evidence of retroperitoneal or mesenteric lymphadenopathy. | 1. Large left pleural effusion with nodular component concerning for underlying pulmonary nodule. Given the associated findings, this is suspicious for a malignant effusion and would consider reevaluation with CT examination after thoracentesis to evaluate for underlying malignancy.2. Spiculated right lower lobe pulmonary nodule suspicious for malignancy.3. Mediastinal and hilar lymphadenopathy concerning for malignancy. |
Generate impression based on findings. | Reason: Does patient have evidence of urologic disease to explain hematuria? Please schedule for CT pyelogram History: hematuria out of proportion to UTI ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Status post cholecystectomy. No suspicious focal liver lesions. No evidence of intrahepatic or extrahepatic ductal dilatation. SPLEEN: No significant abnormality notedPANCREAS: Stable subcentimeter cystic focus in the pancreas.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality noted. No filling defects of the ureters. No evidence of hydronephrosis bilaterally.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Revisualization of a thickened, edematous bladder with mural enhancement compatible with cystitis, unchanged compared to prior exam. No evidence of upper urinary tract involvement.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Thickened, edematous bladder wall with mural enhancement compatible with cystitis. No evidence of involvement of the upper urinary tract. 2.Stable subcentimeter cystic focus in the pancreas. |
Generate impression based on findings. | Primary CNS lymphoma CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Stable reference right hilar lymph node best seen on image 46 of series 3 measuring 1.2 x 0.9 cm.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: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Stable examination; no new adenopathy. |
Generate impression based on findings. | Reason: Evaluate for renal stone versus appendicitis. Has right lower quadrant pain. Worsening and radiating to right flank now. History: Has right lower quadrant pain. Worsening and radiating to right flank now. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No suspicious focal liver lesions. No evidence of intrahepatic or extrahepatic ductal dilatation. Status post cholecystectomy. Stable subcentimeter cystic foci in the head neck and tail of the pancreas.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality noted. No evidence of hydronephrosis bilaterally. No evidence of hydroureter. No evidence of ureteral stones although sensitivity is limited by the administration of IV contrast.RETROPERITONEUM, LYMPH NODES: Scattered subcentimeter retroperitoneal lymph nodes.BOWEL, MESENTERY: Scattered mesenteric lymph nodes. Appendix is visualized and appears normal. No evidence of surrounding inflammatory changes.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality noted. Presumed functional cyst of the right adnexa without associated inflammatory changes given this patient's age.BLADDER: Bladder is collapsed.LYMPH NODES: Scattered inguinal lymph nodes bilaterally.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.No evidence of acute appendicitis.2.Probable functional cyst of the right adnexa without associated inflammatory changes.3.Within the limitation of an IV contrast study, there is no evidence of ureteral stones. No evidence of hydroureter or hydronephrosis. |
Generate impression based on findings. | Rectal carcinoid ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Left lobe segment two benign hemangioma best seen on image 20 of series 11 measuring 1.1 x 1.2 cm.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Uterus absent or atrophicBLADDER: No significant abnormality notedLYMPH NODES: Mildly enlarged mesenteric lymph nodes. A representative pelvic mesenteric lymph node best seen on image 95 of series 11 measures 1.1 x 0.8 cm.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Mildly enlarged pelvic mesenteric lymph nodes. Special attention to these nodes on future surveillance scans suggested. Otherwise unremarkable examination. |
Generate impression based on findings. | Chronic renal disease; evaluate for nephrolithiasis and angiomyolipoma ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Stable cholelithiasisSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable left renal angiomyolipoma best seen on image 42 series 4 measuring 0.8 x 0.8 cm. No acute inflammatory process, obstruction, or renal stone.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: IUDBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Trace ascites; likely physiologic.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Stable left renal benign angiomyolipoma. No evidence for acute GU related abnormality. Specifically, no evidence for renal obstruction or nephrolithiasis. |
Generate impression based on findings. | Anal carcinoma ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Stable peripheral segment two left lobe low attenuation focus best seen on image 12 series 3 measuring 0.4 x 0.7 cm.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Status post hysterectomy. Previously noted vaginal cuff cul-de-sac soft tissue focus no longer present.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Mild soft tissue prominence adjacent and lateral to the inferior left vaginal fornix best seen on image 126 of series 3. | Status post hysterectomy and resection of vaginal cuff/cul-de-sac mass lesion. Mild soft tissue prominence adjacent and lateral to the inferior left vaginal fornix; while this may represent postoperative change, special attention to this area on future surveillance scans suggested. |
Generate impression based on findings. | Reason: 74 yo F with septic shock and abdominal pain, please eval for diverticulitis, cholecystitis, or intrabdominal abscess History: as above ABDOMEN:LUNG BASES: Mild pleural effusions bilaterally with overlying atelectasis.LIVER, BILIARY TRACT: Cholelithiasis without gallbladder wall thickening. In the context of ascites, evaluation for gallbladder pathology is limited. Ultrasound could be useful for further evaluation of gallbladder.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Hypodense lesions in bilateral kidneys are likely cysts. Atrophic kidneys with diminished nephrogram consistent with known renal failure.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the descending aorta and bilateral iliac arteries.BOWEL, MESENTERY: No significant abnormality noted. Appendix is within normal limits.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormalities noted.BLADDER: A Foley catheter balloon is visualized. Air within the bladder is likely secondary to Foley catheter manipulation.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Tube with balloon is visualized within the rectum. No evidence of diverticulitis. No evidence of drainable fluid collections.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of pelvic fluid. | 1.Cholelithiasis without gross evidence of acute cholecystitis. Interpretation of gallbladder pathology is difficult in the context of ascites. Ultrasound could be useful for further evaluation of gallbladder.2.No evidence of diverticulitis. |
Generate impression based on findings. | Reason: evaluate fluid collections History: evaluate fluid collections ABDOMEN:LUNG BASES: Moderate left-sided pleural effusion with overlying atelectasis/consolidation. LIVER, BILIARY TRACT: Mosaic attenuation of the liver diffusely is suggestive of parenchymal dysfunction/fatty infiltration. Hepatic vasculature is patent. No evidence of cholelithiasis. Evidence of intrahepatic or extrahepatic ductal dilatation. Stable, small subcentimeter hypodense lesion in periphery of the right lobe of the liver, segment 5 (series 10272, image 49).SPLEEN: No significant abnormality noted. Interval decrease in size of fluid collection around the spleen. Drainage catheter is visualized within the residual fluid collection.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mildly prominent mesenteric lymph nodes.BONES, SOFT TISSUES: Large midline anterior abdominal wound containing packing material in wound VAC. Slightly inferior collection in the left hemiabdomen contains a drain and is near completely resolved. A third drain in the anterior left hemiabdomen is unchanged in position and does not associate with fluid collection. Diffuse anasarca.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Air within the bladder is presumably secondary to Foley catheter manipulation.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Large loculated fluid collection in the cul-de-sac remains unchanged.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Fluid collection around the spleen with interval decrease in size.2.Left mid hemiabdomen fluid collection with near complete resolution.3.Unchanged loculated fluid collection in the pelvis.4.Left anterior hemiabdomen drain does not appear to be communicating with the level of collection.5.Fatty liver with perfusion abnormalities but patent vasculature again demonstrated.6.Large ventral body wall defect with overlying wound VAC. |
Generate impression based on findings. | Reason: evaluate for possible worsening pulmonary nodules vs. septic emboli; also evaluate for etiology of tender abdomen with guarding History: progressive SOB, increased opacities seen on CXR, abdominal distention 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: Subcentimeter hypodense lesion in the left lobe of the thyroid. Right upper lobe subpleural spiculated mass with the small cavitary component has decreased in size. There are additional left upper and right lower lobe nodules appear similar to prior. Pulmonary granulomata and small right pleural effusion. Right basilar consolidation is like secondary to compressive atelectasis. MEDIASTINUM AND HILA: Borderline enlarged mediastinal lymph nodes. Cardiomegaly.CHEST WALL: Small loculated fluid collection in the soft tissue adjacent to the central line is suspicious for abscess (series 3, image 12).ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis. In the setting of ascites and a noncontrast study, gallbladder pathology is difficult to characterize.SPLEEN: Punctate calcifications consistent with granulomata.PANCREAS: No significant abnormality notedADRENAL GLANDS: Subcentimeter left adrenal nodule.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Moderate amount of ascites.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Right inguinal hernia containing ascites and some soft tissue component.OTHER: Moderate amount of pelvic ascites. | 1.Interval decrease in size of right upper lobe spiculated mass. Interval improvement is suggestive of infection.2.Cholelithiasis. In the context of ascites and a noncontrast study, interpretation of gallbladder pathology is difficult. Ultrasound is could be useful for further evaluation.3.Moderate amount of ascites. |
Generate impression based on findings. | Cellulitis to anterior suprapubic area, sepsis. Assess for cellulitis versus deeper infection. There is reticulation of the subcutaneous fat of the mons pubis extending to the perineal/labial region inferiorly, along the suprapubic subcutaneous fat superiorly, and into the right flank region. The reticulation extends to the abdominal wall musculature as well as the proximal adductor musculature of the right thigh but no focal fluid collections are seen in the subcutaneous fat or musculature itself. There is thickening of the overlying skin. These findings are compatible with cellulitis. Examination of the pelvic viscera is limited due to lack of oral and IV contrast but no gross abnormality is identified.The bones are within normal limits with chronic enthesopathic changes along the greater trochanter. There is a transitional lumbosacral vertebra. | Findings compatible with cellulitis as described above. |
Generate impression based on findings. | Reason: appy v ovarian cyst v other History: infraumbilical pain for 1 day ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Punctate calcification in the left kidney may represent non obstructing nephrolithiasis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. Appendix is normal in appearance. No evidence of surrounding inflammation.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Bilateral adnexal cysts are likely functional given patient's age. No evidence of surrounding inflammation.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.No findings to explain patient's stated symptoms.2.Bilateral adnexal cysts with no evidence of surrounding inflammation are likely functional given patient's age. 3.No evidence of acute appendicitis. |
Generate impression based on findings. | 57-year-old female status post cervical fusion revision now with hand clumsiness. Hardware components of occipital-axial fusion in near-anatomic alignment without radiographic evidence of complication. The surgical screw extending into the right C2 lamina has been replaced with a shorter thicker screw which no longer protrudes into the epidural space. Tiny foci of air present within the bony spinal canal at the level of T2 and intracranially are likely postoperative. Scattered subcutaneous air indicating recent surgery.The previously discussed upper cervical spine changes are stable, although the odontoid tip seems to project higher than the posterior aspect of the clivus, which may be due to patient positioning. The cervical spine is similarly hyperextended. No significant neuroforaminal stenosis identified. The previously seen cervical cord cyst cannot be evaluated on this study. The cervical vertebral bodies heights are normal. No acute fractures or subluxations.The prevertebral soft tissues are within normal limits. | 1.Postsurgical changes as described above without evidence of acute complication. |
Generate impression based on findings. | Reason: hx of prostate ca, fever of unknown origin. r/o occult infection/abscess or malignancy History: fever of unknown origin CHEST:LUNGS AND PLEURA: Small focus of air space consolidation in the left lung lingula (series 4, image 43). Small bilateral pleural effusions.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without evidence of cholecystitis. Hypodense lesion in the right lobe of the liver, segment 7 is presumably a hepatic cyst.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: Cystic lesion in the L3 vertebral body.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Small focus of air space consolidation in the left lung lingula is suggestive of focal infection. This may include fungal etiologies particularly at the patient is immunocompromised. |
Generate impression based on findings. | Reason: stone History: pain ABDOMEN: Within the limitations of a non-IV contrast enhanced examination which limits evaluation of solid organ parenchyma and vascular structures, the following observations can be made:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Fatty, enlarged liver without focal liver lesions. Gallbladder appears opacified with soft tissue density.SPLEEN: No significant abnormality notedPANCREAS: Enlargement of the pancreatic head and blunting of the uncinate process with surrounding fat stranding suggestive of pancreatitis. No surrounding fluid collection.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Punctate calcification in the left kidney likely represents non obstructing nephrolithiasis. No evidence of hydronephrosis bilaterally. Mild fat stranding about the right kidney.RETROPERITONEUM, LYMPH NODES: Scattered subcentimeter retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted. Normal-appearing appendix.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 | Enlargement of the pancreatic head and blunting of the uncinate process with mild surrounding fat stranding suggestive of pancreatitis. No surrounding fluid collection.Findings were communicated to the ER over the phone by Dr. Chang at 9:22 a.m. on 10/12/2013. |
Generate impression based on findings. | Reason: ? fluid collection around abdominal drain History: fluid leaking from around drain site ABDOMEN:LUNG BASES: A moderate to large right-sided pleural effusion with overlying atelectasis.LIVER, BILIARY TRACT: Status post resection of the right lobe of the liver. Mixed density perihepatic fluid with mixed foci of gas likely reflecting a component fluid collection. Interpretation of gas presence is difficult given the placement of a drain. No definite loculation or discrete enhancing rim to suggest abscess.Hypodense, subcentimeter lesion in the left lobe of the liver is too small to further characterize (series 3, image 12). Unchanged, hypodense cyst in the left lobe of the liver measuring 1.1-cm (series 3, image 18). Biliary stent.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Subcentimeter hypodense lesion in the right kidney is too small to further characterize (series 3, image 57).RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Subcentimeter bone cysts in the right femoral head.OTHER: No significant abnormality noted | 1.Status post resection of the right lobe of the liver. 2.Mixed density perihepatic fluid with foci of air likely represents postoperative fluid collection. Foci of air may be secondary to surgical drain but clinical correlation for infection is recommended as air can represent abscess formation. |
Generate impression based on findings. | Reason: intrabdominal abnormal, check colonic stent placement History: hematochezia ABDOMEN:LUNG BASES: Bilateral pleural effusion, right greater than left with overlying atelectasis/consolidation.LIVER, BILIARY TRACT: Stable hypodense lesion in the right lower liver (series 3, image 42). SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Subcentimeter exophytic hypodense lesion in the right lower pole of the kidney remains unchanged.RETROPERITONEUM, LYMPH NODES: IVC filter. Atherosclerotic calcification of the aorta and bilateral iliac arteries. Ectatic proximal celiac artery measures 1.2 cm in diameter and remains grossly unchanged.BOWEL, MESENTERY: Interval placement of bowel stent. Upstream small bowel and colonic distention with a minimal improvement. Mildly prominent mesenteric lymphadenopathy, similar to the prior exam.Extensive peritoneal calcification around the liver, spleen, and mesentery is consistent with known metastatic ovarian cancer.BONES, SOFT TISSUES: Sclerotic lesion in T11 vertebral body remains unchanged. Mixed lytic/sclerotic appearance of the left pelvis remains unchanged. Sclerotic foci of the right pelvis remains unchanged.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Calcified pelvic mass remain stable in size. Calcification in the rectosigmoid mesentery.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Diffuse calcified peritoneal disease consistent with known metastatic ovarian cancer remains unchanged.2.Interval placement of colonic stent with minimal resolution of proximal colon and small bowel dilatation.3.No significant change in bony metastatic lesions.4.Stable hypodense lesion in the right lobe of the liver liver.5.Relatively stable right and left pleural effusions. |
Generate impression based on findings. | Reason: aneurysm vs other cause for abd pain History: pain and distension ABDOMEN:LUNG BASES: Paraseptal and central lobular emphysematous changes. Mild bronchiectasis.LIVER, BILIARY TRACT: Hepatic cyst in the left lobe of the liver and hepatic cysts in the right lobe of the liver remain stable compared to prior exam. Small subcentimeter hepatic cyst in the right lobe of the liver, stable. Cholelithiasis without evidence of cholecystitis. No intrahepatic or extra hepatic ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: Multiple subcentimeter pancreatic cyst.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable benign renal cysts in the left kidney.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the descending or aorta and bilateral iliac arteries. Infrarenal aorto bi-iliac stent with small mural thrombus within the graft lumen. Stable calcification in the unopacified infrarenal aortic aneurysm sac. Chronic celiac axis origin occlusion.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diverticulosis of the descending colon without evidence of diverticulitis.BONES, SOFT TISSUES: Degenerative changes to L5-S1 disk space with vacuum disk phenomenon. Degenerative changes at L3-L4 disk space.OTHER: Surgical clips anterior to right femoral vessels. | 1.Infrarenal aortic stent graft is unchanged with a small amount of mural thrombus in the graft lumen.2.Stable unopacified infrarenal aortic aneurysm sac.3.Unchanged occlusion of the celiac trunk with retrograde filling of its branches.4.Cholelithiasis without evidence of cholecystitis. |
Generate impression based on findings. | Reason: abd pathology History: Status post D&C one week ago with pain and fevers ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No evidence of cholelithiasis. No suspicious focal liver lesions. No intrahepatic or extrahepatic 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: Dilated air filled colon reaching the upper limit of normal in diameter suggests developing ileus.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Enlarged uterus with intrauterine fluid and prominent endometrial cavity consistent with provided history of postoperative status.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Large heterogeneous pelvic fluid collection compatible with hematoma is best appreciated on coronal views aerated and measures 14 x 9 cm (series 80596, image 58). In the superolateral portion of the collection is of lower density 7-cm low-density focus with thin enhancing rim and no internal gas. This likely represents degrading blood products in the hematoma but in the setting of fevers a developing abscess cannot be entirely excluded.The colon is air-filled and at the upper limit of normal in diameter which may represent a developing ileus.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Complex, large heterogeneous fluid collection with cystic components in the pelvis with a thin enhancing rim is compatible with evolving hematoma. Secondary infection cannot be ruled out. |
Generate impression based on findings. | Reason: eval for peri-rectal abscess History: peri-rectal tender to palpation, fluctuance, iduration PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality notedLYMPH NODES: No significant lymphadenopathy.BOWEL, MESENTERY: Colonic diverticula without evidence of diverticulitis.BONES, SOFT TISSUES: Perirectal induration, edema and fat stranding of the soft tissue of the right buttock compatible with cellulitis. There is no drainable fluid collection.OTHER: No significant abnormality noted | Perirectal induration of the soft tissue of the right buttock compatible with cellulitis. There is no drainable fluid collection. The fistula is clinically suspected, MR would be useful. |
Generate impression based on findings. | Female 53 years old Reason: eval for stone History: R flank pain. Exam is not sensitive for detecting lesions in the bowel solid organs due to the lack of oral intravenous contrast. Given those limitations, the following observations are made:ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Cholecystectomy clips. Otherwise unremarkable.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Punctate calcifications redemonstrated left kidney. Scarring lateral aspect left kidney, unchanged. These are of uncertain significance but unchanged since 2011. The no evidence of nephrolithiasis along the course of the ureters. No hydronephrosis or hydroureter. No perinephric fat stranding.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications, no evidence of aneurysm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: The small amount of air is seen in the fundus of the uterus. Correlate clinically.BLADDER: No evidence of nephrolithiasis along the course of the distal ureters or urinary bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Punctate calcifications left kidney unchanged. Scarring left kidney unchanged. No evidence of hydronephrosis.Small amount of air in the uterine fundus. Correlate clinically.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Female 35 years old; Reason: diffuse abdominal pain History: abdominal pain, nausea, vomiting ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: 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: The uterus is markedly distended with fibroids. The bilateral adnexa are unremarkable.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.Leiomyomatous uterus. Otherwise, no CT evidence for patient's abdominal pain. |
Generate impression based on findings. | Female 67 years old; Reason: stone? History: L flank pain ABDOMEN: The absence of intravenous and oral contrast limits evaluation of the solid organs and of the bowels. Given these limitations, the following observations were made: LUNG BASES: Bibasilar scarring/atelectasis.LIVER, BILIARY TRACT: Multiple hypoattenuating lesions in the liver areincompletely characterized but may represent simple cysts. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: The right adrenal gland is nodular, and measures less than 10 Hounsfield units, suggesting an adenoma.KIDNEYS, URETERS: Hypoattenuating lesion in the superior pole of the left kidney with thininternal septation is incompletely characterized by likely represents a benign complexcyst. Multiple subcentimeter hypodensities in the kidneys are too small to characterize,but likely represent simple cysts. Lower pole right renal lesion is hyperattenuating and likely represents an hemorrhagic cyst. Partially duplicated right collecting system.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small hiatal hernia. The cecum is located near themidline. Oral contrast reaches the cecum. No evidence to suggest obstruction. No freeintraperitoneal air or portal venous gas. No no focal mass lesions are identified.BONES, SOFT TISSUES: Foci of gas density in noted within the central spinal canal at thelevel of the L3/L4, most consistent with a disc protrusion.OTHER: Cardiomegaly. Prominent pericardial lymph node.PELVIS:UTERUS, ADNEXA: Calcified fibroid.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diverticulosis, without evidence of diverticulitis. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. No renal stone or ureteral stone is clinically questioned. Stable bilateral renal cysts.2. Leiomyomatous uterus unchanged3. Right adrenal adenoma |
Generate impression based on findings. | Female 44 years old Reason: eval appendicitis History: RLQ pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: Prominent endometrial cavity distorted by the multiple noncalcified masses likely fibroids. Correlate clinically.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No evidence of bowel thickening or dilatation. No free or loculated intraperitoneal fluid. No CT signs of appendicitis. Normal appearing appendix is visualized.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No evidence of appendicitis. Multiple uterine masses noncalcified nonspecific but likely fibroids. Prominent endometrial cavity maybe related to compression and partial obstruction by the fibroids. Correlate clinically. |
Generate impression based on findings. | Female 89 years old; Reason: obstruction? constipation? History: no bm, pain ABDOMEN:LUNGS BASES: Bilateral dependent atelectasis with scarring in the left lung base. No nodule or mass detected.LIVER, BILIARY TRACT: The liver is normal in size and morphology. Small hypoattenuating lesions too small to characterize are noted throughout the liver. Focal adenomyomatosis of the gallbladder seen (series 3 image 50). No evidence of cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: Small hypoattenuating lesion (series 3 image 27) in the body of the pancreas is noted, incompletely characterized on this CT examination.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Numerous too small to characterize lesions in the kidneys. No hydronephrosis or hydro-ureter. No perinephric fluid collections.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Extensive stool noted throughout the bowel. No mass detected. No Evidence of obstruction or free air seen.BONES, SOFT TISSUES: Grade 2 age indeterminant compression deformity noted at T12..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: Extensive stool noted throughout the bowels. No mass detected. No Evidence of obstruction or free air seen.BONES, SOFT TISSUES: Grade 2 age indeterminant compression deformity noted at T12..OTHER: No significant abnormality noted. | 1.Large fecal burden suggesting constipation without evidence of obstruction or free air.2.Small hypoattenuating lesion in the body of the pancreas, incompletely characterized on this examination and may suggest IPMN. MRI/ M.R.C.P. could help characterize lesion3.Age indeterminant compression deformity of T12. |
Generate impression based on findings. | Female 60 years old Reason: eval aortic pathology History: abd pain, back pain, cp.Additional history CT technologist left flank pain. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Normal caliber aorta with no evidence of aneurysm or dissection.CHEST WALL: No significant abnormality noted.ABDOMEN: The exam is limited for detection of disease in the bowel and solid organs due to lack of oral contrast and portal venous phase. Given that limitation, the following observations may: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: Pre-IV contrast no evidence of nephrolithiasis. Extrarenal pelvis on the left.RETROPERITONEUM, LYMPH NODES: No evidence of aneurysm or dissection. Minimal atherosclerotic calcifications.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: 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: Postsurgical and/or posttraumatic changes right groin. Bullet fragment in muscles lateral to the ischium on the right. | No evidence of aneurysm or dissection. Bullet fragment and postsurgical changes are right pelvis soft tissues. |
Generate impression based on findings. | Male 74 years old Reason: s/p ex-lap for SBO requiring take back, washout transferred from OSH intubated, sedated, on pressors History: same Exam is insensitive detecting lesions in the bowel solid organs due to the lack of oral or intravenous contrast. Also streak artifacts as the patient cannot raise her arms. Given these limitations, the following observations are made:CHEST:LUNGS AND PLEURA: Moderate-sized bilateral pleural effusions and adjacent atelectasis.MEDIASTINUM AND HILA: ET tube. NG tube. Coronary artery calcifications.CHEST WALL: Gynecomastia.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Parapelvic cysts bilaterally. These are better seen on the delayed images from the outside CT of 8/23/12 series 4. (NO hydronephrosis). RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Percutaneous gastrostomy tube. Massive generalized ascites there is loculation suggested. Infected fluid collections cannot be excluded.Some foci of pneumoperitoneum likely related to the recent surgery but correlate with duration since surgery.BONES, SOFT TISSUES: Anasarca. Postsurgical changes anterior abdominal wall.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Massive generalized ascites. No evidence of bowel obstruction.BONES, SOFT TISSUES: Anasarca. Postsurgical changes anterior abdominal wall.OTHER: No significant abnormality noted | Massive generalized ascites with loculation. Small amount of intraperitoneal air probably related to the recent surgery. Infected fluid collections cannot be excluded. Anasarca. Pleural effusions. Postsurgical changes. Other findings as above. |
Generate impression based on findings. | Female 71 years old Reason: 71 yo F with hx of ESRD on HD, recurrent GI bleed 2/2 small bowel source, s/p DBE 10/10 demonstrating duodenal lesion, evaluate for submucosal lesion vs mass lesion History: bleeding 2/2 small bowel source, duodenal lesion on double balloon enteroscopy needing CT enterography for further evaluation. ABDOMEN:LUNG BASES: Heavy calcifications in the region of the left AV valve. Correlate with surgical history. A moderate-sized right pleural effusion. Basilar atelectasis or consolidation left lower lobe and calcific granuloma left lower lobe.LIVER, BILIARY TRACT: Few scattered small hypodensities, likely cysts. Cholecystectomy clips. No biliary dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Atrophic kidneys consistent with chronic medical renal disease. Scattered calcifications probably vascular. Stat scattered small hypodensities too small to characterize probably cysts.RETROPERITONEUM, LYMPH NODES: Heavy atherosclerotic disease aorta branch vessels.BOWEL, MESENTERY: A 1cm nodular density in the proximal duodenum may correspond to the patient's endoscopically visualized submucosal mass. See series 15 image 66/160. There is no evidence of bleeding on arterial or venous phases.No other masses are seen.BONES, SOFT TISSUES: Anasarca.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: Atrophic.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Massive generalized ascites. Bowel is normal.Nodular density in the dependent portion of the right hemipelvis series 15 image 120. This is concerning for carcinomatosis.BONES, SOFT TISSUES: Anasarca.OTHER: Heavy atherosclerotic disease. Probably occluded right iliac system. Patent fem-fem graft. | No bleeding site seen. Probable duodenal mass. Massive ascites and concern for focus of carcinomatosis. Patent fem-fem graft. Anasarca. Chronic medical renal kidneys. Probable hepatic cysts. Other findings as above. |
Generate impression based on findings. | Female 66 years old; Reason: Assess disease progress History: abdominal distension; CHEST:LUNGS AND PLEURA: No focal consolidation. Biapical scarring. Stable 4-mm right lower lobe nodule (series 5 image 54). Additional scattered irregular micronodules bilaterally are nonspecific and stable. Emphysematous changes noted.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Right chest port with tip terminating at the caval atrial junction. Heartsize is normal without pericardial effusion. No mediastinal or hilar lymphadenopathy. Prominent left axillary lymph node is not enlarged by CT criteria and stable.ABDOMEN:LIVER, BILIARY TRACT: Punctate hepatic hyperdensities likely represent granulomas.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Mild left-sided hydronephrosis is stable from the prior exam. Thereis hydroureter on the left to the level of the mid ureter, also stable.RETROPERITONEUM, LYMPH NODES: Overall stable retroperitoneal lymphadenopathy. A leftperiaortic node measures 1.1 x 1.1 cm(3/124), from 1.0 x 1.1 cm centimeters previously. Additional non referenced periaortic nodules are also stable in size.BOWEL, MESENTERY: Peritoneal and omental nodularity is stable from the prior exam. A Referenced1.0-cm high attenuation peri-splenic round nodule appears stable.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: UTERUS, ADNEXA: Status post hysterectomy and oophorectomy. Stable left adnexal cyst measures 2.8x 1.7 Cm (3/156).PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality noted.LYMPH NODES: Small scattered pelvic lymph nodes are stable from the prior exam.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild degenerative changes of lumbar spine. Lucency adjacent to theL2 superior endplate is stable and likely degenerative.OTHER: No significant abnormality noted. | 1.Stable omental and peritoneal carcinomatosis.2.Stable lymphadenopathy in the retroperitoneum and pelvis.3.Stable nonspecific scattered irregular pulmonary nodules and micronodules, continued follow-up is recommended.4.Stable left sided mild hydronephrosis with ureteral dilatation to the mid ureter is ofunknown etiology.5.Stable high attenuation peri-splenic round nodule. |
Generate impression based on findings. | Female 51 years old; Reason: 51yo female with stage III ovarian CA, s/p surgery and chemotherapy. assess for disease progression History: as above CHEST:LUNGS AND PLEURA: Few scattered pulmonary micronodules are unchanged. The pleural spacesare clear. Central airways are patent.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. No mediastinallymphadenopathy.Right chest wall port terminates at the distal SVCCHEST 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 retroperitoneal lymphadenopathy. There are multiple smallretroperitoneal clips at the aortic caval space compatible with prior lymph node dissection.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomyBLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Stable exam without evident recurrent disease. |
Generate impression based on findings. | Reason: concern for abscess of the leg History: discharge s/p Left hip core decompression with autologous bone grafting CT of the left hip demonstrates a partially loculated fluid collection under left hip scar measuring approximately 4.2 x 1.3 x 1.3 cm (series 80393, image 40). There is surrounding hyperenhancement and fat stranding. This may represent early abscess formation. The fluid collection and surrounding hyperenhancement involves a portion of the left vastus lateralis muscle.The left femoral head demonstrates deformity and features compatible with avascular necrosis. A tubular lucency extending through the left proximal femoral head and neck is compatible with prior core decompression with bone graft placement. | Subcutaneous fluid collection involving lateral hip suspicious for early abscess as described above. |
Generate impression based on findings. | Female 68 years old Reason: Patient with treatment related aml with neutropenic sepsis, now with worsening mental status and lactic acidosis. Please evaluate for abdominal sources of infection; had perinephric stranding on previous CT History: Tachypnea, AMS The exam is not sensitive for detecting lesions in the bowel or solid organs due to lack of oral or intravenous contrast. Patient unable to raise arms causing streak artifact. Given those limitations, the following observations are made:ABDOMEN:LUNG BASES: Extensive bilateral pleural effusions and atelectasis or consolidation. Opacities right middle lobe as well. Correlate for pneumonia. Pulmonary edema.LIVER, BILIARY TRACT: Gallbladder is surgically absent. Given limitation, no obvious biliary dilatation or focal liver 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: Nasal enteric tube in stomach. No evidence of obstruction. No intramural air or free air. Mild haziness mesentery with mild panniculitis like appearance of uncertain significance.OTHER: No significant abnormality notedPELVIS: Limited by streak artifact from the right hip arthroplasty.UTERUS, ADNEXAE: Atrophic or surgically absent.BLADDER: Air with Foley catheter in place.LYMPH NODES: Surgical clips consistent with lymph node dissection. No pathologic size nodes.BOWEL, MESENTERY: Postsurgical changes pelvis. No evidence of obstruction. Small amount of ascites in the dependent portion of the pelvis.BONES, SOFT TISSUES: Right hip arthroplasty. Postsurgical changes anterior abdominal wall. Mild anasarca.OTHER: No significant abnormality noted | Bilateral pleural effusions and airspace opacities. Correlate clinically. Small amount of ascites. No loculation to suggest abscess. Anasarca. Postsurgical changes. |
Generate impression based on findings. | Female 84 years old; Reason: 84 yr old patient with ovarian cancer eval disease process. please compare to prior scan History: none The absence of intravenous and oral contrast limits evaluation of the solid organs and of the bowels. Given these limitations, the following observations were made: ABDOMEN:LUNG BASES: Scarring is seen in the left lung base. The previously noted pulmonary nodule in the right middle lobe (series 8 image 4) is stable. No new nodule or mass detected.LIVER, BILIARY TRACT: Pneumobilia is unchanged from the prior study. No focal liverlesions are identified. Punctate calcifications in the inferior right liver likelyrepresent calcified granulomas.SPLEEN: No significant abnormality notedPANCREAS: Previously seen air within the pancreatic duct has resolved.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral hypodense kidney lesions are unchanged from the prior studyand likely represent simple cysts.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications are seen throughout the aortaand its branches.BOWEL, MESENTERY: The previously described mass in the gastrocolic ligament is not significantly changed from the prior study and measures 2.5 x 2.8 (series 7 image 34) previously 2.9 x 2.1 cm.BONES, SOFT TISSUES: L2 Schmorl's node is unchanged.PELVIS:UTERUS, ADNEXA: The uterus is atrophic or absent.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: The previously referenced soft tissue mass adjacent to therectosigmoid junction is smaller in size and now measures 2.5 x 3.8 cm (series 7 image 83) previously4.1 x 3.4 cm. The previously referenced small bowel mesenteric mass has also decreased in size and now measures 3.6 x 2.3cm (series 7 image 68) previously 3.6 x 3.0 cm.A new mesenteric nodule in the right lower quadrant adjacent to the small bowel is noted, measuring 3.5 x 3.3 cm (series 7 image 65). | 1. Stable to slight decrease in size of the previously referenced lesions.2. New soft tissue small bowel mesenteric mass in the right lower quadrant as described above. |
Generate impression based on findings. | Male 63 years old Reason: r/o bleed History: s/p LVAD, low Hgb Exam is not sensitive for detecting lesions in the bowel, solid organs of vasculature due to lack of oral or intravenous contrast. Given those that limitation, the following observations are made:CHEST:LUNGS AND PLEURA: Bibasilar atelectasis and scarring, increased compared to the prior exam.MEDIASTINUM AND HILA: ET tube in place. Sternal fixation device. Left ICD in place.CHEST WALL: No significant abnormality notedABDOMEN: In addition to the above limitations, streak artifact from LVAD device limits upper abdomen.LIVER, BILIARY TRACT: Nonspecific calcific focus in the right lobe of the liver, linear in configuration is unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No evidence of retroperitoneal hemorrhage. No evidence of aneurysm. Minimal atherosclerotic calcifications. No pathologic size nodes.BOWEL, MESENTERY: Small amount of ascites particularly perihepatic.BONES, SOFT TISSUES: Postsurgical changes in the abdominal wall.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Foley catheter in place with some air in the urinary bladder presumably from instrumentation.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant intraperitoneal fluid to suggest hemorrhage.BONES, SOFT TISSUES: Degenerative changes. No lytic or blastic disease.OTHER: Right femoral venous catheter. | Perihepatic fluid of uncertain significance. No evidence of retroperitoneal hemorrhage. Increasing bibasilar atelectasis or consolidation. Other findings as above. |
Generate impression based on findings. | Reason: Please evaluate for PE History: tachycardia, chest pain, dilated PA on CXR PULMONARY ARTERIES: Technically adequate examination. No acute pulmonary emboli identified. The main pulmonary artery is top normal in size without evidence of right heart strain.LUNGS AND PLEURA: Moderate centrilobular emphysema with basilar predominant peripheral reticular opacities is similar to previous. Multiple scattered benign appearing micronodules are present. No suspicious pulmonary nodules or masses are identified.MEDIASTINUM AND HILA: Normal heart size. Moderate calcification of the coronary arteries, aorta and its branches.The aorta is normal in caliber and taper without dissection. Small precarinal lymph nodes are identified and are similar to previous.Small hiatal hernia. CHEST WALL: Non-displaced left anterolateral six and seventh rib fractures are new from the prior exam. No additional osseous lesions are identified.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Small bilateral hypoattenuating renal lesions are likely cysts, unchanged. | 1. No pulmonary embolus. 2. Emphysema similar to prior.3. New left anterolateral sixth and seventh rib fractures. |
Generate impression based on findings. | Reason: PE? History: hypoxemia and tachycardia PULMONARY ARTERIES: Technically adequate examination. No pulmonary emboli are identified.The main pulmonary artery is normal in size without evidence of right heart strain.LUNGS AND PLEURA: Mild-moderate centrilobular emphysema is present. There are linear streaky opacities at the lung bases most likely representing atelectasis.No suspicious nodules or masses are identified. MEDIASTINUM AND HILA: Normal heart size without pericardial effusion.Mild bilateral hilar lymphadenopathy is present and is nonspecific.A small hiatal hernia is present.CHEST WALL: Mild bilateral axillary lymphadenopathy is present.There is a right peri-areolar fluid density lesion likely representing a cyst. This can be further evaluated with mammography if clinically indicated.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. An accessory spleen is noted. | 1.No pulmonary embolism.2.Mild bilateral axillary lymphadenopathy and right peri-areolar fluid density lesion which can be evaluated with mammography if clinically indicated. 3.Mild-moderate centrilobular emphysema. |
Generate impression based on findings. | Female 47 years old Reason: w h/o crohn's disease, now with enterocutaneous fistulas History: enterocutaneous fistulas ABDOMEN:LUNG BASES: Bibasilar atelectasis or consolidation.LIVER, BILIARY TRACT: Cirrhotic morphology. No definite focal lesions. Small amount of perihepatic fluid.SPLEEN: Splenomegaly 14.7 cm cephalocaudad as measured on coronal image 49.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: High density material pooling in the wound on series 2 image 102. Uncertain if this represents portion of the iodinated gauze pad. There is little if any positive contrast in the bowel but some is seen in the distribution of the duodenum raising the question as to whether this represents a orally administered contrast exiting the wound via a fistulous communication.Nasoenteric tube in stomach. Postsurgical changes with right lower quadrant ostomy.BONES, SOFT TISSUES: Anterior abdominal wound with packing and surgical drains.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: Persistent hypodense lesion right adnexa consistent with cysts a cystic lesion measuring about 2.4 x 2.4 cm is seen on coronal image 43. Correlate clinically and with ultrasound if clinically indicated.BLADDER: Foley catheter in place.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Expected postsurgical changes. No free or loculated intraperitoneal fluid.Residual small bowel appears adhesed to the anterior abdominal wound. No evidence of obstruction however. Right lower quadrant ileostomy.BONES, SOFT TISSUES: Gaping anterior abdominal wound with packing and drainage tubes. OTHER: No significant abnormality noted | Cirrhotic morphology liver. Expected postsurgical changes bowel no evidence of obstruction. Possible enterocutaneous fistula at the surgical wound as detailed above. Left adnexal cyst or cystic lesion unchanged. Other findings as above. |
Generate impression based on findings. | Reason: r/o pe History: tachycardia, hypoxia PULMONARY ARTERIES: Study is slightly limited by patient motion but is technically adequate. No pulmonary emboli are identified.The main pulmonary is normal in size without evidence of right heart strain. LUNGS AND PLEURA: Bilateral moderate pleural effusions with associated basilar predominant compressive atelectasis are similar to previous. Groundglass opacities, right greater the left, have increased from the prior study and are non-specific. They may be related to pulmonary edema, infection, or given the patient's history of recent hemoptysis, could represent pulmonary hemorrhage.Moderate bilateral bronchial thickening is again noted.MEDIASTINUM AND HILA: Normal heart size without pericardial effusion.Soft tissue density surrounding the hila may represent pleural fluid tracking along hila, slightly decreased from prior study.No definite mediastinal or hilar lymphadenopathy.CHEST WALL: There is a destructive process involving the T9 and T10 vertebral bodies and posterior elements with surrounding soft tissue density, similar to previous. The etiology is unclear, but may relate to a infectious or malignant process.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Partially visualized right upper quadrant tubing likely represents cholecystostomy tube. Partially visualized G-tube. Hypodense hepatic segment 7/8 cyst, similar to previous. | 1.No evidence of pulmonary embolism.2.Bilateral moderate pleural effusions and associated compressive atelectasis, similar to previous.3.Increased bilateral groundglass opacities, right greater than left, nonspecific and may represent pulmonary edema, infection, or pulmonary hemorrhage.4.Destructive process involving T9 and T10 vertebral bodies and associated soft tissue density of unclear etiology, may represent infectious or malignant process, similar to previous. |
Generate impression based on findings. | Male 80 years old male with small cell lung cancer: eval for metastatic burden and biliary pathology History: obstructive labs CHEST:LUNGS AND PLEURA: Right apical dense consolidation and volume loss compatible with priorradiation therapy, unchanged. New moderate left pleural effusion, and trace right pleural effusion. Patchy ground glass opacities are noted throughout the lung fields bilaterally, also new since previous exam. No new mass detected.MEDIASTINUM AND HILA: Small right paratracheal lymph nodes are unchanged. Reference lymphnode measures 5 mm (series 3 image 32). Cardiac size is normal. No pericardial effusion.There is a sub occlusive thrombus in the residual right lower lobe pulmonary arterysegment (image 48, series 3), which is adherent to the wall and appears chronic inetiology.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Interval development of a small amount of perihepatic ascites. No nodule or mass detected in the liver.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Large, necrotic mass measures 9.2 x 8.8cm (image 86,series 3) previously 9.2 x 10.2 cm. The mass appears to enhance less than prior exam andis again seen abutting the pancreas, and left hepatic lobe.The soft tissue nodule in the right lower quadrant has increased in size, currentlymeasuring 3.0 x 2.7 cm (series 3 image 141) previously 2.7 x 2.7 cm.Another necrotic mass in the right lower quadrant has grown in retrospect, currently measuring 6.4 x 4.1 cm (series 3 image 128) previously 2.9 x 4.5 cm. There is a new large fluid collection with a focus of gas in the right lower quadrant and 7.1 x 6.3 cm (series 3 image 166) which does not appear to communicate with the bowel. No oral contrast is noted within the fluid collection.Interval placement of an IVC filter.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes are again seen in the lumbar spine. Multiplesmall foci of gas in the anterior soft tissues of the abdominal wall, likely fromsubcutaneous injections.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Severe degenerative changes affect both hips, worse on the right,with large subchondral cysts.OTHER: No significant abnormality noted | 1.Slight decrease in size of the large epigastric mass.2.Interval increase in size of right lower quadrant soft tissue masses.3. New large fluid collection with focus of gas in the right lower quadrant concerning for abscess. 4. New moderate left pleural effusion with scattered ground glass nodules in the lungs, also new.5.Chronic appearing segmental pulmonary artery thrombusDr. Bargren notified of the findings at 9:45am on 10/13/13 |
Generate impression based on findings. | Female 85 years old Reason: 85 year woman after CABG develops profound metabolic acidosis and distended abdomen; perforated or ischemic bowel suspected. History: respiratory distress (prompting intubation), abdominal discomfort Exam is not sensitive for detecting lesions in the solid organs, bowel vasculature the to the lack of oral or intravenous contrast. Given those limitations, the following observations are made:CHEST:LUNGS AND PLEURA: Bilateral pleural effusions with some suggestion of loculation. Extensive bibasilar atelectasis or consolidation. Correlate for left pneumonia.MEDIASTINUM AND HILA: Heavy atherosclerotic calcifications. Postsurgical changes.CHEST WALL: Postsurgical changes anterior chest wall. Some air in the subcutaneous tissues consistent with recent surgery.ABDOMEN:LIVER, BILIARY TRACT: Possible punctate focus of cholelithiasis. Some pericholecystic fluid may be part of more generalized process. I cannot absolutely exclude cholecystitis. No obvious biliary dilatation.SPLEEN: No significant abnormality noted. Heavy calcification splenic artery with no aneurysm seen.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Perirenal fat stranding extends into the retroperitoneum right greater than left. Probable cyst or right lower pole. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Generalized fat stranding right greater than left. No pathologic size lymph nodes. Heavy atherosclerotic calcification aorta and branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: Foley catheter in place.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small amount of ascites in the dependent portions of the pelvis. Fluid and edematous changes in the presacral space.BONES, SOFT TISSUES: Mild anasarca.OTHER: Heavy atherosclerotic calcifications. | Small amount of ascites. Fat stranding in the retroperitoneum slightly right greater than left with extension to the region of the gallbladder. I cannot exclude an inflammatory process involving gallbladder or less likely the right kidney. Possible cholelithiasis.Extensive bibasilar atelectasis or consolidation and associated pleural effusions.Postsurgical changes in the chest but air in the subcutaneous tissues likely related to the recent surgery.These findings were discussed with clinical service by the radiology resident on call is documented in the stat consult. |
Generate impression based on findings. | Female 74 years old; Reason: r/o abd/pelvic mass History: weight loss, and severe R LE edema ABDOMEN:LUNGS BASES: Patient status post cardiac surgery with pacemaker leads noted. Extensive calcification noted. Right lung base scarring noted.LIVER, BILIARY TRACT: The liver is normal in morphology and size. Numerous subcentimeter hypoattenuating lesions noted too small to reliably characterize. Gallstone noted within the neck of the gallbladder. No evidence of cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: Numerous cystic lesions are noted throughout the pancreas, with largest in the head measuring 4.4 x 3.2 cm (series 3 image 54). Stone is noted in the distal pancreas (series 3 image 54) with cystic lesions measuring 2.4 and 1.8 cm (series 3 image 55) distal to this stone.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The native kidneys are shrunken and atrophic. Transplant kidney noted in the right iliac fossa.RETROPERITONEUM, LYMPH NODES: Mild dilation of the abdominal aortic aneurysm measuring up to 2.2 cm is noted (series 80220 image 59) with extensive atherosclerotic disease.BOWEL, MESENTERY: Extensive diverticulosis without diverticulitisBONES, 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: Right iliac transplant kidney is seen without evidence of perinephric fluid collection or mass lesion. Small hyperattenuating lesion is noted, which likely represents a phlebolith (series 3 image 98). Hypoattenuating lesions seen within the kidney likely represent cysts. | 1.Numerous cystic lesions throughout the pancreas. MRI M.R.C.P. with warranted for full characterization2.status post transplant kidney in the right iliac fossa without evidence of mass lesion or perinephric fluid collection3.diverticulosis without diverticulitis4.focal aneurysmal dilation of the abdominal aorta with extensive atheromatous calcification. |
Generate impression based on findings. | Female 47 years old; Reason: Evaluate liver lesions - 3 were deemed to be hemangiomas on MRI but other lesions were seen on chest CT but not on MRI, also had lytic lesion on T4 on chest CT History: weight loss ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: A total of 3 lesions are noted in the liver in segments 4A, 6 and 8 which demonstrate discontinuous peripheral nodular enhancement and delayed fill-in compatible with hemangiomas. Few punctate too small to characterize hypoattenuating lesions are noted in the liver.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: IUD within the endometrial canal. Multiple fibroids of the uterus. Small left corpus luteal cyst. The right adnexa is unremarkable. Hypoattenuating lesion adjacent to the cervix likely represents a nabothian cyst.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.Total 3 hemangiomas in the liver with numerous too small to characterize lesions. |
Generate impression based on findings. | Reason: Infiltrate/consolidation, compare to previous imaging History: Worsening leukocytosis and continued fevers LUNGS AND PLEURA: Numerous bilateral, diffusely distributed pulmonary nodules are new from the 9/25/2013 study. Some of the nodules are cavitary (series 4, image 42). Given the time course, these are most likely infectious in etiology and may represent septic emboli of bacterial or fungal etiology.The moderate right pleural effusion with associated compressive atelectasis/consolidation has significantly increased in size from the previous study. There is a new left-sided small to moderate pleural effusion with associated atelectasis/consolidation.Diaphragmatic pleural and peritoneal calcifications are noted.MEDIASTINUM AND HILA: The heart is normal in size without pericardial effusion.Mild prevascular and pretracheal lymphadenopathy is nonspecific and similar to previous.An NG tube is present in the esophagus.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. An NG tube is noted with the tip extending beyond the caudal margin of the study. | 1.Numerous bilateral pulmonary nodules some of which are cavitary new from 9/25/2013 exam are most likely infectious in etiology and may represent septic emboli of bacterial or fungal etiology.2.Interval increase in right-sided pleural effusion and development of new left-sided pleural effusion with associated compressive atelectasis/consolidation. |
Generate impression based on findings. | Reason: progression of disease? esophagus patency with mass, lung pathology History: chest pain, dysphagia, history of lung cancer undergoing RT CHEST:LUNGS AND PLEURA: The reference right lower lobe mass measures 3.5 X 4.8 cm (series 5, image 66) and has increased in size from 2.1 x 2.8 cm, compatible with malignancy. A right middle lobe nodule measures 8 mm x 11 mm (series 5, image 40), unchanged from previous. Several other small scattered, predominantly subpleural micronodules are present. The largest of these in the lingula measures 3-mm (series 5, image 49), similar to previous.New bilateral diffuse groundglass opacities, right greater than left, are nonspecific and may represent edema, infection, or inflammatory changes.There is a new small right-sided pleural effusion.MEDIASTINUM AND HILA: Multiple enlarged lymph nodes are seen in the right infrahilar and subcarinal spaces. These are predominantly confluent masses. The subcarinal/paraesophageal mass measures approximately 4.7 x 3.1 cm (series 4, image 36), decreased from 6.0 x 3.7 cm previously. The right infrahilar lymph node mass measures 2.6 x 1.8 cm (series 4, image 45), decreased from 2.6 x 2.6 cm previously. Diffuse thickening of the esophagus has increased from the prior study and may be related to radiation esophagitis.CHEST WALL: Multiple nodular changes are seen in the thyroid, similar to previous. Post surgical changes seen in right axilla. No lymphadenopathy seen in either axilla. Changes of right chest wall suggestive of right breast surgery.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Hypodensities in the right and left lobes of the liver likely represent cysts and are similar to previous. SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Left adrenal gland appears thickened and with inferior lateral limb nodule measuring 1.9 x 1.4 cm, unchanged from previous. Right adrenal gland appears normal.KIDNEYS, URETERS: Bilateral hypoattenuating renal lesions likely representing cysts, unchanged.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Degenerative changes throughout the spine without focal osseus lesions, similar to previous. OTHER: No significant abnormality noted. | 1.Right lower lobe lung mass measuring 3.5 X 4.8 cm, increased from previous and compatible with malignancy. Additional right middle lobe nodule and lingular micronodule unchanged.2.Bulky right hilar and subcarinal lymphadenopathy compatible with metastatic disease, with decrease in size of reference lesions.3.New diffuse bilateral ground glass opacities, right greater than left, which are nonspecific and may represent edema, infection, or hemorrhage.4.Increased diffuse thickening of the esophagus may be related to radiation esophagitis. |
Generate impression based on findings. | Clinical question: Rule out bleed. Headache. Signs and symptoms: Headache in patient with history of aneurysm. Nonenhanced head CT:No detectable acute intracranial process. CT however is insensitive for detection of acute nonhemorrhagic ischemic strokes.Streak artifact from patient's previously placed aneurysm clips in the left parasellar region and coil embolization of right sided aneurysm results in extensive streak artifact in the immediate. Perianeurysmal region. Beyond streak artifact from metallic clips examination demonstrates postoperative changes of left frontal -- temporal craniotomy, several underlying left frontal and temporal encephalomalacia and mild ex vacuo malrotation of left frontal horn similar to prior exam.Unremarkable cerebral cortex, cortical sulci and ventricular system otherwise.All visualized paranasal sinuses and bilateral mastoid air cells and middle ear cavities are well pneumatized. | No acute intracranial findings. Expected postoperative changes of left frontal craniotomy for clipping of aneurysm. |
Generate impression based on findings. | Clinical question: Rule-out mass. Signs and symptoms: Rule out mass. New onset of seizure. Unenhanced head CT:There is no detectable acute intracranial process. There is no evidence of a mass, edema, midline shift, hydrocephalus.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation.Unremarkable calvarium, soft tissues of the scalp, paranasal sinuses, mastoid air cells and limited view of the orbits. | Negative nonenhanced head CT. |
Generate impression based on findings. | Clinical question: 67-year-old female with history of anaplastic anemia and thrombocytopenia presents with bacteremia and type I respiratory failure, new seizing. Signs and symptoms: Seizures. Nonenhanced head CT:Extensive streak artifact reduces the sensitivity of the exam for detection of subtle intracranial findings including subtle cerebral edema.Within this limitation however there is no evidence of acute intracranial process. CT is insensitive for detection of acute nonhemorrhagic ischemic strokes.Cortical sulci, CSF spaces and ventricular system remain within normal and midline is maintained.Consider follow-up with a repeat study with CT or MRI if patient's symptoms persist.Unremarkable calvarium and soft tissues of the scalp.Unremarkable images through the orbits and visualized paranasal sinuses. | Suboptimal exam due to streak artifact however no convincing evidence of any acute intracranial process. |
Generate impression based on findings. | Clinical question: Any change in ventricular size. Signs and symptoms: 17 year old male with NFl, VP shunt and headache. Nonenhanced head CT:Examination demonstrate interval increased size of supratentorial ventricular system. There is an isointense mass in the basal cistern which is very poorly defined and difficult to precisely measure. The mass over demonstrate no convincing evidence of interval change since prior study. Line there are bilateral ventricular catheters via frontal approach and weighted tips of both catheters in the body of the lateral ventricles similar to prior exam. No evidence of parenchymal hemorrhage or edema. There is however a slight further effacement of ventricular system secondary to interval increased ventricular size.Images through posterior fossa demonstrate widened subarachnoid space without interval change since prior exam and likely representing an arachnoid cyst. Associated mass effect on the cerebellum by this findings remains identical to prior exam. | 1.Interval increased size of supratentorial ventricular system with further effacement of cortical sulci.2.Stable bilateral frontal approach ventricular catheter and their position since prior exam.3.No convincing evidence of an isodense mass in the basal cistern and likely representing chiasmatic tumor.4.Stable large extra-axial CSF collection in the posterior fossa suspect that of an arachnoid cyst and its associated mass effect on the cerebellum. |
Generate impression based on findings. | Clinical question: Stroke. Signs and symptoms: Seizure and nonverbal. Nonenhanced head CT:Examination demonstrates very subtle focus of low attenuation with apparent involvement of the cortex and subcortical white matter of left anterior temporal and frontal lobe. There is lobar widening of adjacent cortical sulci. The above finding could represent volume averaging and less likely to represent an ischemic process however this possibility cannot be entirely excluded. Correlate with history and if concern persists recommend follow-up with a dedicated MRI exam.Unremarkable nonenhanced head CT otherwise. CT however is insensitive for detection of early acute non-hemorrhagic ischemic stroke. There are very subtle periventricular and subcortical low attenuation of white matter which considering patient's stated age there are suspected for age indeterminate minimal small vessel ischemic strokes. | 1.No convincing evidence of an acute ischemic stroke. CT however is insensitive for detection of acute non-hemorrhagic ischemic stroke.2.A subtle focus of low-attenuation in the left anterior temporal and inferior frontal lobe is believed to represent volume averaging less likely possibility of stroke cannot be entirely excluded. Correlate with history and follow-up with CT or MRI is recommended.3.Minimal age indeterminate small vessel ischemic strokes. |
Generate impression based on findings. | Clinical question: Fever. Signs and symptoms: Fever. Enhanced maxillofacial CT:Frontal sinuses.Very minimal mucosal thickening in the dependent portion of bilateral maxillary sinuses are noted. This is a new finding since prior exam from July of 2013.Ethmoid sinuses.Minimal bilateral chronic sinus disease which is new since prior exam.Sphenoid sinus.Minimal mucosal thickening along the anterior wall of the sphenoid sinus with resultant "the bilateral sphenoethmoidal recess. This is also a new finding since prior study. Maxillary sinuses.Moderate to extensive patchy mucosal thickening of bilateral maxillary sinuses and with suggestion of small retention cysts is noted. There is complete occlusion of bilateral ostiomeatal unit secondary to changes.There is interval worsening of the findings in the right maxillary sinus and interval slight improvement of the left maxillary sinus.Nasal cavity.Increased mucosal thickening of the nasal passage (right greater than left) since prior study. Stable mild nasal septum deviation to the right and without a bony septal spur.This examination demonstrate no evidence of acute sinusitis. There is also no detectable abnormal enhancement.Bilateral mastoid air cells and middle ear cavities are well pneumatized and unremarkable.Limited images through the orbits are unremarkable.No detectable abnormalities of soft tissues of region of exam or abnormal enhancement. | 1.No evidence of acute sinusitis.2.No detectable abnormal enhancement on post infused images in the region of exam.3.Chronic pansinusitis with interval worsening of sinus disease since prior exam. There are occluded bilateral ostiomeatal units and sphenoethmoidal recesses. |
Generate impression based on findings. | Clinical question: 60-year-old male with AML, neutropenic fever, rule out sinusitis. Signs and symptoms: Neutropenic fever. Non-enhanced maxillofacial CT:Examination demonstrates no evidence of acute sinusitis.Very minimal because of thickening in bilateral frontal sinuses is noted.Minimal mucosal thickening in bilateral anterior ethmoids is noted.Sphenoid sinus is unremarkable.Very minimal localized because of thickening in the dependent portion of bilateral maxillary sinuses are noted. There are patent bilateral ostiomeatal units.Nasal cavity demonstrate concha bullosa of bilateral middle turbinates (left greater than right and positioned unremarkable otherwise.All mastoid air cells and bilateral mandibular cavities are visualized and demonstrate only minimal opacification of few left mastoid air cellsunremarkable images through the orbits. | 1.Very minimal chronic sinus disease as detailed.2.Patent bilateral ostiomeatal units and bilateral sphenoid joint recess. 3.No evidence of acute sinusitis. |
Generate impression based on findings. | Clinical question: Anisocoria right 5 left 1. Signs and symptoms: As above. Nonenhanced head CT:Large acute this setting hematoma in the right frontal lobe and its surrounding vasogenic edema is again noted. There is however increased mass effect on the right frontal horn and midline shift to the left. There is increased low attenuation of the left basal ganglia, left frontal and temporal cortex with near complete effacement of gray -- white matter differentiation. This new finding in the right frontal and temporal lobe are highly suspected of new ischemic change and with resultant increased midline shift to the left. Previously noted large hematoma in the right anterior and mid temporal lobe and its surrounding vasogenic edema demonstrate no convincing evidence of any significant change.Also stable since prior exam is a large left temporal tip hematoma and surrounding vasogenic edema. Subdural hemorrhage along the superior surface of right tentorial demonstrate no convincing evidence of change.Patchy foci of subarachnoid hemorrhage demonstrate interval decreased in extent.Blood in the dependent portion of left occipital horn shows no change.There is interval decreased size of right lateral ventricle and near complete collapse.There is also suggestion of slight interval decreased size of left lateral ventricle. The left lateral ventricle however still remains dilated in particular in its trigone and temporal horn.The third ventricle is smaller in size since prior exam and within normal range. | 1.New since prior exam is further effacement of gray -- white matter differentiation in the right frontal and temporal lobe with resultant further near complete effacement of adjacent cortical sulci.2.Slight interval increased mass effect and leftward midline shift since prior study.3.No convincing evidence of interval new hemorrhage since prior study.4.Stable large bilateral frontal (right greater than left) acute dissecting parenchymal hematomas and bilateral temporal lobe hematomas.5.Stable intraventricular hemorrhage in the dependent portion of left occipital horn.6.There is interval decreased size of supratentorial ventricular system as detailed. |
Generate impression based on findings. | Reason: r/o R sided stone vs pyelo History: R flank pain radiating to suprapubic- urinary urg Lack of IV contrast limits evaluation of solid organ pathology.ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral lower pole calculi. No hydronephrosis. No perinephric collections. There is mild infiltration of the perinephric fat on the right.RETROPERITONEUM, LYMPH NODES: Mildly prominent retroperitoneal lymph nodes are poorly evaluated due to lack of IV contrast.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: Nondistended.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Tiny bilateral lower pole calculi without hydronephrosis. Infiltration of the perinephric fat on the right may reflect a recently passed stone or, in the appropriate clinical setting, pyelonephritis. |
Generate impression based on findings. | Reason: 75 y/o man with hx of metastatic intrahepatic cholangiocarcinoma s/p stent placement p/w RUQ pain and fever, r/o obstruction History: 75 y/o man with hx of metastatic intrahepatic cholangiocarcinoma s/p stent placement p/w RUQ pain and fever, r/o obstruction ABDOMEN:LUNG BASES: Mild pleural effusions bilaterally with overlying atelectasis.LIVER, BILIARY TRACT: Redemonstration of the large heterogeneous predominantly hypodense mass in the right lobe of liver, relatively stable in size compared to prior exam. Interval placement of intrahepatic biliary stent extending to the duodenum. There is mild focal intrahepatic biliary dilatation in the left lobe of the liver.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Right adrenal mass, presumably metastasis is again seen measuring 3.1 x 2.4 cm at its greatest dimension.KIDNEYS, URETERS: Few subcentimeter, hypodense foci in bilateral kidneys are too small to further characterize but are presumably benign renal cysts.RETROPERITONEUM, LYMPH NODES: Prominent, scattered retroperitoneal and periaortic lymph nodes, relatively stable. Atherosclerotic calcification of the aorta and bilateral iliac arteries.BOWEL, MESENTERY: Gastric tube balloon in the stomach lumen. No bowel obstruction. No significant abnormality noted. BONES, SOFT TISSUES: Ventral hernia containing fat. OTHER: Increase in abdominal ascites.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Scattered inguinal lymph nodes bilaterally.BOWEL, MESENTERY: Diverticula in the sigmoid and descending colon without evidence of diverticulitis.BONES, SOFT TISSUES: Degenerative disease of the lower thoracic and lumbar spine.OTHER: Increased amount of pelvic fluid. | 1.Large heterogeneous centrally located hepatic mass is again seen and relatively unchanged in size.2.Interval placement of intrahepatic biliary stent extending to the duodenum.3.Stable mild focal intrahepatic biliary ductal dilatation in the left lobe of the liver.4.No evidence of bowel obstruction.5.Right adrenal metastasis is again demonstrated. |
Generate impression based on findings. | Reason: Please eval for source of fever, tachycardia, abdominal pain History: s/p cystectomy, ileal conduit on 9/26/13. admitted for fever with workup otherwise negative ABDOMEN:LUNG BASES: Multiple new basilar pulmonary nodules. A left lower lobe pulmonary nodule measures 1.0 x 0.8 cm (series 5, image 19). Small bilateral pleural effusions.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Accessory splenule.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Fat attenuation nodule of the right adrenal gland is compatible with a myelolipoma, unchanged.KIDNEYS, URETERS: Bilateral ureteral stents terminating in a right lower quadrant ileal conduit. No hydronephrosis. RETROPERITONEUM, LYMPH NODES: Mildly prominent retroperitoneal lymph nodes.BOWEL, MESENTERY: Large loculated right lower quadrant fluid collection with foci of gas measures 18.6 x 10.2 cm (coronal image 58) and compresses the right external iliac vein. No evidence of bowel obstruction. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy.BLADDER: Status post cystectomy. An amorphous fluid collection with internal gas is present in the cystectomy bed.LYMPH NODES: Status post pelvic lymph node dissection.BOWEL, MESENTERY: No evidence of contrast extravasation to suggest bowel wall injury.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Large loculated fluid collection with internal gas in a right lower quadrant compatible with an infected fluid collection.2.Amorphous collection in the cystectomy bed with foci of gas suggests infected fluid collection or bowel wall injury, although there is no contrast extravasation to suggest the latter.3.Multiple new basilar metastatic pulmonary nodules. |
Generate impression based on findings. | History: 71 yo M with metastatic NSCLC p/w SOB and new afib concern for PE. PULMONARY ARTERIES: No evidence of pulmonary embolism. LUNGS AND PLEURA: Subpleural right upper lobe mass which invades the chest wall is unchanged in size and measures 4.9 x 3.6 cm (series 7, image 82). Mixed ground glass and solid opacity in the left upper lobe along the fissure is again noted and unchanged. Mild basilar scarring/atelectasis. Upper lobe predominant centrilobular emphysema. MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. No significant mediastinal or hilar lymphadenopathy. Mild aortic and coronary calcifications. Left thyroid nodule is unchanged. CHEST WALL: Left subclavian ICD and leads in place. Reference right subpleural lymph node is obscured by intravenous contrast. UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Large hypodense hepatic lesion is compatible with metastatic disease. This lesion measures 6.0 x 5.2 cm and is unchanged in size (series 7, image 308). | 1.No evidence of pulmonary embolism. 2.No significant interval change in subpleural right upper lobe mass and hepatic metastasis. Left upper lobe mixed solid and ground glass opacity is also unchanged and may represent an additional site of primary malignancy. |
Generate impression based on findings. | 52-year-old female with chronic sinusitis Within the nasal cavity no obstructive lesions are appreciated.The frontal sinuses and bilateral the lateral recesses are clear.Maxillary sinuses demonstrate minor mucosal thickening along the floors of the maxillary sinuses with obstruction of bilateral ostiomeatal units, unchanged.Ethmoid air cells demonstrate minor mucosal thickening, unchanged.Sphenoid sinuses demonstrate minor mucosal thickening with slight improvement on the right. Bilateral sphenoethmoidal recesses remain obstructed.Visualized portions of the mastoid air cells and middle ears are clear. Visualized orbits are intact and the visualized intracranial structures are within normal limits.A punctate calcification is present in the right basal ganglia and is unchanged since the previous exam.There is approximately 1 cm calcified focus abutting the dura at the convexity in a right paramedian location, which is stable in appearance and consistent with a small benign meningioma. There is no underlying associated mass effect. | 1.Persistent mucosal thickening which obstructs the osteomeatal complex units. Only the right sphenoid sinus demonstrates interval improvement.2.There is approximately 1 cm calcified focus abutting the dura at the convexity in a right paramedian location, which is stable in appearance and consistent with a small benign meningioma. There is no underlying associated mass effect. |
Generate impression based on findings. | Female 25 years old Reason: 25F w/ ESRD w/ hemptoysis, unilateral effusion and tachycardia concerning for PE History: sob, tachycardia, effusion PULMONARY ARTERIES: Technically limited study due to patient motion and poor opacification. No central pulmonary emboli, and no evidence for right heart strain.There is high-grade stenosis of the right subclavian vein proximal to the thoracic inlet (image 60, series 80796) with significant collateral venous contrast opacification in the right lateral and posterior chest wall, draining into the azygos vein. LUNGS AND PLEURA: Series obtained in expiration. Interval mild decrease in the right lung scattered patchy air space opacities compatible with resolving edema, infection ,or less likely hemorrhage. Unchanged moderate left subpulmonic effusion with improvement of the associated basilar compressive atelectasis. New left upper lobe subsegmental atelectasis. Unchanged bronchial wall thickening suggestive of edema, asthma or bronchitis.MEDIASTINUM AND HILA: Unchanged large mediastinal lymph nodes. Enlarged right hilar lymph node not demonstrated on the prior noncontrast examination.Multichamber cardiomegaly with small unchanged pericardial effusion.CHEST WALL: Enlarged axillary, supra-clavicular and subpectoral lymph nodes unchanged. Bilateral anterior and posterior chest wall venous collateralization.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. No evidence of pulmonary emboli in the central pulmonary arteries. Technically limited study.2. High grade stenosis of the right subclavian artery with prominent collateralization and possible stenosis of the SVC at the level of the azygos.3. Mediastinal, hilar, supraclavicular, axillary and subpectoral lymphadenopathy unchanged.4. Mild decrease in patchy right lung air space opacities suggestive of resolving infection.5. Bronchial wall thickening compatible with edema, asthma or bronchitis unchanged.6. Moderate left subpulmonic pleural effusion unchanged. |
Generate impression based on findings. | Clinical question: Evaluate for hemorrhage. Signs and symptoms: Left facial droop and history of old CVA. Fell down. Nonenhanced head CT:There are no prior exams for comparison.There is no convincing evidence of an acute intracranial process. CT however is insensitive for detection of acute nonhemorrhagic ischemic stroke.There are subtle periventricular and subcortical low attenuation of white matter consistent with age indeterminate small vessel ischemic stroke. Similar findings are also present in bilateral basal ganglia (right greater than left). There is evidence of a large focus of low-attenuation involving the medial aspect of right posterior temporal and extensively of the right occipital lobe consistent with a chronic right PCA territory stroke.Mild vascular calcification of bilateral cavernous carotids and bilateral intracranial vertebrals are noted. High density of bilateral MCA proximal segments consistent with atherosclerotic disease.Unremarkable calvarium and soft tissues of the scalp.Unremarkable images through the orbits, paranasal sinuses and bilateral mastoid air cells. | 1.No acute intracranial process. CT however is insensitive for detection of acute nonhemorrhagic ischemic stroke.2.Age indeterminate mild to moderate small vessel ischemic strokes.3.Large chronic right PCA cortical stroke with resultant ex brought to the location of right trigone and right temporal horn. |
Generate impression based on findings. | Neck pain following syncope with fall. There are no visualized fractures. Vertebral body and intervertebral disk heights are maintained. The odontoid is intact. There is no prevertebral soft tissue swelling.There are significant degenerative changes of the spine considering the patient's age.C2-3: There is a mild disk bulge at this level which does not result in significant canal or bony neural foraminal stenosis.C3-4: There is a prominent disk osteophyte complex which results in effacement of the anterior CSF space and impression on the ventral aspect of the cord. Dorsal CSF space is normal. There is no bony neural foraminal stenosis.C4-5: There is a disk osteophyte complex including a central protrusion which effaces the ventral CSF space and impresses on the ventral cord. There is no bony neural foraminal stenosis.C5-6: There is a disk osteophyte complex including left paracentral disk extrusion with predominantly superior migration of extruded contents which efface the ventral CSF space at the anterolateral aspect of the canal and exert mass effect on the cord. The exiting left sided nerve roots are not clearly visualized. There is no bony neural foraminal stenosis.C6-7: There is a disk osteophyte complex including an extrusion which effaces ventral CSF space, abuts the cord centrally and extends through the left paracentral zone. There is no bony neural foraminal stenosis.C7-T1: There are early osteophytes and a mild bulge at this level. There is no bony neural foraminal stenosis. | There is no visualized sequela of trauma, though note is made of significant changes related to degenerative disk disease including multilevel protrusions/extrusions from the C3-4 through C6-7 levels. If there are attributable symptoms, this could be better assessed by C-spine MRI. |
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.