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Generate impression based on findings. | Reason: Eval ascending aortic aneurysm and compare from previous History: none CHEST:LUNGS AND PLEURA: Stable nodule in the right middle lobe measuring approximately 3 mm. Stable nodular fissural densities within the left major fissure since 2011, likely intrapulmonary lymph nodes.No pleural effusion.MEDIASTINUM AND HILA: Common origin of the innominate and left common carotid arteries.Using similar measurement technique as on the prior study (axial/nonorthogonal dimensions) the caliber of the thoracic aorta has not significantly changed. However, this was a non-ECG gated study and significant artifact precludes precise measurements. For example, on series 9 image 62, there is cardiac motion artifact in the mid ascending thoracic aorta. This measures approximately 4.5 x 3.9 cm at the level of the main pulmonary artery, as compared to 4.5 x 3.9 cm. The descending thoracic aorta at the same level measures 2.9 x 2.6 cm, as compared to 2.8 x 2.7 cm on prior study.The following orthogonal dimensions of the thoracic aorta are as follows:Sinus of Valsalva: 37 x 31 x 31 cmSinotubular junction: 35 x 37 cmMid ascending thoracic aorta: 40 x 42 cmAscending thoracic aorta, immediately proximal to the innominate artery: 38 x 39 cmDistal transverse arch: 30 x 30 cmFollow-up with ECG gated CTA is recommended.The main pulmonary artery is dilated, measuring up to 35 mm transverse, stable. In addition, the right ventricle is moderately dilated. This raises a question of pulmonary arterial hypertension. The left ventricle is upper limits normal size. No pericardial effusion is present.No mediastinal or hilar lymphadenopathy is present.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Thoracic dextroscoliosis.OTHER: No significant abnormality noted. | 1.Measurement of the ascending thoracic aorta is limited by cardiac motion, as this was a non-ECG gated study. However, when compared to nonorthogonal technique from 10/23/12, no significant change is noted. Maximal dimension is 40 x 42 cm. Recommend follow-up imaging with ECG gated CTA thorax.2.Cardiac enlargement is stable with right ventricular chamber dilatation and pulmonary arterial dilation. This raised question of pulmonary arterial hypertension. |
Generate impression based on findings. | Right tonsillar cancer status post CRT. There are post-treatment findings related to right neck dissection, tonsillectomy, and radiation therapy. There is no definite mass lesion in the treatment bed. The is no significant cervical lymphadenopathy. There is partial effacement of the left with piriform sinus. The airway is otherwise patent. The thyroid and major salivary glands are unchanged. There is a stable nonspecific lucency within the C5 vertebral body. There is unchanged degenerative spondylosis. The imaged lung apices appear clear. The imaged intracranial structures are grossly unremarkable. There is a small right maxillary sinus retention cyst. The mastoid air cells are clear. | No evidence of locoregional tumor recurrence of significant cervical lymphadenopathy. |
Generate impression based on findings. | Female 75 years old Reason: mesothelioma, please evaluate for disease and compare with previous scans. s/p 3 months observation CHEST:LUNGS AND PLEURA: Increased size of the previous lesions, and new areas of focal pleural thickening most notably in the left inferior anterior pleural surface and lateral major fissure, spreading laterally to medially.New reference lesion measurement:1. At the level of the inferior left atrium at the 3 o'clock in the left major fissure, 18 mm (image 67, series 3), previously not visualized.Previous reference measurements as follows:1. At the level of the aortic arch at the 5 o'clock position, 5 mm (image 25, series 3), previously 5 mm.2. At the level of the carina, focal pleural thickening adjacent to the descending aorta, 10 mm (image 38, series 3), previously 8 mm.MEDIASTINUM AND HILA: Multiple bilateral thyroid cysts, unchanged.No significant mediastinal hilar lymphadenopathy. Moderate coronary artery calcifications.No pericardial effusion.CHEST WALL: Large left anterior chest wall mass now measures 61 mm in short axis (series 4 image 77) previously 39 mm. Significant interval decrease in the right costophrenic angle lymphadenopathy and right internal mammary chain lymphadenopathy.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Peripherally calcified gallstone.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic appearing right kidney with mild hydronephrosis and right nephroureteral stent in place, position unchanged. Bilateral renal cysts unchanged.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Multilevel degenerative changes of the thoracic and lumbar spine.OTHER: No significant abnormality noted. | 1. New and increased areas of pleural thickening, and significantly increased size of the large left anterior chest wall mass.2. Previously described right internal mammary chain and right costophrenic nodes have significantly decreased in size. |
Generate impression based on findings. | Bilateral enlarged parotid glands. There is no significant interval change in the relatively low attenuation well-defined lobulated mass within the superficial parotid gland that measures 20 AP x 9 RL x 12 SI mm. The right parotid gland is unremarkable, with several normal-appearing lymph nodes. Indeed the dominant nodule within the right parotid gland has involuted. The submandibular glands are unremarkable. There is asymmetric effacement of the left piriform sinus. The airways are otherwise patent. There is no significant cervical lymphadenopathy. The thyroid gland is unremarkable. The major cervical vessels are patent. The imaged intracranial structures and orbits are unremarkable. The imaged portions of the lungs are clear. | No significant interval change in the relatively low attenuation well-defined lobulated mass within the superficial parotid gland that measures up to 20 mm. Differential considerations include a sialocele, developmental cyst, lymphadenopathy, and cystic neoplasm. MRI may be useful for further characterization. |
Generate impression based on findings. | Follow up to assess for hemorrhagic conversion sp heparin drip in patient with recent very large ischemic stroke. There are postoperative findings related to right hemicraniectomy. There are extensive edema in the right MCA territory related to the recent infarct with protrusion of brain through the craniectomy defect, 10 mm of midline shift to the left and subfalcine herniation. However, there is no evidence of hemorrhagic conversion. The ventricular system appears unchanged. The extracranial structures are not significantly changed. | Continued evolution of the extensive subacute right MCA territory infarct with protrusion of brain through the craniectomy defect, 10 mm of midline shift to the left and subfalcine herniation, but no evidence of hemorrhagic conversion. |
Generate impression based on findings. | Large cell lymphoma CHEST:LUNGS AND PLEURA: New 0.3-cm right apical module best seen on image 14 of series 5.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Stable calcified scarlike residual soft tissue within the left axilla best seen on image 21 of series 3 measuring 1.7 x 1.9 cm.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Interval appearance of left lung apical subcentimeter nodule. Special attention to this focus on future surveillance scans recommended. Otherwise, stable examination. |
Generate impression based on findings. | 59-year-old male with history of bladder cancer. Status postcystectomy with neobladder. Evaluate for recurrent/metastatic disease. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Diffuse fatty infiltration throughout the liver is seen. Presenceof fat can obscure visualization of underlying solid parenchymal liver lesions. Punctatecalcification is seen from prior granulomatous disease. No other parenchymalabnormalities are seen. Vessels all appear normal.Cholelithiasis without complication again seen.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Simple left renal cyst, unchanged -- no other significant abnormalitynoted in renal parenchyma. Prompt and symmetric excretion of contrast material intonormal pyelo- calyceal system on the left is seen. The right renal pelvis, however, on wide windows (see series 9, image 67) has a small 2 mm papillary soft tissue projection into the pelvic lumen on delay excretory images and is worrisome for early small urothelial cancer. No abnormalities are seen in the ureters, which are moderately well opacified with only small skip areas of nonopacification.RETROPERITONEUM, LYMPH NODES: No enlarged retroperitoneal lymph nodes seen. Clusters of small lymph nodes again seen, largest of which, together measure 1.2 x 0.9 cm, compared with previous 1.4 x 1.1 cm.. No new foci of lymph node enlargement identified. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post cystoprostatectomy without other abnormality seen.BLADDER: Patient is status post cystectomy with continent neobladder unchanged from prior examination.LYMPH NODES: No adenopathy identified.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes seen throughout the thoracolumbar spine without focal abnormality seen to suggest metastasis.OTHER: No significant abnormality noted | 1. Status post cystoprostatectomy with continent neobladder stable inappearance. 2. Small reference left retroperitoneal, periaortic lymph node, slightlydecreased in size. 3. Two mm papillary lesion along medial wall of right renal pelvis -- see above. 4. No evidence of metastatic disease.Findings discussed with Dr. Steinberg at 4:55 p.m. 10/15/13. |
Generate impression based on findings. | GIST status-post resection CHEST:LUNGS AND PLEURA: Scattered calcified granulomas and micronodules.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post resection of small bowel massBONES, 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. | Status post resection of small bowel mass. No evidence for recurrent tumor, adenopathy, or metastatic focus. |
Generate impression based on findings. | 79-year-old female evaluate for stricture The study is limited due to lack of IV contrast and motion artifactsABDOMEN:LUNG BASES: Bilateral pleural effusions and dependent atelectasis. Mild cardiomegaly.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a 4 x 4 cm mass in the pelvis likely in the distal ileum on image number 64, series number 3 causing mild bowel dilatation. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Please see discussion aboveBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Ileal mass. Differential diagnosis includes gastrointestinal stromal tumor, lymphoma and less likely adenocarcinoma. Bilateral pleural effusions and cardiomegaly. |
Generate impression based on findings. | 35 year-old female with new onset hypoxia with dyspnea on exertion. Evaluate for pulmonary embolus versus edema. Motion artifact limits evaluation. Within this limitation, the following findings are noted.PULMONARY ARTERIES: No evidence of pulmonary embolus.LUNGS AND PLEURA: Bilateral small pleural effusions with underlying atelectasis. Diffuse bilateral alveolar ground glass opacities, compatible with pulmonary edema. There is pulmonary opacity in the right middle lobe (series 6, image 148) and in the right lower lobe; findings are suspicious for an infection. Small region of atelectasis in left upper lobe (series 6, image 69) and lingular region (series 6, image 159).MEDIASTINUM AND HILA: Cardiomegaly without evidence of pericardial effusion. No mediastinal or hilar lymphadenopathy. Mild to moderate atherosclerotic calcifications affect the thoracic aorta.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Mild to moderate atherosclerotic calcifications affect the abdominal aorta and its branches. Dense atherosclerotic calcifications affect the splenic artery. Cholecystectomy clips. | 1 No evidence of pulmonary embolus. 2. Findings suspicious for right middle lobe and right lower lobe pneumonia. 3. Findings as described above suspicious for congestive heart failure.4. Mild to moderate atherosclerotic disease as detailed.Findings relayed to Dr. Anshu Verma, covering pager 2987, over the phone at approximately 1222 hrs. |
Generate impression based on findings. | 60-year-old woman with stage II E. diffuse large B-cell lymphoma status post 6 cycles of therapy. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Stable mildly enlarged mediastinal lymph nodes.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Stable cholelithiasisSPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable right renal cystRETROPERITONEUM, LYMPH NODES: Continued regression of the right retroperitoneal hematoma which currently measures 5.9 x 7.6 cm (image 134; series 3).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Stable fibroid uterus. Presumed dilated ovarian veins on the right side are unchanged compared to prior.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Interval decrease in size of right retroperitoneal hematoma. Otherwise stable exam without evidence for new adenopathy. |
Generate impression based on findings. | Male 69 years old Reason: 69M s/p cardiac arrest, eval for PE History: chest pain PULMONARY ARTERIES: Technically adequate study without evidence of right heart strain or pulmonary emboli. LUNGS AND PLEURA: Severe apical predominant centrilobular and paraseptal emphysema. Mild dependent basilar architectural distortion and interstitial thickening may represent superimposed fibrosis. Biapical scarring. Mild dependent basilar predominant atelectasis. 7-mm left lower lobe subpleural nodule (image 29, series 9): recommend initial CT follow-up in 3 months.MEDIASTINUM AND HILA: Nonspecific mildly enlarged prevascular lymph nodes. Nonenlarged but numerous lymph nodes elsewhere throughout the mediastinum.Significant atherosclerotic plaque seen along the wall of the aortic arch, with areas of penetrating ulcer laterally. Mild/moderate coronary artery calcifications.Normal heart size and no pericardial effusion. Nonspecific mild esophageal wall thickening.CHEST WALL: Multilevel degenerative changes of the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Small hiatal hernia. Status post cholecystectomy. Pancreatic head mass better evaluated on the CT abdomen from 10/15/2013. Hypodense lesion in the dome of the liver again identified. | 1. No evidence of pulmonary emboli.2. Severe centrilobular and paraseptal emphysema with possible mild fibrotic changes seen in the lung bases.3. Left lower lobe pulmonary nodule, recommend initial CT follow-up in 3 months; metastasis cannot be excluded.4. Pancreatic head mass and hepatic lesion suspicious for metastasis better evaluated on CT abdomen dated 10/15/2013.5. Nonspecific mild diffuse lymphadenopathy in the mediastinum. |
Generate impression based on findings. | Reason: evaluate for infectious intrabdominal process History: hx of abdominal mesothelioma, with worsening abdominal pain, leukocytosis ABDOMEN:LUNG BASES: Mild left-sided pleural effusion. Trace right sided pleural effusion. Bilateral lower lobe atelectasis at the bases.LIVER, BILIARY TRACT: No suspicious focal liver lesions. Cholelithiasis. No evidence of intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: Atrophic pancreas.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Subcentimeter, hypodense lesion in the right mid pole of the kidney is too small to further characterize.RETROPERITONEUM, LYMPH NODES: Scattered subcentimeter para-aortic lymph nodes.BOWEL, MESENTERY: There is a loculated collection of fluid in the lesser sac with peritoneal tumoral thickening of the wall. There is air within a thickened gastric wall indicating involvement of the stomach wall. This finding may be due to tumor necrosis although it is worrisome for emphysematous gastritis from an infection which cannot be excluded. There is enhancing ascites omental caking, peritoneal nodules, and diffuse peritoneal thickening of the abdomen and pelvis indicating diffuse extent of mesothelioma from upper abdomen in the lesser sac to the pelvis in the cul-de-sac. There is disproportion of the distal small bowel caliber suggesting an element of small bowel obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Large amount of abdominal and pelvic ascites.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Bladder is partially collapsed.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Diffuse peritoneal and omental involvement by mesothelioma.2.Tumoral involvement of the stomach wall and air within the wall may be due to tumor necrosis although it is worrisome for emphysematous gastritis from an infection which cannot be excluded.3.Disproportion of distal and proximal small bowel caliber suggesting an element of small bowel obstruction. |
Generate impression based on findings. | 14-year-old female. Right-sided pain, swelling per mother. ABDOMEN: LUNG BASES: Bibasilar airspace consolidation, most pronounced in the left lower lobe, are consistent with infection.LIVER, BILIARY TRACT: Normal appearance of the liver. SPLEEN: Normal appearance of the spleen. PANCREAS: Normal appearance of the pancreas. ADRENAL GLANDS: Normal appearance of the adrenal glands. KIDNEYS, URETERS: Normal appearance of the kidneys. No renal or ureteral calculi. No hydronephrosis. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Normal caliber of the bowel.BONES, SOFT TISSUES: Normal appearance of the bones. OTHER: No free fluid.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Normal appearance of a distended bladder. No bladder calculi. LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Normal caliber of the bowel.BONES, SOFT TISSUES: Normal appearance of the bones. OTHER: No significant abnormality noted | 1. Bibasilar airspace consolidation, most pronounced in the left lower lobe, consistent with pneumonia. 2. No renal or ureteral stones. No hydronephrosis. |
Generate impression based on findings. | S.O.B. and pleuritic pain. PULMONARY ARTERIES: Although contrast infusion quality is adequate, there is severe motion artifact present which limits assessment for pulmonary emboli. Within this limitation, no filling defects are identified within the the main pulmonary arteries to the proximal segmental level in the upper lobes and the lobar level in the lower lobes. LUNGS AND PLEURA: Focal consolidation within the posterior segment of the right lower lobe (series 10 image 100). Patchy subsegmental atelectasis elsewhere the lung bases. No pleural fluid or pneumothorax. Severe respiratory motion artifact limits assessment for pulmonary nodules or other fine detail. MEDIASTINUM AND HILA: Symmetric enlargement of the thyroid gland with suggestion of internal hypoattenuation in the left thyroid lobe, nonspecific by CT and is very poorly assessed due to motion artifact. Right paratracheal lymph node is mildly enlarged (7/71), 11-mm. Anterior mediastinal soft tissue (7/87) nonspecific and could represent hyperplastic thymus. Mild subcarinal lymphadenopathy, 13-mm (7/137).Normal heart size. No pericardial fluid. The interventricular septum appears straightened suggestive of right heart strain.CHEST WALL: Soft tissues of the chest wall incompletely included within the field of view. Several small axillary and sub-pectoral lymph nodes are noted bilaterally, symmetric in appearance and not enlarged though abnormal in multiplicity.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. No significant abnormalities are appreciated. | 1. Limited examination for pulmonary embolus. No acute PE is identified to the proximal segmental level in the upper lobes and to the lobar are level in the lower lobes. Emboli distal to these areas cannot be ruled out by this examination.2. Focal consolidation in the right lower lobe is poorly assessed due to motion and of unclear etiology. Differential considerations include infarction or infection depending upon the clinical presentation. Follow-up PA and lateral chest radiographs are recommended in 6 weeks to assess for resolution.3. Mild mediastinal lymphadenopathy and numerous non-enlarged lymph nodes in the axilla and subpectoral regions of unclear etiology. As there is additionally residual soft tissue in the thymic bed, short-term follow-up with CT in 3 to 6 months is suggested to exclude the possibility of lymphoma unless the patient has an underlying medical condition which could result in lymphadenopathy. If the referring clinical service has additional clinical information, an addendum to this report can be made if requested.4. Straightening of the intraventricular septum is suggestive of right heart strain. |
Generate impression based on findings. | 47-year-old male with pain and swelling to the dorsal wrist. Evaluate for wrist fracture. There is edema of the subcutaneous tissue of the dorsal aspect of the hand. The soft tissues otherwise appear normal given the limitations of CT. No fracture is evident. There is slight dorsal translation of the distal ulna relative to the sigmoid notch of the radius which may simply be an artifact or pronation rather than a true distal radial ulnar joint subluxation. | No fracture is evident. Slight dorsal translation of the distal ulna relative to the distal radius is probably an artifact of pronation. |
Generate impression based on findings. | Reason: r/o pancreatic pathology History: epigastric pain ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Pneumobilia predominantly in the left hepatic lobe, unchanged from 2007 status post choledochoduodenal anastomosis. Status post cholecystectomy. Small stone in the distal common bile duct.SPLEEN: No significant abnormality noted.PANCREAS: Coarse pancreatic calcifications compatible with chronic pancreatitis. There is a stone in the proximal pancreatic duct with distal pancreatic ductal dilatation, unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mildly prominent retroperitoneal lymph nodes.BOWEL, MESENTERY: No evident bowel obstruction, pneumatosis intestinalis, or pneumoperitoneum. The appendix is normal in appearance.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: Distended.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No acute intraabdominal abnormality or significant change from comparison exam. |
Generate impression based on findings. | Right shoulder dislocation status post attempted reduction. Patient with total shoulder arthroplasty in place. Evaluation limited by metallic streak artifact due to the patient's total shoulder arthroplasty device.Alignment of the prosthesis is within normal limits. There is deformity of as well as round and tubular lucencies within the glenoid which likely reflect post operative changes of prior Laterjet procedure. No fracture is evident. A couple of small densities are seen within the soft tissues beneath the inferior glenoid rim which were present on the prior study and hence of doubtful current clinical significance. Please note evaluation of the rotator cuff musculature is limited on this exam, but there are no gross abnormalities of the rotator cuff. | No evidence of dislocation with other findings as described above. |
Generate impression based on findings. | 50, 1-year-old female with CML, status post stem cell transplant -- concern for PTLD. EB virus viremia, on immunosuppression. ABDOMEN:LUNG BASES: Bibasilar pleural effusions and left basilar atelectasis.LIVER, BILIARY TRACT: No significant abnormality noted -- no parenchymal liver mass seen.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No enlarged, lymph nodes or other masses identified.BOWEL, MESENTERY: No significant abnormality noted - no evidence for bowel wall thickening to suggest intestinal involvement by PTLD. No evidence of bowel obstruction. No free mesenteric fluid..BONES, SOFT TISSUES: Diffuse findings consistent with anasarca with subcutaneous edema diffusely. Anterior abdominal wall ventral hernia containing only mesenteric fat.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No enlarged lymph nodes identified.BOWEL, MESENTERY: Visualized small and large bowel shows no diagnostic abnormalities. No free mesenteric fluid.BONES, SOFT TISSUES: Diffuse subcutaneous edema consistent with anasarca.OTHER: No significant abnormality noted | 1. Bibasilar pleural effusions. 2. Diffuse subcutaneous edema compatible with anasarca. 3. No enlarged lymph nodes or other masses/abnormality seen to show evidence of PTLD. |
Generate impression based on findings. | Male, 10 months old, intracranial tumor status post biopsy, patient less arousable. Evaluate for edema, impending herniation. Changes are demonstrated compatible with a right-sided craniotomy. Scalp swelling and subcutaneous air persists. There has been near complete resolution of postoperative pneumocephalus. A small amount of mixed density extra-axial fluid/blood product is evident adjacent to the craniotomy.A large, heterogeneous and centrally necrotic right cerebral tumor is reidentified likely containing both calcified elements and blood products. Accurate measurement is difficult due to changes in patient positioning. The most reproducible views are likely to be found on sagittal imaging where the tumor measures 8.8 x 6.6 cm (image 33 series 80688), previously 8.5 x 6.4 cm when measured similarly. As before, there is a surgical defect within the anterior/inferior aspect of the tumor which has progressively filled with fluid.Significant generalized mass-effect is demonstrated with effacement of all right-sided sulci and to a lesser degree the left-sided sulci. At the level of the septum pellucidum, there is a 1.3-cm midline shift to the left which is an improvement over the previous measurement of 1.6 cm. There has been an interval expansion in the caliber of the ventricular system, both supra- and infratentorially. This is most noticeable in the right lateral ventricle, particularly in the occipital horn, which on coronal images measures 2.7 cm, previously 1.4 cm. Hyperdense blood product persists similar to prior within the right temporal horn. The left lateral ventricle, third ventricle and fourth ventricle are all larger than prior. Medialization of the right uncus is demonstrated with a slightly greater degree of effacement of the suprasellar cistern. A significant degree of mass effect is exerted on the midbrain which is compressed in the transverse dimension and leftwardly deviated. Mildly hyperdense material is present within the posterior aspect of the suprasellar cistern (see image 19 series 5), which seems to be new relative to the prior examination and may represent blood product. There also seems to be a small amount of subarachnoid blood product within the left central sulcus, not clearly evident on the prior exam.Also new from the prior examination is the appearance of developing hypodensity within the brainstem. This is most noticeable within the medulla (see image 12 series 5) but may involve the pons and midbrain to some degree as well. This is a region prone to artifact, and as such, this finding is not completely reliable. However, it is seen on several slices which makes it more likely to be real. Gray-white differentiation in the bilateral occipital regions is also not well seen, but this is not a significant change from the prior exam. | 1. Redemonstration of surgical change status post biopsy of a large right cerebral tumor. Accurate measurement of the tumor is complicated by differences in patient positioning. Size is grossly similar or at most a few millimeters larger.2. The caliber of the ventricular system has increased since the prior exam. This may in some part be due to shifting brain structures, but the appearance of increasing generalized mass-effect suggests an obstructive process.3. Also new from the prior examination is apparent developing hypodensity within the medulla and perhaps to a lesser degree the pons and midbrain. Although there is a chance that this finding is artifactual in nature, it is nevertheless concerning for edema or ischemia. MRI is suggested to better evaluate this finding.4. Blood product is suspected within the posterior aspect of the suprasellar cistern and within the left central sulcus. This may represent redistribution of postoperative blood. Continued follow-up is suggested. |
Generate impression based on findings. | Reason: CVA History: RUE \T\ RLE weakness, slurred speech x1 day The CSF spaces are appropriate for the patient's stated age with no midline shift. There is some hypodense subcortical and periventricular white matter hypodensities present in suspicion for hypodensity in the left ponsNo abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses demonstrates scattered opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.The possibility of lacunar infarct cannot be excluded. If clinically appropriate MRI of the brain may be of further benefit. 2.Subcortical hypodensities are present which could represent large perivascular spaces or infarction or other entity. If clinically appropriate MRI of the brain would be of further benefit to evaluate further.3.No evidence for acute intracranial hemorrhage mass effect or edema. |
Generate impression based on findings. | Male 71 years old Reason: hypoxia, also with history of cavitary lesion PULMONARY ARTERIES: Technically adequate study without evidence of right heart strain or pulmonary emboli.LUNGS AND PLEURA: New focus of solid/ground glass opacity in the lingula suggestive of pneumonitis or hemorrhage, associated with atelectasis. Left lower lobe segmental atelectasis with debris seen in the left lower lobe bronchus and segmental bronchi. Nonspecific bronchial wall thickening may be related to bronchitis or chronic aspiration. Small filling defect (image, series 10) in the nondependent left mainstem bronchus most compatible with adherent debris, attention on subsequent exams.Right lower lobe cavitary lesion measures 2.4 x 3 .8 cm (image 81, series 9), previously 2.2 x 4.2 cm. The cavitary component continues to increase in extent with associated reduction of the soft tissue component and wall thickness. The cranial caudal component also appears slightly smaller in size.The noncalcified solid left apical nodule measures 10 mm x 9 mm (image 20, series 10), previously 10 x 9 mm. This nodules has been present since 2008, and has decreased in size compared to the initial studies, therefore likely benign. Scattered calcified micronodules unchanged.Severe paraseptal and centrilobular emphysema unchanged.MEDIASTINUM AND HILA: Surgical changes compatible with right upper lobectomy again noted. Index right high paratracheal lymph node measures 9 mm in short axis (image 83, series 7), previously 8 mm.Moderate hiatal hernia.CHEST WALL: Multilevel degenerative changes of the thoracic spine. Healed left seventh rib fracture again noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Hypoattenuating focus in the right hepatic lobe too small to characterize and appears unchanged. | 1. No evidence of pulmonary emboli.2. Left lower lobe segmental atelectasis with endobronchial debris, and diffuse bronchial wall thickening compatible with bronchitis and associated aspiration .3. Interval decrease in size of the right upper lobe cavitary mass.4. Stable paratracheal lymphadenopathy.5. Left upper lobe opacity with groundglass and solid components most likely post inflammatory or postinfectious; however, recommend 6 week follow-up to assess for resolution given history of malignancy. |
Generate impression based on findings. | Reason: patent blood flow? History: weakness CT head:The CSF spaces are appropriate for the patient's stated age with no midline shift. Atherosclerotic calcifications are present along the distal internal carotid arteries.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.No evidence for acute internal hemorrhage mass effect or edema.2.CTA of the head and neck was not possible due to infiltration of contrast at the intravenous injection site. |
Generate impression based on findings. | Reason: 65 year old male with pancreatic cancer and dyspnea. Evaluate for possible PE and disease status. History: abdominal pain and dyspnea CHEST:LUNGS AND PLEURA: Interval mild increase in size of multiple, bilateral pulmonary nodules. Left lower lobe and right lower lobe pulmonary nodule (series 12, image 83) with interval increase in size. Right subcentimeter pulmonary nodule (series 12, image 81) is unchanged in size. Filling defects of the right pulmonary artery segmental and subsegmental branches indicative of pulmonary embolism.MEDIASTINUM AND HILA: Atherosclerotic calcifications of the aortic arch. Superior left mediastinal lymph node (series 13, image 14) is increased in size.CHEST WALL: Interval increase in size of prominent right axillary lymph node measuring 1.7 x 1.4 cm (series 13, image 13). A loss of vertebral body height at T7/T8 vertebral bodies as well as disk base is again demonstrated.ABDOMEN:LIVER, BILIARY TRACT: There is an interval increase in number and size of multiple bilobar hepatic metastatic lesions. Interval increase in size of reference right hepatic lobe lesion now measuring 5.3 x 7.7 cm. Cholelithiasis with edematous gallbladder wall suggestive of cholecystitis. No evidence of intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted. Splenic vein thrombosis with gastroepiploic varices are again demonstrated.PANCREAS: Significant atrophy of the distal pancreatic body and tail.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Moderate to severe atherosclerosis of the descending abdominal aorta and bilateral iliac arteries. Calcification at the origin of the celiac artery. Atherosclerotic calcification at the origin of bilateral renal arteries. Interval increase in portacaval and non-referenced retroperitoneal lymphadenopathy. Reference portacaval lymph node measures 2.5 x 1.5, previously measuring 1.9 x 1.1 cm (series 13, image 89).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: Scattered diverticula in the ascending and descending colon without evidence of diverticulitis. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Filling defects of the right pulmonary artery segmental and subsegmental branches are indicative of acute pulmonary embolism.2.Mild interval increase in size of multiple, bilateral pulmonary nodules. 3.Interval increase in size of mediastinal and axillary lymphadenopathy.4.Interval increase in number and size of multiple bilobar hepatic metastatic lesions. 5.Cholelithiasis with edematous gallbladder in the setting of abdominal pain is suggestive of of cholecystitis. Clinical correlation is advised.6.Interval increase in size of portacaval and retroperitoneal lymphadenopathy. |
Generate impression based on findings. | Headache. There is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. | No evidence of intracranial hemorrhage, mass, or cerebral edema. |
Generate impression based on findings. | Reason: R/O PCP pna History: SOB LUNGS AND PLEURA: Interval increase in extensive groundglass opacity asymmetrically throughout both lungs more prominent on the right. Interval increase in numerous small cysts on an underlying background of central lobular emphysema.Mild basilar fibrosis with mild honeycombing and traction bronchiectasis unchanged.Interval improvement in the left basilar pleural thickening and focal area of consolidation.Subpleural nodules and right lower lobe nodule (image 40 series 5) without significant interval change.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of a pericardial effusion.Moderate coronary artery calcification.CHEST WALL: Old fracture deformity of the left sixth rib. Degenerative changes in the lower thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Status post cholecystectomy. Surgical clips noted along the greater curvature of the stomach. | 1.Significant interval increase in groundglass opacity and numerous small cysts in both lungs more prominent on the right. This may be related to atypical infection (PCP). The differential diagnosis would also include desquamative interstitial pneumonia (DIP).2.Upper lobe predominant centrilobular emphysema.3.Stable basilar fibrosis in a UIP pattern. |
Generate impression based on findings. | T3 N3 HPV positive right tonsil cancer completed chemoradiation in August 2011. Research scan for Merck MK3475-012 Study (IRB13-0311). There is unchanged filling defect within the right sigmoid sinus and internal jugular vein, consistent with chronic thrombosis. There is no abnormal enhancement within the brain. There is no evidence of intracranial hemorrhage, mass, or cerebral edema. There is mild scattered cerebral white matter hypoattenuation, which is likely related to microangiopathy. The ventricles and sulci are mildly prominent diffusely, indicating cerebral volume loss. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull appears unremarkable. There are bilateral lens implants. | 1. No evidence of intracranial metatases.2. Unchanged filling defect within the right sigmoid sinus and internal jugular vein, consistent with chronic thrombosis. |
Generate impression based on findings. | Reason: Recurrent ovarian cancer receiving chemotherapy. Restaging. History: n/a CHEST:LUNGS AND PLEURA: Scattered bilateral pulmonary nodules without significant interval change in size. Reference left lower lobe nodule measures 6 x 5 mm (series 4, image 66), previously 7 x 5 mm. No pleural effusions.MEDIASTINUM AND HILA: Prominent right supraclavicular lymph node is unchanged. Reference right paratracheal lymph node measures 1.4 x 1.1 cm (series 3, image 36), previously 1.4 x 0.9 cm. Reference paraesophageal node measures 0.8 x 0.8 cm (series 3, image 78), previously 0.9 x 0.8 cm. Heart size is normal without pericardial effusion.CHEST WALL: Right chest wall Port-A-Cath tip terminates in the SVC.ABDOMEN:LIVER, BILIARY TRACT: Reference hepatic dome lesion measures 2.6 x 2.5 cm (series 3, image 79), previously 4.4 x 3.7 cm. Left hepatic lesion appears grossly unchanged. Status post cholecystectomy.SPLEEN: Thrombosed splenic artery aneurysm is unchanged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic left kidney. Left nephroureteral stent is in its appropriate position.RETROPERITONEUM, LYMPH NODES: Reference gastrohepatic lymph node measures 0.9 x 0.7 cm (series 3, image 80), previously 0.7 x 0.4 cm. Reference paraaortic lymph node measures 1.0 x 0.5 cm (series 3, image 120), previously 1.1 x 0.7 cm. Soft tissue density adjacent to left common iliac artery measures 1.5 x 1.2 cm (series 3, image 152), previously 2.3 x 1.7 cm. Soft tissue density adjacent to the right iliopsoas measures 1.4 x 0.7 cm (series 3, image 141), previously 2.3 x 1.4 cm.BOWEL, MESENTERY: No evidence of bowel obstruction or peritoneal carcinomatosis.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: Colonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Decreasing right hepatic lobe metastasis.2.Mediastinal lymphadenopathy is unchanged from the comparison exam, but is decreased over several exams dating back to March, 2013.3.Gastrohepatic and retroperitoneal lymphadenopathy is unchanged.4.Decreasing soft tissue masses in the region of the common iliac vessels. |
Generate impression based on findings. | Male; 61 years old. Reason: Subcutaneous emphysema in patient s/p stem cell transplant, also new hypoxia. LUNGS AND PLEURA: Bilateral basilar predominant ground glass opacities with multifocal areas of consolidation. No pleural effusions. No suspicious pulmonary nodules or masses. Findings are compatible with atypical infection or aspiration pneumonia with accompanying edema. MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. Multiple enlarged mediastinal lymph nodes new from prior exam. Extensive pneumomediastinum and pneumopericardium is present. Dense coronary artery calcifications.CHEST WALL: There is extensive bilateral subcutaneous emphysema which extends into the retrocrural space inferiorly and soft tissues of the neck superiorly. This finding may be secondary to patient's recent laryngoscopy at outside hospital.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Mildly dilated loops of visualized bowel. No evidence of pneumoperitoneum. | 1.Interval development of extensive bilateral subcutaneous emphysema, pneumomediastinum, and pneumopericardium. Findings may be secondary to patient's recent laryngoscopy at outside hospital.2.Bilateral basilar predominant ground glass opacities with multifocal areas of consolidation. Differential considerations include atypical infection or aspiration pneumonia with accompanying edema. |
Generate impression based on findings. | Fall, AMS. There is mild cerebral white matter hypoattenuation that is consistent with small vessel ischemic disease. There is unchanged ex vacuo dilatation of right lateral ventricle secondary to chronic right basal ganglia and frontal lobe coronal radiata lacunar infarcts. There is no evidence of hydrocephalus. There are calcifications of bilateral cavernous and supraclinoid internal carotid and to a lesser degree of bilateral vertebral arteries. The calvarium and soft tissues of the scalp are unremarkable, without evidence of fracture. The partially imaged orbits also appear unremarkable. The imaged paranasal sinuses and mastoid air cells are clear. | 1. No evidence of acute intracranial hemorrhage. 2. Unchanged small vessel ischemic disease and chronic infarct affecting the right basal ganglia and right frontal lobe corona radiata. However, noncontrast CT is insensitive for detection of acute nonhemorrhagic stroke. |
Generate impression based on findings. | Reason: stroke History: stroke There is redemonstration of a patchy hypodensity in the inferior aspect of the right cerebellar hemisphere and a a patchy hypodensity in the superior aspect of the right cerebellar hemisphere which continued to evolve. Some subtle patchy hypodensities are present in the left cerebellar hemisphere and in the brainstem. There is redemonstration of a hypodensity in the medial posterior aspect of the left occipital lobe which continues to evolve .There is redemonstration of a marked atherosclerotic calcifications along the distal vertebral arteries left more than rightThe hyperdense basilar artery sign identified on the early 10/14 exam has resolved.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.No evidence for acute intracranial hemorrhage.2.Patchy hypodensities in the cerebellar hemispheres (right worse than left), brainstem and left occipital lobe are compatible with early subacute infarctions there is no evidence for hemorrhagic conversion. |
Generate impression based on findings. | History of relapsed neuroblastoma, restaging status post MIBG therapy CHEST:LUNGS AND PLEURA: Right upper lobe micronodule is unchanged. No consolidation or pleural effusion. No suspicious pulmonary nodule or mass.MEDIASTINUM AND HILA: Left PICC tip lies in the superior SVC. No mediastinal or hilar lymphadenopathy is seen. The heart is normal in size and there is no pericardial effusion.CHEST WALL: Mixed sclerotic/lytic lesions throughout the thoracolumbar spine is unchanged.ABDOMEN:LIVER, BILIARY TRACT: The previously referenced segment 8 liver lesion measures 0.9 x 0.7 cm (image 59, series 3), previously 1.2 x 1.0 cm. Multiple additional hypoattenuating lesions in the liver are too small to characterize.No trabeculated dilation is seen. The hepatic vasculature is patent.SPLEEN: No focal splenic lesion is seen.PANCREAS: The pancreas appears normal.ADRENAL GLANDS: Status post right adrenalectomy. Retroperitoneal soft tissue mass is again seen crossing the midline which encases the bilateral renal, celiac and superior mesenteric arteries and encases two thirds of the aorta. This now measures 5.3 x 4.5 cm (image 70, series 3), previously 4.7 x 5.2 cm.KIDNEYS, URETERS: The kidneys enhance homogeneously and symmetrically without hydronephrosis or perinephric stranding.RETROPERITONEUM, LYMPH NODES: Multiple calcified lymph nodes are again seen. Right peritoneal mass as described above.BOWEL, MESENTERY: No bowel obstruction or free intraperitoneal air.BONES, SOFT TISSUES: Multiple mixed sclerotic/lytic lesions are again seen. T11-T12 compression deformities are unchanged.PELVIS:PROSTATE, SEMINAL VESICLES: Prostate and seminal vesicles are normal for the patient's age.BLADDER: No bladder wall thickening is seen. LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No bowel obstruction or free intraperitoneal air.BONES, SOFT TISSUES: Mixed sclerotic/lytic lesions are again seen. There is increased periosteal reaction along the left ilium. | 1.Increased periosteal reaction along the left ilium.2.No change in retroperitoneal mass, right upper lobe pulmonary micronodule, or osseous metastases.3.Slight decrease in size of liver metastases. |
Generate impression based on findings. | Female; 51 years old. Reason: Please evaluate for resolution of ground glass opacities and consolidation. LUNGS AND PLEURA: There has been near-complete resolution of scattered bilateral ground glass opacities and areas of consolidation compared to the prior study, compatible with resolving infection. Small bilateral pleural effusions with overlying compressive atelectasis are present. No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Mild cardiac enlargement with small pericardial effusion. There are small paratracheal and subcarinal lymph nodes, but no significant mediastinal or hilar lymphadenopathy.CHEST WALL: Interval removal of left central venous catheter. Punctate metallic densities in the right pectoralis muscle are unchanged. Heterogeneous increased density of the visualized osseous structures is unchanged and may represent metabolic bone disease including renal osteodystrophy.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Mild abdominal wall soft tissue edema has increased since the prior exam. | Near-complete resolution of multifocal pneumonia .Increasing pleural effusions and subcutaneous edema, suggestive of CHF/volume overload. |
Generate impression based on findings. | Reason: 6 month post op cervical laminoplasty History: 6 month f/u The cervical vertebral bodies are appropriate in overall alignment and height. No fractures are identified in the cervical spine. The patient is status post multilevel right-sided laminoplasty from C3 down to C7 with osseous bridging noted at C6 and C4. Note is made of a segmented ossification of the posterior longitudinal ligament from C4 down to C7At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there are bilateral uncovertebral osteophytes present at this level associated with endplate osteophytes resulting in neural foramina encroachment. There is narrowing of the spinal canal at this level.At C4-5 there are bilateral uncovertebral osteophytes present at this level associated with endplate osteophytes resulting in neural foramina encroachment and narrowing of the spinal canal at this level. There is some ossification of posterior longitudinal ligament contributing to the narrowing of the spinal canalAt C5-6 there are bilateral uncovertebral osteophytes present at this level associated with endplate osteophytes resulting in neural foramina encroachment and narrowing of the spinal canal at this level. There is some ossification of posterior longitudinal ligament contributing to the narrowing of the spinal canalAt C6-7 there are bilateral uncovertebral osteophytes present at this level associated with endplate osteophytes resulting in neural foramina encroachment and narrowing of the spinal canal at this level. There is some ossification of posterior longitudinal ligament contributing to the narrowing of the spinal canalAt C7-T1 there is no significant compromise to the spinal canal or neural foramina. | 1.There are multilevel degenerative changes present in the cervical spine associated with ossification of posterior longitudinal ligament status post laminoplasty with the multilevel encroachment on exiting nerve roots due to osteophytes predominantly in the narrowing of the spinal canal due to ossification of posterior longitudinal ligament and endplate osteophytes. The canal narrowing appears to be somewhat worse at C3-4 and C6-7. MRI would be more appropriate in evaluating for spinal stenosis . |
Generate impression based on findings. | Reason: r/o PE History: hypoxia, tachycardia PULMONARY ARTERIES: No evidence of a pulmonary embolus.LUNGS AND PLEURA: Moderate sized bilateral pleural effusions with underlying atelectasis.Perihilar and upper lobe ground glass opacities compatible with edema.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.There is cardiac enlargement 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. | 1.No evidence of a pulmonary embolus.2.Moderate to large sized bilateral pleural effusions with evidence of pulmonary edema compatible with decompensating CHF |
Generate impression based on findings. | Female; 76 years old. Reason: metastatic thyroid ca, on therapy, eval for dz progression with measurements. CHEST:LUNGS AND PLEURA: Low lung volumes with mild posterior and basilar scarring/discoid atelectasis. No focal consolidation or pleural effusion. Scattered punctate micronodules are again observed but there are no new suspicious pulmonary lesions. Small lingular nodule is again noted but not significantly changed in size or appearance.MEDIASTINUM AND HILA: Enhancing, centrally necrotic mass in the superior and anterior mediastinum posterior to the clavicular head is unchanged in size and measures 2.6 x 2.4 cm (series 3, image 17). Stable necrotic right paratracheal lymph node (series 3, image 23). Normal heart size without pericardial effusion. Small hiatal hernia.CHEST WALL: No significant axillary lymphadenopathy. ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Stable scattered hepatic cysts. SPLEEN: Accessory splenule.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Unchanged bilateral renal cysts. PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Multilevel spinal degenerative changes with severe facet joint arthropathy in the lower lumbar spine. No suspicious lytic or blastic lesions. OTHER: No significant abnormality noted. | No significant interval change in superior mediastinal mass and mediastinal adenopathy. No new sites of disease identified. |
Generate impression based on findings. | Male; 51 years old. Reason: pt with lung ca s/p Tarceva therapy (oral) therapy > 16 months History: now needs disease evaluation compare to previous scans and comment CHEST:LUNGS AND PLEURA: Left paramediastinal fibrosis is again noted and compatible with prior radiation treatment. Reference left upper lobe nodule is unchanged in size and measures 14 x 9 mm (series 5, image 28). Left upper lobe micro-nodule is similar in appearance to the prior exam (series 5, image 43). No new suspicious pulmonary nodules or masses. No focal consolidation or pleural effusion.MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. No mediastinal or hilar lymphadenopathy. Mild coronary artery calcifications.CHEST WALL: Multiple vertebral metastases.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Fatty infiltration of the liver. Reference lesion in the posterior right hepatic lobe is unchanged in size over multiple exams and measures 26 x 23 mm (series 3, image 87), and may represent an hemangioma . No new suspicious lesions are identified. 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: Sclerotic lesions in T2 and T11 vertebral bodies, as well as primarily lytic lesions in T10, L2, and L4 vertebral bodies, are unchanged. Large left ileal osteolytic metastasis with cortical disruption has not been imaged on prior exams.OTHER: No significant abnormality noted. | 1.No significant interval change in pulmonary or osseous lesions, which likely represent metastatic disease. Enhancing hepatic lesion may represent a hemangioma.2.Identification of large left ileal osteolytic lesion with cortical breakthrough. Recommend dedicated CT/MR of this region. |
Generate impression based on findings. | Reason: evaluation of malignant lesions s/p radiation History: surveillance CHEST:LUNGS AND PLEURA: Left upper lobe pleural based nodule measures 1.6 x 0.9 cm (series 6, image 31), previously 1.4 x 0.8 cm. Reference left lower lobe pulmonary nodule measures 5 mm (series 6, image 37), previously 6 mm. Additional scattered pulmonary nodules are unchanged.Right anterior pleural-based mass measures 1.7 x 0.9 cm (series 4, image 56), unchanged.MEDIASTINUM AND HILA: No lymphadenopathy.CHEST WALL: Left chest wall nodules measuring up to 2.2 x 1.3 cm (series 4, image 53), previously 1.9 x 1.5 cm.ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Left paraaortic lymph node measures 2.3 x 1.3 cm (series 4, image 105), unchanged.BOWEL, MESENTERY: Right paracolic gutter peritoneal implant measures 4.0 x 3.1 cm (series 4, image 139), previously 6.7 x 4.6 cm. Left paracolic gutter peritoneal implant measures 1.7 x 1.7 cm (series 4, image 149), previously 1.1 x 0.9 cm.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy and bilateral salpingo-oophorectomy. Hypodense adnexal lesion measures 2.3 x 1.6 cm (series 4, image 173), previously 3.8 x 3.7 cm.BLADDER: No significant abnormality noted.LYMPH NODES: Status post pelvic lymph node dissection.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Spinal stimulator is present.OTHER: No significant abnormality noted. | Mixed response of index lesions in the chest, abdomen, and pelvis. |
Generate impression based on findings. | Female 68 years old Reason: Distant history of small cell lung CA s/p chemo and RT History: growing nodule seen on recent non-infused CT CHEST:LUNGS AND PLEURA: Solid noncalcified right upper lobe nodule measures 11 x 9 mm (image 46, series 5), previously 11 x 10 mm. The caudal aspect of the nodule causes tenting of the minor fissure and is irregular in appearance. This lesion is compatible with an indolent primary pulmonary malignancy.The previously described perihilar right lower lobe spiculated mass, which is inseparable from the right major fissure, adjacent lymphadenopathy and bronchovascular bundle now measures 3.5 x 2.6 cm (image 53, series 5), previously 2.2 x 2.7 cm. This lesion is highly compatible with an indolent primary pulmonary malignancy.Mild centrilobular and paraseptal emphysema unchanged. Left apical scarring and traction bronchiectasis along the mediastinal margin compatible with radiation fibrosis. No pleural effusion or new focal air space opacity identified.MEDIASTINUM AND HILA: 15-mm right hilar lymph node with punctate peripheral calcifications appears unchanged since 20006, and likely related to prior granulomatous disease. Remainder of hila and mediastinum appear free of lymphadenopathy.Moderate atherosclerosis of the coronary arteries and thoracic aorta.Small pericardial fluid collection appears unchanged. Heart size is normal. Hypodense thyroid lesion compatible with thyroid nodule.CHEST WALL: Mild degenerative changes of the 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: Small left adrenal nodule unchanged since 2006.KIDNEYS, URETERS: Chronic moderate right hydronephrosis with associated cortical thinning. Renal cysts unchanged.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Severe atherosclerosis of the abdominal aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Small hiatal hernia.BONES, SOFT TISSUES: Mild degenerative changes of the thoracic and lumbar spine.OTHER: No significant abnormality noted. | 1. Unchanged right perihilar mass and right upper lobe nodule highly compatible with primary pulmonary malignancies.2. No evidence of metastatic disease. |
Generate impression based on findings. | Reason: Please evaluate kidneys, ureters, bladder for malignancy, abnormality History: hx of bladder cancer ABDOMEN:LUNG BASES: Basilar atelectasis. LIVER, BILIARY TRACT: Two likely benign enhancing lesions in the right hepatic lobe (series 7, image 19 and 45).SPLEEN: Status post splenectomy. Soft tissue density in the left upper quadrant (series 7, image 35), may represent an accessory splenule.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Symmetric renal parenchymal enhancement and contrast excretion into normal pelvocalyceal systems. The ureters opacify with contrast except for the distal third of the left ureter, although no sizeable lesion is seen in this region. Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal and mesenteric lymph nodes.BOWEL, MESENTERY: No evidence of bowel obstruction. Scattered surgical clips throughout the mesentery.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: Status post bilateral pelvic lymph node dissection.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Scoliosis with degenerative changes.OTHER: No significant abnormality noted. | No evidence of recurrent or metastatic disease. |
Generate impression based on findings. | Reason: incidental find pt with 8-10cm thoracoabdominal aneurysm, need imaging with contrast History: back pain CHEST:LUNGS AND PLEURA: Nonenhancing, peripherally calcified right upper lobe lung nodule measuring 1.2 x 1.1 cm (series 11, image 32). Mild paraseptal emphysematous changes two bilateral lung bases. Small right pleural effusion. Calcified right hilar lymph nodes.MEDIASTINUM AND HILA: Mild atherosclerotic calcifications of the aortic arch. Mild atherosclerotic calcifications of the coronary arteries. CHEST WALL: No significant abnormalities noted.ABDOMEN:LIVER, BILIARY TRACT: No suspicious focal liver lesions. No extrahepatic or intrahepatic biliary ductal dilatation. No evidence of cholelithiasis.SPLEEN: No significant abnormality noted. Splenic artery calcifications without evidence of pseudoaneurysm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Mild nodularity to the left adrenal gland.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Large aneurysmal dilatation of the abdominal aorta starting above the level of the celiac axis and extending down to the level of the renal arteries measuring 10.4 cm in its largest diameter. There is a large mural thrombus within the aneurysm which slightly increased in density worrisome for a possible intramural hematoma. The celiac axis, SMA, bilateral renal arteries are patent. Bilateral common iliac arteries are patent. Severe atherosclerotic calcifications of the aorta and bilateral common iliac arteries. There is also a focal aneurysmal dilation of the lumbar aorta below the renal arteries measuring 3.3 cm in diameter. There is no evidence of retroperitoneal or periaortic fluid collection to suggest rupture.BOWEL, MESENTERY: Scattered colonic diverticula without evidence of diverticulitis.BONES, SOFT TISSUES: Dextroscoliosis with degenerative disease of the lower thoracic and lumbar spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Large thoracoabdominal aneurysm extending from above the celiac axis to the level of the renal arteries as outlined above. There is a large thrombus within the aneurysmal component with slightly increased density which is worrisome for a possible intramural hematoma.2.Second focal , infrarenal abdominal aneurysm.The findings were discussed with surgery service, pager 2567, over the phone at 1120 on 10/16/2013 by Dr. Alexander. |
Generate impression based on findings. | Refractory neuroblastoma, assess for response to chemotherapy CHEST:LUNGS AND PLEURA: No consolidation or pleural effusion. No suspicious pulmonary mass or nodule.MEDIASTINUM AND HILA: Left anterior/superior mediastinal mass at the level of the clavicular heads now measures 2.1 x 1.0 cm (image 10, series 3), previously 2.0 x 1.2 cm.Right upper quadrant port catheter tip lies in the SVC. No mediastinal or hilar lymphadenopathy. The heart is normal in size without pericardial effusion.CHEST WALL: Several sclerotic lesions are seen throughout the vertebral bodies and manubrium, unchanged from the prior study.ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size and morphology without focal liver lesion. No intrahepatic biliary duct dilation is seen. Hepatic vasculature is patent.SPLEEN: No focal splenic lesion is seen.PANCREAS: The pancreas appears normal.ADRENAL GLANDS: The left adrenal gland is not visualized. The right adrenal gland appears normal.KIDNEYS, URETERS: The kidneys enhance homogeneously and symmetrically without hydronephrosis or perinephric stranding.RETROPERITONEUM, LYMPH NODES: Multiple retroperitoneal soft tissue density masses are seen anteromedial to the left kidney which appear unchanged from the prior study. The previously reference mass posterior to the left renal vein and now measures 1.7 x 0.9 cm (image 75, series 3), previously 1.8 x 0.9 cm.BOWEL, MESENTERY: No bowel obstruction or free intraperitoneal air.BONES, SOFT TISSUES: Multiple lucent and sclerotic lesions are seen throughout the vertebral bodies.PELVIS:PROSTATE, SEMINAL VESICLES: The prostate and seminal vesicles are normal for the patient's age.BLADDER: The bladder is distended without bladder wall thickening.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No bowel obstruction or free intraperitoneal air.BONES, SOFT TISSUES: Multiple lucent and sclerotic lesions are seen throughout the bones. | No change in the intraperitoneal soft tissue masses anteromedial to the left kidney. No change in superior mediastinal soft tissue mass. |
Generate impression based on findings. | Male 64 years old Reason: History of prior nodule/abnormality, also needed for work-up for heart transplant History: getting work up for heart transplant, has history of abnormality/nodule on a prior CT. LUNGS AND PLEURA: Nonspecific left lower lobe micronodules measures less than 4 mm (image 105, series 4) and likely inflammatory/infectious in etiology. Patchy ground glass opacities compatible with aspiration. Mild centrilobular emphysema.Moderate right pleural effusion, septal thickening and bronchial wall thickening compatible with pulmonary edema secondary to CHF. MEDIASTINUM AND HILA: Nonspecific right paratracheal lymph node measures 12 mm (image 24, series 3) and may represent two confluent nodes. Numerous other mediastinal lymph nodes not enlarged but prominent in number.Multichamber cardiomegaly. Severe atherosclerosis of the coronary arteries with coronary artery stents in place. Moderate atherosclerosis of the thoracic aorta. No pericardial effusion.Dual lead AICD pacemaker device in place.CHEST WALL: Sternal fixation hardware in place, and sternum well aligned. Mild/moderate bilateral body wall edema.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Diffusely hypoattenuating hepatic parenchyma consistent with fatty infiltration. Mild perihepatic and perisplenic ascites. Haziness of the mesentery may relate to edema or less likely inflammation. | 1. Findings compatible with aspiration and pulmonary edema.2. Nonspecific pulmonary micronodule in the left lower lobe. |
Generate impression based on findings. | Right soft palate swelling, throat pain. There is diffuse fluid attenuation within the retropharyngeal space that measures up to 8 mm in thickness, which extends from the level of the C2 to C7 vertebrae. There is also diffuse ill-defined hypoattenuation in the right parapharyngeal space at the level of the oropharynx and mild swelling of the epiglottis. While there is diffuse swelling in the region of the right tonsillar fossa, there is no evidence of peritonsillar abscess. There is mild narrowing of the oropharyngeal airway. There is no significant cervical lymphadenopathy. However, there is a mildly prominent left paraaortic lymph node that measures 12 x 15 mm of uncertain significance. The major salivary glands are unremarkable. There is a diffusely enlarged thyroid gland with multiple hypoattenuating subcentimeter nodules. The major cervical flow voids are intact. The osseous structures and dentition are unremarkable. The imaged portions of the intracranial structures and orbits are unremarkable. There is a small left maxillary sinus retention cyst. The imaged portions of the lungs are clear. | Diffuse edema within the right oropharyngeal and hypopharyngeal region as well as extensive retropharyngeal effusion with mils airway narrowing. Differential considerations include angioedema related to enalapril or other medications versus an infectious pharyngitis. No evidence of tonsillitis or mass lesions.Discussed with Dr. Sakaria at 10:50 AM on 10/16/13. |
Generate impression based on findings. | Female, 76 years old, metastatic thyroid cancer on therapy, evaluate for disease progression. No mass effect, focal edema or suspicious enhancement is seen to suggest brain parenchymal metastatic disease. The bones of the calvarium and skull base are intact. Post surgical change consistent with thyroidectomy is redemonstrated. A minimally enhancing mass is reidentified within the left thyroidectomy bed which measures 3.1 x 2.9 cm on coronal images (image 38 series 80364), previously 2.9 x 2.8 cm on 08/21/13 and previously 3.1 x 2.9 cm on 06/26/13. Additional pretracheal and prevascular adenopathy is also redemonstrated appearing similar to prior exams. On the present study, the margins of all the above lesions are less well defined which could be technical or related to motion artifact. By size, the lesions appear unchanged allowing for 1 or 2 mm of error.Elsewhere in the neck, no masses or pathologic adenopathy is detected. Evidence of left vocal cord dysfunction is again seen with dilatation of the left piriform sinus and laryngeal ventricle as well as medialization of the vocal cord. Vocal cord augmentation material is evident on the left which appears to erode through the the left thyroid cartilage, a stable finding. The salivary glands are free of focal lesions. The cervical vessels vessels are patent.A lucent lesion is partially visualized within the right aspect of the T4 vertebral body. This was present on prior examinations including an exam dating back to 2011. The appearance and stability over this time period would suggest a benign etiology such as a hemangioma, but given the clinical history, continued attention to this area on subsequent exams is advised. Otherwise, the bony structures are unremarkable. | 1. No definite evidence of disease progression in the neck. A mass in the left thyroid bed is grossly stable allowing for some degree of measurement error due to more ill-defined margins on the present study, felt to be technical. Additional upper mediastinal adenopathy is also not significantly changed but is better assessed on chest imaging.2. A lucent lesion is partially visualized within the right aspect of the T4 vertebral body. This has not significantly changed dating back to 2011. The lesion may therefore be benign, but given the clinical history, continued attention to the bony structures on subsequent exams is suggested.3. No intracranial metastatic disease. |
Generate impression based on findings. | Lung cancer CHEST:LUNGS AND PLEURA: Stable unchanged diffuse bronchiolitis with tree in bud opacities throughout all right lung lobes, unchanged. Small subcentimeter nodular opacities are also stable in appearance without interval alteration. No effusion.The left lung cavity with a large loop fluid collection representing a post pneumonectomy unchanged. Interval resolution of the small gas collection.MEDIASTINUM AND HILA: No lymphadenopathyThe cardiac and pericardial appearance are unchanged and within limits. Mild mediastinal right to left shift unchangedCHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Stable hypodensity in the posterior right hepatic lobe with cystic changes and peripheral vascular enhancement. No suspicious new hepatic lesions. Gallbladder unremarkableSPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable nephrolithiasis on the right without evidence of obstruction.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. | Postsurgical changes with findings on the right stable in appearance and likely representing recurrent aspiration and much less likely infection given stability. Stable small more focal opacity in the anterior right upper lung, again more obtained serial follow-up imaging to exclude recurrent malignancy |
Generate impression based on findings. | Nasal head and neck cancer. Check for malignancy CHEST:LUNGS AND PLEURA: The previously referenced right upper lobe and right middle lobe nodules are currently not visualized and suspected to have resolved. The peripheral right upper lobe nodular opacity is grossly unchanged questionably partially calcified, again measuring 3 mm (image 26 series 6). No effusions. Moderate central lobular emphysema diffusely. Mild atelectasisMEDIASTINUM AND HILA: No lymphadenopathyExtensive coronary calcifications. The heart and pericardium are otherwise unremarkableModerate hilar herniaCHEST WALL: Right chest portABDOMEN: 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. Small stable exophytic cyst on the rightPANCREAS: 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: Scoliosis, stable degenerative changes in moderate wedge deformity of L1. Fraying and focal lucency in T6 and T7 again without interval change and of uncertain significance.OTHER: No significant abnormality noted. | 1. Resolution of two referenced nodules with stability in the third remaining right upper lobe nodule, measurement above.2. Nonspecific osseous changes mid thoracic spine also unchanged with a stable appearing compression fracture of L1 |
Generate impression based on findings. | History of lung nodule. Bladder cancer LUNGS AND PLEURA: Interval advancement with enlargement of the previously described posterior nodule in the superior segment of the left lower lobe (image 55 series 5). This finding abuts the pleura with associated diffuse nodular thickening throughout the left hemithorax greater in the upper lung zone. The nodule currently measures 2.1 cm from a prior measurement of 0.6 cm. The pleural thickening demonstrates discrete areas of decreased density suggesting loculated fluid with questionable compressed lung although pleural and fissural metastatic disease must be considered. Additional left lower lobe nodules are also observed, the largest measuring 1 cm in diameter, (image 74 series 5). The right lung additionally demonstrates suspicious new nodular suspected metastatic disease the largest measuring 0.9 cm in the right middle lobe (image 58 series 5)MEDIASTINUM AND HILA: No lymphadenopathyMild coronary calcifications without additional cardiac abnormalitySmall hiatal herniaCHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No infra-diaphragmatic abnormality observed in this limited evaluation | Interval progression of the canal bilateral suspected metastatic disease with new lesions and left pleural changes |
Generate impression based on findings. | Reason: restaging scans s/p 4 cycles of investigational PDL1 systemic treatment History: hx of metastatic bladder cancer CHEST:LUNGS AND PLEURA: No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: No lymphadenopathy. Heart size is normal without pericardial effusion. Coronary artery stents. Hiatal hernia.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Enhancing soft tissue lesion along the distal right ureter (series 3, image 144).Moderate left hydronephrosis with delayed parenchymal enhancement. Mild right hydronephrosis. RETROPERITONEUM, LYMPH NODES: Left paraaortic lymph node measures 0.9 x 0.6 cm (series 3, image 121), previously 1.6 x 1.4 cm. Atherosclerosis of the abdominal aorta and its branches. BOWEL, MESENTERY: Postoperative changes of ileal conduit.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: Status post cystectomy.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. Enhancing soft tissue lesion along the distal right ureter suspicious for residual disease.2. Decrease in the size of the left paraaortic lymph node. |
Generate impression based on findings. | Thyroid cancer CHEST:LUNGS AND PLEURA: Numerous scattered bilateral nodules greater on the right are again observed, many calcified. All essentially remain unchanged such as the right middle lobe nodule (image 20 series 5) remains 5 mm and the left lower lobe reference nodule (image to 71 series 5) remains 4 mm when each are measured similarly. Other reference nodules appear mildly different from the immediate prior scan - but when compared to numerous prior studies over the year - overall stability is observed and the differences are likely due to differences in patient breathing and technique. The superior segment left lower lobe nodule (image 43 series 5) currently measures 3 mm and the right upper lobe peripheral nodule currently measures 5 mm (image 23 series 5) taking differences into account. No new effusions end of their than mild emphysematous changes, no new air space abnormalities.MEDIASTINUM AND HILA: Postoperative thyroid bed with small nodular soft tissue focus in the anterior midline unchanged (image 7 series 3). Calcified lymph nodes compatible with old healed granulomatous disease.No cardiac abnormality of the mild coronary calcificationsCHEST WALL: Right mastectomy and postoperative changesABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholecystectomy, liver otherwise unremarkableSPLEEN: Calcified granulomaADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts unchangedPANCREAS: 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: Diffuse moderate degenerative changes and scoliosis throughout the lower thoracic and upper lumbar spine unchanged. No suspicious lytic or blastic lesionsOTHER: No significant abnormality noted. | Stable numerous multiple pulmonary nodules compatible with known metastatic disease and granulomata. See reference measurements provided. |
Generate impression based on findings. | Reason: followup post change in drain pressure to 10cm H20 History: followup post change in drain pressure to 10cm H20 There is redemonstration of a right hemispheric hematoma associated with an drainage catheter. The hematoma appears very similar compared to prior exams measuring 45 mm in width and 22 mm AP dimension which is very similar prior exams. Please note that this hematoma is irregular. A right thalamic hematoma measuring 8 mm in diameter and is still present. Intraventricular blood is still present. Midline shift is still present. There is a shift of the septum pellucidum approximately 14 mm to the left of midline which previously was the same.There is redemonstration of the ventriculostomy tube coursing through the left frontal lobe into the left lateral ventricle with the tip in the frontal horn.The visualized portions of the paranasal sinuses demonstrate mucosal thickening and partial opacification with air fluid levels in the sphenoid sinuses status-post intubation. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.There is continued evolution of the patient's large right hemispheric hematoma without evidence for new hemorrhage. There is redemonstration of associated midline shift and intraventricular hemorrhage and a left-sided ventriculostomy tube. |
Generate impression based on findings. | Shortness of breath. Additional history of multiple myeloma and question of radiation pneumonitis per prior report. LUNGS AND PLEURA: Respiratory motion artifact degrades image quality. Lung volumes slightly decreased when compared to earlier scans this year. Volume loss left hemithorax with leftward mediastinal shift unchanged compared to most recent exam but has progressed compared to earlier scans.Small pleural fluid collections, left greater than right, with near complete resolution of fluid in the left major fissure seen previously. Paramediastinal traction bronchiectasis mainly on the left, seen to a much lesser extent in the paramediastinal right lung.Extensive architectural distortion with interstitial thickening and ground glass opacities, left greater than right with a progression slightly in the right lung since the previous examination. New right lower lobe air space opacity (4/49) outside of the previously affected area suspicious for a superimposed infectious process in the appropriate clinical context.Scattered subcentimeter nodular opacities, assessment limited due to motion and size.MEDIASTINUM AND HILA: Leftward mediastinal deviation. Several small mediastinal lymph nodes, some of which are slightly larger in the interim. For example, a low right paratracheal lymph node (3/36) which measures 12-mm previously measured 5-mm. Mild cardiomegaly. Physiologic volume of pericardial fluid.Right subclavian single lead ICD terminates in the right ventricle near the interventricular septum.CHEST WALL: Diffuse lytic and sclerotic skeletal lesions consistent with myeloma. Pathologic fractures through the right lateral aspects of the T6 vertebral body and the manubrium unchanged. New bulky soft tissue lesions left anterior chest wall involving through both the skin and subcutaneous soft tissues. Length of the largest lesion measures 7-cm on coronal image 76. Small left internal mammary chain lymph nodes.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. Motion artifact causes slice misregistration. | 1. New right lower lobe air space opacities suspicious for pneumonia. Alternatively, this could left acute radiation pneumonitis in the appropriate clinical setting if the patient had received additional RT to the right chest wall at a later date.2. Minimal progression of pulmonary opacities most consistent with evolving radiation fibrosis.3. Interval development of mild mediastinal lymphadenopathy.4. Interval development of large left anterior chest wall soft tissue mass lesions consistent with metastases. |
Generate impression based on findings. | Male; 49 years old. Reason: elevated right hemidiaphragm History: dyspnea LUNGS AND PLEURA: Marked elevation of the right hemidiaphragm with suspected right lung base atelectasis and/or scarring. Diaphragmatic elevation is of unknown chronicity and significance. No focal consolidation or pleural effusion. No evidence of central airway obstruction.MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. No significant mediastinal or hilar lymphadenopathy.CHEST WALL: Focal calcific deposits in T10/T11 disk space may reflect prior diskitis. UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Calcified splenic granulomata. Multiple right renal cysts. | 1.No acute cardiopulmonary abnormality identified. 2.Marked elevation of the right hemidiaphragm, of unknown chronicity and significance. |
Generate impression based on findings. | 67-year-old male with history of colon cancer -- evaluate for progression. CHEST:LUNGS AND PLEURA: Nonspecific left lower lobe nodule (series 4, image 39) is unchanged in size, measuring 4 mm.. No new nodules are seen. No new infiltrates, masses, or effusions seen.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Chest wall Port-A-Cath again seen with catheter tip at the caval atrial junction.ABDOMEN:LIVER, BILIARY TRACT: Reference segment 8 lesion (series 3, image 73) has decreased in size and now measures 2.0 x 1 .6 cm, previously 2.0 x 2.4 cm. Similarly, large right lobe. Calcified lesion has decreased in size. Other lesions have similarly slightly decreased in size.Since prior examination is been interval placement of a large bore biliary stent with pneumobilia now present.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Reference, portacaval lymph node (series 3, image 103) is unchanged, measuring 1.9 x 1 .3 cm, previously 2.0 x 1.3 cm.BOWEL, MESENTERY: No significant abnormality noted in large or small bowel. No free mesenteric fluid identified..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 noted in large or small bowel. No free mesenteric fluid seen.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. No change in 4-mm nonspecific left lower lobe lung nodule and no other thoracic abnormalities of significance is seen. 2. Decrease in size of liver metastases. 3. Interval insertion of large bore biliary stent with pneumobilia as expected. 4. Stable appearance to an enlarged portacaval lymph node. |
Generate impression based on findings. | Confusion, tangential thinking. There is no evidence of acute intracranial hemorrhage, mass, or cerebral edema. There is mild patchy cerebral white matter hypoattenuation, which likely represents microangiopathy. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. | No evidence of acute intracranial hemorrhage, mass, or cerebral edema. |
Generate impression based on findings. | Reason: eval for swelling History: eval for swelling There are patchy hypodensities involving gray and white matter in the right middle cerebral artery distribution predominately in the right temporal lobe but also in the right to frontal lobe and right parietal lobe. Additionally there are hypodense foci present in the right basal ganglia with volume loss. Hypodensity with volume loss is also present in the right half of the midbrain. There is ex vacuo effect present along the right lateral ventricle. Punctate hypodensities are also present in the thalami and brainstem. These findings were present on the previous exam and have not changed substantially. Atherosclerotic calcifications are present along the distal internal carotid arteries.Periventricular and subcortical white matter hypodensities of a moderate degree are present.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.Findings are compatible with subacute infarction involving the entire right middle cerebral artery distribution superimposed on old infarctions in the right middle cerebral artery distribution with old lacunar infarcts in the right basal ganglia and evidence for Wallerian degeneration. There is no evidence for hemorrhagic conversion2.Periventricular and subcortical white matter hypodensities of a moderate degree are present.3.Punctate hypodensities are present in the thalami and brainstem suspicious for lacunar infarcts |
Generate impression based on findings. | AML s/p BMT presents with fevers and red swollen eyes s/p recent laryngoscopy. There is extensive emphysema within the bilateral neck soft tissues, right greater than left, including the retropharyngeal space, parapharyngeal spaces, right masticator space, and paraspinal spaces. There are no associated fluid collections apparent. There is a defect in the left posterior left maxillary alveolus with oroantral fistula. There is mild maxillary sinus mucosal thickening. The other paranasal sinuses are clear. The right mastoid air cells are markedly underpneumatized. There is soft tissue attenuation material within the right external auditory canal, which likely represents cerumen. There is mild periapical lucency affecting lingual root of ADA 5. The imaged intracranial structures and orbits are grossly unremarkable. | 1. Extensive neck soft tissue emphysema, likely a complication of the recent laryngoscopy at another institution.2. Mild mucosal thickening within the left maxillary sinus associated with an oroantral fistula.Discussed with Dr. Walker at 11: 50 AM on 10/16/13. |
Generate impression based on findings. | Shortness of breath and chest pain unspecified. Evaluate pulmonary nodule status post thoracentesis. Weight loss. LUNGS AND PLEURA: Small circumferential pneumothorax at the apex with an additional small anterior component extending into deep left anterior cardiophrenic angle and extraperitoneal space. Maximal pleural separation of the chest wall from the apex is 1cm. Mild centrilobular emphysema. Trace volume of pleural fluid on the left. Smooth left pleural thickening and enhancement in the costophrenic angle region persists and could indicate empyema or neoplasia.Air space consolidation left lower lobe contains a heterogeneous, solid internal nodule measuring approximately 15 mm in size, unchanged (3/78). No internal lipid or calcium attenuation is appreciated. The second possible nodule seen on the prior examination is not conclusively identified on the current examination but could be obscured within the atelectatic lung.Scarlike abnormality right lower lobe appears fairly flat on the coronal reconstructions with a thickness of only 4 mm, favoring a scar over neoplastic process, though the latter cannot be entirely excluded without comparison to remote prior examinations.MEDIASTINUM AND HILA: Thyroid gland is moderately enlarged but symmetric in appearance, nonspecific by CT.Although no significantly enlarged lymph nodes are identified, several mediastinal lymph nodes are abnormally enhancing and suspicious in appearance (subcarinal, lower left paratracheal, high right paratracheal, prevascular and left paraaortic chains). Normal heart size. Physiologic volume of pericardial fluid.CHEST WALL: Left internal mammary chain lymphadenopathy measuring up to 5-mm in short axis (3/48). Enlarged left cardiophrenic angle lymph node measures 7-mm (3/80). Enlarged left intercostal chain lymph node (3/59).Scattered sclerotic and lucent lesions in the spine too small to be characterized but atypical in appearance for a benign bone island; metastases cannot be excluded.Note is made of enhancement of the spinal cord which is not normally visible on CT. The possibility of leptomeningeal metastases or infection cannot be excluded.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. Subcentimeter hypoattenuating lesions in the liver too small to characterize but statistically most likely reflect cysts. Incompletely visualized cystic lesion at the apex of the left kidney. Nodular thickening of the left adrenal gland measuring 10 x 12 mm each does not meet the criteria for adenoma. | Start numbering1.1cm left hydropneumothorax.2.15-mm left lower lobe solid nodule, indeterminate and suspicious for neoplasm or possibly atypical infection such as Coccidioidomycosis in the appropriate clinical context.3.Abnormal enhancement of the left pleura and meninges which could be infectious or neoplastic.4. Left chest wall lymphadenopathy in the internal mammary, intercostal and cardiophrenic chains.5. Numerous small lymph nodes in the mediastinum are not enlarged however are abnormal in multiplicity and CT attenuation suggesting that they are pathologic.6. Right lower lobe lesion appears scarlike, correlation with any remote outside prior CTs may be of use if they can be obtained and submitted by the referring clinical service to assess for stability.7. Indeterminate skeletal lesions.8. Indeterminate left adrenal gland nodular thickening. |
Generate impression based on findings. | Lung cancer, compare to prior CHEST:LUNGS AND PLEURA: Postsurgical right upper lobectomy changes without interval new abnormality. No specific findings to suggest recurrence. The left upper lobe subpleural nodule is unchanged again measuring 5 x 9 mm (image 42 series 4). Scattered pulmonary micronodules many of which are calcified are also unchanged. No suspicious new findings, no effusions. Mild central lobular emphysema with minimal atelectasis. Previously described bronchiolitis has resolvedMEDIASTINUM AND HILA: No lymphadenopathyThe cardiac and pericardium are unremarkable other than moderate coronary and aortic calcificationsCHEST WALL: Scattered moderate degenerative changes with a more sclerotic focus and T3 unchanged.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Multiple faint densities within the gallbladder suggesting gallstones unchanged. Liver otherwise unremarkableSPLEEN: Solitary splenuleADRENAL 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: Stable appearing well marginated focal lucency in the right iliac wing (image 140 series 3), probable cystOTHER: No significant abnormality noted. | No evidence of focal local recurrence or new metastatic disease. |
Generate impression based on findings. | Female 85 years old; Reason: pancreatic cancer restaging History: pancreatic cancer restaging CHEST:LUNGS AND PLEURA: Ground glass nodule adjacent to the right upper lobe airway measures 2.7 x 2.1 cm (image 42/series 4) previously, 3.2 x 1.7 cm.A solid parenchymal nodule adjacent to the right posterior mediastinal border measures 2.2 x 1.3 cm (image 31/series 4) previously, 2.3 x 1.8 cm. It is located in the right azygoesophageal recess and is inseparable from the esophagus.Multiple scattered nonspecific pulmonary micronodules, many of which are calcified and are unchanged.MEDIASTINUM AND HILA: Heart size is enlarged. No pericardial effusion. Coronary calcifications in a triple vessel distribution.There are calcified right hilar lymph nodes.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Spleen is normal in size with calcified splenic granulomata.PANCREAS: Fatty pancreatic atrophy. The pancreatic tail mass measures 2.2 x 1.6 cm (image 97/series 3) previously, 3.0 x 1.8 cm.ADRENAL GLANDS: Stable thickening of the left adrenal gland.KIDNEYS, URETERS: Bilateral renal cysts, largest in the left kidney.RETROPERITONEUM, LYMPH NODES: Calcific arteriosclerotic disease of the aorta. No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Uterus is absent or atrophic.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.Decrease in the size of the pancreatic tail lesion.2.No significant size change in the two right lung lesions. |
Generate impression based on findings. | T4N0 sinonasal SCC status post CRT complete on 9/6/13. Head: There is a residual soft tissue mass present in the right pterygopalatine fossa that measures approximately 13 x 14 mm associated with expansion of the pterygopalatine fossa and the right foramen rotundum, which is not significantly changed. There are residual punctate foci of demineralization in the posterior wall of the right maxillary sinus and diffuse sclerosis of the right floor of the middle cranial fossa, which is likely related to radiation therapy. There are new air-fluid levels within the right maxillary and sphenoid sinuses. There is an unchanged 9 mm diameter left ethmoid sinus osteoma. There is no abnormal intracranial enhancement. There is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are stable in size and configuration. There is no midline shift or herniation. The orbits are unremarkable. There is mild opacification of the right mastoid air cells. There is an unchanged cystic lesions in the left occipital subcutaneous tissues that measures up to 15 mm.Neck: There is no significant cervical lymphadenopathy. The thyroid gland and major salivary glands are unchanged. The upper airway is patent. There is a right internal jugular venous catheter. The major cervical vessels otherwise appear patent. There is multilevel degenerative spondylosis of the cervical spine without lytic or blastic lesions. There is pulmonary emphysema and calcified right apical nodules, which are not changed. Refer to the separate chest CT report for additional details. | 1.Stable post-treatment findings with unchanged residual tumor within the right pterygopalatine fossa and right foramen rotundum.2.No evidence of intracranial metastases of significant cervical adenopathy.3.New sinonasal air-fluid levels may represent acute rhinosinusitis in the appropriate clinical setting. |
Generate impression based on findings. | Reason: f/u post fossa tumor resection History: post fossa tumor Since the previous exam, the patient has undergone posterior fossa craniectomy with mesh placement and C1 decompression.The patient has undergone recent posterior fossa surgery. Some hyperdensity is present along the right upper midbrain posteriorly and right upper vermis which could represent blood products or residual tumor. There is redemonstration of extensive hypodensity involving the cerebellar hemispheres more on the right than the left and hypodensity in the right and to a lesser degree left thalamus and internal capsules. There is extensive subarachnoid air present. A ventriculostomy tube courses through the right occipital lobe into the right lateral ventricle with tip in the body of the right lateral ventricle.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.Status post suboccipital craniectomy and and C1 decompression for tumor resection with attendant post operative changes2.Hyperdense focus along the posterior aspect of the right midbrain and upper vermis could represent a blood products . The possibility of residual tumor cannot be excluded on the basis of this exam.3. |
Generate impression based on findings. | Male, 60 years old, history of brain tumor with headache. Imaging was performed with a stereotactic frame in place. Streak artifact from this device degrades image quality. Within this limitation, the following observations are made.Surgical change is redemonstrated status post placement of a right parietal ventriculostomy catheter. The catheter courses transversely and inferiorly, crossing both lateral ventricles to terminate within the left frontal horn. Positioning is stable.When compared with the prior CT, the caliber of the ventricular system has increased in size. The caliber is similar to that seen on the same day MRI.The patient's extensive lobulated tumor is inadequately visualized on the present study. Fine detail of the brain parenchyma is also inadequately visualized.A left parietal burr hole is evident status post prior biopsy. A prior right frontal burr hole is also demonstrated secondary to an old shunt tract. | Limited surgical planning examination of the head. Pre-existing right parietal approach ventriculostomy catheter is in stable position. When compared to the prior CT, ventricular caliber is increased. |
Generate impression based on findings. | Male 67 years old; Reason: Met CRC: Restaging History: none ABDOMEN:LUNGS BASES: A opacity at the left lung base is new. It is more linear in configuration a suggesting of focal atelectasis or scarring. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Severe hydronephrosis of the left kidney with severe parenchymal thinning. There is a small distal calculus at the level of the aortic bifurcation.Right kidney has a cyst at its upper pole. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: The left hydronephrosis is caused by a soft tissue mass that is poorly imaged without contrast lateral to the left common iliac artery.BOWEL, MESENTERY: Right lower abdominal colostomy.BONES, SOFT TISSUES: Post operative changes in the anterior abdomen.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: Bladder is distorted due to postsurgical change in the pelvis.LYMPH NODES: Reference left external iliac lymph node measures 2.2 x 1.2 cm (image 120/series 4) previously, 2.1 x 1.1 cm.BOWEL, MESENTERY: Status post partial colectomy and right abdominal colostomy. Soft tissue nodularity persists in the expected location of the rectum.BONES, SOFT TISSUES: The left inguinal mass now has a large soft tissue defect. The mass component measures approximately approximately 4.7 x 4.3 cm (image 146/series 4) previously, 5.0 x 3.8. cm.Fracture deformity of the left femoral neck. Severe osteo- arthritis of the left hip. Stable sclerotic lesion in the left ilium. OTHER: No significant abnormality noted. | 1.Large soft tissue defect in the left inguinal region; further evaluation a contrast enhanced MRI is suggested.2.Severe left hydronephrosis likely due to a large soft tissue mass at the level of the left common iliac artery; further evaluation with a contrast-enhanced MRI of the pelvis is suggested .3.Soft tissue thickening and nodularity in the presacral space.4.Chronic displaced fracture deformity of the left femoral neck. |
Generate impression based on findings. | Male, 60 years old, history of brain tumor, headache, postop following ventriculostomy. Since the prior examination, a left temporal approach ventriculostomy catheter has been placed. The catheter courses transversely, crossing the left temporal horn, and terminating in the region of the interpeduncular cistern just posterior to the dorsum sella. A small amount of pneumocephalus is consistent with recent instrumentation.A right parietal approach ventriculostomy catheter is in grossly stable position traversing both frontal horns and terminating within the left frontal horn.Ventricular caliber has not significantly changed when compared to the recent examinations dated 10/15/13. There remains some hypoattenuation surrounding the right frontal horn, similar to prior exams.Redemonstrated is the patient's heterogeneous, lobular central tumor involving multiple ventricular compartments as well as the hypothalamus, corpus callosum and left medial temporal lobe. Allowing for differences in technique, there has been no substantial change when compared to the same the MRI, and again some tumor enlargement is seen when compared to the prior CT.No evidence of any large parenchymal hematoma or significant extra-axial fluid collection is seen. | 1. Status post placement of a new left temporal approach ventriculostomy catheter. Stable right parietal approach ventriculostomy catheter. The caliber of the ventricular system is not substantially changed when comparison is made to the other same day examinations.2. Re-demonstration of the patient's large multi-compartmental tumor, again stable relative to the same day exams and slightly larger when compared to the more remote study. |
Generate impression based on findings. | Lung cancer status post 2.5 months on Tarceva. CHEST:LUNGS AND PLEURA: Postradiation change on the left with ipsilateral mediastinal shift. Underlying mass slightly decreased in size, measuring 27 x 30 mm, previously 32 x 30 mm. Additional smaller lesions in the same lobe (3/44, 3/42) also decreased in size.Subcentimeter nodules left lower lobe decreased in size (4/52, 4/54). Previously seen nodule in the region of the lingula is not currently identified. Additional micronodules are unchanged.MEDIASTINUM AND HILA: Unchanged small left jugular lymph nodes. Unchanged mildly enlarged high left paratracheal lymph node (3/21).Index lower right paratracheal lymph node unchanged in size and has a benign-appearing fatty hilum, stable at 10-mm.Low left paratracheal (A-P window region) lymph node 7 mm, previously 11-mm (3/35).Cardiomegaly and enlargement of the central pulmonary vasculature unchanged.Smoothly marginated left interlobar lymphadenopathy (3/41) better seen on today's study, unchanged.CHEST WALL: Healed rib fractures. Degenerative changes of thoracic spine.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Mild wall thickening and discontinuous calcifications of the gallbladder wall suggestive of adenomyomatosis. Cystic lesion in the portal hilum present previously.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Numerous hypoattenuating cysts. Subcentimeter lesions are too small to accurately characterize, some of which do not have the density of simple cysts and are indeterminate in appearance.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.Focally dilated loop of small bowel in the left upper quadrant (3/85).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Slight decrease in measurements of left upper lobe mass and adjacent nodules. Decrease in size of low left paratracheal lymph node, other lymph nodes are unchanged. Focally dilated small bowel in the left upper quadrant of unclear clinical significance, correlate for symptoms. |
Generate impression based on findings. | Not tolerating tube feeds. It is J.P. out? Rule out leak. ABDOMEN:LUNG BASES: Increasing bilateral pleural effusions with overlying compressive-type atelectasis.LIVER, BILIARY TRACT: Fatty infiltration of the liver. Stable cholelithiasisSPLEEN: 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 upper quadrant drainage catheter described previously has been removed. Feeding jejunostomy terminates in the jejunum without evidence of leakage. BONES, SOFT TISSUES: Stable ventral abdominal woundOTHER: New 7.2 x 3.3 cm left upper quadrant fluid collection (image 50; series 3). There are additional smaller collections with small foci of air anteriorly and a smaller peri-splenic collection laterally and posteriorly.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Foley catheter decompresses the bladder.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | New left upper quadrant fluid collections as described. Clinical service (pager number 4428) notified of this finding at the time of dictation. Increasing bilateral pleural effusions with overlying compressive-type atelectasis. |
Generate impression based on findings. | Male 65 years old; Reason: Pt is a 65 y/o male with met prostate cancer, rising PSA, evaluate for progression History: prostate cancer, rising PSA CHEST:LUNGS AND PLEURA: No suspicious pulmonary lesions. The pleural spaces are clear.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. No mediastinal lymphadenopathy.CHEST WALL: Sclerotic expansile right rib lesion.There are postoperative changes in the thoracic spine with a vertebral body cage graft and left vertebral body screws and vertical members.OTHER: ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. Mild intrahepatic biliary ductal dilatation predominantly on the left, unchanged and of unclear etiology. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal gland nodule in the medial limb measures 2.1 x 1.7 cm (image 98/series 4) previously, 2.2 x 1.8 cm.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Mild calcific arteriosclerotic disease of aorta. No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Bladder wall is thickened.LYMPH NODES: Right external iliac lymph node measures 1.1 x 0.6 cm (image 152/series 4) previously, 1.3 x 0.7 cm.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Post operative changes in the right hip with 3 screw fixation of the femoral neckOTHER: No significant abnormality noted | 1.Slight decrease in the size of the reference pelvic lymph node. |
Generate impression based on findings. | Fall. Rule out intracranial hemorrhage. There is hyperattenuation in a gyriform configuration overlying the right frontal (series 5 images 21-23) and temporal lobes (image 17) representing subarachnoid hemorrhage. There is no intraventricular hemorrhage. There is no mass effect or hydrocephalus. The midline is intact. There is a soft tissue density consistent with a prominent right frontal scalp hematoma in the orbital/supraorbital region. There are no bony fractures.There is sulcal prominence diffusely in keeping with a degree of atrophic change. There is patchy periventricular and subcortical white matter hypodensity in keeping with chronic small vessel ischemic disease as well as more focal wedge-shaped area of encephalomalacia within the right parietal lobe (image 24) which is likely in keeping with a chronic more focal infarct which was not demonstrated in 2009.Orbits are unremarkable. There is a small amount of soft tissue thickening within the right maxillary sinus, remaining sinuses are unremarkable. | Subarachnoid blood associated with the right frontal and right temporal lobes which is most likely related to trauma given the history and associated right frontal scalp hematoma. No depressed skull fracture. |
Generate impression based on findings. | Malignant neoplasm of the thymus CHEST:LUNGS AND PLEURA: Stable postsurgical findings of the right upper lobe wedge resection without new suspicious abnormality. No effusions. Minimal scarring atelectasis scattered but greater in the upper lungs.MEDIASTINUM AND HILA: No lymphadenopathy. The superior mediastinal clips and thymoma resection changes are unchanged. Specifically the minimal focal soft tissue and probable scarring anterior to the descending aorta is unchanged in appearance.The cardiac and pericardium are within limits other than coronary and aortic calcifications. Moderate hiatal herniaCHEST WALL: Sternotomy fixationABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Old cystectomy clips. No discrete hypodensities previously observed, possibly secondary to phase of contrast and timingSPLEEN: No significant abnormality noted.ADRENAL GLANDS: Stable left adrenal nodule with peripheral calcification.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.Scattered benign appearing mesenteric lymph nodesBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No evidence of recurrent or metastatic disease superimposed upon postsurgical changes |
Generate impression based on findings. | Malignant epithelioid mesothelioma. LUNGS AND PLEURA: Left hemithorax nodular pleural thickening and volume loss consistent with provided history of mesothelioma. Trace fluid collection at the base. Left pleural catheter terminates in the left posterior costophrenic angle. Involvement of the visceral pleural surface noted by nodular thickening of the left major fissure.Reference measurements on the left will be as follows:Level of the top of the aortic arch (4/I7): 2 o'clock position 6-mm, 4 o'clock position 4 millimeter.Level of the mid aortic arch (4/30): 1 o'clock position 10 mm, 2 o'clock position 9-mm.Level of the main pulmonary artery (4/41): 1 o'clock position 8 mm, 7 o'clock position 7-mm.No conclusive contralateral pleural disease.Subpleural atelectasis on the left. No suspicious intraparenchymal nodules.MEDIASTINUM AND HILA: Mild diffuse bilateral mediastinal and hilar/intrapulmonary lymphadenopathy. A lower right paratracheal lymph node measures 13 mm short axis on series 4 image 38. Ascending aorta is heavily calcified with aortic valve and coronary artery calcifications noted. The patient appears to be status post CABG. Mild cardiomegaly. Calcified mitral annulus. Bilateral cardiophrenic lymph node enlargement. Mild pericardial thickening and nodularity, but no significant pericardial fluid.CHEST WALL: Left pleurex catheter enters the chest wall and eighth/ninth rib interspace. Small axillary and subpectoral lymph nodes on the left, abnormal in multiplicity.Left lateral chest wall soft tissue stranding and fluid, correlate with recent surgical history as this could be post procedural hematoma and scarring however is nonspecific without comparison to prior studies. This should be followed for resolution on subsequent examinations.Mildly enlarged low cervical lymph nodes on the left (4/6).Sternotomy wires are present. Degenerative changes of the lower thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. Hypoattenuating lesions in the liver are suggestive of cysts. Subcentimeter retroperitoneal lymph nodes are nonspecific. Numerous small soft tissue nodules which project overlying the left upper quadrant (4/77) are contained within the inferior extent of pericardial fat and are not intraperitoneal. The left hemidiaphragm is thickened, and there is loss of fat plane between the diaphragm and the lateral aspect of the spleen. | Left hemithorax pleural thickening consistent with provided history of mesothelioma. Diffuse bilateral mediastinal and hilar lymphadenopathy and numerous small lymph nodes in the left chest wall are suspicious for nodal metastases. Visceral pleural thickening is nodular, consistent with disease involvement. Pericardial thickening appears nodular in some areas which is suspicious for early pericardial involvement however is not conclusive. No specific evidence of intraperitoneal spread of disease. |
Generate impression based on findings. | Cancer, follow-up CHEST:LUNGS AND PLEURA: Minimal tree in bud left upper lobe changes suggesting mild aspiration or post inflammatory findings. No specific focal nodular air space abnormality. Minimal basilar atelectasis without effusions. Scattered calcified granuloma and moderate centrilobular emphysematous changes number unchanged.MEDIASTINUM AND HILA: Multiple scattered calcified subcarinal lymph nodes compatible with old granulomatous disease exposure. No suspicious lymphadenopathyThe cardiac and pericardium are significant for coronary calcifications unchanged.CHEST WALL: Interval left mastectomy with postsurgical changesABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Calcified granulomasADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Scattered renal cysts unchangedPANCREAS: Thrombosed splenic artery aneurysm unchanged. Pancreas otherwise unremarkableRETROPERITONEUM, LYMPH NODES: Descending aortic and branch calcificationsBOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Interval left breast mastectomy without findings to suggest pulmonary metastatic disease |
Generate impression based on findings. | Known metastatic disease involving skull. Left frontal headache. There are no acute intracranial abnormalities including hemorrhage, hydrocephalus or CT evidence of acute ischemia. There are focal bony lesions including a lytic lesion with intraorbital and intracranial soft tissue components centered at the left orbital roof (3.1 AP x 2.5 trans x 3.1 cm CC -- coronal series 80229 image 14). The intraorbital portion is stable, though the intracranial portion has slightly increased since the prior exam. The left-sided proptosis this lesion causes is slightly worse than on the prior exam. There is a dural-based lesion in the left anterior cranial fossa (1.3 x 1.5 cm -- axial series 9 image 29) which was less apparent on the prior motion degraded exam and likely has increased in size as well. A small lytic lesion of the right parietal bone (1.1 x 1.3 x 0.7 cm -- axial series 81316 image 31) is stable.There is patchy heterogeneity within bones of the skull and face, including at the occiput and right superior alveolar ridge which likely represents sequelae of metastatic disease. Lucency within the alveolar ridge is contiguous with soft tissue density in the right maxillary sinus likely representing tumor. There is also partial opacification of left ethmoid sinuses which likely represents tumor infiltration from the adjacent left orbital lesion. The right orbit is normal. There is no new intracranial mass, fluid collection, hemorrhage, hydrocephalus or CT evidence of acute ischemia. | Findings suggestive of multifocal metastatic disease of skull and facial bones including a left orbital roof lesion with intraorbital and intracranial components causing proptosis. |
Generate impression based on findings. | Male 69 years old; Reason: Please eval for metastasis History: Gleason 4+3=7 prostate cancer and PSA >20 ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver is normal in morphology. Nonspecific subcentimeter hypodensity in segment 6 of the liver (image 42/series 4)SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral renal cysts. No nephrolithiasis or hydronephrosis.RETROPERITONEUM, LYMPH NODES: Mild calcific arteriosclerotic disease of the aorta. No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy is evident.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small sclerotic lesions in the left ilium.OTHER: No significant abnormality noted. | 1.Small sclerotic left ilium lesions, can be further evaluated with a bone scan.2.Nonspecific subcentimeter hypodense right hepatic lobe lesion. |
Generate impression based on findings. | 83-year-old female left upper quadrant abdominal pain, abdominal distention, vaginal bleeding and change in stool. Evaluate for suprapubic mass or pelvic mass. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality noted -- incidentally noted are benign simple cysts.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Small benign left cortical cyst --. No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Rapid progression of orally administered contrast through normal-appearing stomach, small bowel, and colon. No evidence of obstruction. Diffuse colonic diverticulosis is seen without complication. No free mesenteric fluid and no other abnormality seen.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Status post hysterectomy. No evidence of mass in the pelvic region or adnexa.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Rapid progression of orally administered contrast through normal-appearing small bowel, and colon. No evidence of obstruction. Diffuse colonic diverticulosis is seen without complication. No free mesenteric fluid and no other abnormality seen.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. No findings seen to account for patient's symptomatology. 2. Diffuse diverticulosis without complication. 3. Status post hysterectomy and, specifically, no evidence of visible pelvic mass. |
Generate impression based on findings. | Lung cancer, compare to prior Motion heavily degrades sensitivityCHEST:LUNGS AND PLEURA: The right lower lobe previously described peribronchial vascular nodule remains unchanged measuring 8 mm (image 59 series 6) yet evaluation is severely limited due to motion mentioned. A calcified nodule of the right lower lobe is also unchanged remaining 1.6 x 1.7 cm (image 74 series 6).Centrilobular emphysema partially visualized and grossly unchanged. Mild central bronchiectasis at the level of the right hilum again is associated with architectural distortion and suspected radiation fibrotic changes. No effusions.MEDIASTINUM AND HILA: The reference pre-aortic lymph node remains 8 mm (image 45 series 5). Calcified subcarinal lymph nodes are also unchanged.Marked coronary calcifications. The cardiac and pericardium are otherwise unremarkable.Moderate hiatal hernia.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: Extensive vascular calcificationsBOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Moderate degenerative is largely involving the lower thoracic and upper lumbar spineOTHER: No significant abnormality noted. | Unchanged appearance with reference measurements provided. |
Generate impression based on findings. | Female, 26 years old, history of stage IVa alk+ anaplastic large cell lymphoma status post 6 cycles of CHOP, restaging scan. Scattered small lymph nodes are present on both sides of the neck, none meeting size criteria for pathologic enlargement and none showing significant interval change. A reference left level 2 lymph node measures 11 x 6 mm (image 30 series 6), previously 9 x 6 mm.The aerodigestive mucosa is within normal limits. The salivary glands are free of focal lesions. The thyroid is mildly heterogeneous similar to prior and a 3-mm hypodense nodule in the right lobe is unchanged. Cervical vessels are patent. No concerning bony lesions are detected. | Stable examination with no pathologic adenopathy in the neck. |
Generate impression based on findings. | Reason: lung cancer on chemotherpay check response History: cough CHEST:LUNGS AND PLEURA: Severe upper lobe predominant centrilobular paraseptal emphysema.Left lower lobe postsurgical changes with pleural thickening and effusion similar in appearance to the prior exam.Stable right upper and middle lobe micronodules (images 54, 16 in series 6) .No new suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of a pericardial effusion.CHEST WALL: Degenerative changes in the thoracic spine with fusion of L1-L2 vertebrae.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable right renal cyst.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic changes 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: Sclerosis within the L4 vertebrae unchanged.Severe degenerative changes and changes of degenerative disk disease.Partial fusion of L1 and L2.Interspinous fixation device noted at L3-4.OTHER: No significant abnormality noted. | 1.Post surgical changes in the left lower lobe with stable pleural thickening and fluid.2.No new suspicious pulmonary nodules or masses.3.No sites of disease identified. |
Generate impression based on findings. | 61-year-old male -- evaluate metastatic disease. CHEST:LUNGS AND PLEURA: Reference left lower lobe lung nodule measures 8 x 8 mm (series 4, image 29), unchanged from previous. The reference left upper lobe nodule (series 4, image 53) has increased in size to 8 x 8 mm, compared with 5-mm previously. In addition, new nodules are seen, in the right upper lobe (series 4, image 39). New bilateral pleural effusions are seen with bibasilar atelectasis. MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No change in left axillary small lymph node (series 3 Image 23) measuring 1.2 x 0.8 centimeter. Interval post surgical hardware for the thoracic spine is seen in the upper and mid thoracic vertebral bodies fixing the region of lytic lesion in the T6 vertebral body seen on 5/6/13 CT.New right paravertebral soft tissue mass at the T1/T2 level measuring 5.0 by 2.9-cm (series 3, image 9). This has adjacent bony destruction into the vertebral body and the posterior elements. This has markedly increased in size since prior exam where in retrospect a small lesion was present.ABDOMEN:LIVER, BILIARY TRACT: Stable appearance to liver. Following right hepatectomy -- remaining liver shows no evidence of mass occupying lesions and normal appearing portal and hepatic veins.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted to suggest abdominal musculoskeletal metastases.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality noted. No enlarged lymph nodes seen.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Right hip prosthesis, unchanged -- creates streak artifact across the pelvis. No lesion seen to suggest metastatic disease.OTHER: No significant abnormality noted | 1. Increasing size and number of pulmonary nodules, presumably metastases. 2. New right T1/T2 paravertebral soft tissue mass lesion with adjacent bony destruction. |
Generate impression based on findings. | Reason: 60 yr old male with h/o Hodgkin lymphoma; pre allo SCT evaluation History: Evaluate CHEST:LUNGS AND PLEURA: 6-mm pulmonary nodule in the right upper lobe (series 4, image 46), unchanged.Additional scattered pulmonary micronodules are not significantly changed.MEDIASTINUM AND HILA: Increasing subcarinal lymph node measures 2.5 x 1.5 cm (axial image 53).CHEST WALL: Left chest Port-A-Cath tip terminates in the SVC. Increasing right axillary lymph node measures 1.3 x 0.8 cm (axial image 33). Lytic focus in the posterior right third rib, unchanged.ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesions. Reference porta hepatis lymph node measures 1.3 x 1.1 cm (axial image 111), previously 1.6 x 1.4 cm.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Nonobstructive left renal calculus, unchanged.RETROPERITONEUM, LYMPH NODES: Decreasing retroperitoneal lymphadenopathy. Reference aortocaval lymph node measures 2.6 x 1.3 cm (axial image 116), previously 0.6 x 1.9 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Reference left external iliac lymph node measures 1.3 x 0.8 cm (axial image 175), previously 1.6 x 1.3 cm. Decreasing inguinal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Bowel containing right inguinal hernia.OTHER: No significant abnormality noted. | 1.Increasing lymphadenopathy in the mediastinum and right axilla. 2.Decreasing lymphadenopathy in the abdomen and pelvis. |
Generate impression based on findings. | Metastatic neuroblastoma presents with swelling of right and left orbits status post MIBG therapy. There is no significant change bilateral skull metastases with intracranial and right orbit soft tissue components. No new skull metastases are identified. There are no brain parenchymal metastases. There is preseptal soft tissue swelling of the right orbit with stranding in the periorbital fat has slightly diminished. There is no midline shift. The ventricles are stable in size and configuration. There is mild scattered paranasal sinus opacification. The mastoid air cells are clear. | 1.Stable bilateral skull metastases with intracranial and right orbit soft tissue components. 2.The mild right preseptal soft tissue swelling has slightly diminished. |
Generate impression based on findings. | 10 month old male. Intracranial malignancy CHEST:LUNGS AND PLEURA: Bilateral lower lobe dependent streaky opacities, likely representing atelectasis. MEDIASTINUM AND HILA: ETT tip is below the thoracic inlet and above the carina. No mediastinal or hilar lymphadenopathy.CHEST WALL: Bilateral subcentimeter axillary lymph nodes.ABDOMEN:LIVER, BILIARY TRACT: Normal appearance of the liver. No focal hepatic lesion. No biliary ductal dilatation. SPLEEN: Normal appearance of the spleen.PANCREAS: Normal appearance of the pancreas.ADRENAL GLANDS: Normal appearance of the adrenal glands.KIDNEYS, URETERS: Normal appearance of the kidneys. No focal renal lesion. RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Normal caliber of the bowel. NG tube tip terminates in the stomach.BONES, SOFT TISSUES: Normal appearance of the bones.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Normal appearance of the prostate. BLADDER: Markedly distended bladder.LYMPH NODES: No pelvic lymphadenopathy. BOWEL, MESENTERY: Normal caliber of the bowel. BONES, SOFT TISSUES: Normal appearance of the bones.OTHER: Trace free fluid. | 1. No evidence of metastasis in the chest, abdomen, or pelvis. 2. Dependent lower lobe opacities bilaterally, likely atelectasis. |
Generate impression based on findings. | Reason: Bladder cancer compare to last CT \T\ measure 1) LUL nodule \T\ 2) tail of pancreas mass History: post 2 cycles of therapy CHEST:LUNGS AND PLEURA: Interval increase in size and number of bilateral parenchymal nodules consistent with progressive metastatic disease. Reference nodule in the left upper lobe currently measures 1.2 x 0.7 cm previously measuring 0.9 x 0.5 cm (series 5, image 45).MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No focal suspicious liver lesions. No intrahepatic or extrahepatic ductal dilatation. Cholelithiasis without evidence of cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: A cystic lesion arising from the tail of the pancreas measuring 2.8 x 2.8 cm is relatively stable, previously measuring 2.8 x 2.4 cm (series 3, image 103).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Interval decrease in bilateral hydronephrosis. Duplicated collecting system on the left side which both ureters draining into ileal conduit. Right ureter drains into ileal conduit. Interval resolution of bilateral hydroureters.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: Right lower quadrant ileostomy with new intra-stomal hernia involving a loop of small bowel without evidence of obstruction. Ventral abdominal wall hernia containing loops of small bowel without evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Not visualized.BLADDER: Status post cystectomy.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is a slightly prominent soft tissue density along the left external iliac vessels, stable since the August 2013 study. This may be the left adnexa but clinical correlation would be helpful as metastatic disease cannot be excluded if patient has has had prior oopherectomy.OTHER: Small amount of pelvic ascites, stable compared to prior exam. | 1.Interval increase in size and number of bilateral lung nodules suspicious for metastatic disease.2.Interval resolution of the hydronephrosis and hydroureter.3.Relatively stable cystic lesion arising from the tail of the pancreas.4.Stable soft tissue density mass along the external iliac vessels may represent the left adnexa. Clinical correlation and follow up on future scans is advised as metastatic disease cannot be excluded if patient with prior hysterectomy has has prior oopherectomy. |
Generate impression based on findings. | Male; 65 years old. Reason: lung cancer s/p 20 cycles of chemo. please evaluate for disease and compare with previous scans CHEST:LUNGS AND PLEURA: Postoperative changes compatible with left upper lobectomy and right upper lobe wedge resection are again noted. Scattered pulmonary micronodules are unchanged. Right upper lobe ground glass nodule is unchanged in size and morphology and measures 16 x 15 mm (series 5, image 28). No new suspicious pulmonary lesions. MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. Severe atherosclerotic disease affects the aorta and coronary arteries. Enlarged pulmonary trunk diameter is compatible with pulmonary hypertension.Multiple enlarged mediastinal lymph nodes are again noted. Reference prevascular space node measures 15 mm and is unchanged (series 3, image 25). Calcified mediastinal and hilar lymph nodes are suggestive of prior granulomatous infection. CHEST WALL: Mild bilateral gynecomastia. ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Scattered hepatic granulomata. SPLEEN: Scattered splenic granulomata.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Unchanged left upper pole renal cyst. Duplicated right renal collecting system. 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: Mild multilevel degenerative changes of the visualized spine. OTHER: Severe atherosclerotic calcification of the abdominal aorta and its major branches. | 1.No evidence of metastatic disease with unchanged mediastinal lymphadenopathy.2.Unchanged appearance of right upper lobe ground glass nodule, which remains concerning for an indolent primary adenocarcinoma. Annual surveillance is suggested. |
Generate impression based on findings. | Reason: 52 y/o male with Myxofibrosarcoma of the chest wall, RT-induced; s/p resection and RT; assess for recurrence/mets History: surveillance scan LUNGS AND PLEURA: Minimal basilar atelectasis/scarring.Minimal left apical groundglass opacity similar in appearance to the prior exam and may represent radiation reaction.No suspicious 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: Postsurgical changes in the left supraclavicular region with partial resection of the left clavicle.No axillary lymphadenopathy.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Status post splenectomy with residual splenule. | No evidence of recurrent or metastatic disease. |
Generate impression based on findings. | Lung cancer resection, one year follow-up. LUNGS AND PLEURA: Numerous groundglass opacity nodules bilaterally, left greater than right. Reference right lower lobe lesion measures 11 x 6 mm, previously 10 x 7 mm, not conclusively changed allowing for scan variability. Postoperative changes consistent with wedge resections in the upper lobes bilaterally.Left lower lobe groundglass lesion which is associated with a thin-walled cyst not significantly changed compared to the most recent examination but appears slightly larger compared back to 12/29/10. The groundglass component measures 13 x 10 mm (5/47) compared to 9 x 8 mm in 2010. The cystic component is 18-mm in size compared to 14-mm previously and 2010 (5/50). Additional faint spherical ground glass lesion in the left lower lobe measures approximately 18 x 12 mm, difficult to visualize even in retrospect on the 2010 exam but around 12 x 12 mm in size (5/47), and increased in both size and density since that time. This lesion is unchanged compared to the most recent previous study.Right lower lobe pie-shaped mixed density nodule which appears mostly groundglass but has part solid components measures 13 x 14 mm (5/65), not appreciably changed since the most recent previous study. On the 2010 exam, this lesion was also barely visible, 10 x 6-mm.MEDIASTINUM AND HILA: Atherosclerotic calcification of the aorta and its branches. Main pulmonary artery is mildly enlarged, 3-cm. The native coronary arteries are severely calcified. Normal heart size. No pericardial fluid. No visible lymphadenopathy within the limitations of an unenhanced scan. Apparent focal narrowing of the distal aortic arch most consistent with pseudocoarctation.CHEST WALL: Left rib fracture deformity. Degenerative changes spine. Calcified lesion anterior to the left subscapularis muscle may arise from the left shoulder joint space, suspicious for a loose body.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Atherosclerotic calcifications of the aorta and its branches. Cholecystectomy clips. | 1. Reference right lower lobe lesion not significantly changed allowing for differences in scan variability and remain suspicious for an indolent adenocarcinoma.2. Left lower lobe lesion associated with the cyst not significantly changed compared to recent previous however is increased in size compared to 2010, suspicious for adenocarcinoma in situ (AIS) or minimally invasive adenocarcinoma (MIA).3. Second left lower lobe groundglass nodule has increased in both size and density compared to 2010, compatible with an indolent AIS or MIA.4. Right lower lobe part solid lesion increased in size and density compared to 2010, also consistent with indolent adenocarcinoma. Internal of solid density could reflect minimally invasive or invasive component.5. Additional groundglass lesions are less than one cm in size and but likely reflect additional areas of atypical adenomatous hyperplasia or adenocarcinoma in situ. Continued annual CT monitoring recommended. |
Generate impression based on findings. | Bilateral moderate sensorineural hearing loss. On the right, there is minimal soft tissue attenuation material within the external auditory canal, which may represent cerumen. The middle ear and mastoid air cells are well-pneumatized and clear. The ossicular chain is intact. The facial nerve describes a normal course. The inner ear structures are unremarkable without evidence of cochlear dysplasia, vestibular aqueduct enlargement, or cochlear fossette stenosis.On the left, there is minimal soft tissue attenuation material within the external auditory canal, which may represent cerumen. There is opacification of the obturator foramen of the stapes, round window niche, sinus tympani, facial nerve recess, and hypotympanum. The ossicular chain is otherwise intact. The mastoid air cells are well-pneumatized and clear. The inner ear structures are unremarkable without evidence of cochlear dysplasia, vestibular aqueduct enlargement, or cochlear fossette stenosis. There is moderate scattered paranasal sinus opacification. | 1. Nonspecific opacification within portions of the left middle ear without associated bony erosions may represent otitis media in the appropriate clinical setting. 2. The inner ear structures are unremarkable. However, temporal MRI may be useful for further evaluation.3. Moderate scattered paranasal sinus opacification. |
Generate impression based on findings. | Reason: Lul nodule recheck History: sob LUNGS AND PLEURA: Severe centrilobular emphysema.Left upper lobe nodular scar like opacity (image 21 series 7) has decreased in size since the prior exam. No new suspicious pulmonary nodules or masses.No pleural effusions.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of a pericardial effusion.Moderate coronary artery calcification.Small hiatal hernia.CHEST WALL: Partial collapse of the T5 vertebrae new from the prior exam. Diffuse degenerative changes in the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.Left upper lobe nodular and scarlike opacity decreased in size compared to the prior exam.2.Severe emphysema. |
Generate impression based on findings. | Reason: metastatic breast cancer History: metastatic breast cancer CHEST:LUNGS AND PLEURA: Near interval resolution of anterior right upper and middle lobe reticular opacities. Basilar atelectasis.MEDIASTINUM AND HILA: No lymphadenopathy. Heart size is normal without pericardial effusion. Central catheter tip terminates at the cavoatrial junction.CHEST WALL: Status post right mastectomy. Small fluid collection along the lateral aspect of the surgical bed measures 1.5 x 1.3 cm (axial image 41), previously 2.3 x 1.7 cm.ABDOMEN:LIVER, BILIARY TRACT: Increasing right hepatic lobe lesions. Reference segment VI lesion measures 1.7 x 1.6 cm (axial image 89), previously 1.5 x 1.1 cm.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multiple sclerotic lesions throughout the thoracolumbar spine and sacrum, most pronounced in the T8-T9 vertebral bodies, demonstrate increased sclerosis from the prior exam but are unchanged in distribution.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Increasing hepatic metastases.2. Sclerotic osseous metastases are unchanged in distribution. |
Generate impression based on findings. | Reason: 82 y/o M with mesothelioma needs baseline staging. History: pain ABDOMEN:LUNG BASES: See separately dictated CT chest.LIVER, BILIARY TRACT: Multiple benign cysts. Few scattered hypodensities are too small to further characterize, but likely benign. Gallstones.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Large cystic mass arising from the inferior pole of the left kidney demonstrates thick walls and peripheral calcifications as well as internal gas, suspicious for infected cystic renal neoplasm. The mass measures 7.7 x 7.5 cm (series 7, image 77). There are mesenteric inflammatory changes about the mass. While renal abscess can have similar appearance, the presence of calcifications within the thick wall implies a longer time frame process with calcifications not commonly seen, unlike neoplasm.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Near fluid attenuation mass in the right lower quadrant measures 10.9 x 2.6 cm (series 7, image 91) suspicious for a peritoneal implant. There is thickening of the lateral conal fascia bilaterally.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: Air in the bladder is of indeterminate etiology.LYMPH NODES: Small pelvic lymph nodes.BOWEL, MESENTERY: No additional significant findings other than described in abdomen, above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Left inferior pole mass suspicious for infected cystic renal neoplasm. Recommend correlation with prior imaging, particularly if from 12 months or greater in past to help clarify characterization.2.Right lower quadrant near fluid attenuation mass suspicious for peritoneal implant.Findings discussed with Dr. Kindler by telephone at 3:00 pm on 10/16/2013. |
Generate impression based on findings. | Neuroendocrine tumor of the lung status post chemo and RT to lung and pancreas. CHEST:LUNGS AND PLEURA: Left lower lobe nodule measures 19 x 13 mm (7/67), previously 18 x 9 mm; this may be pleural or intraparenchymal. Bilateral pleural nodules present previously given the benefit of retrospect, slightly larger on today's exam but unchanged in number, now compatible with metastases. Two soft tissue density nodules abutting the right mediastinum likely arise from the pleura and cause slight mass effect upon the superior vena cava (5/40, 5/48), largest lesion is 13-mm compared to 9-mm previously (5/40). Intraparenchymal non-index left upper lobe nodule (7/42) contained within the area of radiation fibrosis has in retrospect increased in size over the past two studies 15-mm compared to 7 and 4 mm previously.Enlarging left lower lobe segmental level nodal metastasis (7/50). Paramediastinal radiation fibrosis.MEDIASTINUM AND HILA: Left cardiophrenic angle lymph node stable at 17-mm in short axis (5/83).Loculated fluid collections in the anterior pericardial fat again noted, the larger lesion has an internal or adjacent solid component (5/61). Normal heart size. Small pericardial fluid collection with mild anterior pericardial thickening.Mild bilateral hilar lymphadenopathy may be slightly increased on the right.Infiltrating soft tissue in the left paratracheal space surrounding the origins of the great vessels unchanged over the last 2 scans.CHEST WALL: Right port catheter appears to be in a small collateral vein. The tip determinates at its juncture with the left brachiocephalic vein which is narrowed and partially opacified. Small filling defects in the proximal left jugular vein (5/19-20). Small low cervical lymph nodes on the left are unchanged. Right chest port. Sternal fixation wires. Left 12th rib fracture is chronic, with osseous nonunion.Subtle foci of sclerosis in the thoracic spine and right seventh rib and reflect treated metastases. Nodular cortical thickening along the cranial aspect of the sternal body (coronal image 62) unchanged given the benefit of retrospect.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Hypoattenuating poorly defined lesions in the liver, unchanged in size and number. Largest lesion at the dome was previously described as a hemangioma on MRI of 8/3/12.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophy of the inferomedial aspect of the left kidney presumably secondary to previous infarct. Subcentimeter lesions too small to accurately characterize.PANCREAS: Index pancreatic body lesion measures 2.5 x 2.5 cm, increased from prior examination where it measured 1.5 x 1 .Scam (5/99). There are several additional intrapancreatic hypoattenuating nodules in the body and tail which are larger.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: Subtle lesion in the right pedicle of T1 is unchanged. There is questionable slight sclerosis within the posterior aspect of the vertebral body at that level.OTHER: No significant abnormality noted. | 1. Pleural metastases bilaterally increased in size.2. Index left costophrenic angle nodule measures slightly larger.3. Non-index left upper lobe nodule increased in size. 4. Next left cardiophrenic angle lymph node stable. Nonindex hilar lymphadenopathy on the right appears slightly increased.4. Residual chronic thrombus in the proximal left jugular vein.5. Subtle areas of skeletal sclerosis are consistent with indolent metastatic disease, probably unchanged.6. Multiple pancreatic metastases with increase in size of the dominant pancreatic body lesion. |
Generate impression based on findings. | 60 year-old metastatic thyroid cancer on therapy. Head: There is no significant interval change in the enhancing lesion that measures 7 x 4 mm in the right Heschl's gyrus. No new intracranial metastases are identified. The ventricles are stable in size and configuration. The skull and orbits are unremarkable. The mastoid air cells and paranasal sinuses are clear. Neck: There are postoperative findings related to right total thyroidectomy. There is no significant interval change in the necrotic mass anterior to the left sternocleidomastoid, which measures 15 x 21 mm, previously 15 x 21 mm. There is perhaps slight interval increase in size of a homogeneously enhancing nodule within the left supraclavicular subcutaneous tissues, which now measures 11 x 8 mm, previously 10 x 7 mm. The previously described nodular appearance of the party wall is less prominent suggesting physiological tissue redundancy likely related to peristalsis. Otherwise, there is no evidence of new mass lesions or cervical adenopathy. The nasopharynx, oral cavity, oropharynx, hypopharynx, larynx, and trachea are unremarkable. There is an unchanged calcification within the right submandibular gland. The major cervical flow voids are intact, including a retropharyngeal left internal carotid artery. There is multilevel degenerative spondylosis without evidence of lytic or blastic lesions. Refer to the concurrent separate chest CT report for additional details. | 1.No significant interval change in the enhancing lesion that measures 7 x 4 mm in the right Heschl's gyrus. No new intracranial metastases are identified.2.Unchanged necrotic metastasis anterior to the left sternocleidomastoid, which measures 15 x 21 mm. 3.Perhaps slight interval increase in size of a homogeneously enhancing nodule within the left supraclavicular subcutaneous tissues, which now measures 11 x 8 mm, previously 10 x 7 mm. |
Generate impression based on findings. | Malignant neoplasm of the kidney. Check for metastatic disease LUNGS AND PLEURA: Mild left basilar atelectasis and/or scarring with an associated small subcentimeter nodular density unchanged since 2/19/13 (image 71 series 4). Mild centrilobular emphysema without additional focal air space abnormality. No effusions.MEDIASTINUM AND HILA: Mild anterior soft tissue compatible with residual or recurrent thymus, unchanged. No lymphadenopathy.The cardiac and pericardium other than moderate coronary calcifications remains unremarkableCHEST WALL: Minimal gynecomastia, unchangedUPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Pancreatic fullness in the mid body grossly unchanged from 8/20/13, please correlate with dedicated pending abdominal imaging. No additional subdiaphragmatic abnormalities observed on this limited upper abdominal evaluation are | No pulmonary metastatic disease identified |
Generate impression based on findings. | Tongue cancer, check for metastatic disease LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No lymphadenopathy.The cardiac and pericardium are unremarkableSmall hiatal herniaCHEST WALL: Mild gynecomastiaUPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Mild gynecomastia without additional intrapulmonary abnormality. |
Generate impression based on findings. | Reason: evaluate for proximal jejunal submucosal lesion vs extrinsic compression vs vascular lesion History: melena, lesions seen on capsule endoscopy ABDOMEN:LUNG BASES: Bilateral pleural effusions, right greater than left with overlying atelectasis.LIVER, BILIARY TRACT: Multiple punctate calcifications throughout both lobes of the liver compatible with granulomata. Status post cholecystectomy. Mild biliary ductal dilatation is likely normal given post cholecystectomy status. Multiple focal areas of hyperattenuation on arterial phase with no visible washout on portal venous phase. Largest area is in hepatic segment 5 with no visible washout on portal venous phase (series 8, image 28).SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple subcentimeter hypodense nonenhancing lesions in the right kidney and left kidney likely represent benign renal cysts. Vascular calcification of the renal arteries bilaterally.RETROPERITONEUM, LYMPH NODES: Mild to moderate atherosclerotic calcification of the aorta and bilateral common iliac arteries.BOWEL, MESENTERY: Diverticula of the ascending colon without evidence of diverticulitis.BONES, SOFT TISSUES: Vacuum disk phenomenon at the L4-L5 and L5-S1 disk spaces.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Not visualized.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Vacuum disk phenomenon at the L4-L5 and L5-S1 disk spaces.OTHER: No significant abnormality noted | 1.No evidence mass or lesion to explain the patient's symptomatology. CT is not sensitive to resolve mucosal lesions.2.Right colonic diverticula without evidence of diverticulitis.3.Multiple small hyper enhancing lesions in the liver are nonspecific. |
Generate impression based on findings. | Lung nodule, follow-up CHEST:LUNGS AND PLEURA: Interval slow but continuous increase in the part solid ground glass nodular opacity anterior to the left major fissure in the right upper lobe (image 18 series 5 close parentheses. Although difficult to measure, currently this focus measures approximate 2.2 by 1.1 cm and similar to the 8/30/13 scan, an increased increased density by 5/20/13 is observed. No new suspicious satellite or additional nodules in either lung. No effusions.The previously described 6-mm subpleural pulmonary nodule (image 25 series 5) remains unchanged in the colon along with the calcified right apical pulmonary nodule compatible with old granulomatous disease. Small focal scar like change in the right middle lobe also unchanged.MEDIASTINUM AND HILA: The reference pre-carinal lymph node remains 9 mm in short axis (image 32 series 3). No new additional lymph nodes or lymphadenopathy.The cardiac and pericardium are within limits other than extensive severe coronary calcifications.Small hiatal herniaSubcentimeter nodule in the inferior pole the left thyroid lobeCHEST WALL: Left breast surgery with retained strict surgical clips and calcifications unchanged. Midline sternotomy wiring. The paragraph severe degenerative changes with relative preservation of vertebral body heights and alignmentABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Nonspecific focal hypodensity likely representing a small cyst posteriorlyADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Suspected left renal cyst unchangedPANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Para-aortic lymph node remains 1.6 cm (image 101 series 3)BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Dense and degenerative changes as previously describedOTHER: No significant abnormality noted. | Continued interval increasing part solid ground glass nodular opacity showing slow interval increased size in the left upper lobe adjacent to the major fissure. Concern for primary malignancy remains high such, such as indolent invasive primary adenocarcinoma |
Generate impression based on findings. | Reason: PO contrast ONLY. s/p OLT with drop in hgb to 6, recurrent pleural effusion History: as above Lack of intravenous contrast limits evaluation of the mediastinum, lymph nodes, and solid organ pathology.CHEST:LUNGS AND PLEURA: Moderate right pleural effusion with overlying compressive atelectasis increased from the prior exam. MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Gynecomastia.ABDOMEN:LIVER, BILIARY TRACT: Status post liver transplant multiple surgical clips within the hepatic hilum. Calcification within the portal vein.SPLEEN: Splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Transplant kidney in the right iliac fossa with nephroureteral stent in place. No hydronephrosis. Complex collection surrounding the transplant kidney has markedly decreased in size from the prior examination. No evidence of acute hemorrhage. Multiple foci of gas within the collection are suspicious for superimposed infection. Percutaneous drain terminates in the right hemipelvis in the lateral aspect of the collection.Endstage native kidneys. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Body wall anasarca.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: Cemented right hip arthroplasty, unchanged.OTHER: No significant abnormality noted. | 1.Decreasing pelvic hematoma surrounding the transplant kidney with new foci of gas concerning for superimposed infection. No evidence of acute hemorrhage. |
Generate impression based on findings. | 79-year-old male with prostate cancer, metastatic disease and new renal insufficiency. Evaluate for progression. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral hydronephrosis is seen. New since prior examination and with dilated ureters. The right ureter is seen. Dilated extending to the level of the bladder and right external iliac adenopathy which may be obstructing the ureter. The left ureters seen dilated also up to the level of external adenopathy and not visualized more distally and may be obstructed by tumor there. Lack of IV contrast limits ability to see the ureters optimally. RETROPERITONEUM, LYMPH NODES: Diffusely enlarged retroperitoneal, periaortic lymph nodes are again seen. These have subjectively slightly increased in size, although the lack of IV contrast makes differentiation of size measurements difficult, due to adjacent vessels unopacified. The prior reference lymph node posterior to the inferior vena cava (series 3 counter 62) now measures 4.4 cm x 2.4 cm, compared with previous 4.3 x 1.9 cm. Other periaortic lymph nodes have similarly slightly increased in size. Largest increased in size size of lymph nodes are seen in the right retrocrural, para-aortic region (series 3, image 18). An enlarged lymph node now measures and previously 1.9 x 1.8 cm .BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Increasing size of diffuse pelvic lymphadenopathy is seen. Reference lymph node right external iliac chain (series 3Com image 101) does not show significant change, measuring 3.5 x 4.2 cm compared with previous 4.3 x 3.3 cm. However, other lymph nodes do show increasing size, for example, left external iliac (series 3, image 101) measures 1.5 x 1 .5 cm, previously 1.2 x 1.1 cm.. Exact measurement of many of the lymph nodes are not possible due to unopacified adjacent abutting vessels.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Increasing abdominal and pelvic lymphadenopathy with reference measurements as measured above. 2. No bilateral hydronephrosis -- dilated ureters are seen down to the level of. Pelvic adenopathy and may be tumor obstructing -- lack of IV contrast limits optimal visualization of the ureters. |
Generate impression based on findings. | Female; 45 years old. Reason: is there a pe History: hemoptysis, elevated d dimer PULMONARY ARTERIES: No evidence of pulmonary embolism. LUNGS AND PLEURA: Small clustered tree-in-bud like opacities in the left upper lobe likely reflect prior aspiration/infection. No focal consolidation or pleural effusion. MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. Mildly enlarged prevascular space lymph node is likely reactive, but there is otherwise no mediastinal or hilar lymphadenopathy.CHEST WALL: Moderate multilevel degenerative disease in the visualized spine. No significant axillary lymphadenopathy. UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. Bilateral extrarenal pelvises. Punctate nonobstructive left renal calculus. | 1.No evidence of pulmonary embolism.2.Small clustered tree-in-bud like opacities in the left upper lobe likely reflect prior aspiration/infection. No areas of focal consolidation. |
Generate impression based on findings. | Pleural effusions. Failing extubation attempts. LUNGS AND PLEURA: Right lower lobe atelectasis due to a large right pleural fluid collection. Significant motion artifact is present; collapse of the airways this cannot be excluded without expiratory phase scanning and is suspected.Consolidation and atelectasis in the left lower lobe extending from the superior segment to the lung base and a disproportionate to the volume of pleural fluid on the left which is small, suspicious for underlying pathologyModerate centrilobular emphysema. No pneumothorax. No visible pulmonary AVMs in the aerated portion of the lungs on the MIP sequence.MEDIASTINUM AND HILA: Large goiter with tracheal narrowing above the level of the thoracic inlet to within 2-mm of the endotracheal tube diameter (12-mm transverse with the tube in place). The underlying thyroid gland is nodular and heterogeneous in appearance; nonspecific by CT, underlying thyroid pathology cannot be assessed by this modality.Duplication of the superior vena cava. Right jugular catheter tip terminates at the SVC/RA junction. Moderate cardiomegaly. Large circumferential pericardial fluid collection. Punctate foci of air are identified within the right ventricle which could be iatrogenic if the patient had a recent IV access.The main pulmonary artery is significantly enlarged, measuring 4cm in transverse dimension, compatible with pulmonary arterial hypertension.CHEST WALL: Diffuse subcutaneous edema. Large mass arising from the right fourth posterior rib. The underlying rib has expansile sclerotic and permeative components. The large soft tissue component causes compressive atelectasis of the adjacent lung, proximally 4.3 x 7.1 cm in size (3/22), and unchanged from most recent previous study and not significantly changed from 2009. Right fourth neural foramen may be occluded by the mass. Focal lesion with a rim of irregular sclerosis is present in the sternal body on the left (3/21) unchanged from 10/2/13 but new from 2009. Numerous additional skeletal lesions are seen. One expansile lesion in the left 10th rib may have cortical breakthrough suspicious for pathologic fracture. Severe compression fracture of T8 to is chronic, compression fractures of T6 and T3 are unchanged compared to the recent previous study. Superior endplate depression in T10 and T12 also noted and unchanged. Myelomatous lesions are seen at nearly all vertebral levels to varying extents. Rib lesions are seen on the right in the 9th, 10th and 11th ribs. A healing left 2nd rib fracture is noted. Myelomatous lesions are seen in the left 3rd, 4th, 8th, 9th, 11th and 12th ribs.Right paraspinal mass measuring 3.4 x 2 cm arising from T8 laterally with cortical erosion consistent with multiple myeloma. Assessment for smaller lesions is limited by unenhanced technique.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. Large volume of ascites. Feeding tube extends to the stomach but the tip is off the caudal margin of the scan. | 1. Low cervical trachea is incompletely assessed but appears to be collapsed around the endotracheal tube. Tracheomalacia or other airway pathology cannot be excluded.2. Limited assessment of airway patency due to single phase scanning and significant motion artifact however appearance is suspicious for collapse of the airways during respiration which would indicate bronchomalacia.3. Left lower lobe consolidation suspicious for pneumonia. Serial chest radiograph follow-up recommended to assess resolution.4. Persistent large right pleural fluid collection with compressive atelectasis of the right lower lobe. Consider hepatic hydrothorax.5. Pulmonary arterial hypertension.6. Large pericardial fluid collection. Punctate air foci in the right ventricle may be iatrogenic and are unlikely to be clinically significant unless the patient has a known septal defect.7. Large volume of abdominal ascites and diffuse subcutaneous edema, correlate for liver pathology/hypoalbuminemia.. |
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