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Generate impression based on findings. | Reason: s/p APR on 9/27, ongoing ileus, purulent drainage from pelvic drain, eval for obstruction, fluid collections. History: ileus/bowel obstruction ABDOMEN:LUNG BASES: Bilateral pleural effusions, right greater the left, with overlying compressive atelectasis. Mild patchy consolidation in the right middle and lower lobes.LIVER, BILIARY TRACT: Moderate ascites. Tiny left hepatic lobe hypodensity is too small to further characterize, but likely benign.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Persistently dilated and fluid-filled small bowel loops with a transition point in the left pelvis (series 3, image 95).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Brachytherapy seeds in the prostate bed.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post proctectomy with left lower quadrant colostomy. There is a non-loculated fluid collection in the presacral soft tissues with foci of gas measuring approximately 6.5 x 7.1 x 7.6 cm (AP x TR x CC, axial image 133, sagittal image 56). A percutaneous surgical drain terminates in the right hemipelvis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Status post proctectomy with fluid and gas in the presacral soft tissues suggestive of an infected fluid collection. 2.Persistent small bowel obstruction. 3.Ascites and pleural effusions. |
Generate impression based on findings. | Clinical question: 46 year-old female with AML, for a baseline sinus disease. Signs and symptoms: AML. Maxillofacial CT:Frontal sinuses demonstrate no evidence of disease.Ethmoid sinuses demonstrate mild (right greater than left) anterior ethmoid sinus disease.Sphenoid sinus demonstrate minimal mucosal thickening along its anterior wall and with resultant occlusion of bilateral sphenoethmoidal recess.Maxillary sinuses demonstrate moderate diffuse mucosal thickening on the right with resultant occluded right ostiomeatal unit. Left maxillary sinus demonstrates a small dictation cyst in its dependent portion and unremarkable otherwise/patent ostiomeatal unit. Images through nasal cavity demonstrate mild leftward nasal septum deviation without convincing evidence of a bony septal spur. There is significant increased soft tissue density in the right nasal passage including soft tissues along the right aspect of nasal septum and increased soft tissue density at the level of right middle turbinate. Cannot exclude possibility of a small polyps. There is significant effacement of airspace secondary to the changes in the right nasal passage.Bilateral mastoid air cells and middle cavities all remain well pneumatized and unremarkable. | 1.No evidence of acute sinusitis.2.Mild to moderate chronic sinusitis as detailed above.3.Occluded right ostiomeatal unit and bilateral sphenoethmoidal recess.4.Extensive soft tissue thickening in the right nasal passage with significant compromise of the air space detail. |
Generate impression based on findings. | Headache and posterior hematoma following syncope with fall. Rule out fracture or intracranial hemorrhage. There is a scalp hematoma overlying the left occipital region. There are no visualized fractures. There is no Intracranial hemorrhage, fluid collection, mass or hydrocephalus. Gray-white matter differentiation is maintained bilaterally and the midline is intact.There is mucosal thickening within the maxillary and ethmoid sinuses. Frontal sinuses are clear. Orbits are unremarkable. | Scalp hematoma without underlying fracture or intracranial sequela of trauma. |
Generate impression based on findings. | 54-year-old female with malignant neoplasm of colon, Restaging CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Status post ablation changes in the right posterior liver with a large hypodensity extending towards the liver capsule. Small hypo-attenuating lesion along the inferior aspect of the ablation site best seen on image 63, coronal plane measures 1.6 x 1 .2 cm, previously measured 2 x 1.2 cm. The ablation defect shows changing morphology and appears more lobulated along the superior aspect than seen previously (image 60, coronal plane). A reference hepatic lesion near the porta hepatis now measures 1.3 x 1 .2 cm, previously measured 1.6 x 1.3 cm (image 79, 3) minimally decreased in size. Another right hepatic lesion (image 73, 3) appears to be mostly unchanged.Referenced lesion in the inferior right lobe (image hundred, 3) measures 1.6 x 1.1 cm previously measured 1.7 x 1 .7 cm, mostly unchanged.Hepatic vessels are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: no enlarged lymph nodes.BOWEL, MESENTERY: Multiple diverticula without evidence of diverticulitis. 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: Stable index right common femoral lymph node measures 1.2 x 0.8 cm, mostly unchanged, previously measured 1.2 cm in diameter (series 3, image 170). Other small nonreference pelvic lymph nodes are stable.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Interval post ablation changes in the right lobe of liver with mild change in morphology. Previously described lesion along the inferior aspect of the ablation site has minimally decreased in size. Other reference hepatic lesion also appears minimally decreased in size.2. No new site of disease. |
Generate impression based on findings. | Clinical question: History of head and neck cancer, pulmonary micronodules, compared to prior exam, measurements please, baseline prior to starting chemo/RT. Signs and symptoms: None. Enhanced neck CT:Limited view of intracranial space demonstrate no abnormalities.Normal size and pattern of enhancement the bilateral cavernous sinuses, unremarkable images through the skull base and including all paranasal sinuses and bilateral petrous bones.Unremarkable nasopharynx and nasal passage.Unremarkable images through the oropharynx and oral cavity.Examination demonstrates extensive bilateral postoperative changes of neck significant distortion of anatomical landmarks and subcutaneous fat stranding from prior total laryngectomy and neck dissection.A previously reported left sided necrotic loculated rim enhancing nodes has been since removed. There is evidence of postsurgical changes of a seroma at the site extending approximately 35mm in craniocephalad axis and 18 x 11-mm in transaxial dimensions. This finding extends from immediately superior to the left lobe of thyroid superiorly for approximately 35mm and is best appreciated on sagittal reformatted images 44 and axial images 33 through 43. A couple surgical clips are noted along the superior extent of this findings. There is no evidence of any cervical adenopathy by CT size criteria.Stable left-sided node of approximately 7.7 mm at the level of left clavicular head (axial image 187) and two right-sided anterior mediastinal node measuring at 7.4 and 8.1 mm in short axis (axial image 210 and 214) since prior exam. | 1.Interval removal of previously noted left neck necrotic node and with development of a rim enhancing seroma measuring 35mm in craniocephalad axis and 18 x 11 mm in transaxial dimensions.2.No evidence of recurrence of tumor or adenopathy by CT size criteria.3.Stable small nonpathologic by CT size criteria superior mediastinal lymph nodes as detailed/measured above. |
Generate impression based on findings. | Female 74 years old; Reason: R LE edema of unclear etiology; already ruled out for DVT (by doppler U/S) but unresponsive to furosemide/metolazone History: severe RLE edema. A large right knee joint effusion is seen with an associated large Baker's cyst exiting between the semimembranosus and medial gastrocnemius tendons. The Baker's cyst measures 1.6 x 2.2 cm in transverse dimension (series 8048, image 204) and extends inferiorly by 11.5 cm (series 80411, image 51). A confluent fluid collection is found in the posterior medial subcutaneous tissues adjacent to the Baker cyst, likely representing rupture of the Baker's cyst and measures 1.2 x 3.4 cm (8048, image 205). An additional subcutaneous fluid collection is seen in the posterior lateral aspect of the distal lower extremity likely from the same process. Diffuse soft tissue swelling and subcutaneous fat stranding is also noted of the lower extremity predominantly within the posterior soft tissues of the distal extremity below the knee and is also likely related to rupture of the Baker's cyst. | Large knee joint effusion with rupture of a large Baker's cyst, which is likely the cause of the diffuse posterior soft tissue swelling and fat stranding in the lower extremity below the knee. |
Generate impression based on findings. | Reason: distention ileus History: pain and distension Lack of intravenous contrast limits evaluation of solid organ pathology.ABDOMEN:LUNG BASES: Basilar subsegmental atelectasis and small pleural effusions. Calcified hilar and mediastinal lymph nodes compatible with prior granulomatous disease.LIVER, BILIARY TRACT: Right hepatic lobe cysts, likely benign. Hepatic dome granuloma. Status post cholecystectomy with prominence of the common bile duct, unchanged.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic stent is in place. Moderate infiltration of the peripancreatic fat about the pancreatic head and uncinate process. No discrete peripancreatic fluid collections. Surrounding gas appears to be entirely intraluminal.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts. No hydronephrosis or nephrolithiasis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of bowel obstruction. No pneumoperitoneum.BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine. Compression deformity of the T12 vertebral body of indeterminate age.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small amount of free fluid in the pelvis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.ERCP related acute pancreatitis without evidence of local complications. |
Generate impression based on findings. | Reason: evaluate for stone or renal abscess History: flank pain, history of urostomy 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: Punctate calcifications in the left lung base likely represent granulomata. Focal area of pleural thickening the right lung base.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left moderate-sized hydronephrosis with hydroureter of the proximal ureter with surrounding fat stranding. There is rapid tapering of the distal left ureter without evidence of obstructing stone or ureteral calculus. These findings are similar to the 2008 CT study although new compared to the 2013 ultrasound which did not demonstrate hydronephrosis. The dilated proximal ureter wall is thickened compared to prior 2008 CT exam.RETROPERITONEUM, LYMPH NODES: Scattered, mildly prominent retroperitoneal lymph nodes. Atherosclerotic calcifications of bilateral iliac arteries.BOWEL, MESENTERY: Scattered, mildly prominent mesenteric lymph nodes.BONES, SOFT TISSUES: Degenerative disease of the lower thoracic spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Thickened bladder wall which may be due to enlarged prostate accentuated by partial collapse of the bladder.LYMPH NODES: Scattered, prominent pelvic lymph nodes. Largest left pelvic lymph node measuring 2.2 x 1.7 cm.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: There is a soft tissue density mass arising from the subcutaneous tissue of the left hip which is infiltrative but does not appear to involve the underlying muscle. OTHER: No significant abnormality noted | 1.New left hydronephrosis and hydroureter with thickening of the proximal ureteral wall. 2.Soft tissue density mass arising from the subcutaneous tissue of the left hip with prominent pelvic lymph nodes. Mild interval increase in size compared to 2008 CT study. Clinical correlation is advised. |
Generate impression based on findings. | Female; 57 years old. Reason: r/o PE History: desaturations PULMONARY ARTERIES: No evidence of pulmonary embolism. LUNGS AND PLEURA: Upper lobe predominant nodular ground glass opacities and bibasilar consolidation and small underlying pleural effusions, compatible with aspiration and/or infection. Calcified granuloma in right upper lobe. MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. No significant mediastinal or hilar lymphadenopathy. A small hiatal hernia is seen.CHEST WALL: Left central venous catheter in the left brachiocephalic vein. No axillary lymphadenopathy. UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.No evidence of pulmonary embolism. 2.Bibasilar consolidation and underlying pleural effusions, compatible with aspiration and/or infection. |
Generate impression based on findings. | Clinical question: Altered mental status, not moving her limbs, evaluate for cervical spinal abscess/hematoma. Signs and symptoms: Four limb there is cyst, AMS. Nonenhanced cervical spine CT:CT is to inappropriate exam due to its insensitivity for detection of hemorrhage or abscess in the spine. Consider an MRI exam for definitive diagnosis of clinical concerns of abscess and hematoma. Images through the skull base and are unremarkable.There is normal anatomical alignment of vertebral column and craniocervical junction.There is however straightening of cervical lordosis which could be positional.Foramen magnum is unremarkable.C2 -- C3 is unremarkable.C3 -- C4 demonstrate degenerative changes with resultant significant compromise of right neural foramina due to asymmetric extensive right articulating facet hypertrophic changes.C4 -- C5 demonstrate mild degenerative disk disease and moderate right facet hypertrophy changes and right uncovertebral hypertrophy changes. There is resultant moderate right neural foraminal compromise and unremarkable otherwise.C5 -- C6 demonstrate advanced disk disease evident by significant loss of disk height, uncovertebral hypertrophic changes on the right and mild degenerative changes of posterior elements. There is moderate right and mild left neural foraminal compromise. This exam is not accurate for assessment of central spinal stenosis.C6 -- C7 demonstrate moderate disk disease and minimal degenerative changes of posterior elements. There is significant right and moderate left neural foraminal compromise. CT cannot assess with accuracy spinal stenosis.C7 -- T1 demonstrate hypertrophic changes of facet complex on the right however no evidence of neuroforaminal compromise.There is no detectable paraspinal soft tissue abnormalities. The fascial planes of soft tissues of neck are preserved and unremarkable.No meniscal osseous or cartilaginous erosive/sclerotic changes.No evidence of fracture or malalignment. | 1.CT is not an appropriate exam for detection of intraspinal hemorrhage or abscess as is questioned clinically. If clinical concern persist consider MRI examination of cervical spine.2.Examination demonstrates no evidence of fracture or malalignment and no evidence of perispinal soft tissue abnormalities.3.Degenerative changes of cervical spine results in multilevel neural foraminal compromise (some significantly) as detailed per level above.4.CT is insensitive for accurate assessment of central spinal stenosis however within this limitation there is no finding to suggest osseous cause for compromise of spinal canal. |
Generate impression based on findings. | Female 85 years old Reason: r/o PE History: tachy, hypoxic PULMONARY ARTERIES: Technically adequate study without evidence of right heart strain or pulmonary emboli.LUNGS AND PLEURA: Apical predominant moderate centrilobular and paraseptal emphysema. Biapical and bibasilar scarring. Mild bronchial wall thickening suggestive of bronchitis. No suspicious pulmonary nodules or masses.No pleural effusion.MEDIASTINUM AND HILA: Nonspecific enlarged mediastinal and hilar lymph nodes.Normal heart size and no evidence of pericardial effusion.CHEST WALL: Wedge deformity of T6 vertebral body compatible with compression fracture of indeterminate age. Moderate/severe degenerative changes of the thoracic spine. Right humeral head prosthesis.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Status post cholecystectomy. Prominence of the extrahepatic biliary ductal system and pancreatic duct. | 1. Technically adequate study without evidence of pulmonary emboli.2. Moderate central and paraseptal emphysema.3. Mild bronchial wall thickening suggestive of bronchitis.4. Compression fracture the T6 vertebral body. |
Generate impression based on findings. | Malignant neoplasm of prostate, evaluation of disease after 53 days of investigational therapy ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Splenule is noted.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomyBLADDER: No significant abnormality notedLYMPH NODES: Stable left pelvic sidewall lymph node measures 1.6 x 1 cm previously measured 1.8 x 1 cm, minimally reduced in size from prior study.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Sclerotic focus in T11 vertebral body appears slightly increased. Small sclerotic focus in T3 vertebral body also appears to increase from prior study.OTHER: No significant abnormality noted | 1. Interval decrease in left pelvic lymph node.2. Minimal interval increase in sclerotic focus in T11 and T3 vertebral body. |
Generate impression based on findings. | Reason: hx of pancreatic necrosis with pancreatic tail abscess, decreased drainage from drain, now with drain erythema and outer drainage History: above ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No evidence of cholelithiasis. No evidence of intrahepatic biliary ductal dilatation. No focal liver lesions. Common bile duct stent.SPLEEN: No significant abnormality notedPANCREAS: Pancreatic tail fluid collection with drain is slightly increased in size, extends inferiorly adjacent to the splenic flexure and appears to be communicating with a prominent pancreatic duct. Necrotic appearing the pancreas appears similar to the prior study. There is another fluid collection in the body of the pancreas with interval increase in size now with small focus of air.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: A few subcentimeter, hypodense foci in bilateral kidneys are too small to further characterize but presumably represent benign renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Interval decrease in amount of ascites and anasarca.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Complex septated pseudocyst in the tail of the pancreas with interval increase in size. The surgical drain is unchanged in location.2.Interval increase in size of pseudocyst in the body of the pancreas.3.Interval decrease in ascites and anasarca. |
Generate impression based on findings. | Reason: abd pain, leukocytosis, fever History: abd pain ABDOMEN:LUNG BASES: Nonspecific peripheral basilar reticular opacities, unchanged from CT chest dated 10/4/2013.LIVER, BILIARY TRACT: Mild ascites. Periportal and pericholecystic fluid/edema.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: Diffuse bowel wall thickening and mucosal enhancement involving the small bowel and colon. No evidence of bowel obstruction, pneumoperitoneum, or drainable fluid collections.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small amount of free fluid in the pelvis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Diffuse wall thickening and mucosal enhancement of the small bowel and colon most compatible with chemotherapy related enteritis/colitis. |
Generate impression based on findings. | Reason: ?duodenal mass obstruction History: Dizzyness, poor appetite, nausea, vomiting ABDOMEN:LUNG BASES: Multiple pulmonary nodules increasing in size and number. Index left lower lobe pulmonary nodule measures 1.2 cm (series 4, image 1), previously 0.9 cm.LIVER, BILIARY TRACT: Percutaneous biliary drain and stent with expected pneumobilia. Mild intrahepatic biliary ductal dilatation, unchanged. Innumerable hypoattenuating foci compatible with metastatic disease reference segment 6 lesion measures 4.4 x 6.5 cm (series 3, image 21), previously 4.5 x 5.4 cm. Segment IVa lesion measures 2.3 cm (series 3 x 22), previously 1.9 cm. Dilated gallbladder with pericholecystic fluid, unchanged.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic ductal dilatation and peripancreatic fluid is unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mass involving the third and fourth portions of the duodenum is subjectively larger than the prior exam but is not amenable to reliable measurements. Increasing peritoneal carcinomatosis. Reference peritoneal nodule measures 2.5 x 1.5 cm (series 3, image 64), previously 1.6 x 1.1 cm. No evidence of bowel obstruction. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Small amount of free fluid in the pelvis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.No evidence of bowel obstruction.2.Increasing pulmonary, hepatic, and peritoneal lesions. |
Generate impression based on findings. | Reason: PE? History: hypoxemia PULMONARY ARTERIES: There is opacification of the pulmonary arterial tree limits the examination. There is no evidence of pulmonary emboli within the central pulmonary arteries to the level of the bulbar branches.LUNGS AND PLEURA: Bilateral basilar subsegmental atelectasis and septal thickening.No pleural effusions.. Scattered nonspecific micronodules.No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of a pericardial effusion.Moderate coronary artery calcification.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Limited exam demonstrates no evidence of large central pulmonary emboli. Bilateral basilar subsegmental atelectasis and septal thickening. |
Generate impression based on findings. | Reason: Appendicitis vs. Diverticulitis History: Lower abdominal pain. Additional history obtained from pathology report on 8/15/2013: History of myeloma status post stem cell transplant ABDOMEN:LUNG BASES: Mild dependent atelectasis in bilateral bases.LIVER, BILIARY TRACT: No suspicious focal liver lesions. No intrahepatic or extrahepatic biliary ductal dilatation. Status post cholecystectomy.SPLEEN: Atherosclerotic calcification of the splenic artery.PANCREAS: No significant abnormality notedADRENAL GLANDS: Mild nodularity of the left adrenal gland.KIDNEYS, URETERS: Punctate calcifications in the right kidney may represent nephrolithiasis or vascular calcifications. Hypodense partially exophytic lesion in the superior pole of the right kidney is of water density and likely represents a benign renal cyst.RETROPERITONEUM, LYMPH NODES: Mild ectasia and aneurysmal dilation of the infrarenal aorta prior to the iliac bifurcation. Atherosclerotic calcification of the descending aorta and bilateral iliac arteries.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Loss of height of T12.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Heterogeneous collection in and abutting the wall of the sigmoid colon with surrounding fat stranding consistent with diverticulitis with intramural abscess and walled off perforation. Although there is no visible diverticula, diverticulitis is the most likely etiology. The approximate measurements of the abscess measure 6.9 x 3.4 cm.BONES, SOFT TISSUES: Calcified focus in the soft tissue of the right hip. OTHER: Moderate amount of pelvic fluid. | 1.Presumptive diverticulitis with intramural abscess and walled off perforation.2.Mild ectasia and aneurysmal dilatation of the infrarenal aorta prior to the iliac bifurcation.3.Nodular left adrenal gland with slight interval increase in size compared to 2012 CT study. |
Generate impression based on findings. | Male 58 years old Reason: Pt is a 58 y/o male with met melanoma, on vemurafenib, evaluate for progression History: met melanoma CHEST:LUNGS AND PLEURA: In the right upper lobe nodule is ill-defined flow is mild mural nodular component remaining. Overall dimensions including the solid and non-solid components is 8 x 6 mm series 4 image 38. Previously 10 x 8 mm.No new nodules. No effusions.MEDIASTINUM AND HILA: Index prevascular node which is actually in the anterior mediastinal space measures 5 x 4 mm series 2 image 31. Previously 8 x 5 mm. Line of the small nodes are unchanged.CHEST WALL: Index left subpectoral node measures 7 x 5 mm series 3 image 26. Previously 10 x 8 mm.Manubrial sclerosis redemonstrated. No new nodes. Surgical clips and postsurgical stranding within the fat of the left axillaOther scattered lesions are grossly unchanged with no new lesion seen. Moderate kyphosis.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No previously seen liver lesions are conspicuous or measurable. A few punctate ill-defined foci remain, for example series image 102.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Index aorta caval node which previously measured AP rather than short and long axis. 1.4 x 0.8 cm. As compared to the prior exams there is image 104 measures 1 x 0.7 cm.Other scattered small retroperitoneal nodes are grossly unchanged.Scattered atherosclerotic disease, no evidence of aneurysm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No new sites of disease. Small changes in measurements as above. |
Generate impression based on findings. | Reason: r/o dissection History: s/p high speed MVC CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality noted. No evidence of acute aortic injury.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No suspicious focal liver lesions. No evidence of cholelithiasis. No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No evidence of acute aortic injury.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Nondisplaced fractures of the left transverse processes of L2 and L3. Partial lumbarization of S1 with early degenerative change on the left side.OTHER: No significant abnormality noted | 1.No evidence of acute aortic injury. 2.Nondisplaced fractures of the left transverse processes of L2 and L3. |
Generate impression based on findings. | Female 72 years old Reason: h/o HNC, compare to previous, measurements pls, h/o CRT History: none CHEST:LUNGS AND PLEURA: Moderate apical predominant centrilobular emphysema.Scattered pulmonary micronodules, unchanged. No new suspicious pulmonary nodules or masses identified.No focal air space opacities or pleural effusions.MEDIASTINUM AND HILA: Stable mildly enlarged mediastinal lymph nodes.Severe atherosclerotic disease of the coronary arteries and thoracic aorta and its branches.CHEST WALL: Multilevel degenerative changes of thoracic and lumbar spine.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis without evidence of cholecystitis.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 evidence for retroperitoneal lymphadenopathy. Severe atherosclerosis of the abdominal aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Multilevel degenerative changes of the thoracic and lumbar spine. OTHER: No significant abnormality noted. | No significant interval change, and no evidence of metastatic disease in the chest or upper abdomen. |
Generate impression based on findings. | Male 70 years old Reason: More detailed view of LAD and possibly lobulated pleural effusions History: Diffuse LAD.Additional history: Reported Ex lap from McNeil. Possible sarcoid history. No malignancy found yet. CHEST:LUNGS AND PLEURA: Bilateral pleural effusions with some areas of loculation. Is this initial changes with groundglass opacities suggestive of edema. No nodules.MEDIASTINUM AND HILA: Cardiomegaly. Postsurgical changes. Pacer wire.Extensive mediastinal adenopathy. Clusters of right paratracheal nodes cyst image 27, 4.2 x 3.2 cm. No prior for comparison.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis. Focal somewhat wedge-shaped hypoattenuation in the subcapsular portion of the left lobe, multifocal probably vascular in nature. There is some capsular retraction at that site suggesting fibrosis. Some of these findings may be related to the history of sarcoidosis. Hepatic vasculature is grossly patent without thrombus. There is no biliary dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Scattered aortocaval and left para-aortic pathologic size lymph nodes. S1 left para-aortic lymph node measures 2.1 x 1.7 cm series 10 image 122. Previously 2.2 x 1.18. Other nodes are also unchanged.BOWEL, MESENTERY: Small amount of generalized ascites. Several ringlike calcified foci to abutting the liver and one in the right and one in the left paracolic gutter below the pelvic inlet, unchanged. These could represent calcified nodes calcified foci of infarctive fat or calcified implants.No evidence of bowel wall thickening or dilatation. Mesenteric vasculature enhances without evidence of thrombus.BONES, SOFT TISSUES: Persistent anasarca.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: Persistent marked anasarca. Gliosis degenerative changes. No lytic or blastic disease.OTHER: No significant abnormality noted | Adenopathy unchanged. Ascites, anasarca, bilateral pleural effusions, pulmonary edema. Cholelithiasis. Vascular flow phenomenon the liver with some areas of capsular retraction suggesting fibrosis. Discussed with covering physician Dr. Michael Drazier pager 1181 covering pager 2693. |
Generate impression based on findings. | Male; 37 years old. Reason: opacities on CXR, little change after thoracentesis - loculations? pneumonia? History: mild SOB, no other signs of pneumonia. LUNGS AND PLEURA: There is a moderate right pleural effusion with overlying compressive atelectasis/consolidation. There is a trace amount of a right pneumothorax. Mild basilar scarring/atelectasis is noted in the left lung. MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. No significant mediastinal or hilar lymphadenopathy.CHEST WALL: Diffuse osteopenia and endplate deformities involving the anterior aspects of several mid thoracic vertebra. Bilateral gynecomastia.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Cholecystectomy clips. Additional surgical clips also project over the upper abdomen. | 1.Right pleural effusion with trace right-sided pneumothorax. 2.Right basilar consolidation/atelectasis. This may represent a source of infection. |
Generate impression based on findings. | 49 year-old female with history of T1N1 right anterior tongue status post partial glossectomy and bilateral neck dissection. There is no clinically significant lymphadenopathy. The thyroid gland appears intact. The airway appears patent. There are no new soft tissue masses or findings suspicious for recurrence.The parotid and the submandibular glands appear intact. Presumed left accessory submandibular tissue which has been present since January 2012 and is stable.The visualized lung apices appear clear. Please see separate chest CT dictation for complete discussion of thoracic contents.The carotid and vertebral vasculature appears intact. The cervical vertebral bodies in general are intact with no evidence for canal stenosis. There is a disk protrusion present at C4-5 creating a mild to moderate degree of spinal stenosis. There is a left lateral recess disk protrusion present at C6-7 which encroaches on the left hemicord and left-sided exiting nerve root. These findings are stable.The visualized intracranial structures which include the posterior fossa are intact. The visualized portions of the orbits are intact. The paranasal sinuses are clear. The mastoid air cells are clear. | No evidence for local recurrence or clinically significant neck lymphadenopathy. |
Generate impression based on findings. | Female; 76 years old. Reason: Evaluate for progression of metastatic disease; compare to previous scan. CHEST:LUNGS AND PLEURA: Postsurgical changes compatible with left lower lobectomy and right upper lobe segmental resections. Innumerable small solid and ground glass pulmonary nodules are again noted. These are not significantly changed in size or extent since the prior study and are compatible with diffuse metastatic disease. Right middle lobe reference nodule measures 5 mm, unchanged (series 4, image 56). Trace left basilar scarring. MEDIASTINUM AND HILA: Hypodense right thyroid nodule again noted. Filling defects in the distal right and left main pulmonary arteries, extending into all right lobar and left upper lobar arteries are compatible with acute pulmonary emboli. The enlarged precarinal lymph node now measures 7 mm, previously 1.1 cm (series 3, image 41). No new mediastinal or hilar lymphadenopathy is noted. Normal heart size without pericardial effusion. Small hiatal hernia. CHEST WALL: No axillary or subpectoral lymphadenopathy. ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No focal hepatic lesions or biliary ductal dilatation. Scattered hypodense liver lesions are too small to fully characterize but likely represent benign cysts. 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: Severe degenerative disk disease in the lumbar spine.OTHER: No significant abnormality noted. | 1.Acute pulmonary emboli extending from the distal main pulmonary arteries into several bilateral lobar arteries as described above. 2.No significant interval change in diffuse pulmonary metastatic disease, with interval decrease in size of precarinal lymph node. |
Generate impression based on findings. | Female 58 years old Reason: restaging History: hx of lymphoma Exam is not sensitive for detecting lesions in the vasculature or solid organs due to lack of intravenous contrast. Given that limitation, the following observations are made:CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Venous access catheter tip in the SVC right atrial junction. No pathologic size nodes. Minimal atherosclerotic calcification aortic arch. No evidence of aneurysm.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Limitation of no IV contrast, no focal lesions. No evidence of fatty liver. Gallbladder is surgically absent. No obvious biliary dilatation.SPLEEN: Surgically absent.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate calcifications in the right upper pole the parenchymal, unchanged. Some areas of scarring right kidney. Left kidney appears normal. No hydronephrosis or hydroureter on either side.RETROPERITONEUM, LYMPH NODES: No shotty nodes unchanged. Index left para-aortic noted measures 1.1 x 0.9 cm, series 3 image 110. Previously 1.2 x 1 cm. No new nodes.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 within the bladder presumably from this instrumentation.LYMPH NODES: No pathologic size nodes. Index distal right external iliac node series 2 image 169, measures 1.3 x .8 cm. Previously 1.3 x 0.9 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No pathologic size nodes. Stable small index nodes. Scarring right kidney. Gallbladder and spleen surgically absent. |
Generate impression based on findings. | Reason: h/o HNC, CRT, compare to previous, measurements pls, know pelvic mets History: none CHEST:LUNGS AND PLEURA: Index right apical pulmonary nodule measures 6 mm (series 6, image 13), unchanged. Index lingular nodule measures 8 mm (series 6, image 48), previously 8 mm. New scattered ground glass opacities in the right upper lobe. Increasing pleural nodularity at the left base. Left pleural effusion is unchanged.MEDIASTINUM AND HILA: Prominent mediastinal lymph nodes, unchanged. Index right paratracheal lymph node measures 1.0 x 0.7 cm (series 4, image 25), previously 1.0 x 0.9 cm. Heart size is normal without pericardial effusion.CHEST WALL: Sclerotic foci in right sided ribs, unchanged. Left back lipoma.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Nonspecific pancreatic tail cystic lesions, unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Parapelvic left renal cyst, unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic lesions in the T7, T12, L5 vertebral bodies and the left iliac wing, unchanged.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Increasing left pleural and fissural nodularity compatible with metastatic disease.2.New upper lobe ground glass opacities. Differential considerations include infection and drug reaction. |
Generate impression based on findings. | Male 48 years old Reason: 47Yrs male here for follow-up of T1N2B BOT scc completed TPF f/b TFHX 10/24/10. Please re-eval for recurrence CHEST:LUNGS AND PLEURA: Scattered bilateral pulmonary nodules, unchanged in size and distribution. Biapical scarring unchanged. No new suspicious pulmonary nodules or masses identified.MEDIASTINUM AND HILA: Mildly enlarged partially calcified mediastinal and hilar lymph nodes, unchanged in size and morphology.CHEST WALL: Multilevel degenerative changes of the thoracic and lumbar spine.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Multilevel degenerative changes of the thoracic and lumbar spine.OTHER: No significant abnormality noted. | 1. Unchanged pulmonary nodules and apical scarring suggestive of sarcoidosis.2. No specific evidence of metastatic disease. |
Generate impression based on findings. | 64-year-old male with history of base of tongue cancer status post CRT, Oligomet on 4/13, reevaluate and compare to prior. There is new mild enhancement along the left posterior lateral aspect of the nasopharyngeal mucosa without mass effect or nodularity (best seen series 7, image 16).Redemonstrated are postsurgical and posttreatment changes in the neck including fatty replacement and volume loss in the right aspect of the tongue. Additionally, there is soft tissue thickening involving the submandibular and carotid spaces bilaterally amongst numerous surgical clips. Edematous changes involving the supraglottic mucosa persists. No evidence of enhancing mass. These findings are unchanged in appearance. The parotid and submandibular glands are stable. No evidence of clinically significant lymphadenopathy.The left jugular vein is not clearly opacified, as seen on prior exam. Right internal jugular vein is very small in caliber. Remaining major vessels of the neck are unremarkable. The orbits are unremarkable. No evidence of destructive osseous lesions. Degenerative degenerative changes in the cervical spine including multiple anterior osteophytes suggesting diffuse idiopathic skeletal hypertrophy with uncovertebral hypertrophy with multilevel varying degrees of spinal stenosis and neural foramina narrowing. Additionally, there is ossification of posterior longitudinal ligament. These findings are unchanged.The visualized intracranial contents are unremarkable. The visualized portions of the paranasal sinuses and mastoid air cells are clear. The visualized portions of the orbits are intact.Please see separate chest CT dictation for discussion of thoracic contents. | Stable postsurgical/post treatment changes of the neck as detailed above without evidence of enhancing mass, lymphadenopathy or fluid collection. |
Generate impression based on findings. | Male 61 years old Reason: h/o HNC, pulmonary micronodules, compare to previous, measurements pls, baseline prior to starting chemoRT LUNGS AND PLEURA: Stable scattered pulmonary micronodules.Reference right lower lobe micronodule measures 4 mm (image 266, series 4), previously 4 mm. Reference right middle lobe micronodules measures 5 mm (image 155, series 4), previously 5 mm.Left lower lobe bronchiectasis, ground glass opacities and tree in but opacities compatible with chronic aspiration.Mild centrilobular and paraseptal emphysema.MEDIASTINUM AND HILA: Mediastinal and hilar lymphadenopathy unchanged. Reference AP window lymph node measures 8 mm (image 36, series 3), previously 9 mm.Patulous esophagus and small sliding type hiatal hernia.CHEST WALL: Status post tracheostomy with phonation device in place. Mild thickening of the proximal trachea suggestive of tracheitis in the appropriate clinical setting.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Hypoattenuating focus in the left lobe of the liver unchanged. Hyperattenuating segment 8 focus likely represents a flash filling hemangioma, and was not well demonstrated on the prior exam, likely due to contrast phase.Splenic artery calcifications unchanged. | 1. Stable pulmonary micronodules more likely postinflammatory than metastatic though continued follow up is recommended.2. Stable findings of chronic aspiration.3. Unchanged mediastinal and hilar lymphadenopathy. |
Generate impression based on findings. | Reason: fever History: fever LUNGS AND PLEURA: New small bilateral pleural effusions and interlobular septal thickening.Calcified granuloma in the right lower lobe and stable micronodule (image 50 series 5). Mild bronchial/bronchiolar wall thickening.No focal areas of consolidation.MEDIASTINUM AND HILA: Right central venous catheter with its tip in the SVC/RA junction.No hilar or mediastinal lymphadenopathy.Cardiac size is normal.New small pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Splenomegaly.New perihepatic ascites. | 1.New small bilateral pleural effusions and interlobular septal thickening most prominent at the lung bases compatible with edema.2.New small amount of perihepatic ascites and splenomegaly.3.No specific evidence of acute infection. |
Generate impression based on findings. | Female; 46 years old. Reason: 46 female with AML, r/o baseline pulmonary infiltrate. LUNGS AND PLEURA: Scattered micronodules are present but there are no suspicious pulmonary nodules or masses. 4 mm micronodule along the left major fissure likely represents an intrapulmonary lymph node (series 4, image 38). No focal consolidation or pleural effusion. MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. Scattered subcentimeter mediastinal and hilar lymph nodes are seen, with reference precarinal and left hilar nodes both measuring 6 mm in short axis (series 3, images 28 and 34). A hypoattenuating blood pool compatible with anemia.CHEST WALL: Prominent axillary lymph nodes.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Splenomegaly. | No acute cardiopulmonary abnormalities noted. |
Generate impression based on findings. | Clinical question: History of head and neck cancer, compared to prior exam, measurements. Signs and symptoms: None. Enhanced neck CT:Limited view of the intracranial contents is unremarkable.Normal bilateral cavernous sinuses, skull base.Chronic sinusitis the visualized paranasal sinuses with slight interval improvement since prior study.Unremarkable images through the nasopharynx and nasal passage. Postoperative changes however are noted of the right nasal cavity and right maxillary sinus similar to prior exam.Unremarkable masticator spaces.Unremarkable images through the oropharynx and oral cavity. Unremarkable salivary glands.Unremarkable images through hypopharynx, larynx.Unremarkable thyroid.Unremarkable images to supraclavicular region and partially visualized upper mediastinum.There is no detectable mass or any adenopathy based on CT size criteria and nodes. Examination demonstrates as was noted on prior exam moderate to advanced degenerative disk disease at C4 to C5, C5 -- C6 and C6 --C7 levels with resultant neural foraminal compromise at C4 -- C5 bilaterally and C5 -- C6 bilaterally (left greater than right) secondary to significant left uncovertebral hypertrophic changes.Enhanced head CT:Examination demonstrates no evidence of abnormal parenchymal or leptomeningeal enhancement.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and preserved gray -- white matter differentiation.Unremarkable calvarium and soft tissues of the scalp. | 1.Stable enhanced CT of the soft tissues of the neck and without evidence of recurrence of tumor or cervical adenopathy since prior study.2.Negative enhanced head CT. |
Generate impression based on findings. | Reason: h/o HNC, compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: Stable scattered nonspecific micronodules. No suspicious pulmonary nodules or masses.No pleural effusions.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of 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: Degenerative changes in the thoracic and lumbar spineOTHER: No significant abnormality noted. | No interval change. No evidence of metastatic disease. |
Generate impression based on findings. | 56 year old male with history of right tonsillar cancer, chemotherapy follow up examination. Posttreatment changes again include reticulation of the subcutaneous fat, thickening of the platysma, effacing of the deep fascial planes, and hyperemia of the submandibular glands. The previously demonstrated hyper enhancement of the mucosal surfaces and laryngeal edema has decreased is nearly resolved.The right tonsillar mass seen on the original examination is not visualized on today's examination with only persistent soft tissue density thickening without discrete mass lesion. Mild hyper enhancement of the tongue base is less apparent.Right level 2a reference lymph node which previously currently measures 8 x 4 mm (previously 9 x 6 mm). There is no clinically significant lymphadenopathy.Visualized intracranial contents are unremarkable. Complete opacification of the left maxillary sinus is present with enhancing tissue noted at the maxillary ostium extending into the infundibulum and left middle meatus. The enhancing tissue appears similar in density to the mucosa of the left maxillary sinus. These findings are unchanged.Carotids and internal jugular veins are patent. No lytic cervical vertebral lesions are present. Please see separate chest CT dictation for discussion of thoracic contents. | 1.No CT evidence for residual or recurrent enhancing tumor.2.Continued interval decrease in size of reference lymph node. No new clinically significant lymphadenopathy.3.Enhancing tissue in the left ostiomeatal complex with complete opacification of the left maxillary sinus is again noted and unchanged. |
Generate impression based on findings. | Reason: Assess vasculature prior to kidney transplant History: Known PVD - assess vasculature prior to kidney transplant ABDOMEN:LUNG BASES: Small ground glass opacities in the left lung base.LIVER, BILIARY TRACT: No suspicious focal lesions. No intrahepatic or extrahepatic biliary ductal dilatation. No evidence of cholelithiasis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Atrophic kidneys with punctate calcifications bilaterally likely representing vascular calcifications. Few subcentimeter hypodense lesions in bilateral kidneys are too small to further characterize but likely represent benign renal cysts. Mild atherosclerotic calcifications at the origins of bilateral renal arteries.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the infrarenal aorta and bilateral common iliac arteries. Bilateral external iliac arteries do not have visible calcifications. No aneurysmal dilatation of the aorta or bilateral common iliac arteries.BOWEL, MESENTERY: Diverticula of the descending colon. Duodenal diverticulum.BONES, SOFT TISSUES: Collapse of the T10 and T11 thoracic vertebra.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Bladder is collapsed.LYMPH NODES: Mildly prominent inguinal lymph nodes bilaterally. Mildly prominent pelvic lymph nodes.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.No evidence of plaque of the external iliac artery.2.Mildly prominent pelvic lymph nodes bilaterally. |
Generate impression based on findings. | Reason: please evaluate for leakage from neobladder History: s/p cystectomy and orthotopic neobladder. XR cystogram is suggestive of entero-neobladder fistula. UTERUS, ADNEXA: Status post hysterectomy.BLADDER: Status post cystectomy. Contrast opacifies the patient's neobladder with retrograde flow of contrast into the distal ureters. No evident contrast extravasation.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Expected appearance of neobladder without evident leak. |
Generate impression based on findings. | Neurofibromatosis and VP shunt. Chronic abdominal pain. History of abdominal fluid loculations. ABDOMEN:LUNG BASES: Left pleural effusion has resolved. Minimal dependent atelectasis is identified. Left paraspinal soft tissue mass at the level of T10/11 measures 4.9 cm in its longest axis.LIVER, BILIARY TRACT: Enhancement is normal. No biliary ductal dilatation is identified. The gallbladder is distended and normal in appearance.SPLEEN: Normal in enhancement. Normal in size.PANCREAS: Normal in appearance.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Symmetric contrast enhancement. No pelvicaliceal dilatation.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No dilated bowel loops are present. Small mesenteric lymph nodes are noted.BONES, SOFT TISSUES: Multiple small subcutaneous neurofibroma are again visualized.OTHER: Two were and intraperitoneal shunt catheters identified. Both tips are in the left upper quadrant.PELVIS:PROSTATE, SEMINAL VESICLES: Normal in appearance.BLADDER: Distended and normal in appearance.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: The appendix is retrocecal. It has a diameter of approximately 1 cm. No inflammatory changes are identified around the appendix. The contrast material that was previously present in the appendix is no longer identified.BONES, SOFT TISSUES: Multiple small subcutaneous neurofibromas are again visualized.OTHER: Right lower quadrant fluid collection has resolved. Left lower quadrant fluid collection is smaller and measures 2.7 x 1.4 x 0.6 cm. It has a very thin wall and no inflammatory changes around. | Right lower quadrant fluid collection has resolved. Left lower quadrant fluid collection is smaller. |
Generate impression based on findings. | 53-year-old male with fungal sinusitis and URI symptosis. Opacification of the right maxillary sinus has improved, yet there remains a thin band of soft tissue density demonstrated within the retromaxillary fat immediately posterior to the right maxillary sinus wall which extends to the pterygopalatine fossa. Previously demonstrated mottled appearance of the involved adjacent bone is suggestive of potential bony involvement although is stable. The left maxillary sinus opacification has improved and there remains punctate calcific foci demonstrate along the lateral wall. Bilateral ostiomeatal units remain involved, although to a lesser degree.Bilateral frontal sinuses have improved, and the left frontoethmoidal recess is now patent. There is only persistent mild narrowing of the right frontoethmoidal recess.Ethmoid and sphenoid sinus opacification has improved. Bilateral sphenoethmoidal recesses are now clear.As before, a couple of air cells at the mastoid tip contain fluid, unchanged. Right mastoid air cells are clear.Soft tissue stranding is present within the nasal cavity, right greater left, likely representing secretions.The orbits and visualized intracranial contents remain unremarkable. | Improvement in pan sinus findings as described in detail above. There remains a thin band of soft tissue density demonstrated within the retromaxillary fat immediately posterior to the right maxillary sinus wall which extends to the pterygopalatine fossa. Previously demonstrated mottled appearance of the involved adjacent bone is suggestive of potential bony involvement although is stable. |
Generate impression based on findings. | History of Ewing's sarcoma. Pre-transplant evaluation. CHEST:LUNGS AND PLEURA: No evidence of lung parenchymal nodules or opacities. No pneumothorax or pleural effusions.MEDIASTINUM AND HILA: Right-sided Port-A-Cath has been removed. A new left-sided IJ venous access has as been placed and its tip is at the right atrium/SVC junction.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Normal liver enhancement with no evidence of liver metastases. No evidence of intra-or extra but it biliary duct dilatation. Gallbladder is distended with no gallbladder sludge or stones.SPLEEN: Normal splenic enhancement.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Renal cortical enhancement is symmetric. No evidence of hydronephrosis or kidney stones. No ureteral dilatation.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: Distended and normalLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Multiple surgical clips are noted.BONES, SOFT TISSUES: Sclerotic and lytic conspicuous lesions consistent with the known history of Ewing's sarcoma are visualized over the left iliac wing. Less conspicuous lesion of similar characteristics is visualized on the right iliac wing.OTHER: No significant abnormality noted | Sclerotic and lytic lesions over both iliac wings, consistent with a known history of Ewing's sarcoma also visualized on pelvic MR from outside institution on 08/05/13. |
Generate impression based on findings. | 61 year old patient. Headache and nausea -- rule out intracranial hemorrhage. There is no intracranial mass, fluid collection, hemorrhage, hydrocephalus or CT evidence of acute ischemia. Gray-white differentiation is normal and the midline is intact. Orbits and paranasal sinuses are unremarkable. | Unremarkable CT examination of the head. |
Generate impression based on findings. | NSIP from HP looking for change. SOB. LUNGS AND PLEURA: Bilateral heterogeneous subpleural interstitial abnormality with areas of groundglass opacity and traction bronchiectasis are not significantly changed. New nonspecific 4 mm irregular subpleural micronodule in right upper lobe (image 25/89) is presumably postinflammatory though continued follow up is recommended. Other scattered punctate micronodules, the largest which are calcified are unchanged and presumably postinflammatory.MEDIASTINUM AND HILA: Exophytic right thyroid nodules unchanged. Scattered small mediastinal and hilar nodes are unchanged. Atherosclerotic calcification of the aorta and its branches. Coronary calcification. Small hiatal hernia.CHEST WALL: Degenerative change involving spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Status post cholecystectomy. | Interstitial lung disease in NSIP pattern not significantly changed. New nonspecific 4 mm subpleural nodule in right upper lobe is presumably postinflammatory though continued follow up is recommended. |
Generate impression based on findings. | Altered mental status. There is patchy hypoattenuation within the PICA territory of the right cerebellar hemisphere. There is no significant mass effect including tonsillar herniation. There is marked calcification of the vertebral arteries bilaterally and the basilar artery. There is less prominent calcification within the supraclinoid ICAs.There is no fluid collection, hemorrhage or hydrocephalus. There is no CT evidence of acute ischemia supratentorially. Orbits and bony structures are unremarkable. There is mild soft tissue thickening within the maxillary sinuses bilaterally which could imply underlying sinus disease. | 1.Patchy low-attenuation within the right cerebral hemisphere. This could represent sequelae of ischema versus edema related to an underlying lesion. MRI is recommended for better characterization.2.Significant vascular calcification within the posterior circulation. 3.No supratentorial abnormality, though CT is suboptimally sensitive for acute ischemia and this, too, could also be assessed by MRI.This result was communicated verbally to the emergency room physician caring for the patient physician (Dr. Beiser) on 10/14/2013 at 1:06 p.m. A STAT consult alert was triggered at 12:51 p.m. |
Generate impression based on findings. | History of head and neck cancer. CHEST:LUNGS AND PLEURA: Scattered punctate micronodular unchanged and presumably postinflammatory. No new pulmonary nodules.MEDIASTINUM AND HILA: Atherosclerotic calcification of the aorta and its branches. Coronary calcification.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Stable mild left adrenal gland thickening.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Extensive vascular calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Stable CT with no definitive evidence of metastatic disease. |
Generate impression based on findings. | History of metastatic breast cancer on treatment. CHEST:LUNGS AND PLEURA: Stable basilar scarring. No suspicious pulmonary nodules.MEDIASTINUM AND HILA: Right thyroid nodule unchanged. Coronary calcification.CHEST WALL: Moderate degenerative disease of the thoracolumbar spine. Small stable nodule in the right breast (image 39 series 3).ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Nodular liver contour and retraction compatible with treated metastatic disease. Numerous mixed density lesions are noted throughout the liver. The reference left hepatic lesion measures 12 x 7mm (image 86 series 3) unchanged. Minimal perihepatic fluid unchanged.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Unchanged presumed renal cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Stable lucent lesions in lumbosacral spine (L1 and L5). Degenerative change in spine. Lucent lesion in left iliac wing only partially visualized (image 151/151). | Stable metastatic disease. |
Generate impression based on findings. | Base of tongue cancer. CHEST:LUNGS AND PLEURA: No suspicious pulmonary nodules or masses. Bibasilar and right middle lobe linear scarring, unchanged. Punctate right upper lobe granuloma.MEDIASTINUM AND HILA: Scattered small mediastinal nodes, all < 1cm. Aspirated debris in trachea (image 20/110).CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No focal mass lesion is seen in the liver. Cholelithiasis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: 10 mm hypodense (but not water density) exophytic renal lesion (image 113/148) involving midpole of right kidney. On prior studies dating back to 7/2007 this area showed a punctate hypodense focus too small to characterize but has now unequivocally enlarged.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.G-tube tip is in the stomach. Diverticulosis without evidence of diverticulitis of the visualized colon.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 10 mm exophytic lesion involving the right kidney which is presumably a very small renal cell carcinoma. Alternatively, but less likely, this could represent complex cyst or metastatic disease. |
Generate impression based on findings. | 56-year-old male with neuroendocrine carcinoma, need triphasic CT for Therasphere mapping/injection CHEST:LUNGS AND PLEURA: Few small micronodules in the right lung. MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Tip of porta-cath at the junction of right atrium and SVC. ABDOMEN:LIVER, BILIARY TRACT: Status post right hepatectomy. Background liver parenchyma demonstrates normal attenuation. Multiple arterially enhancing lesions identified throughout the left lobe of liver and caudate lobe which most likely represent metastatic neuroendocrine disease. Few of the smaller lesions have coalesced to form a larger lesion. Referenced lesion along the dome of the left lobe in segment 4 A. measures 4 x 5 cm (image 67, 12). Second referenced lesion in segment 3 measures 2 x 2.8 cm (image 101, 12). Left portal vein and left hepatic artery is patent.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Small right renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Lytic lesion in T11 vertebral body with a sclerotic rim could be degenerative or metastatic. This is not definitely seen on prior study in 2012.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Mildly enlargedBLADDER: 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. Status post right hepatectomy with multiple arterially enhancing lesions throughout the left lobe of liver and caudate lobe likely representing metastatic neuroendocrine disease.2. Lytic lesion in T11 vertebral body with a sclerotic rim most likely degenerative than bone metastasis. |
Generate impression based on findings. | History of thoracic aneurysm. Evaluate for routine surveillance. LUNGS AND PLEURA: Calcified granuloma in right lower lobe. Scattered areas of peripheral scarring. Scattered small punctate micronodules are presumably post inflammatory.MEDIASTINUM AND HILA: Thoracic aortic aneurysm. The ascending aorta measures 44 mm. The descending thoracic aorta measures 44 mm. The ectatic segment extends to the diaphragmatic hiatus though the portions of the abdominal aorta that are visualized on the study appear to be normal caliber. Extensive atherosclerotic calcification involving the aorta and its branches. Coronary calcification. Heterogeneous thyroid. Scattered small nodes measuring up to 1 cm.CHEST WALL: Degenerative change involving the thoracic spine. Scoliosis. Small axillary lymph nodes.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Splenic calcifications consistent with healed granulomatous disease. Left renal hyperdense cyst. | Thoracic aortic aneurysm measuring up to 44 mm in diameter. |
Generate impression based on findings. | 71-year-old female with microscopic hematuria ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Symmetric nephrogram and excretion of contrast noted. No focal lesions. No hydronephrosis. No evidence of renal stones. Symmetric opacification of the pelvocaliceal system and bilateral ureters noted. Bilateral ureters demonstrate normal course and caliber. No abnormal filling defects noted within the opacified pelvicaliceal system. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Few degenerative changes noted within the lumbosacral spine.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Bulky heterogenous uterusBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No CT findings to explain patient's symptoms. |
Generate impression based on findings. | Female 38 years old; Reason: pt history of metastatic breast cancer, receiving treatment - please eval for response/progression and compare with previous. History: see above CHEST:LUNGS AND PLEURA: Extensive subpleural emphysematous changes. There are multiple bilobar pulmonary nodules. A new left lower lobe pulmonary nodule measures 1.4 x 1.2 cm (image 55/series 5). MEDIASTINUM AND HILA: Extensive mediastinal lymphadenopathy. Reference right hilar lymph node measures 2.0 x 1.9 cm (image 45/series 3) previously, 2.2 x 1.8 cm.CHEST WALL: Left breast thickening and with enhancing left axillary nodes. Right chest wall Port-A-Cath terminates at the cavoatrial junction.Extensive left chest wall collaterals.ABDOMEN:LIVER, BILIARY TRACT: Multiple hypodense hepatic lesions a compatible with metastatic disease.The reference segment 7 lesion measures 4.7 x 4.2 cm (image 85/series 3) previously, 2.3 x 1.7 cm. Other liver lesions have also progressed in size. The hepatic and portal veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No 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.Progression in the pulmonary and hepatic lesions. |
Generate impression based on findings. | History of head and neck cancer. CHEST:LUNGS AND PLEURA: Reference pulmonary nodules are stable to decreased.Left upper lobe nodule (image 56/104) measures 2 mm previously measuring 3 mm.Left lower lobe reference nodule (image 78/104) measures 3 mm unchanged.No new pulmonary nodules identified. Other scattered punctate micronodules are unchanged.MEDIASTINUM AND HILA: Calcified nodes consistent with healed granulomatous disease. ICD lead in RV apex. Coronary calcification.CHEST WALL: Left chest wall ICD. Left axillary lymph node is unchanged at 14 x 8 mm (image 17/141).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: Benign appearing peripherally sclerotic focus in right iliac wing is only partially visualized but is grossly unchanged. Sclerotic lesion in T11 unchanged and likely degenerative in nature. OTHER: No significant abnormality noted. | Pulmonary micronodules are stable to decreased. Stable left axillary lymph nodes. |
Generate impression based on findings. | Male 74 years old; Reason: NHL, re-eval and compare to previous History: NHL CHEST:LUNGS AND PLEURA: Subpleural nodule adjacent to the minor fissure (image 59/series 130) is nonspecific and unchanged. No dominant lung lesion. The pleural spaces are clear. The central airways are patent.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. No mediastinal lymphadenopathy.CHEST WALL: Right chest wall port terminates at the cavo-atrial junction.OTHER: ABDOMEN:LIVER, BILIARY TRACT: Stable hypodense segment two lesion in the liver. The hepatic and portal veins are patent.SPLEEN: The spleen is normal in size.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Calcific arteriosclerotic disease of the aorta. Small retroperitoneal lymph nodes are unchanged.The reference mesenteric lymph node measures 3.5 x 2.8 cm (image 140/series 5) previously, 3.7 x 3.1 cm.BOWEL, MESENTERY: Mesentery lymph node is detailed above. No bowel obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Coarse calcifications within the prostate.BLADDER: No significant abnormality notedLYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Stable exam |
Generate impression based on findings. | 87-year-old male status post fall, hitting head Redemonstrated is encephalomalacia present along the right orbital gyrus and gyrus rectus. Periventricular and subcortical confluence white matter hypodensities of a moderate to severe degree are again noted, unchanged. The ventricles are unchanged in size or shape without evidence of interval dilatation. There are no masses, mass effect or midline shift. There is no evidence for acute intracranial hemorrhage or acute cerebral or cerebellar cortical infarction. There are no extraaxial fluid collections or subdural hematomas. The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | No acute intracranial abnormality. |
Generate impression based on findings. | Question pneumonia, granuloma. Left lower lobe nodule on CXR. LUNGS AND PLEURA: 8-mm cavitary nodule in left upper lobe (image 13/100) Nonspecifc area of scarring or atelectasis in right posterior upper lobe. Scattered punctate micronodules.MEDIASTINUM AND HILA: Lower paraesophageal lymphadenopathy with nodes measuring up to 18 mm in short axis (image 44/100). No definitive esophageal lesion is seen though this technique is extremely limited in evaluation.CHEST WALL: Nonspecific sclerotic lesion in the left anterior sixth rib of unknown etiology (image 66/100). UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Ill-defined hypodensity in left kidney is too small to characterize, especially without IV contrast. | 1. Small 8-mm cavitary nodule in left upper lobe suggestive of malignancy. Alternatively this could be the result of infection such as TB, though this would be atypical. Its location and size would make a high yield transthoracic needle biopsy limited though PET/CT may be of utility. Short term imaging and clinical follow up is recommended. 2. Lower paraesophageal lymphadenopathy of unknown etiology.Findings communicated to ED via stat consult tool at the time of report. |
Generate impression based on findings. | Male 49 years old; Reason: evaluate for parastomal hernia History: ventral hernia at stoma site ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver has a smooth contour. No suspicious hepatic lesions. Hepatic portal veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Rotated right kidney without hydronephrosis. No nephrolithiasis in either kidneys evident.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Right lower abdominal ostomy with multiple loops of bowel within the ostomy outside the fascial plane in the subcutaneous tissues. No bowel obstruction. Status post colectomy. 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: Right lower abdominal ostomy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Right lower ostomy with redundant loops of bowel within the ostomy superficial to the fascial plane in the subcutaneous tissues. No evident peristomal hernia or obstruction. |
Generate impression based on findings. | Reason: 83 male with CML on niltonib now with chemical pancreatitis. Please assess for radiographic evidence, aware that study suboptimal without IV contrast, but patient has renal insufficiency History: Pancreatitis ABDOMEN: Within the limitations of a non-IV contrast enhanced examination which limits evaluation of solid organ parenchyma and vascular structures, the following observations can be made:LUNG BASES: Mild focal pleural thickening of the left lung base. Mild pericardial effusion.LIVER, BILIARY TRACT: Subcentimeter hypodense lesion in the left superior lobe of the liver is too small to further characterize but likely represents a hepatic cyst. Another subcentimeter hypodense lesion in the caudate lobe is too small to further characterize.SPLEEN: No significant abnormality notedPANCREAS: No pancreatic calcifications. No ductal dilatation. No fluid collections. No CT evidence of pancreatitis or associated complications.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality noted. RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the descending aorta at the origin of the celiac axis and SMA as well as bilateral common iliac arteries.BOWEL, MESENTERY: No significant abnormality noted..BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Partially collapsed bladder. LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Small sigmoid and descending colon diverticula without evidence of diverticulitis.BONES, SOFT TISSUES: Degenerative disease in bilateral femoral heads. Degenerative disease of the lower lumbar spine.OTHER: No significant abnormality noted | No CT evidence of pancreatitis or associated complications. |
Generate impression based on findings. | Reason: RP bleed History: drop in hgb, abdomen pain Lack of intravenous contrast limits evaluation of solid organ pathology.ABDOMEN:LUNG BASES: Motion artifact limits evaluation of the lung bases. Small pleural effusions with basilar atelectasis.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis or nephrolithiasis.RETROPERITONEUM, LYMPH NODES: No evidence of retroperitoneal hematoma. Moderate atherosclerosis of the abdominal aorta and its branches. BOWEL, MESENTERY: No evidence of obstruction. No free intraperitoneal air or mesenteric free fluid. Small fat containing umbilical hernia.BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine. Nonspecific subcutaneous fat stranding.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: Decompressed by Foley catheter.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Rectal catheter is in place.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Right femoral artery catheter. | No evident retroperitoneal hematoma. |
Generate impression based on findings. | Reason: 67 yo female with rectal cancer who completed XRT on 9/9/13. Need to evaluate extent of disease and for any evidence of metastatic disease. History: none CHEST:LUNGS AND PLEURA: Scattered nonspecific pulmonary micronodules. No pleural effusions.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size is normal without pericardial effusion. CHEST WALL: Right chest wall Port-A-Cath tip terminates in the right atrium.ABDOMEN:LIVER, BILIARY TRACT: Multiple hepatic hypodensities are likely benign cysts.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Indeterminate left upper pole hypodense lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small hiatal hernia. BONES, SOFT TISSUES: Sclerotic and slightly expansile left iliac wing lesion. Scoliosis.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Sclerotic expansile lesion of the left iliac wing is suspicious for metastasis. Correlate for additional malignancy (breast), as an isolated metastasis to the left iliac wing would be unusual for a rectal cancer. |
Generate impression based on findings. | Male 58 years old Reason: right flank pain History: pain radiating to grown Exam is not sensitive for detecting lesions in the bowel, solid organs of vasculature due to the lack of oral or intravenous contrast. Given those limitations, the following observations are made:ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Cholelithiasis. No evidence of cholecystitis or biliary dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Scarring lateral aspect mid right kidney. Punctate calcification in the parenchyma the jacent to that area of scarring consistent with possible nephrolithiasis. No other calcifications elsewhere in the kidney. No perinephric fat stranding, hydronephrosis or hydroureter.The left kidney is normal.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No evidence of calcifications in the urinary bladder along the course of the distal ureters.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Minimal atherosclerotic calcifications. | Scarring right kidney. Single punctate calcification right kidney possibly representing nephrolithiasis. No hydronephrosis or hydroureter.Cholelithiasis with no evidence of cholecystitis. |
Generate impression based on findings. | Locally advanced esophageal cancer s/p chemo XRT/ Finished XRT 9/13/2013. Evaluate extent of disease and for metastases. CHEST:LUNGS AND PLEURA: Scattered punctate micronodules, the largest of which are calcified, are likely postinflammatory. Very mild emphysema.MEDIASTINUM AND HILA: Circumferential distal esophageal wall thickening extending the to the GE junction. For continued reference the wall measurement is 29 mm on image 79/158 and the entire esophageal diameter is 46 mm on the same image though this does include the air filled lumen.Coronary calcification. Atherosclerotic calcification of the aorta and its branches. Port catheter tip in SVC.CHEST WALL: Right chest wall port. Presumed sebaceous cysts involving the posterior back (image 30 and 42/158).ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Negative.SPLEEN: Small thrombosed splenic artery aneurysm (image 98/158).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate calcification in periphery of right kidney too small to characterize.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Scattered small <5-mm lymph nodes in the upper abdomen.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Esophageal thickening extends to the proximal stomach consistent with known carcinoma. Balloon retained J tube present.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Distal esophageal mass extending into proximal stomach consistent with known carcinoma. No evidence of pulmonary or hepatic metastases. |
Generate impression based on findings. | Female 67 years old Reason: 67 y/o F w/ new d/o breast ca needs staging imaging. Please evaluate for metastatic disease History: none CHEST:LUNGS AND PLEURA: Moderate left pleural effusion and small right pleural effusion. Several lung nodules bilaterally consistent with metastatic disease.For baseline purposes right upper lobe nodule as measured on series 6 image 37, 0.6 x 0.6 cm.MEDIASTINUM AND HILA: A few small mediastinal nodes not pathologic by size criteria. No internal mammary nodes.CHEST WALL: Skin thickening right breast. Nodular soft tissue density right breast. This is measured for baseline purposes on series 4 image 58, 1.9 x 1 .8 cm.Clusters of small axillary nodes bilaterally suspicious for metastatic disease. Some nodes have foci of calcification.Few punctate sclerotic foci in the vertebral body suspicious for metastatic disease one large area of sclerosis is seen involving what is probably T8 vertebral body, best seen on coronal image 25/91. These findings are consistent with metastatic disease.ABDOMEN:LIVER, BILIARY TRACT: Gallbladder is surgically absent. Prominent common bile duct and minimal central biliary prominence possibly related to the cholecystectomy. No focal liver masses.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Cyst right lower pole. Otherwise unremarkable.RETROPERITONEUM, LYMPH NODES: No pathologic size nodes. Mild atherosclerotic calcifications of evidence of aneurysm.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: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis. No evidence of ascites or carcinomatosis.BONES, SOFT TISSUES: Several punctate sclerotic foci are seen in the pelvis, lumbar spine, and femora concerning for metastatic disease.OTHER: No significant abnormality noted. | Right breast mass. Lung metastases and lymphadenopathy. Osseous metastases. Other findings as above. |
Generate impression based on findings. | 49-year-old male with ataxia. Redemonstrated is patchy hypoattenuation within the PICA territory of the right cerebellar hemisphere. There is no significant mass effect nor tonsillar herniation. There is marked calcification of the vertebral arteries bilaterally and the basilar artery making the diagnosis of arterial occlusion difficult. There is less prominent calcification within the supraclinoid ICAs.There is no fluid collection, hemorrhage or hydrocephalus. There is no CT evidence of acute ischemia supratentorially. Orbits and bony structures are unremarkable. There is mild soft tissue thickening within the maxillary sinuses bilaterally which could imply underlying sinus disease. | 1.Persistent patchy low-attenuation within the right cerebral hemisphere which could represent sequelae of ischema versus edema.2.Marked calcification of the vertebral arteries bilaterally and the basilar artery making the diagnosis of arterial occlusion difficult.3.MRI and/or MRA could further characterize the cerebellar abnormality as well as define flow status within the arterial system. |
Generate impression based on findings. | Reason: NHL, re-eval and compare to previous. Please measure pulmonary nodule. History: NHL, pulmonary nodule CHEST:LUNGS AND PLEURA: Increasing left upper lobe pulmonary nodule measures 3.1 x 2.3 cm (series 4, image 30), previously 2.3 x 1.7 cm. Scattered micronodules without significant interval change. There are multiple well-defined pulmonary cysts. Surgical sutures in the left lower lobe. No pleural effusions.MEDIASTINUM AND HILA: Reference prevascular lymph node measures 1.5 x 0.9 cm (series 3, image 30), previously 1.4 x 0.9 cm. Additional small mediastinal lymph nodes without significant interval change. Heart size is normal without pericardial effusion.CHEST WALL: Small left subpectoral lymph node is unchanged. Stable sclerotic focus in the left lateral aspect of the T12 vertebral body.ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy.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: Misty mesentery compatible with treated lymphoma, unchanged. Small mesenteric lymph nodes.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. | Increasing left upper lobe pulmonary mass. Otherwise, stable exam. |
Generate impression based on findings. | Clinical question: Evaluate lumbar fusion. Signs and symptoms: Radicular pain in left leg. Nonenhanced lumbar MRI:The alignment of vertebral column is abnormal and with evidence of minute retrolisthesis of L1 on L2, mild grade 1 retrolisthesis of L2 on L3 and minute retrolisthesis of L4 on L5.There is evidence of excessive degenerative disk disease and vacuum phenomenon throughout the lumber spine.There is evidence of posterior spinal fusion with placement of bilateral transpedicular screws from L2 through L5 levels.There is minimal bony lucency surrounding the bilateral transpedicular screws at L2 level.There is mild projection of the left transpedicular screws into the left neural foramina.There is no evidence of disk space fusion.There is evidence of intra-disk space placement of prosthetic metallic devices only at L3 -- L4 and L4 -- L5 levels. They remain within the intervertebral disk space and without projection into the spinal canal. The articulating facets as well as the facet spaces are visualized bilaterally and without convincing evidence of effusion. The articulating facet at the L2 -- L3 level is widened (right greater than left).Bony graft material is noted only posterior and lateral to the left articulating facet at L5 -- S1 and without convincing evidence of fusion to the native bone. | 1.Evidence of bilateral transpedicular screw placement and posterior fixating rods extending from L2 to L5. The right transpedicular screw at L5 projects into the superior aspect of the right neural foramina.2.Minimal bony lucency surrounding the transpedicular screws at L2 as detailed.3.Articulating facets and facet spaces are well visualized and without evidence of fusion. There is some widening of the facet spaces bilaterally at L2 -- L3 level. 4.Bony graft material is detected only at the level of the left articulating facet of L5-S1 and without evidence of perfusion to the native bone.5.Prosthetic device noted within the disk spaces at L3 -- 4 and L4 -- 5 levels without projection into spinal canal. 6.Multilevel mild retrolisthesis at L1 -- L2, L2 -- L3 and L4 -- L5 levels as mentioned above.7.Multi-level extensive degenerative disk disease and vacuum disk as mentioned above. |
Generate impression based on findings. | 33-year-old male with history of squamous cell carcinoma of the right tongue treated with chemoradiation and partial glossectomy. Postsurgical changes status post removal of a right submandibular gland and partial glossectomy are similar to prior study. No abnormal enhancement, new discrete mass, or clinically significant lymphadenopathy is seen in the neck. Sclerosis involving the right mandible is unchanged given differences in technique when compared to the prior CT and MRI modalities and is presumably treatment related.Asymmetry of the piriform sinuses is again noted, with soft tissue prominence on the left, which is stable and likely anatomic variation. The parotid, left submandibular, and thyroid glands are unremarkable. The carotid arteries and jugular veins are patent. The osseous structures are unremarkable.The visualized intracranial contents are unremarkable. Only minimal mucosal thickening is present within left ethmoid air cells. The remaining visualized paranasal sinuses and mastoid air cells are clear.Please see separate chest CT dictation for discussion of thoracic content. | 1.Stable treatment related changes of the right tongue and right neck without evidence of residual or recurrent tumor.2.No clinically significant lymphadenopathy.3.Sclerosis involving the right mandible is unchanged given differences in technique when compared to the prior CT and MRI modalities and is presumably treatment related. |
Generate impression based on findings. | Female 45 years old Reason: Dx Metastatic Breast Ca History: Evaluate disease/Check progression CHEST:LUNGS AND PLEURA: Redemonstration of postradiation fibrotic changes in the anterior portion of the lung along the right upper lobe. Nodular scarring in the right apex and several small subpleural nodules on the right are unchanged. No new suspicious lung nodules. No effusions.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Redemonstration of non-osseous union right anterior rib fracture several levels. Postsurgical changes right chest wall.Previously seen soft tissue fullness in the right subpectoral area encompassing the region of the right subclavian vein is unchanged.ABDOMEN:LIVER, BILIARY TRACT: Multifocal liver lesions consistent with metastatic disease. Index lesions remeasured as follows: Reference lesion in segment 4, medial segment increased in size measuring 4.9 x 2.5 cm on series 3 image hundred and 9. Previously 3.4 x 2.9 cm.Reference lesion in segment 7 is now confluent with some of the adjacent lesions. It also abuts the inferior vena cava now. The margins are well-defined in its size is estimated at 5.2 x 3 .8 cm. on series 2 image 96. Previously 2.5 x 2.2 cm.There may be some new liver lesions as well.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Scarring right kidney unchanged. No hydronephrosis. Left kidney normal.RETROPERITONEUM, LYMPH NODES: Scans of retroperitoneal adenopathy particularly in the left periaortic area, is increased.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: 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. | Progression of disease particularly in the liver and lymphadenopathy in the retroperitoneum. |
Generate impression based on findings. | Reason: metastatic breast cancer on therapy please assess response and compare to previous imaging History: MBC CHEST:LUNGS AND PLEURA: Stable bilateral micronodules.MEDIASTINUM AND HILA: Atherosclerotic calcifications of the aortic arch, coronary arteries. Calcified hilar lymph nodes.CHEST WALL: No significant abnormality noted. Peripheral calcification of bilateral breast implants.ABDOMEN:LIVER, BILIARY TRACT: Stable hypoattenuating lesions in the right and left lobe of the liver.SPLEEN: No significant abnormality noted.PANCREAS: Small hypoattenuating lesion in the neck of the pancreas which appears slightly larger compared to prior exam.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable left renal cyst.RETROPERITONEUM, LYMPH NODES: Hypodense mural plaque in the descending aorta above the level of the renal arteries with no evidence of ulceration. Calcification of the origin of the right renal artery. Moderate atherosclerotic calcification of the aorta and bilateral common iliac arteries.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: Stable left iliac lytic lesion with sclerotic borders. OTHER: No significant abnormality noted. | Stable examination. |
Generate impression based on findings. | Esophageal cancer status post 3 additional cycles of chemo. Needs disease evaluation. CHEST:LUNGS AND PLEURA: Bilateral nodular airspace opacities with variable cavitation.Reference left upper lobe lesion is slightly larger at 17 x 11 mm on image 37/103 (16 x 8 mm on prior). Reference left lower lobe lesion again measures 26 x 9 mm on image 51/103 though has more solid components. Other opacities are stable.MEDIASTINUM AND HILA: Coronary calcification. Venous catheter tip in SVC.Nonspecific stable mild wall thickening of the upper esophagus at the site of the initial lesion, unchanged.CHEST WALL: Right chest wall port. Degenerative change involving the spine.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: 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: 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. | Left upper lobe reference nodule slightly larger. Left lower lobe reference nodule stable in size though is now more solid. No new sites of disease. |
Generate impression based on findings. | History multiple myeloma. Low-grade fevers. Assess for possible pneumonia. LUNGS AND PLEURA: New basilar predominant interstitial abnormality with very mild bronchiectasis and patchy areas of groundglass opacity. New small area of consolidation at left base and to a lesser degree involving the lingula.MEDIASTINUM AND HILA: Port tip at RA/SVC junction.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Multiple hepatic hypodensities which are presumably cysts but incompletely evaluated. Please see prior abdomen pelvis CT report for further details. | Basilar predominant interstitial abnormality with mild bronchiectasis and patchy groundglass opacity. A few small areas of consolidation are also noted. The findings are suggestive of aspiration/aspiration pneumonia, though a drug reaction may appear similarly. The findings are relatively nonspecific and can also be seen with NSIP (nonspecific interstitial pneumonitis) in the appropriate clinical setting. |
Generate impression based on findings. | Female 73 years old Reason: evaluate for recurrence of hernia, or seroma. post ventral hernia repair in 12/2012 History: persistent abdominal bulge post hernia repair 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: Large left renal cyst. Small punctate a foci right kidney likely cysts a small to characterize.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications aorta and origin of the celiac artery and renal arteries. No evidence of aneurysm.BOWEL, MESENTERY: No evidence of bowel wall thickening or dilatation. No free or loculated intraperitoneal fluid. Anterior abdominal wall ventral hernia, nonobstructive.Scattered small mesenteric nodes.BONES, SOFT TISSUES: Broad-based ventral hernia with wide neck of about 10 cm as seen on series 4 image 100 containing colon and omentum, nonobstructive.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: Atrophic or surgically absent. Pessary in place.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 | Broad-based nonobstructive ventral hernia. Large left renal cyst. Atherosclerotic disease. |
Generate impression based on findings. | Reason: 19F w/ h/o sickle cell s/p cholecystectomy w/ RUQ pain, white count and fever, eval for appendicitis vs intraabd infection History: RUQ pain ABDOMEN:LUNG BASES: Basilar subsegmental atelectasis.LIVER, BILIARY TRACT: Periportal edema is nonspecific. Status post cholecystectomy.SPLEEN: Atrophic spleen.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Prominent retroperitoneal lymph nodes.BOWEL, MESENTERY: Small fat-containing umbilical hernia. No evidence of obstruction. The appendix is normal in appearance. Nonspecific wall thickening of the terminal ileum. Prominent mesenteric lymph nodes. No pneumoperitoneum or mesenteric free fluid. No drainable fluid collections.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Bilateral femoral head sclerosis compatible with infarction.OTHER: No significant abnormality noted. | 1.Wall thickening of the terminal ileum of indeterminate etiology. Differential considerations include infectious/inflammatory etiologies. 2.No evidence of appendicitis. 3.No drainable fluid collections. |
Generate impression based on findings. | Female 67 years old Reason: pt with met lung ca s/p 2 cycles of chemo last one 9/27 Diabetic on insulin too History: now needs disease evaluation prior to more chemo any changes since last Ct compare and comment CHEST:LUNGS AND PLEURA: Large right pleural effusion markedly increased in size compared to the prior exam. The right lung is nearly completely collapsed. This is a new finding compared to the prior exam. The residual aerated upper lobe demonstrates a similar appearance to the prior exam with dense groundglass opacities and consolidation.Although there is blunting to the respiratory motion, the left lung is aerated although not hyperinflated with no evidence of nodules or effusion.MEDIASTINUM AND HILA: Mediastinal lymphadenopathy involving multiple chains including superior mediastinal, pretracheal, paratracheal, AP window and prevascular spaces. Subjectively stable. The index subcarinal node is ill-defined and estimated at 1.4 x 1 cm series 2 image 50.Central venous catheter tip SVC at the right atrial junction.CHEST WALL: Redemonstration of fracture with abundant callus involving the anterior aspect of one of the upper right ribs. Possible lytic focus one of the posterior right rib series 3 image 44.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Nodular thickening right adrenal gland measuring 2.8 x 1.5 cm on series 3 image 130 previously 2.9 x 2.1 cm.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic disease. No evidence of aneurysm. No pathologic size retroperitoneal lymph nodes.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: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diverticulosis. No evidence of ascites or carcinomatosis. No bowel wall thickening or dilatation.BONES, SOFT TISSUES: Postsurgical changes anterior abdominal lower.OTHER: No significant abnormality noted. | Near complete collapse of right lung with large increasing pleural effusion and persistent consolidation and small aerated right upper lobe. Increasing size right adrenal nodule. Persistent mediastinal adenopathy. Redemonstration of osseous findings as described. |
Generate impression based on findings. | Reason: 70 y/o M w/ stage IIIb NSCLC s/p chemo needs restaging in 10/2013 History: cough CHEST:LUNGS AND PLEURA: Interval increase in the paramediastinal and paravertebral fibrosis with increasing left lower lobe consolidation and interstitial opacities compatible with post radiation changes. Left basilar consolidation/mass (image 74 series 3) now measures 5.3 cm by 2.4 cm previously measuring 5.2 cm by 3.2 cm. Difference may be accounted for by the degree of inspiration.Left pleural thickening and effusion increased since the prior exam.Severe upper lobe predominant centrilobular and paraseptal emphysema.MEDIASTINUM AND HILA: Stable small mediastinal lymph nodes with reference left paratracheal lymph node open parentheses image 37 series 3) measuring 9 mm unchanged.Reference subcarinal lymph node (image 52 series 3) unchanged measuring 8 mm.Dilated esophagus with small air-fluid level.Large pericardial effusion is increased in size since the prior exam.CHEST WALL: Stable endplate depression of T12.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Scattered small hypodensities unchanged.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts unchanged.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Marked atherosclerotic changes of the aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Probable lipoma of the ileocecal valve.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Left basilar mass/consolidation without significant interval change.2.Increasing paramediastinal and paravertebral fibrosis, increasing left basilar interstitial opacities , and increasing left pleural thickening/effusion most likely representing post radiation changes.3.Moderate to large sized pericardial effusion increased since the prior exam. |
Generate impression based on findings. | Reason: history of ovarian cancer. baseline scan prior to starting new treatment - please use measurements if applicable. thanks! History: see above if you CHEST:LUNGS AND PLEURA: Few scattered pulmonary micronodules. No pleural effusions.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size is normal without pericardial effusion.CHEST WALL: Sclerotic foci in the T3 vertebral body and pedicles compatible with metastasis.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Multiple nonspecific hypodense splenic lesions may represent metastases.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Retroperitoneal lymphadenopathy. Index paraaortic lymph node measures 2.0 x 1.4 cm (series 3, image 106).BOWEL, MESENTERY: Omental nodularity compatible with peritoneal carcinomatosis. Index soft tissue nodule measures 1.0 cm in maximal diameter (series 3, image 107). Mesenteric lymphadenopathy. No evidence of bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Omental nodularity compatible with peritoneal carcinomatosis.2.Sclerotic T3 foci compatible with metastatic disease.3.Nonspecific hypodense splenic lesions may represent metastases.4.Retroperitoneal and mesenteric lymphadenopathy. |
Generate impression based on findings. | 84-year-old male with history of bitemporal headaches which come and go, often present in the afternoon. There is no detectable acute intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus. The cortical sulci and ventricular system remain within normal size and morphology for patient's stated age of 83. Redemonstrated are findings of small vessel disease of indeterminate age is present. CT is insensitive for early detection of acute ischemic strokes. Calvarium, orbits, mastoid air cells and middle ear cavities are unremarkable. Redemonstrated is chronic pansinusitis. | 1.Persistent chronic pansinusitis.2.No acute intracranial abnormality. |
Generate impression based on findings. | Reason: hyperaciditiy (pH =1 in stomach), multiple gastric ulcers, refractory reflux, evaluate for neuroendocrine tumor History: vomiting, reflux, ulcers. ABDOMEN:LUNG BASES: No significant abnormality noted. Bilateral breast implants.LIVER, BILIARY TRACT: Hypoattenuating, nonenhancing lesion in the right lobe of the liver, segment IV a/ IV b, is most likely a hepatic cyst. No enhancing, focal liver lesions. No evidence of cholelithiasis. No intrahepatic or extra hepatic ductal dilatation.SPLEEN: Subcentimeter hypodense, nonenhancing lesion in the spleen.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Small subcentimeter hypodense, nonenhancing lesions in bilateral kidneys likely representing benign renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Excellent distention of the small ball with exit in the proximal jejunum and no masses are seen. Appendix is normal appearing.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant animality noted.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 | No evidence to explain patient's stated symptoms. |
Generate impression based on findings. | Lung cancer status post two cycles of chemotherapy please evaluate for disease and compare with baseline on 7/24/13 CHEST:LUNGS AND PLEURA: Multiple bilateral subpleural and peripheral pulmonary nodules not significantly changed from prior study. Stable postsurgical changes in the right middle lobe.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Tip of the porta catheter at the junction of right atrium and SVCThe compression deformity of the T6 vertebral body is not significantly changed from prior study, without significant spinal canal narrowing at this level.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter small hypodensities in both lobes of the liver are mostly unchanged.Subtle hypodense right hepatic lobe lesion measures 2.7 x 2.9 cm on a noncontrast study (image 111, 3), previously measured 3.4 x 3 cm on a postcontrast study making comparison difficult.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Subcentimeter lymph nodes along the left iliac chain are mostly unchanged.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Sclerotic sacral lesion in midline is unchanged.OTHER: No significant abnormality noted | 1. Minimally decreased right hepatic lesion.2. Stable bilateral pulmonary nodules.3Stable sclerotic sacral lesion. Unchanged compression deformity T6 vertebral body.. |
Generate impression based on findings. | Male 56 years old Reason: Esophageal/GEJ AC: Restaging History: none CHEST:LUNGS AND PLEURA: First reference right apical ground glass nodule now measures 5 mm (image 20, series 5), previously 3 mm.Second reference right apical ground glass nodule now measures 6 mm (image 19, series 5), previously 4 mm.No new focal air space opacities, nodules or masses identified.MEDIASTINUM AND HILA: Index subcarinal lymph node now measures 12 mm (image 45, series 3), previously 10 mm.Nonspecific distal esophageal thickening below the GE junction unchanged.Normal heart size and no pericardial effusion.Right internal jugular venous catheter with tip at the cavoatrial junction.CHEST WALL: Chest port.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: Bilateral adrenal gland enlargement compatible with metastases, unchanged.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Increasing retroperitoneal lymphadenopathy with increasingly necrotic appearing lymph nodes. Increase in size and extent of the porta hepatis lymphadenopathy.Index gastrohepatic lymph node now measures 17 mm (image 99, series 3), previously 13 mm.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Esophageal thickening extending into proximal stomach.BONES, SOFT TISSUES: No evidence of metastatic disease in the osseous structures of the abdomen and chest. OTHER: No significant abnormality noted. | 1. Slight interval enlargement of the right upper lobe nodule.2. Slight interval enlargement of reference lymph nodes.3. Stable adrenal metastases.4. Esophageal thickening extending into proximal stomach.5. No new sites of disease. |
Generate impression based on findings. | History of squamous cell carcinoma of the tongue status post CRT. LUNGS AND PLEURA: Scattered punctate micronodules are stable and presumably postinflammatory.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | No evidence of metastatic disease. |
Generate impression based on findings. | Smoker, recurrent pneumonia, history of aspiration. Rule out nodule, assess for COPD. LUNGS AND PLEURA: Clustered groundglass opacities are noted at the left lung base and lingula. Areas of scarring or atelectasis are noted at the right medial lung base. Multifocal small centrilobular nodules are present, right greater than left suggestive of aspiration, though significantly improved versus 2009. No new suspicious pulmonary nodules are present. Postop change on the right. Centrilobular emphysema. Bronchial wall thickening.MEDIASTINUM AND HILA: Small subcentimeter mediastinal and hilar nodes are unchanged. Hiatal hernia. Coronary calcification.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Hiatal hernia. Small focus of calcification in right posterior segment of liver, presumably post inflammatory. | 1. Findings consistent with chronic aspiration, right greater than left, less severe than on 2009 CT. 2. No new suspicious pulmonary nodules. 3. Centrilobular emphysema.4. Hiatal hernia. |
Generate impression based on findings. | Reason: Please evaluate for upper tract recurrence of bladder cancer History: hx of bladder carcinoma in situ s/p TURBT and intravesical BCG therapy ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Fatty infiltration.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Asymmetric left peripheral enlargement and enhancement of the prostate.BLADDER: No significant abnormality noted.LYMPH NODES: New enlarged pelvic lymph node and measures 2.7 x 2.0 cm (series 7, image 121).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Asymmetric enhancement and enlargement of the prostate is highly suggestive of prostate malignancy.2.New left pelvic lymphadenopathy. |
Generate impression based on findings. | Male 66 years old Reason: pt with nexly dx small cell lung ca no therapy so far only surgical bx History: doing well now needs disease evaluation CHEST:LUNGS AND PLEURA: Interval right upper lobectomy removing a round solid mass previously seen in the posterior segment of the right upper lobe. There is residual soft tissue thickening along these staple line measuring 11 x 25 mm (image 38 series 4), which likely represents postoperative changes but residual tumor cannot be excluded. Continued follow up is recommended.New large right partially loculated pleural effusion with associated nodular thickening (image 8, series 3) seen along the posterior and lateral aspects of the right pleural surface.No new suspicious pulmonary nodules or masses identified.Paraseptal and centrilobular emphysema.MEDIASTINUM AND HILA: No evidence of mediastinal or hilar lymphadenopathy.Large left thyroid mass.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: Multiple hypodense lesions in the right renal parenchyma compatible with simple renal cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: S/P aorto bifemoral bypass with chronic appearing occlusion of left iliac limb.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No evidence metastasis to the osseous structures of the chest and abdomen.OTHER: No significant abnormality noted. | 1. Nodular thickening of the right pleura which should be followed to exclude pleural metastatic disease.2. Soft tissue density seen along the staple line from a prior right upper lobectomy likely postoperative in nature; however, residual tumor cannot be excluded.3. Large left thyroid mass, more likely a primary thyroid neoplasm than metastatic disease. |
Generate impression based on findings. | Male 79 years old Reason: evaluate aortic aneurysm repair History: h/o aneurysm. CHEST:LUNGS AND PLEURA: Redemonstration of index left lower lobe nodule series 8 image 86 measuring 0.9 x 0.8 cm. Previously 0.9-cm. Is probably unchanged.Left apical nodule too small to accurately measure estimated that 0.8 x 0.3 cm series 8 image 26.Apical scarring bilaterally right greater than left. No effusions. No new nodules.MEDIASTINUM AND HILA: Findings consistent with a descending aortic root repair. There is no evidence of aneurysm or dissection. Mild tortuosity of the aorta. Mid descending aorta 2.6-cm transverse coronal image 64/83.Postsurgical changes as seen the right coronary artery is occluded with retrograde flow filling it distally. Atherosclerotic changes seen in the left coronary artery unchanged. No evidence of pericardial effusion.Tricuspid aortic valve. Normal size heart.CHEST WALL: No significant abnormality noted.OTHER: Shows portions of the upper abdomen are unremarkable. No evidence of fatty liver. Normal size spleen. Focal globular calcification seen in the right lobe of the liver. | No interval change in appearance of the aorta. Stable left lower lobe nodule. Other findings as above. |
Generate impression based on findings. | Lung cancer restaging. Cough. CHEST:LUNGS AND PLEURA: Multifocal consolidative lung masses are stable in appearance. Reference right lower lobe mass measures 5.0 X 4.2 cm (series 4, image 61), unchanged. Small bilateral loculated pleural effusions are stable.MEDIASTINUM AND HILA: Atherosclerotic calcification of the aorta and its branches. Small left thyroid hypodense nodule unchanged.CHEST WALL: Status-post vertebroplasty in the lower thoracic and lumbar spine. T12 compression deformity unchanged.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Stable presumed hepatic cysts.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable punctate nonobstructive right renal calculus.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Status-post vertebroplasty in the lower thoracic and lumbar spine. T12 compression deformity unchanged.OTHER: No significant abnormality noted. | Stable multifocal consolidative masses consistent with history of mucinous adenocarcinoma. No new sites of disease. |
Generate impression based on findings. | Reason: rule out bowel perforation History: s/p ileal conduit c/b wound dehiscence and debridement, now with brown output from wound (?tube feedings) ABDOMEN:LUNG BASES: Motion artifact limits evaluation of the lung bases. Bilateral pleural effusions with overlying compressive atelectasis. Right base consolidation.LIVER, BILIARY TRACT: Mild intrahepatic biliary ductal dilatation. Gallstone sludge.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: Right lower quadrant ileostomy. Left lower quadrant colostomy with bowel containing parastomal hernia. Large midline abdominal wound. Enteric contrast opacifies bowel loops immediately deep to the wound. There is enteric contrast within the wound itself compatible with an enterocutaneous fistula although no definite tract is seen. No evidence of obstruction. No pneumoperitoneum.BONES, SOFT TISSUES: Body wall edema.OTHER: Status post gastric bypass. NG tube tip terminates in the gastric remnant.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Cystectomy with ileal conduit.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Lipoma of the filum terminale. Cannulated screw device affixes a left femoral neck fracture.OTHER: No significant abnormality noted. | 1. Enterocutaneous fistula involving the midline abdominal wound and adjacent small bowel.2. Bowel containing parastomal hernia about the colostomy. |
Generate impression based on findings. | Headache and dizziness. Rule out intracranial hemorrhage. No intracranial mass, fluid collection, hemorrhage, hydrocephalus or CT evidence of acute ischemia. Gray-white matter differentiation is maintained bilaterally and the midline is intact. Bones are unremarkable. Visualized portions of the orbits are unremarkable. Mastoid air cells are clear. | No intracranial abnormality demonstrated. |
Generate impression based on findings. | History of head and neck cancer status post cycle 5 of 5 CRT on 9/13/13 CHEST:LUNGS AND PLEURA: Emphysema. Scattered punctate micronodules are stable and presumably postinflammatory.MEDIASTINUM AND HILA: Atherosclerotic calcifcation of the aorta and its branches. Coronary calcification. Port tip at RA/SVC junction.CHEST WALL: Right chest wall port. Degenerative change involving the spine.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cyst unchanged.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.G-tube tip in stomach.BONES, SOFT TISSUES: Multilevel degenerative disease.OTHER: No significant abnormality noted. | No evidence of metastatic disease. |
Generate impression based on findings. | Male; 56 years old. Reason: altered mental status, hypoxia, rule out PE History: altered mental status, hypoxia Motion artifact limits diagnostic sensitivity.PULMONARY ARTERIES: No evidence of pulmonary embolism. Mildly enlarged pulmonary trunk diameter is suggestive of pulmonary arterial hypertension.LUNGS AND PLEURA: Scattered pulmonary micronodules but no suspicious masses or lesions. Mild basilar scarring/atelectasis. Small right pleural effusion. Lower right paramediastinal emphysematous bullae.MEDIASTINUM AND HILA: Cardiomegaly with enlarged right heart. No pericardial effusion. No significant mediastinal or hilar lymphadenopathy. Moderate aortic and coronary artery calcifications.CHEST WALL: Left subclavian ICD with leads in place. Right chest wall lipoma.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Reflux of contrast into the IVC. | 1.No evidence of pulmonary embolism. 2.Small right pleural effusion. |
Generate impression based on findings. | Clinical question: Evaluate for abscess. Signs and symptoms: Right facial swelling/pain. Enhanced CT of maxillofacial region:Examination demonstrate soft tissue edema and subcutaneous fat stranding on the right and extending from the level of the body of mandible superiorly to the soft tissues of the cheek. This finding appears slightly worse at the level of the right maxillary premolar tooth (axial images 79 to 86) which demonstrate dental decay and periapical lucency. There is however no convincing evidence of any associated abscess formation on this exam.Closer follow-up is recommended if patient's symptoms do not improve it conservative treatment.Minimal right maxillary chronic sinus disease and unremarkable other paranasal sinuses.Unremarkable images through the orbits.Well pneumatized bilateral mastoid air cells and middle ear cavities. | 1.Examination demonstrate dental decay and periapical lucency of the right maxillary premolar tooth.2.There is edema and soft tissue thickening of the right side of the face and cheek and at the level of mandible/maxilla which is more pronounced at the level of the above described dental decay. There is however no convincing evidence of an associated abscess formation on this initial study.3.Consider follow-up if symptoms do not improve with conservative treatment. |
Generate impression based on findings. | COPD and smoking history with outside hospital abdominal CT imaging which revealed 3-mm right middle lobe nodule. LUNGS AND PLEURA: Scattered punctate micronodules measuring up to 4 mm in the left apex (image 13/113). Some demonstrate calcification, consistent with healed granulomatous disease. Basilar scarring and atelectasis. Mild bronchial wall thickening. Mild emphysema.MEDIASTINUM AND HILA: Coronary calcification. Scattered small subcentimeter nodes.CHEST WALL: Healed rib fractures.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Cholelithiasis. Hypodense exophytic right upper pole renal nodule and is presumably a cyst but incompletely evaluated. | 1. Scattered punctate pulmonary micronodules measuring up to 4 mm which are presumably benign postinflammatory nodules. However, in high risk patients, these are typically followed with CT at 12 months to evaluate for growth and exclude malignancy.2 Emphysema.3. Bronchial wall thickening which is nonspecific but most likely due to asthma or bronchitis.4. Cholelithiasis. |
Generate impression based on findings. | Lung cancer status post neoadjuvant chemo and RT. CHEST:LUNGS AND PLEURA: The solid portion of the left apical lung mass with irregular margins measures 20 x 15 mm on image 18/89 (18 x 20 mm previously). The nodule is contiguous with the pleura and may be invading it. As on prior scan, a measurement of the total diameter of the lesion including the non-solid portion is provided for evaluation and measures 35 mm on image 18/89 (38 mm on prior).Interval increase in bronchial thickening with lower zone bronchiectasis and bronchiolitis, including areas of centrilobular nodules. This may be due to aspiration or infection. It is not typical of metastatic disease though continued follow up is recommended.MEDIASTINUM AND HILA: Scattered small subcentimeter mediastinal lymph nodes are unchanged. Roughly 1 cm bilateral hilar nodes are stable. Paratracheal air cyst.CHEST WALL: Unchanged subcutaneous nodule in the left posterolateral chest wall measuring 13 x 28 mm, likely benign.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Hepatic steatosis.SPLEEN: Subcentimeter hypodensities unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Scattered small upper abdominal lymph nodes are unchanged.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: Upper portion of a large uterine fibroid is a incompletely visualized. | 1. Interval decrease in left upper lobe nodule.2. Stable small intrathoracic nodes.3. Interval increase in extensive bronchiectasis and bronchiolitis. This is likely due to aspiration or possibly infection. Though not typical of metastatic disease, continued follow-up is recommended. |
Generate impression based on findings. | Female 84 years old Reason: eval acute infection History: altered mental status, R-sided opacity on CXR LUNGS AND PLEURA: Series acquired during expiration limiting evaluation.Right perihilar focal consolidation with air bronchograms, associated ground glass opacities and bronchial wall thickening compatible with aspiration or pneumonia.Left apical solid/groundglass nodule may be infectious or inflammatory in etiology; however, recommend CT follow-up in 6 to 12 months to assess for stability/resolution.Bilateral minimal dependent atelectasis. No pleural effusion.MEDIASTINUM AND HILA: No evidence of mediastinal or hilar lymphadenopathy.Normal heart size the small/trace pericardial effusion unchanged.CHEST WALL: Left medial breast mass appears unchanged.Right subclavian venous catheter with tip in the distal SVC.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. Right perihilar consolidation compatible with aspiration or pneumonia. Given the patient's age this should be followed to resolution to exclude underlying malignancy.2. Right apical status groundglass nodule suggestive of a infectious or inflammatory etiology; however, recommend CT surveillance in 6 to 12 months to assess for stability/resolution.3. Left medial breast mass unchanged. |
Generate impression based on findings. | Head and neck cancer. Baseline evaluation. CHEST:LUNGS AND PLEURA: Apical scarring and fibrosis presumably related to radiation changes. No evidence of pulmonary metastases.MEDIASTINUM AND HILA: Port tip at RA/SVC junction.CHEST WALL: Right chest wall port.Expansile lesion of right posterior ninth rib is highly suggestive of metastatic disease. For continued reference this measures 16 mm in thickness on image 74/155.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: Expansile lesion of right posterior ninth rib is highly suggestive of metastatic disease. OTHER: No significant abnormality noted. | Expansile lesion of right posterior ninth rib highly suggestive of metastatic disease. No evidence of pulmonary metastases. |
Generate impression based on findings. | Clinical question: Dental trauma, swelling and redness to upper lip with missing and loose upper and lower front teeth. Maxillofacial CT:Examination demonstrates absence of the right lateral mandibular incisor likely secondary to recent trauma. There is also absence of bony density anterior to the missing tooth and presumed fracture. There is subtle bony lucency surrounding the two left-sided mandibular incisor. There is no evidence of mandibular fracture. There is also absence of the left first incisor and minimal periapical lucency of the right maxillary first incisor with associated tiny bony fracture anteriorly (axial series 80532 images 72 through 75). There are extensive periapical lucencies of the more marked on the right mandible secondary to dental caries and possible periapical abscesses. Mandibular condyles are unremarkable and in proper location.Examination demonstrates no convincing evidence of any maxillofacial fracture. No detectable fracture of the nasal bones.Images through the orbits are unremarkable.All paranasal sinuses are well pneumatized and unremarkable.Bilateral mastoid air cells and middle ear cavities are well pneumatized and unremarkable. There is soft tissue thickening at the level of the upper and lower lips secondary to recent trauma. | 1.Absence of right mandibular second incisor and the left first maxillary incisor likely secondary to recent trauma. Small bony fracture at the level of right first maxillary incisor and absence of bone anteriorly at the level of missing right mandibular incisor presumed fracture. 2.No evidence of mandibular fracture or any additional maxillofacial fracture.3.Extensive periapical lucency of right mandibular molar tooth representing dental decay and suspected periapical abscess.4.Soft tissue thickening of upper lip and progressive memory of the lower compatible with recent trauma. |
Generate impression based on findings. | Clinical question: Rule-out intracranial process. Signs and symptoms: Decreased responsiveness. Nonenhanced head CT: No detectable acute intracranial process. CT however is insensitive for detection of acute nonhemorrhagic ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation.Midline is maintained.Unremarkable calvarium, soft tissues of the scalp, paranasal sinuses, orbits and bilateral mastoid air cells. | No acute intracranial process. |
Generate impression based on findings. | Clinical question: Infarct the worsening/edema. Signs and symptoms: Comatose. Nonenhanced head CT: No acute intracranial process CT however is insensitive for detection of acute nonhemorrhagic ischemic strokes.Unremarkable images through posterior fossa and with normal size and midline fourth ventricle.Subacute right MCA territory frontal and temporal ischemic stroke without evidence of hemorrhagic changes is noted very subtle associated mass effect is present.Multiple right basal ganglia lacunar infarcts remain similar to prior brain MRI from 10 -- 14 -- 13. Mildly dilated supratentorial ventricular system remain similar to prior exam and with maintained midline.Calvarium and soft tissues of the scalp are unremarkable.Images through the orbits of paranasal sinuses and mastoid air cells are unremarkable. | 1.No acute intracranial process.2.Stable extensive right hemispheric MCA territory subacute nonhemorrhagic ischemic stroke.3.Grossly similar multiple right basal ganglia lacunar infarcts.4.Stable mildly prominent supratentorial ventricular system and maintained midline. |
Generate impression based on findings. | Clinical question: Evaluate for intracranial abnormalities. Signs and symptoms: Blunt head trauma and loss of consciousness. Nonenhanced head CT:No evidence of acute posttraumatic intracranial, calvarial or soft tissues of the scalp findings.Crowding of cerebellar tonsils at the level of foramen magnum as was noted on prior head CT and MRI exam is again noted. There is resultant effacement of subarachnoid space at the level of foramen magnum.Unremarkable cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation otherwise. Calvarium and soft tissues of the scalp as well as visualized orbits, paranasal sinuses and mastoid air cells are unremarkable. | 1.No acute intracranial process.2.Revisualization of crowding of cerebellar tonsils at the level of foramen magnum as was noted on prior MRI exam. |
Generate impression based on findings. | Clinical question: Evaluate for obstructing, VA shunt. Signs and symptoms: Headache, blurred vision and recent shunt revision. Nonenhanced head CT:Examination demonstrates collapsed supratentorial ventricular system and a left-sided approach ventricular catheter which projects in the expected location of collapsed right frontal horn. This is identical to prior head CT exam from 9 -- 17 -- 13.No detectable acute intracranial process CT however is insensitive for detection of acute nonhemorrhagic ischemic strokes.Bilateral small linear encephalomalacia along the track of previously removed bilateral frontal approach catheters is again noted.There is prominence of the cerebellar and vermian folia for patient of stated age similar to prior exam and concerning for underlying parenchymal volume loss. There is resultant ex vacuo dilatation of the fourth ventricle. This is identical to prior exam. | 1.No acute intracranial process.2.Stable shunted collapsed supratentorial ventricular system and with maintained midline.3.Cerebella parenchymal volume loss and ex vacuo dilatation of the fourth ventricle similar to prior exam. |
Generate impression based on findings. | Female 65 years old Reason: 65 F with metastatic mullerian tumor, hypoxic History: hypoxia PULMONARY ARTERIES: Technically adequate study. The pulmonary trunk is enlarged measuring 3.5 cm in diameter. There is a filling defect in the right main and inferior lobar pulmonary arteries (image 110 and image 107, series 8) compatible with pulmonary emboli.LUNGS AND PLEURA: Multifocal nodular opacities of variable size from subcentimeter to 2 cm, mostly subpleural, with surrounding ground glass opacities and air bronchograms suggestive of infection including septic emboli. If the patient is immunocompromised atypical infection such as fungal aspergillosis should be included in the differential diagnosis.There is septal thickening suggestive of pulmonary edema.No pleural effusion.MEDIASTINUM AND HILA: Right chest wall internal jugular venous catheter with tip in the cavoatrial junction.Enlarged prevascular lymph node.Cardiomegaly with left ventricular predominant hypertrophy. No pericardial effusion.CHEST WALL: Diffuse sclerotic changes of the C7 vertebral body unchanged from prior. Multilevel degenerative changes of the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Interval resolution of free air and ascites. | 1. Pulmonary emboli in the right main and inferior lobar pulmonary arteries.2. New multifocal nodular opacities and areas of consolidation suggestive of infection possibly septic emboli. If the patient is immunocompromised atypical infection such as fungal or aspergillosis should be included in the differential..3. Septal thickening and diffuse ground glass opacities suggestive of pulmonary edema. |
Generate impression based on findings. | Clinical question: Rule-out intracranial mass, infarct. Signs and symptoms: Headache, transient left-sided weakness. Unenhanced head CT:No detectable acute intracranial process CT however is insensitive for detection of acute nonhemorrhagic ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation.Calvarium and soft tissues of the scalp are unremarkable.Images through the orbits, paranasal sinuses and mastoid air cells are unremarkable with the exception of small retention cyst in the right maxillary sinus. | No acute intracranial process or |
Generate impression based on findings. | Abdominal pain there the umbilicus ABDOMEN:LIVER, BILIARY TRACT: Ill-defined, wedge-shaped hypodensity in the liver likely represents perfusion difference.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: Increased density within the subcutaneous tissues of the umbilical may represent cellulitis.OTHER: No significant abnormality noted. | No CT findings to explain patient's acute abdominal pain. Possible cellulitis involving the umbilicus.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
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