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Generate impression based on findings. | Persistent headache for 6 weeks after head trauma. 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. | Female 64 years old; Reason: diverticular disease with ?fistulas History: abd pain ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No suspicious hepatic lesions. Liver contour is smooth . No intra-or extrahepatic ductal dilatation following cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mild scarring at the upper pole of the left kidney. Simple right renal cyst. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mild gaseous distention of the jejunal bowel loops. There are scattered sigmoid colonic diverticula without inflammation.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: Colonic diverticulosis without active inflammation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Colonic diverticulosis. |
Generate impression based on findings. | Sensorineural hearing loss, left worse than right. On the right, there is a focus of relatively low attenuation in the region of the fissula ante fenestram that extends to the posterior aspect of the apical turn of the cochlea. There is another focus of relatively low attenuation adjacent to the anterior aspect of the basal turn of the cochlea. There is no cochlear fossette stenosis or semicircular canal dehiscence. The middle ear and mastoid air cells are well-pneumatized. There is minimal opacification of the mastoid air cells. The middle ear cavity is clear. The ossicular chain is intact. The facial nerve describes a normal course. The external auditory canal is patent and clear.On the left, there are extensive low attenuation areas that extend from the region of the fissula ante fenestram to the apical turn of the cochlea and along the basal turn of the cochlea. There is no cochlear fossette stenosis or semicircular canal dehiscence. 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 external auditory canal is patent and clear.There are prominent arachnoid granulations in the occipital bone. | Bilateral fenestral and cochlear otospongiosis, left worse than right. |
Generate impression based on findings. | Reason: r/o abscess History: MRSA+ cellulitis, now RLQ abd pain ABDOMEN:LUNG BASES: Basilar atelectasis.LIVER, BILIARY TRACT: Nonspecific right hepatic lobe lesions, likely hemangiomas.SPLEEN: Accessory splenule.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of obstruction. No pneumoperitoneum or mesenteric free fluid.BONES, SOFT TISSUES: Poorly loculated phlegmon in the right anterior abdominal wall musculature measures 7.1 x 2.5 cm (series 4, image 90) with surrounding subcutaneous inflammatory change and overlying skin thickening. Associated foci of gas are compatible with infection.Healing left rib fracture is incompletely evaluated.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. | Phlegmonous anterior abdominal wall collection.Findings text paged to Dr. Poston at 4:50 pm on 10/16/2013. |
Generate impression based on findings. | Lower extremity hyperreflexia. Rule out stenosis, disk disease. The cervical lordosis is maintained. The vertebral body heights are preserved. There is intervertebral disk height loss at C5-6 and C6-7. No fractures are identified. There is no lymphadenopathy or prevertebral soft tissue swelling.Additional findings by level:C2-3: There is no disc bulge or significant degenerative change.C3-4: There is a small central protrusion without significant canal stenosis. There is no significant degenerative change or neural foraminal stenosis.C4-5: There is a disc-osteophyte complex which includes a small central protrusion that effaces the anterior CSF space without significant impressing on the cord. There are bilateral degenerative changes at the facets and uncovertebral joints, more so on the left and then right, which result in a mild left neural foraminal stenosis without significant right neural foraminal stenosis.C5-6: There is a small central disc-osteophyte complex and bilateral degenerative facet and uncovertebral joint arthropathy including a subchondral cyst at the right C5 endplate. This results in bilateral mild neural foraminal stenosis.C6-7: There is a central disc protrusion and anterior/posterior osteophytes with bilateral degenerative facet and uncovertebral joint arthropathy including a subchondral cyst at the left C6 endplate. There is mild bilateral neural foraminal stenosis.C7-T1: There is fusion of the left facet joint. There are no significant posterior disc-osteophyte complex or spinal canal or neural foraminal stenosis. | Mild multilevel degenerative spondylosis, most pronounced at the C4-5 and C5-6 levels, but no significant spinal canal stenosis. |
Generate impression based on findings. | Female; 59 years old. Reason: evaluate for cause of SOB and History: SOB and chronic cough LUNGS AND PLEURA: Several scattered small lung nodules/micronodules are nonspecific but appear unchanged since the prior study. Mild bronchial wall thickening but no focal consolidation or pleural effusion. No new suspicious lesions are identified. MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. No mediastinal or hilar lymphadenopathy. Moderate coronary artery calcifications. Common trunk of brachiocephalic and left common carotid arteries is a normal variant. Heterogeneous thyroid gland is unchanged.CHEST WALL: Left rib deformities are again noted and likely secondary to prior trauma.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Cholecystectomy clips. Extrarenal right pelvis is unchanged. | No acute cardiopulmonary abnormality identified. Several scattered small lung nodules/micronodules are nonspecific but unchanged. |
Generate impression based on findings. | Reason: eval for appendicitis, RLQ pain History: as above, ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Mild splenomegaly. PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right kidney with a focal segment of hypoattenuating parenchyma extending to the capsule with haziness of the underlying parenchyma. No evidence of perinephric fat stranding often seen with acute inflammation.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Focal the appendix is not visualized, the surrounding fat and opacified bowel is normal in appearance without evidence of acute inflammation to suggest acute appendicitis. There is no evidence of fluid collections in the peritoneum.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Anteverted uterus with normal appearance. There is a left-sided cystic lesion with peripheral enhancement adjacent to the iliac vessels consistent with a functional cyst in a premenopausal patient. No adjacent fat stranding to suggest inflammation. A normal appearing right adnexa.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: There is a cystic lesion in the right labia majora measuring 2.0 x 1.5 cm possibly representing a nabothian cyst.OTHER: No significant abnormality noted | 1.Although the appendix is not visualized, there is no evidence to suggest acute appendicitis.2.Left-sided corpus luteum cyst.3.Right nabothian cyst.4.Right kidney with a focal area of poor perfusion extending up to the capsule with haziness along the parenchyma. These findings are nonspecific and may be old scarring, but could suggest pyelonephritis or vascular phenomenon either chronic or or acute. |
Generate impression based on findings. | Conductive hearing loss, h/o tympanostomy tubes. On the right, the mastoid air cells are not significantly pneumatized beyond the aditus ad antrum, which is partially opacified. The middle ear is also underpneumatized. The tympanic membrane is thickened and retracted. The ossicles are dysmorphic. In particular, the head of malleus and incus body appear to be smaller than normal with apparent mild widening of the incudomalleal joint space. The scutum appears to be sharp. The facial nerve describes a normal course. The inner ear structures are unremarkable. On the left, the mastoid air cells are not significantly pneumatized beyond the aditus ad antrum. The middle ear is also underpneumatized and nearly completely opacified. The long process of the incus and stapes crura are not conspicuous against the background opacification. However, the ossicular chain otherwise appear to be intact. The scutum appear to be sharp. The facial nerve describes a normal course. The inner ear structures are unremarkable. | Stigmata of bilateral chronic otomastoiditis with markedly underpneumatized middle ears and mastoid air cells and left greater than right tympanomastoid opacification, but no definite evidence of cholesteatoma. |
Generate impression based on findings. | Clinical question: Rule out bleed. Signs and symptoms: Headache Nonenhanced head CT: No detectable acute intracranial process. CT however is insensitive for detection of acute nonhemorrhagic ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system and CSF spaces.Prominence of cerebellar and vermian folia for patient stated age of 54. Correlate with history and risk factors.Unremarkable calvarium, orbits and mastoid air cells.Evidence of acute right maxillary sinusitis and unremarkable other paranasal sinuses. | 1.No acute intracranial process.2.Acute right maxillary sinusitis and unremarkable other paranasal sinuses. |
Generate impression based on findings. | Clinical question: Rule out hemorrhage. Signs and symptoms: Altered mental status. Nonenhanced head CT: Streak artifact obscure portions of the exam and makes detection of subtle findings difficult. Within this limitation however examination demonstrate moderate degree of periventricular and subcortical low attenuation of white matter with resultant ex vacuo dilation of the lateral ventricles. Findings are believed to represent age indeterminate small vessel ischemic strokes. Findings remains grossly similar to prior exam from 2011. CT is insensitive for detection of acute intracranial process. No evidence of hemorrhage, mass effect, midline shift or hydrocephalus. | 1.No detectable acute intracranial process.2.Extensive age indeterminate small vessel ischemic strokes, mild ex vacuo dilatation of supratentorial ventricular system without gross interval change since prior exam. |
Generate impression based on findings. | Clinical question: CVA. Signs and symptoms: Left facial droop. Nonenhanced head CT:There is no detectable acute intracranial process CT however is insensitive for detection of acute non-hemorrhagic ischemic strokes.Examination demonstrate diffuse periventricular and subcortical low attenuation of white matter believed to represent age indeterminate small vessel ischemic strokes. There is no gross interval change of this finding since prior exam from June of 2013.Unremarkable calvarium and soft tissues of the scalp.Unremarkable orbits, paranasal sinuses and mastoid air cells. | Extensive age indeterminate small vessel ischemic strokes. |
Generate impression based on findings. | Clinical question: Evaluate for intracranial pathology. Signs and symptoms: Altered mental status. Nonenhanced head CT:There is no detectable acute intracranial process CT however is insensitive for detection of acute nonhemorrhagic ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation.Unremarkable calvarium and soft tissues of the scalp.Unremarkable images through the orbits.Unremarkable bilateral mastoid air cells, middle ear cavities and the paranasal sinuses with the exception of a retention cyst in the right maxillary sinus. | No acute intracranial findings. |
Generate impression based on findings. | Clinical question: Evaluate for altered mental status. Signs and symptoms: Hypoxia. Nonenhanced head CT:There is no detectable acute intracranial process. CT however is insensitive for detection of acute nonhemorrhagic ischemic strokes.Cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation is unremarkable.Calvarium and soft tissues of the scalp are unremarkable.Limited images through the orbits, paranasal sinuses and mastoid air cells are unremarkable. | Negative nonenhanced head CT. |
Generate impression based on findings. | Clinical question: Status post trauma. Signs and symptoms: 33-year-old with headache after head trauma. Nonenhanced head CT:No detectable acute posttraumatic intracranial, calvarial or soft tissues of the scalp findings.The cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation remains within normal.Calvarium and soft tissues of the scalp are unremarkable.All visualized mastoid air cells and paranasal sinuses are well pneumatized. Limited images through the orbits are unremarkable. | Negative nonenhanced head CT. |
Generate impression based on findings. | Clinical question: Rule out hemorrhage. Signs and symptoms: History of fall, increasing headaches. Nonenhanced head CT:No detectable acute intracranial process. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation.Unremarkable calvarium and soft tissues of the scalp.Unremarkable orbits, paranasal sinuses and mastoid air cells. | Negative nonenhanced head CT. |
Generate impression based on findings. | Clinical question: CVA. Signs and symptoms: CVA Nonenhanced head CT:No detectable acute intracranial process CT however is insensitive for detection of acute nonhemorrhagic ischemic stroke.Examination demonstrates a focus of encephalomalacia in the left occipital and medial aspect of posterior left temporal lobe consistent with a chronic ischemic stroke in the distribution of left PCA. This finding remains is stable since prior head CT from 2012.Moderate periventricular and subcortical low attenuation white matter is consistent with age indeterminate small muscle ischemic strokes. This finding remains grossly similar to prior exam.Calvarium and soft tissues of the scalp are unremarkable.Paranasal sinuses, mastoid air cells and middle ear cavities are well pneumatized.Orbits are unremarkable. | 1.No acute intracranial process.2.Age indeterminate small vessel ischemic stroke and chronic left PCA cortical stroke grossly similar to prior exam. |
Generate impression based on findings. | Male 56 years old Reason: evaluate for pulmonary embolus History: hypoxia, respiratory distress PULMONARY ARTERIES: No evidence of pulmonary embolism or right heart strain. Technically adequate study.LUNGS AND PLEURA: Bibasilar atelectasis and bronchial wall thickening with associated left basilar predominant mild bronchiectasis, occasional tree in bud opacities and dependent left lower lobe focal consolidation compatible with aspiration and superimposed aspiration pneumonia.Nonspecific predominately peripheral reticular interstitial opacities appear unchanged, and could represent pulmonary toxicity from prior chemotherapy.Left upper lobe micronodule significantly decreased in size since 7/27/2012, likely post infectious/post inflammatory in etiology.MEDIASTINUM AND HILA: Endotracheal tube terminates 6 cm above the carina, enteric feeding tube with tip in the body of the stomach.No significant mediastinal or hilar lymphadenopathy.CHEST WALL: Mild/moderate body wall edema.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Diffuse bowel wall thickening and enhancement, perihepatic/perisplenic ascites, and biliary sludge. Please refer to CT abdomen and pelvis from the same day for further evaluation. | 1. No evidence of pulmonary emboli.2. Findings compatible with atelectasis, aspiration and suggestion of superimposed aspiration pneumonia.3. Persistent interstitial opacities possibly related to toxicity from prior chemotherapy.4. Findings compatible with colitis/enteritis, refer to CT abdomen from the same day for further evaluation. |
Generate impression based on findings. | 52 year old female with left breast cancer status post mastectomy, radiation therapy, now on AI. Left axillary adenopathy, suspicious on FNA. CHEST:LUNGS AND PLEURA: Postradiation changes along the anterior lungs bilaterally. Ill-defined 6-mm nodular opacity with surrounding ground glass in the left upper lobe (series 5, image 16), which is nonspecific. While this may represent postradiation changes, malignancy cannot be excluded. Scattered calcified and noncalcified micronodules, similar to the prior exam. MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Normal sized heart without pericardial effusion.CHEST WALL: Postsurgical changes of bilateral mastectomies. Soft tissue thickening and edema at the left chest wall is presumably secondary to radiation treatment. Surgical clips in the left axilla. No axillary lymphadenopathy is seen. Subcentimeter nonspecific right thyroid lobe nodule. ABDOMEN: LIVER, BILIARY TRACT: Unchanged scattered hypodense hepatic lesions, likely benign. No new suspicious lesions are seen.Cholelithiasis, without evidence of cholecystitis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted. No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted. No suspicious lytic or sclerotic lesions seen.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality noted. No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes at the sacroiliac joints. No suspicious lytic or sclerotic lesions are seen. | 1. Ill-defined 6-mm nodular opacity in the left upper lobe, which is nonspecific. This may represent postradiation changes, however, continued follow up is recommended.2. Post-treatment changes at the left breast and left axilla, without lymphadenopathy seen. |
Generate impression based on findings. | Female 20 years old Reason: persistent tachycardia post operatively History: tachycardia Technically adequate study.PULMONARY ARTERIES: Central filling defect in a left basilar segmental pulmonary artery (image 122, series 9) compatible with acute pulmonary embolism. No evidence of right heart strain.LUNGS AND PLEURA: Small wedge-shaped subpleural area of consolidation which appears to be fed by the infarcted pulmonary artery, and is compatible with pulmonary infarction.Basilar atelectasis with superimposed consolidation in the right lower lobe suggestive of aspiration, but superimposed infection cannot be excluded.MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. Normal heart size and no pericardial effusion. CHEST WALL: Left PICC line with the tip terminating in the mid-SVC.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Pneumoperitoneum presumably postoperative. Mildly distended stomach. See CT abdomen and pelvis from the same day for further evaluation. | 1. Pulmonary embolism in a left basilar subsegmental artery and probable small subpleural pulmonary infarction in the distribution of this vessel.2. Bibasilar atelectasis with superimposed consolidation in the right lower lobe suggestive of aspiration but superimposed infection cannot be excluded.3. Postoperative pneumoperitoneum, see CT abdomen and pelvis from the same day for further evaluation. |
Generate impression based on findings. | Reason: r/o abscess History: fevers and chills s/p abd reconstruction on 10/1 with RLQ JP drain in place ABDOMEN: LUNG BASES: Bilateral scarring/atelectasis of bilateral lung bases.LIVER, BILIARY TRACT: A hypodense subcentimeter lesion in hepatic segment 8 is too small to further characterize. Another small subcentimeter hypodense lesion in hepatic segment 5 likely represents a benign hepatic cyst.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Small scattered periaortic lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is evidence of abdominal surgery. There is soft tissue fat stranding and edema of the subcutaneous tissue overlying the anterior abdominal wall. There is a drain coursing superiorly in the subcutaneous tissue of the anterior abdominal wall. There is a large, thin loculated fluid collection with an enhancing rim draping over the anterior abdominal wall with the fluid component measuring only 4mm in thickness. There are adjacent small enhancing phlegmons and loculated fluid collections both in the subcutaneous fat and within the rectus abdominous muscle. These fluid collections appear too small to percutaneously drain.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Sclerotic foci in the right sacral ala and left iliac bone. Chronic appearing, marked anterior spondylolisthesis of the L5 vertebral body with a pars interarticularis defect.OTHER: No significant abnormality noted | Large, thin loculated fluid collection with an enhancing rim draping over the anterior abdominal wall is suspicious for infection. There are adjacent small enhancing phlegmons and loculated fluid collections with enhancing walls both in the subcutaneous fat and in the underlying rectus muscle. |
Generate impression based on findings. | 54-year-old male with melena and syncope. ABDOMEN:LUNG BASES: bibasilar atelectasis or scarring.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Benign cortical cysts in right kidney -- no significant abnormality seen in the kidneys.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Orally administered contrast rapidly traverses normal-appearing stomach, small bowel, and colon. No evidence of obstruction is seen. No intrinsic bowel wall abnormality is seen. No mesenteric masses or mesenteric fluid identified. Metallic foreign body in the rectum, most likely capsule device.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: Orally administered contrast rapidly traverses normal-appearing small bowel, and colon. No evidence of obstruction is seen. No intrinsic bowel wall abnormality is seen. No mesenteric masses or mesenteric fluid identified. Metallic foreign body in the rectum, most likely capsule device.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. No diagnostic abnormality seen in the abdomen or pelvis. |
Generate impression based on findings. | Neoplastic workup. Fever of unknown origin. Blood dyscrasias. CHEST:LUNGS AND PLEURA: Mild-to-moderate pulmonary edema. Moderate right and small left pleural effusions with overlying compressive atelectasis. No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Enlarged mediastinal and hilar lymph nodes. Precarinal lymph node measures 1.9 cm in short axis (series 3, image 39). Cardiomegaly with moderate-sized pericardial effusion. Mild coronary artery calcifications.CHEST WALL: Mild diffuse soft tissue edema. Subcentimeter axillary lymph nodes.ABDOMEN: LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted. No mesenteric or retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Nondistended loops of bowel, without associated wall thickening, mesenteric stranding, or fluid collections.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality noted. No pelvic lymphadenopathy.BOWEL, MESENTERY: Nondistended loops of bowel, without associated wall thickening, mesenteric stranding, or fluid collections.BONES, SOFT TISSUES: No significant abnormality noted | 1. Mild to moderate pulmonary edema with bilateral pleural effusions and moderate-sized pericardial effusion.2. Few enlarged thoracic lymph nodes, which are of uncertain clinical significance. These may be reactive or secondary to edema.3. No acute intra-abdominal process evident. 4. No specific CT findings to account for the patient's fever. |
Generate impression based on findings. | Cervicalgia. There is mild reversal of the normal cervical lordosis without evidence of spondylolisthesis, which may be positional or related to muscle spasm. The vertebral body heights are preserved. There is no evidence of cervical spine fractures. The imaged portions of the skull base and craniocervical junction are intact. There are enlarged transverse processes at C7 with rudimentary ribs bilaterally, right greater than left. The prevertebral soft tissues are unremarkable. | 1. No evidence of cervical spine fractures or spondylolisthesis.2. Enlarged C7 transverse processes with rudimentary ribs bilaterally, right greater than left. |
Generate impression based on findings. | 45-year-old male in motor vehicle collision 24 hours ago, now with an episode of rectal bleeding and left lower quadrant abdominal pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Homogeneous liver parenchyma without evidence of trauma.Occupying lesions. Patient status post cholecystectomy. No intrahepatic or extrahepatic biliary duct dilatation seen. Hepatic vasculature appears normal.SPLEEN: Normal appearing without evidence of traumatic abnormality.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Orally administered contrast traverses through normal appearing stomach and small bowel. Distal small bowel, and colon are not opacify with oral contrast, but appear normal. No free fluid collections are seen in the mesentery.BONES, SOFT TISSUES: Bilateral anterior low abdominal wall subcutaneous fat edema/induration with thickening of the overlying skin was compatible with subcutaneous contusion. Changes are limited to the subcutaneous fat and do not demonstrate any focal fluid collections.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Orally administered contrast traverses through normal appearing small bowel. Distal small bowel, and colon are not opacify with oral contrast, but appear normal. No free fluid collections are seen in the mesentery.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Anterior abdominal wall subcutaneous indurations, most likely from seatbelt injury. No intra-abdominal organ injury or evidence of traumatic abnormality. |
Generate impression based on findings. | Female; 21 years old. Reason: r/o PE; better characterize b/l lower lobe opacities (infection vs acute chest vs old infarction vs atalectasis vs other) History: Sickle cell crisis; h/o acute chest. Coagulopathic with multiple known DVTs. PULMONARY ARTERIES: No evidence of pulmonary embolism.LUNGS AND PLEURA: Although the pulmonary artery feeding a peripheral wedge-shaped opacity in the right lower lobe appears patent, this finding may represent a recent pulmonary infarct. Subsegmental atelectasis is also a differential consideration. Basilar subsegmental atelectasis/scarring, but no pleural effusion worse than on the prior exam.MEDIASTINUM AND HILA: Mild stable cardiomegaly without pericardial effusion. Mildly enlarged subcarinal and hilar lymph nodes.CHEST WALL: Mild axillary lymphadenopathy. Right central venous catheter tip in SVC.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Unchanged left renal cyst. Multiple hyperdense foci in the spleen are also again noted and presumably benign. | 1.No evidence of acute pulmonary embolism.2.Peripheral wedge-shaped opacity in the right lower lobe, for which differential considerations include subsegmental atelectasis and pulmonary infarct. |
Generate impression based on findings. | 72-year-old female with tachypnea, tachycardia, and sepsis. Within the limits of a non-IV contrast enhanced examination which limits evaluation of vascular structures and solid parenchymal organs, the following observations can be made:CHEST:LUNGS AND PLEURA: Marked elevation of the left hemidiaphragm again seen as evidenced on recent chest radiographs. Small left pleural effusion and bibasal infiltrates which most likely represent atelectasis although superimposed aspiration or infection cannot be differentiated.MEDIASTINUM AND HILA: Atherosclerotic vascular calcification seen diffusely. No mediastinal masses or abnormal fluid collection seen. Endotracheal tube in expected position.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Morphology of the liver shows a substantial atrophy. The right lobe of the liver with left lobe. Prominence and widening of intrahepatic fissures -- this suggests chronic liver disease. Parenchyma is homogeneous, but without IV contrast, mass lesions cannot be assessed. Gallbladder shows no diagnostic abnormalities and no intrahepatic or extrahepatic biliary duct dilatation is seen to suggest biliary tract abnormality.SPLEEN: Absent. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple diffuse water density lesions seen throughout both kidneys, consistent with benign cysts, however, lack of IV contrast limits ability to definitively characterize these lesions. No other abnormalities are seen. No evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Slightly dilated proximal small bowel are compared with more distal small bowel, but without definite transition point and may well relate more to physiologic progression of orally administered contrast material distending bowel, rather than a partial small bowel obstruction. Small bowel shows no other abnormalities. Colon is redundant and feces filled and does show extensive descending and sigmoid colon diverticulosis without complication. No mesenteric fluid. BONES, SOFT TISSUES: Degenerative changes in thoracic/lumbar spine without focal abnormality. Lower lumbar spine degenerative disease does narrow the spinal canal (series 3, image 128). OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No uterus, visualized -- there is extensive artifact from bilateral hip prostheses, which may obscure a small uterus, at this level. No other abnormalities.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Pelvic small bowel shows no intrinsic abnormalities. Colon is redundant and feces filled and does show extensive descending and sigmoid colon diverticulosis without complication. No mesenteric fluid.BONES, SOFT TISSUES: Bilateral hip prostheses -- these create extensive streak artifacts across pelvis, obscuring details. At these levels.OTHER: No significant abnormality noted. | 1. Marked elevation left hemidiaphragm. 2. Bibasilar lung infiltrates most likely relating to atelectasis but superimposed airspace disease cannot be excluded. 3. Slight disproportion dilatation proximal small bowel compared with mid and distal -- this may be physiologic. See above. 4. No evidence for source of sepsis identified. |
Generate impression based on findings. | Neck pain following MVC. There is normal alignment of the cervical spinal column without evidence of spondylolisthesis. The vertebral body heights are preserved. There is no evidence of cervical spine fractures. There is a small anterior disc-osteophyte complex at C5-6 with associated vacuum disc phenomenon. There does not appear to be any significant spinal canal stenosis. There is a small well-corticated ossific body superior to the dens, which may represent an os terminale. Otherwise, the imaged portions of the skull base and craniocervical junction are intact. The temporomandibular joints are intact. The paranasal sinuses are clear. The prevertebral soft tissues are unremarkable. | No evidence of cervical spine fractures or spondylolisthesis. |
Generate impression based on findings. | 52 year-old female with incidental right renal mass. Evaluate for metastases. CHEST:LUNGS AND PLEURA: Dependent subsegmental atelectasis. Scattered small pulmonary cysts, likely representing mild centrilobular and paraseptal emphysema. No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Normal size heart without pericardial effusion. CHEST WALL: 1.7-cm lobulated mass in the right lateral breast. Subcentimeter axillary lymph nodes.ABDOMEN: LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: 1.9 x 1.8 cm lesion in the lower pole of the right kidney, corresponding to the solid mass seen on the prior CT. This lesion is hypoattenuating compared to the renal parenchyma, though measures higher than simple fluid attenuation. PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted. No retroperitoneal or mesenteric lymphadenopathy.BOWEL, MESENTERY: No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Large globular uterus, likely representing fibroids.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Multiple subcentimeter scattered sclerotic lesions throughout the iliac bones, which appear benign in etiology. Degenerative changes are present at the left hip with peripheral femoral head lucencies suspicious for avascular necrosis. | 1. 1.9 cm indeterminate right renal mass, without evidence of metastases. This study was performed as a screening study for metastases. If further characterization of this lesion is clinically warranted, a dedicated renal protocol CT or MRI may be helpful.2. 1.7-cm lobulated mass in the right lateral breast. Correlation with mammography or prior biopsy results is recommended.3. Peripheral left femoral head lucencies suspicious for avascular necrosis. |
Generate impression based on findings. | Head trauma. Head: There is a left frontal and periorbital subcutaneous hematoma, which measures up to 14 mm in thickness. There is no evidence of acute 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 mastoid air cells are clear. There is no evidence of calvarial fracture. Maxillofacial: There is no evidence of orbital fracture or retrobulbar hematoma and the globes appear to be intact. There is complete opacification of the right maxillary sinus with extension into the middle meatus via a secondary ostium. There are obstructed secretions with the anterior right ethmoid air cells and frontoethmoid recess. There is no associated aggressive osseous erosion. There are also small left maxillary sinus retention cysts. The dentition and temporal mandibular joints are intact. There is no evidence of maxillofacial fracture. | 1. Left frontal and periorbital subcutaneous hematoma, which measures up to 14 mm in thickness. No evidence of orbital fracture or retrobulbar hematoma. 2. No evidence of acute intracranial hemorrhage, calvarial fracture, mass, or cerebral edema.3. Right antromeatal polyp with associated osteomeatal complex obstruction. |
Generate impression based on findings. | 59 year old male. Reason: chest pain - evaluate for atherosclerosis History: chest pain Height: 72 in Weight: 165 lbs BSA: 1.96 m^2BMI: 22.4 kg/m^2Calcium Score:LM: 0LAD: 184LCx: 26.5RCA: 117Total: 327, This represents the 84% for this patients age and gender.Cardiac Morphology:Left Ventricle:EDV: 150 ml The left ventricle is normal in size, shape, wall thickness, and volume. Right Ventricle:EDV: 159 ml The right ventricle is normal in size, shape, wall thickness, and volume. Left Atrium: The left atrial volume minus the pulmonary veins is 115 cc, within normal limits. There are four distinct pulmonary veins which drain normally into the left atrium.Right Atrium: The right atrial volume is within normal limits. The right atrium is structurally normal. Cardiac Veins: The coronary sinus is normal.Cardiac Valves: There are no aortic calcifications. There is no mitral annular calcification.Great Vessels: Aorta: The aortic arch is left sided. The brachiocephalic vessels branch normally from the arch. Visualized portions of the aorta demonstrate no evidence of dissection or aneurysm. Largest dimensions of the thoracic aorta are as follows:Sinuses of Valsalva: 35 mm Ascending: 27.5 mm Sinotubular Junction: 26 mm Descending: 22 mmPulmonary Artery: Main PA: 25 mmRight PA: 20 mmLeft PA: 18 mmVena Cavae: The SVC is normal in size and without structural abnormality. The IVC is normal in size and without structural abnormality.Pericardium: The pericardium is normal in thickness. There is no pericardial effusion.Coronary Artery Anatomy:LM: The left main coronary artery arises normally from the left sinus of valsalva and bifurcates into the left anterior descending and left circumflex coronary arteries. There is no significant plaque in the left main.LAD: The LAD gives rise to the diagonal and septal branches. There is multifocal dense calcification in the LAD with 4 separate sites and one is associated with a 50% stenosis. There are focal calcifications in the D2 and D3 branches without associated stenoses. LCx: The left circumflex artery gives rise to the obtuse marginal branches. There is one focus of dense calcification in the 2nd obtuse marginal branch with associated stenosis, estimated at 50%.RCA: The RCA arises normally from the right sinus of valsalva. It is the dominant coronary artery giving rise to the posterior descending artery and a posterolateral branch. There is one focus of calcification in the mid-RCA without associated stenosis. There are two foci of calcification with minimal stenosis in the distal posterolateral branch. EXTRACARDIAC CHEST | Total Calcium score was 324; 84% for age and gender.Diffuse multifocal coronary artery calcifications in the RCA, LCx and LAD. Normal ventricular volume and morphology. |
Generate impression based on findings. | Female 71 years old; Reason: preop planning; need entire glenoid History: pain. CT of the left shoulder demonstrates a minimally displaced posterior superior fracture of the osseous glenoid. The fracture fragment measures 2.7 x 0.7 mm. There is some sclerosis around the fracture line indicating a subacute nature of the fracture. The humerus and remaining bones of the shoulder, including clavicle and visible ribs, are without fracture. The humerus is high riding, leaving an acromiohumeral interval of only 6 mm. There is mild supraspinatus muscle atrophy. Again seen is severe osteoarthritis of the left shoulder with osteophyte formation, subchondral sclerosis and multiple subchondral cysts along the medial humeral head. Degenerative changes are also noted of the acromioclavicular joint. | Posterior superior glenoid fracture with mild displacement and severe osteoarthritis of the shoulder. |
Generate impression based on findings. | Reason: eval for intra-abd infection History: altered mental status ABDOMEN: LUNG BASES: Inferior lobe airspace consolidation/atelectasis of bilateral lung bases.LIVER, BILIARY TRACT: No evidence of cholelithiasis. No suspicious focal liver lesions. No intrahepatic or extrahepatic biliary ductal dilatation. Small amount of fluid around the liver. Periportal edema is again demonstrated.SPLEEN: Small amount of fluid around the spleen.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: NG tube tip within the gastric body. No evidence of obstruction. There is fluid tracking along the paracolic gutters bilaterally. Diffuse bowel wall thickening and mucosal enhancement involving the small bowel and colon is again demonstrated. Edema of the colon has decreased compared to prior exam. Edema of the small bowel remains grossly unchanged. No loculated fluid collections.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Foley catheter balloon noted in the bladder. Small amount of air within the bladder is presumably secondary to Foley catheter manipulation.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality noted BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of dependent pelvic fluid. | 1.Mild to moderate amount of abdominal/pelvic fluid, stable compared to prior exam. No loculated fluid collections.2.Diffuse mucosal enhancement and edema of the small bowel and portions of the colonic walls indicative of ileitis and colitis. Interval improvement of colonic wall edema. Small bowel findings remain stable compared to prior exam. |
Generate impression based on findings. | Female; 26 years old. Reason: evaluate for PE History: Hx of PE, now with chest pain. PULMONARY ARTERIES: Nondiagnostic study due to lack of intravenous access. Mild subsegmental atelectasis or scarring is present. | Nondiagnostic study due to lack of intravenous access. |
Generate impression based on findings. | Fall off bike, nausea. Head: There is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. Cervical Spine: There is normal alignment of the cervical spinal column without evidence of spondylolisthesis. The vertebral body heights are preserved. There is no evidence of cervical spine fractures. There does not appear to be any significant spinal canal stenosis. The skull base and craniocervical junction are intact. The temporomandibular joints are intact. The paranasal sinuses are clear. The prevertebral soft tissues are unremarkable. | 1. No evidence of intracranial hemorrhage, mass, or cerebral edema.2. No evidence of cervical spine fracture or spondylolisthesis. |
Generate impression based on findings. | Male; 24 years old. Reason: Better characterize progression of pulmonary fibrosis, r/o pneumonia History: Fevers, SOB LUNGS AND PLEURA: Combined emphysematous and fibrotic changes are again noted and appear to have progressed in the left lung. No superimposed areas of consolidation or pleural effusions are noted. Subpleural reticular opacities, traction bronchiectasis, architectural distortion, and honeycombing are present in a predominantly basal and peripheral distribution. Scattered ground glass opacities are also present, predominantly concentrated in the lower lobes. Large emphysematous bullae are again noted in the right apex, with scattered smaller bullae in an upper lobe predominant paraseptal distribution.MEDIASTINUM AND HILA: Mildly enlarged mediastinal lymph nodes are again noted and not significantly changed. Normal heart size without pericardial effusion. Mildly enlarged pulmonary trunk diameter is suggestive of pulmonary arterial hypertension.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Findings compatible with combined pulmonary fibrosis and emphysema (CPFE) which have progressed in the left lung since the prior CT. No evidence of superimposed acute abnormality. |
Generate impression based on findings. | Reason: persistent post op tachycardia s/p fistula takedown, SBR, cecal resection, lysis of adhesions History: tachycardia ABDOMEN:LUNG BASES: Mild air space consolidation/atelectasis in bilateral lung bases.LIVER, BILIARY TRACT: No suspicious focal liver lesions. No evidence of cholelithiasis. No evidence of intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Oral contrast is passed through to the rectum but bowel and colon are incompletely distended making delineation of disease difficult. There is redemonstration diffuse thickening of the sigmoid colon. Postoperative changes to the cecum. Mildly dilated loops of terminal ileum preceding the operative site may be expected.BONES, SOFT TISSUES: Small foci of air within the soft tissue of the anterior abdominal wall, presumably postoperative. Mild fat stranding of the soft tissue in the anterior abdominal wall without drainable fluid collections.OTHER: Free air in the abdomen is presumably secondary to postoperative status.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Air in the bladder presumably secondary to Foley catheter manipulation.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Loculated and free appearing fluid collections in the lower abdomen/pelvis. While CT cannot characterize fluid, there are no associated signs of infection with these collections, and in light of recent surgery are often encountered with similar appearance as post operative changes. | 1.Previous segment of sigmoid colon with wall thickening is against demonstrated. Incomplete distention of the portions of the colon make delineation of disease difficult.2.Postoperative changes to the cecum with mild, expected distention of preceding small bowel.3.Loculated fluid collections in the lower abdomen/pelvis may be normal in the postoperative state. No definite signs of infection. |
Generate impression based on findings. | Patient status post thrombectomy for basilar artery distribution 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 visualized portions of the paranasal sinuses demonstrates a minor mucosal thickening. 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. | 47-year-old female with abdominal pain and vomiting. Evaluate for obstruction. ABDOMEN:LUNG BASES: Bibasilar subsegmental atelectasis/scarring.LIVER, BILIARY TRACT: Innumerable scattered metastatic lesions throughout the liver, which have increased in size and number compared to the prior study. For reference, a segment 8 lesion measures 2.2 x 2.0 cm (series 3, image 22), previously 1.4 x 1.4 cm. There is no intrahepatic or extrahepatic biliary ductal dilatation. The portal vein is patent. 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: The previously seen submucosal edema of the gastric antrum appears increased in extent, now extending proximally to the gastric body and distally into the duodenum. This remains a nonspecific finding and may represent a drug reaction, or infectious/inflammatory process. Otherwise nondistended loops of bowel without wall thickening, pneumatosis, or pneumoperitoneum. There is a moderate amount of stool throughout the colon, decreased compared to the prior exam.BONES, SOFT TISSUES: Innumberable sclerotic and lytic lesions throughout the axial skeleton, compatible with widespread metastases. Unchanged T11 compression fracture.OTHER: There is a small amount of ascites throughout the abdomen and pelvis.PELVIS:UTERUS, ADNEXA: Leiomyomatous uterus. The largest of these, measuring 6.8 cm and with peripheral calcification, appears similar to the prior exam.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Nondistended loops of bowel without wall thickening, pneumatosis, or pneumoperitoneum.BONES, SOFT TISSUES: Innumerable sclerotic and lytic lesions throughout the pelvic bones, compatible with widespread metastases. Bilateral intramedullary rod and screw fixations of the femurs.OTHER: Left lower abdominal quadrant intrathecal infusion pump. | 1. Widespread metastatic disease, with worsening disease in the liver.2. Increased non-specific gastric wall thickening. This may represent a drug reaction, infectious, or inflammatory process. 3. Moderate stool burden throughout the colon, without evidence of bowel obstruction. |
Generate impression based on findings. | Clinical question: Rule out intracranial mass. Signs and symptoms: Intermittent blurry vision bilaterally, nausea and frontal headache. Nonenhanced head CT:No detectable acute intracranial process. CT is insensitive for detection of acute nonhemorrhagic ischemic strokes.There is a focus of subtle increased density along the medial aspect of right cerebellum inferiorly with suggestion of very subtle mass effect on the lateral recess of the fourth ventricle. Although the finding could represent an artifact follow-up with a dedicated brain MRI is recommended to exclude possibility of a small mass at this site.The 4th ventricle however is within normal size and no evidence of supratentorial ventriculomegaly. The cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation remains otherwise within normal for patient's stated age.Calvarium and soft tissues of the scalp are unremarkable.All paranasal sinuses are visualized and unremarkable with the exception of a small retention cyst in the left maxillary sinus and a single right posterior ethmoid opacification.Bilateral mastoid air cells and middle ear cavities remain well pneumatized.Finding and concern on this exam were discussed by phone with emergency physician Dr. Larry Mo # 3267 at the time of review of exam at 9:36 AM | 1.Subtle focus of parenchymal increased density along the medial/inferior aspect of the right cerebellum with suggestion of subtle mass effect on the fourth ventricle. Recommend follow-up with MRI to exclude a mass.2.Unremarkable nonenhanced head CT otherwise. |
Generate impression based on findings. | RUE pain and numbness. There is no evidence of intracranial hemorrhage, mass, or cerebral edema. There is mild patchy cerebral white matter hypoattenuation, which is likely related to microangiopathy. There are unchanged bilateral basal ganglia calcifications. 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. Non-contrast CT is not sensitive for detection of acute non-hemorrhagic infarction. Brain MRI may be considered for further evaluation if the patient does not have any contraindications and if clinically warranted. |
Generate impression based on findings. | Reason: evaluate lung disease, asthma History: sob LUNGS AND PLEURA: No pulmonary or pleural abnormalities identified.No significant air trapping or evidence of interstitial disease.MEDIASTINUM AND HILA: Mild enlargement of the thyroid gland with hypodensities in both lobes similar in appearance to the prior exam.No hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of a pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | No pleural or pulmonary abnormalities identified. No evidence of interstitial lung disease. |
Generate impression based on findings. | Colon carcinoma CHEST:LUNGS AND PLEURA: Interval increase in size of many of the previously noted numerous bilateral pulmonary metastatic nodules. The reference right upper lobe nodule best seen on image 27 of series 6, now measures 1.1 x 1 cm; this is in comparison to 0.6 x 0.7 cm on 8/14/2013.MEDIASTINUM AND HILA: Stable reference cardiophrenic lymph node best seen on image 60 of series 4 measuring 1.6 x 1.1 cm.CHEST WALL: Stable gynecomastiaABDOMEN:LIVER, BILIARY TRACT: Interval increase in size of the previously noted bilobar metastatic lesions. The reference confluent right lobe lesion best seen on image 79 of series 4, measures 12.9 x 13.9 cm; this is in comparison to 11.9 x 10.5 cm on 8/14/2013.Stable cholelithiasis. Hepatic vessels remain patent. No ductal dilatation.SPLEEN: Stable splenomegalyPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No change in intraluminal IVC thrombus. Stable aortocaval reference lymph node best seen on image 132 of series 4 measuring 1.5 x 0.9 cm.BOWEL, MESENTERY: Trace ascites. No significant change in subtle peritoneal nodularity.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: Trace ascitesBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Interval increase in size of many of the numerous bilateral pulmonary metastatic nodules as well as interval increase in size of bilobar hepatic metastatic lesions. |
Generate impression based on findings. | Renal carcinoma status post partial nephrectomy CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Stable reference right hilar lymph node best seen on image 47, series 3, measuring 1.3 x 0.7 cm.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Stable hepatic dome hemangiomaSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post partial left nephrectomy.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No change in left posterior lateral incisional hernia with small colonic bowel loops within the hernia sac without bowel wall edema or bowel obstruction.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Stable examination without acute, inflammatory, or metastatic process. |
Generate impression based on findings. | Urothelial carcinoma with ileal conduit ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Fatty infiltration of the liver again noted.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable minimal bilateral hydronephrosisRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Uterus absent.BLADDER: Status post cystectomy. Unremarkable ileal conduit.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No evidence for recurrent or metastatic focus. Stable minimal bilateral hydronephrosis. Fatty infiltration of the liver again noted. |
Generate impression based on findings. | Female; 58 years old. Reason: eval for PE History: tachycardia. PULMONARY ARTERIES: No evidence of acute pulmonary embolism. LUNGS AND PLEURA: Bibasilar airspace opacities are compatible with focal atelectasis/consolidation. The distribution and extent of atelectasis is suggestive of aspiration. No pleural effusion or pneumothorax. MEDIASTINUM AND HILA: Mild cardiomegaly without pericardial effusion. No mediastinal or hilar lymphadenopathy. Mild coronary artery calcifications. Eccentric, disconnected foci of air are seen in the distal esophagus, not significantly changed since the prior CT. In the absence of dysphagia, this finding may represent a somewhat patulous and collapsed esophagus. CHEST WALL: No significant axillary lymphadenopathy. UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Postsurgical changes compatible with liver wedge resection. Multiple liver lesions discussed on prior abdominal CT are not well evaluated on this study. | 1.No evidence of acute pulmonary embolism. 2.Basilar airspace opacities are compatible with aspiration and atelectasis. |
Generate impression based on findings. | Male; 59 years old. Reason: r/o PE for SOB. PULMONARY ARTERIES: Multiple small acute pulmonary emboli are noted in the distal lobar/proximal segmental arteries of the right lower, left upper, and left lower lobes. Upper normal main pulmonary trunk diameter. LUNGS AND PLEURA: Severe upper lobe predominant chronic interstitial disease again noted, with associated focal areas of atelectasis/consolidation, traction bronchiectasis, and architectural distortion. These findings are not significantly changed. New ground glass opacity in the right lower lobe may represent developing hemorrhage/infarct (series 11, image 100); other areas of mild reticular and ground glass opacity are not significantly changed. No pleural effusions or evidence of superimposed infection. Chronic left basilar pleural thickening is unchanged. MEDIASTINUM AND HILA: Multiple calcified mediastinal and hilar lymph nodes are compatible with sarcoidosis. Extensive coronary artery calcifications. Normal heart size without pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Calcified lymph nodes and scattered vascular calcifications are unchanged. | 1.Multiple acute pulmonary emboli in bilateral distal lobar/proximal segmental pulmonary arteries. New ground glass opacity in the right lower lobe may represent developing hemorrhagic infarct. 2.No significant interval change in severe chronic interstitial lung disease as described above, compatible with sarcoidosis.The above findings were discussed with the patient's physician Dr. Amit Patel on 10/17/2013 at 11:15 am. |
Generate impression based on findings. | Reason: ? ILD extent and source of hemoptysis History: hemoptysis and dyspnea LUNGS AND PLEURA: Subpleural and basilar predominant chronic interstitial disease with reticular and honeycomb components consistent with fibrosis.Extensive cystic abnormalities anteriorly in the left upper lobe with associated traction bronchiectasis are compatible with honeycombing secondary to fibrosis and this has not appreciably changed. However, in both lower lobes there is been progression of coarse cystic disease and consolidation, and bronchiectasis, not typical of UIP. The distribution here is predominantly bronchocentric with relative sparing of the periphery. Large confluent cystic areas with thickened walls have developed, and they have markedly increased in extent since the previous scan. This raises the question of a superimposed process such as infection and/or aspiration. There may also be a component of organizing pneumonia.There is no significant air trapping.MEDIASTINUM AND HILA: Enlarged mediastinal nodes are present throughout the mediastinum and both hila. However a prevascular/AP window lymph node has slightly decreased in size, now 7 mm in short axis diameter. Other nodes have not significantly changed.Moderate coronary artery calcification.CHEST WALL: Status post left mastectomy with lymph nodes in the left axilla.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Severe atypical chronic interstitial disease with marked progression of cystic destruction in both lower lobes and areas of consolidation in a peribronchial distribution that raises the question of infection, aspiration and organizing pneumonia, on a background of UIP. |
Generate impression based on findings. | Urothelial carcinoma with ileal conduit ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Fatty infiltration of the liver again noted.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable minimal bilateral hydronephrosisRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Uterus absent.BLADDER: Status post cystectomy. Unremarkable ileal conduit.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No evidence for recurrent or metastatic focus. Stable minimal bilateral hydronephrosis. Fatty infiltration of the liver again noted. |
Generate impression based on findings. | 59 year-old female with anal cancer status post hepatic resection in May 2013. CHEST:LUNGS AND PLEURA: Scattered nonspecific pulmonary micronodules, similar to the prior exam. Unchanged pulmonary cysts and biapical scarring. No suspicious pulmonary nodules or masses. MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Normal size heart without pericardial effusion..CHEST WALL: Right chest Port-A-Cath tip at the superior cavoatrial junction. No axillary lymphadenopathy.ABDOMEN: LIVER, BILIARY TRACT: Status post right hepatectomy. There is a sliver of trace subcapsular fluid, now measuring 0.5 cm thick (series 3, image 96), previously 2.3 cm. The previous ascites has resolved. No focal hepatic lesions are seen. There is no intrahepatic or extrahepatic biliary ductal dilatation. The portal vein is patent.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Unchanged right hepatic cyst. Subcentimeter hypodense lesions in the left kidney are too small to characterize.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted. No retroperitoneal or mesenteric lymphadenopathy.BOWEL, MESENTERY: No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality noted. No pelvic lymphadenopathy.BOWEL, MESENTERY: Left lower abdominal quadrant ostomy, without significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Resolution of the previous ascites. | 1. Right hepatectomy, now with near resolution of the associated fluid collection. 2. No evidence of metastatic disease. |
Generate impression based on findings. | Reason: left lung nodule, right paraesophageal lymph node History: left lung nodule, right paraesophageal lymph node CHEST:LUNGS AND PLEURA: Scattered nonspecific micronodules. Calcified left lower lobe granuloma.Stable 10 mm x 9 mm left basilar subpleural solid nodule is unchanged over several prior exams dating back to 2/26/13. There are well-defined margins without evidence of internal calcification and this may represent a benign uncalcified granuloma.No pleural effusions.MEDIASTINUM AND HILA: Hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of pericardial effusion.Small fluid collection (image 59 series 3) noted adjacent to the right inferior pulmonary vein may represent either small pericardial cyst or pericardial recess.CHEST WALL: Degenerative changes in the midthoracic spine.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cyst 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: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.10-mm left basilar subpleural nodule unchanged over 8 months and may represent a noncalcified granuloma. Recommend follow-up examination in one year.2.Scattered calcified and noncalcified micronodules compatible with prior granulomatous disease.3.No evidence of mediastinal or hilar lymphadenopathy. Small right pericardial cyst or pericardial recess. |
Generate impression based on findings. | Reason: CT adrenals to evaluate for changes in adrenal nodule History: CT adrenals to evaluate for changes in adrenal nodule ABDOMEN:LUNG BASES: Mild dependent edema and atelectasis of the lung bases bilaterally. Mild prominence of subcentimeter right middle lobe micronodular.LIVER, BILIARY TRACT: Punctate hepatic calcifications likely represent calcified granulomata. No suspicious focal liver lesions. No intrahepatic or extrahepatic biliary ductal dilatation. No evidence of cholelithiasis.SPLEEN: Punctate splenic calcification represent calcified granulomata.PANCREAS: Hypodense lesion in the uncinate process remains relatively unchanged in size and appearance compared to prior exam. This lesion may be an IMPN or a pancreatic cyst.ADRENAL GLANDS: Mild nodularity of the left adrenal gland. The right adrenal gland lesion remains unchanged in size compared to prior exam measuring 2.7 x 1.6 cm previously measuring 2.7 x 1.6 cm (series 6, image 17). There are portions of macroscopic fat and near soft tissue density within the lesion. Post contrast images show enhancement and the absolute adrenal contrast washout is calculated at 85% confirming this lesion as a benign adenoma.KIDNEYS, URETERS: Large left renal cyst is again noted, with interval increase in size now measuring 6.4 x 6.6 cm previously measuring 6.1 x 6.1 cm (series 6, image 45).RETROPERITONEUM, LYMPH NODES: Scattered retroperitoneal lymph nodes.BOWEL, MESENTERY: Scattered mesenteric lymph nodes.BONES, SOFT TISSUES: Degenerative changes are seen in the lower lumbar spine.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Findings confirming a lipid poor adrenal adenoma that is stable in size compared to prior exam.2.Nonspecific pancreatic hypodensity is unchanged. |
Generate impression based on findings. | Headache s/p hemispherectomy and EVD replacement x2. There are interval postoperative findings related to completion right hemispherectomy with a fluid collection and hemostatic material deep to the craniotomy plate that collectively measure up to 10 mm in thickness. There is a catheter that terminates within the hemispherectomy cavity and a catheter that terminates within the atrium of the left lateral ventricle. There is a small amount of pneumocephalus and expected midline shift to the right. There is no evidence of acute intracranial hemorrhage. The remaining left cerebral hemisphere is grossly unremarkable. There is partial resorption of the craniotomy plate, which is not significantly changed. The extracranial structures are unchanged. | Expected postoperative findings related to interval completion right hemispherectomy with external ventricular drains in position. |
Generate impression based on findings. | Nasal congestion, DNS, h/o nasal polyps. The maxillary, frontal, and sphenoid sinuses are clear. There is minimal focal opacification in a left anterior ethmoid air cell. The nasal cavity is clear. There is minimal nasal septal deviation. The left ethmoid roof is approximately 2 mm higher than the right ethmoid roof. The ethmoid roofs are intact. The carotid grooves and optic canals are covered by bone. The imaged mastoid air cells are clear. The imaged intracranial structures and orbits are grossly unremarkable. | No evidence of sinusitis or sinonasal polyposis. |
Generate impression based on findings. | Colon carcinoma CHEST:LUNGS AND PLEURA: Stable emphysema.Stable micronodules. Reference right middle lobe nodule best seen on image 59 of series 4, measures 0.4 cm in diameter.MEDIASTINUM AND HILA: Stable right thyroid nodule. Stable reference AP window lymph node, best seen on image 40 of series 3, measuring 2 x 0.9 cm.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Status post partial hepatectomy. Stable segment 4b low-attenuation focus as seen on image 103 of series 3 measures 1.1 x 0.7 cm.SPLEEN: No significant abnormality notedPANCREAS: Slight interval decrease in size of pancreatic body lesion best seen on image 104, series 3, now measuring 2.9 x 1.8 cm; this is in comparison to 3.2 x 2.7 cm on 7/11/2013. Upstream pancreatic ductal dilatation, unchanged.ADRENAL GLANDS: Stable left adrenal nodularity.KIDNEYS, URETERS: Stable bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: Stable retroperitoneal enlarged lymph nodes. Reference left periaortic lymph node is seen on image 110 of series 3 measures 1.2 x 1.7 cm. Reference aortocaval lymph node best seen on image 124, series 3, measures 1.4 x 0.9 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: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Slight interval decrease in size of pancreatic body mass; other reference lesions stable. |
Generate impression based on findings. | 58-year-old male with renal cancer. CHEST:LUNGS AND PLEURA: The reference right lower lobe nodule measures 1.0 cm (series 5, image 64), previously 0.7 cm. The left lower lobe nodule measures 1.1 cm (series 5, image 69), previously 0.9 cm. Additional micronodules appear unchanged.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Normal sized heart without pericardial effusion. Mild coronary artery calcifications.CHEST WALL: No axillary lymphadenopathy. Mild degenerative changes affect the thoracic spine.ABDOMEN: LIVER, BILIARY TRACT: Geographic region of increased attenuation in segment IV of the liver likely represents focal fatty sparing and has been present since 2/16/12.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy. Stable subcentimeter hypodense lesions in the left kidney, likely representing cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted. No retroperitoneal or mesenteric lymphadenopathy.BOWEL, MESENTERY: No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality noted. No pelvic lymphadenopathy.BOWEL, MESENTERY: Sigmoid diverticulosis without evidence of diverticulitis. No significant abnormality noted otherwise.BONES, SOFT TISSUES: Small fat-containing right inguinal hernia. No significant abnormality noted otherwise. | 1. Slight increase in size of several pulmonary nodules. Continued follow-up is recommended.2. No acute intra-abdominal findings. |
Generate impression based on findings. | Male 59 years old Reason: eval for metastatic disease History: none LUNGS AND PLEURA: No suspicious pulmonary nodules or masses identified. Mild bibasilar scarring/atelectasis unchanged.MEDIASTINUM AND HILA: Mediastinal and hilar lymph nodes, unchanged. Reference borderline enlarged precarinal node measures 11 mm (image 48, series 80280), previously 11 mm.The heart size is normal and there is no pericardial effusion. Mild coronary artery calcifications.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Patient status post splenectomy. Fat density well circumscribed submucosal lesion along the gastric antral wall suggestive of a stromal lipoma, not significantly changed since 11/15/2010. Nonspecific thickening of the first part of the duodenum stable since 2011. | No evidence of metastatic disease and no significant interval change. |
Generate impression based on findings. | Breast cancer and CLL; pain and fullness in left side of neck and left supraclavicular fossa. Streak artifact related to dental amalgam obscures surrounding structures. There is asymmetric prominence of the right tongue base with partial effacement of the right vallecula. The nasopharynx. hypopharynx, larynx, and trachea are otherwise unremarkable. The thyroid gland is heterogenous with a dominant left thyroid nodule that measures up to 11 mm. There is no significant cervical lymphadenopathy by size criteria. The major salivary glands are unremarkable. There is mild degenerative spondylosis with a well-defined lucency in the superior endplate of C4, which likely represents a Schmorl node. The major cervical vessels are patent. The imaged intracranial structures are orbits are unremarkable. The imaged portions of the lungs are clear. | 1. Asymmetric prominence of the right tongue base with partial effacement of the right vallecula, which can be further evaluated via direct inspection.2. Heterogeneous thyroid gland with a dominant left thyroid nodule that measures up to 11 mm. This can be further characterized via thyroid ultrasound. |
Generate impression based on findings. | 21-year-old male off therapy for Ewing's sarcoma, evaluate for pulmonary metastases LUNGS AND PLEURA: Right upper lobe micronodule is unchanged (image 31, series 4). No suspicious pulmonary nodule or mass. No consolidation or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy is seen. Residual thymic tissue again noted. The heart is normal in size and there is no pericardial effusion.CHEST WALL: No axillary lymphadenopathy. No osseous lesions.UPPER ABDOMEN: Within the limitations of a noncontrast examination, the visualized upper abdominal organs are within normal limits. | Stable right upper lobe micronodule without new suspicious pulmonary nodule or mass. |
Generate impression based on findings. | 59 year old female. Reason: Pancreas cancer. Please compare to previous scan and provide index lesion measurements for RECIST. History: Metastatic pancreatic cancer. CHEST:LUNGS AND PLEURA: Bibasilar atelectasis or scarring.MEDIASTINUM AND HILA: Enlarged thyroid with multiple hypodense nodules. CHEST WALL: Right-sided venous access device is in expected position.ABDOMEN:LIVER, BILIARY TRACT: Hepatomegaly with better defined hypoattenuating foci consistent with metastatic disease. The lesions are now better defined compared with the prior exam. The discrete lesion in the lateral segment of the left lobe measured on series 3 image 79, 1.3 x 1.7 cm. All of the hepatic lesions appear smaller in comparison with the prior exam. Status post cholecystectomy. Stable 1.5-cm near water density cyst just caudal to the to the liver of uncertain etiology.SPLEEN: No significant abnormality notedPANCREAS: Pancreatic head enlargement of atrophy of the body and tail consistent with history of pancreatic neoplasm. The distal pancreatic duct is enlarged to 1 cm diameter in the pancreatic neck. The pancreatic head mass measures 3x3 cm at image 102 of series 3, smaller since the prior exam. ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal simple cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Fat containing umbilical hernia. PELVIS:UTERUS, ADNEXAE: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: The right colon is collapsed but there is suggestion of possible submucosal edema in the mid descending colon and cecum. No evidence of ascites.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Questionable thickening of the ascending colon and cecum on the prior exam has resolved.Pancreatic mass with pancreatic ductal obstruction. Diffuse hepatic ill-defined lesions consistent with metastatic disease are smaller and better defined. The pancreatic head mass appears smaller on this exam. |
Generate impression based on findings. | Disturbances of sensation of smell and taste. There is mild mucosal thickening within the alveolar recess of the right maxillary sinus. The left maxillary sinus is clear. There is minimal diffuse mucosal thickening within the bilateral ethmoid sinuses. The frontal and sphenoid sinuses are clear. The nasal cavity and olfactory recesses are essentially clear. There is no significant nasal septal deviation. There is minimal irregularity of the right nasal bone likely related to prior trauma, but no evidence of nasal valve stenosis. There are clusters of coarse calcifications within the left cheek subcutaneous tissues, which may be related to cosmetic fillers. The imaged intracranial structures and orbits are grossly unremarkable. | No significant sinonasal opacification. |
Generate impression based on findings. | 47 year old male with metastatic colon cancer, please evaluate for interval change compared to outside (uploaded) CT. History: status post chemotherapy and radiation ABDOMEN:CHEST: LUNGS AND PLEURA: Stable small focus of scarring versus chronic infarct in the inferior aspect of the lingula.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Right chest port has been removed.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. Unchanged subcentimeter hypodensity in the right upper renal pole, too small to characterize.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted. An infrarenal IVC filter is in place.BOWEL, MESENTERY: Stable not enlarged scattered mesenteric nodes.BONES, SOFT TISSUES: Stable broad-based anterior incisional hernia.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post right colectomy with stable postop changes. There has been resolution of the right lower quadrant mesenteric mass. There is a small amount of residual circumferential wall thickening of an angulated small bowel segment previously involved by the mass. The bowel segment is angulated and 4.5-cm in length, seen best on coronal image 92. Residual soft tissue density is inseparable from the adjacent transversalis fascia. No abnormally dilated bowel is seen to suggest obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Status post resolution of right lower quadrant mesenteric mass, with stable residual circumferential soft tissue associated with adjacent small bowel and the anterior body wall.No measurable metastatic disease. No new lesions. |
Generate impression based on findings. | 52 year old male. Reason: Baseline evaluation of thoracoabdominal aorta after descending aortic replacement. History: Hx of Type A aortic dissection, with ascending replacement Jan 2013, now s/p Descending Aortic Replacement 10/9/13. CHEST:LUNGS AND PLEURA: Left upper lobe atelectasis and pleural thickening. Mild rightward tracheal deviation and caudal displacement of the left main bronchus consistent with aneurysm/hematoma is unchanged. Left apical/extrapleural fluid collection appears loculated laterally. Left subpleural basilar effusion may be loculated. MEDIASTINUM AND HILA: Cardiomegaly and significant mediastinal widening are unchanged. Descending aortic stent is in place at axial image 81 of series 3. Ascending aorta stent is unchanged in position. Large amount of adipose tissue in the anterior mediastinum. Small pockets of mediastinal gas are present in exam done without enteric contrast. Cannot rule out abscess at axial images 70-80 or 29 of series 10719, due to small gas bubbles. Or these may simply be due to recent post-op changes. CHEST WALL: Status post median sternotomy. Subcutaneous emphysema and chest tube tract with small pneumothorax at axial image 92 of series 3. Periaortic hematoma surrounds most of the descending thoracic aorta. The aorta is intact with single lumen to the left hemidiaphragm where the graft ends and dissection begins. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality noted. Splenule at the hilum. PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple bilateral large simple renal cysts are stable. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: IVC filter is in the expected position. Aortic dissection anteriorly extends from the anterior fourth of the thoracic aorta distally into the abdominal aorta. The aortic dissection flap extends into the left renal artery. Contrast is present in the true and false lumen. The dissection extends into the left common iliac ectatic and external iliac arteries and terminates at the left femoral artery.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Aortic and extends into the left common iliac and external iliac arteries to the left femoral artery. Bilateral fat-containing inguinal hernias. Contrast opacification is present in both the true and false lumens. | Postop changes from a recent thoracic aortic dissection repair involving the descending aorta from the arch to the left hemidiaphragm. A hematoma surrounds the thoracic descending aorta. Some pockets of gas bubbles between and adjacent to the thoracic aorta and spine suggest possible infection or may be due to residual gas from recent surgery. An aortic dissection begins at the distal thoracic aorta and extends throughout the abdominal aorta into the left common and external iliac arteries. |
Generate impression based on findings. | Right ear squamous cell carcinoma status post resection x 2 (most recently October 2010) and radiation completed on 1/14/11. There are post-treatment findings related to right parotidectomy, right neck dissection, and radiation. There is no discrete enhancing mass in the treatment bed to suggest local recurrence. The remaining salivary and thyroid glands are unchanged. There is no significant cervical lymphadenopathy by CT criteria. The oral cavity, nasopharynx, oropharynx, hypopharynx, and larynx are unremarkable. The imaged paranasal sinuses are clear. There is mild opacification of the right mastoid air cells. The orbital contents and imaged intracranial structures are grossly unremarkable. No destructive osseous lesions are identified. The major cervical vascular structures are intact. The imaged portions of the lungs are clear. | Stable post-treatment findings for a right preauricular squamous cell carcinoma without evidence of locoregional tumor recurrence or cervical lymphadenopathy. |
Generate impression based on findings. | 14-year-old with history of recurrent osteosarcoma, currently asymptomatic LUNGS AND PLEURA: No suspicious pulmonary nodule or mass. No consolidation or pleural effusion.MEDIASTINUM AND HILA: Left port catheter is seen in place with its tip in the right atrium. No mediastinal or hilar lymphadenopathy is seen. The heart is normal in size and there is no pericardial effusion.CHEST WALL: Status post right shoulder arthroplasty. Compression deformity of T8 with inferior endplate degenerative changes and vacuum disk phenomenon between T8-T9 are unchanged from the prior study. Lucent manubrial lesion is unchanged. No new osseous lesions identified.UPPER ABDOMEN: No significant abnormality given noncontrast technique. | No evidence of metastatic disease. |
Generate impression based on findings. | 68 year old male with pancreatic neuroendocrine tumor. Surveillance scan. Reason: pancreatic neuroendocrine tumor on observation and Gleason 4+4 prostate s/p XRT. Evaluate for disease progression. CHEST:LUNGS AND PLEURA: Stable biapical scarring is again noted. Stable micronodules. Reference left lower lobe micronodule is unchanged in size, measuring 0.6 cm in diameter (Series 9, Image 83). The bilateral major fissure nodular foci are unchanged, and compatible with normal intrafissural lymph nodes. No new lesions are identified. MEDIASTINUM AND HILA: Coronary artery calcification. CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions or biliary ductal dilatation. SPLEEN: No significant abnormality notedPANCREAS: Stable size of heterogenous pancreatic head mass which measures 8.8 x 7.2 cm (Series 7, Image 56). Surrounding vasculature remains patent.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Stable mild aortic ectasia. Dense atherosclerotic calcification of the abdominal aorta and its branch vessels. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Multiple metallic seeds in the prostate. BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Stable exam, with no new lesions identified. |
Generate impression based on findings. | Reason: evaluate I:LD History: follow up for recently noted ILD LUNGS AND PLEURA: Stable subpleural reticulation, septal thickening, and bronchiectasis in more prominent in the right lung involving both the upper and lower lobes. There is a minimal honeycombing. No significant groundglass opacities or air trapping.No suspicious pulmonary nodules or masses.No pleural effusions.MEDIASTINUM AND HILA: Stable enlarged mediastinal lymph nodes with precarinal lymph node (image 40 series 3) unchanged measuring 19 mm.Calcified right hilar lymph nodes.There is mild cardiac enlargement without evidence of a pericardial effusion.Evidence of a previous CABG.Mild coronary and moderate aortic calcification.CHEST WALL: Median sternotomy.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Stable mild interstitial fibrosis in an atypical UIP pattern. Underlying etiologies would include mixed connective tissue disease and chronic hypersensitivity pneumonitis. |
Generate impression based on findings. | 63 year old male. Hodgkin lymphoma s/p ASCT 10/2010. Evaluate disease status. Re-eval and compare to previous. CHEST:LUNGS AND PLEURA: Subcentimeter left lower lobe pulmonary nodule nodule on image 89/series 4, is unchanged. No suspicious lesions. The pleural spaces are clear. Mild left hemithorax pleural thickening is unchanged.MEDIASTINUM AND HILA: Heart size is normal. Reference anterior mediastinal node measures 6 x 6 mm on image 40 series 3. Coronary artery calcification. CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Stable probable cyst in the right hepatic lobe. No suspicious hepatic lesions. Hepatic and portal veins are patent.SPLEEN: Spleen is normal in sizePANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Mild calcified arteriosclerotic disease of the aorta. No adenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes of the lumbar spineOTHER: Small fat-containing left inguinal hernia. | Stable exam. |
Generate impression based on findings. | Left orbital injury. There is mild diffuse left preseptal swelling, but no evidence of retrobulbar hemorrhage or orbital fracture. The globes appear to be intact. There is no evidence of abscess. There is mild right and moderate left maxillary sinus mucosal thickening. The imaged intracranial structures are grossly unremarkable. | Mild diffuse left preseptal hematoma, but no evidence of retrobulbar hemorrhage or orbital fracture. |
Generate impression based on findings. | Recurrent ear infections On the right, the tympanic segment of the facial nerve is dehiscent and low lying, positioned adjacent to the stapes capitellum. The ossicular chain is otherwise intact. The mastoid air cells are underpneumatized and opacified. The middle ear is clear. The inner ear structures are unremarkable. The external auditory canal is patent. On the left, the mastoid air cells are underpneumatized and partially opacified. The middle ear is clear. The facial nerve describes a normal course, but appears dehiscent along the tympanic segment. The inner ear structures are unremarkable.The imaged portions of the brain are grossly unremarkable. There is partially imaged diffuse paranasal sinus opacification. | 1. Evidence of chronic bilateral otomastoiditis with underpneumatization and opacification of the mastoid air cells, right greater than left. No definite evidence of cholesteatoma.2. The right facial nerve is dehiscent and low lying, positioned adjacent to the stapes capitellum. |
Generate impression based on findings. | 54-year-old male with history of non-Hodgkin lymphoma status post autologous stem cell transplant in need of restaging. CHEST:LUNGS AND PLEURA: No new nodules, infiltrates or effusions. The small right middle lobe micronodules seen best on the MIP images (image 28) remained stable dating back to 2011. MEDIASTINUM AND HILA: No adenopathy. No significant abnormality notedCHEST WALL: No significant abnormality noteddABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noteddSPLEEN: No significant abnormality noteddPANCREAS: No significant abnormality noteddADRENAL GLANDS: No significant abnormality noteddKIDNEYS, URETERS: No significant abnormality noteddRETROPERITONEUM, LYMPH NODES: No adenopathy or masses seen.BOWEL, MESENTERY: No significant abnormality noted..BONES, SOFT TISSUES: No significant abnormality noteddOTHER: No significant abnormality noteddPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noteddBLADDER: No significant abnormality noteddLYMPH NODES: No enlarged lymph nodes seen.BOWEL, MESENTERY: No significant abnormality noteddBONES, SOFT TISSUES: Left inguinal hernia containing only mesenteric fat, unchanged.OTHER: No significant abnormality notedd | Stable examination with no evidence for recurrent adenopathy or disease. |
Generate impression based on findings. | Colon carcinoma CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Stable segment 8 subcentimeter low attenuation focus; favor benign etiology such as cyst.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Slight interval increase in size of intermediate attenuation focus within the lower pole right kidney seen on image 121 of series 3, now measuring 1.1 x 1.3 cm; in comparison this lesion measured 1.1 x 0.7 cm on 8/2/2012. Other intermediate attenuation foci have remain stable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Interval appearance of moderately large parastomal hernia with loops of colon within the hernia sac. Not associated with bowel wall thickening, or bowel obstruction.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Uterus absentBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Interval decrease in size of presacral postoperative fluid collection.BONES, SOFT TISSUES: Stable extensive bony sclerosis and deformities.OTHER: No significant abnormality noted. | Slight interval increase in size of intermediate attenuation cystic focus arising from the lower pole of the right kidney. Would recommend dedicated renal CT to further characterize this lesion. Interval appearance of moderately enlarged parastomal hernia with colonic involvement. No evidence for bowel wall thickening or bowel obstruction.No metastatic focus. |
Generate impression based on findings. | 71-year-old female with abdominal pain -- pressure feeling in abdomen, and bladder -- known large ventral or inguinal hernia. ABDOMEN: Within the limits of a non-IV contrast-enhanced examination which limits ability to evaluate solid parenchymal organs and vascular structures, the following observations can be made:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Punctate calcifications consistent with prior granulomatous disease. Mild hepatomegaly. There are scattered small subcentimeter hypodensities, most likely to be benign cysts are seen. No other mass lesions are seen although the lack of IV contrast limits ability to detect solid lesions.Gallbladder and biliary tract appear normal.SPLEEN: Numerous punctate calcifications from prior granulomatous disease. No other abnormalities.PANCREAS: Not well visualized due to paucity of retroperitoneal fat and abutting adjacent mesenteric bowel -- no mass is seen in the region of the pancreas or other abnormalities.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Anterior abdominal wall ventral hernia containing mesenteric fat and small bowel without complication (series 3, image 55). Scattered descending colon and sigmoid diverticular changes are seen without complication. Small and large bowel, otherwise, shows no significant abnormalities. No mesenteric fluid is seen.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: Scattered descending colon and sigmoid diverticular changes are seen without complication. Small and large bowel, otherwise, shows no significant abnormalities. No mesenteric fluid is seenBONES, SOFT TISSUES: Right inguinal hernia containing only mesenteric fat is seen -- no other abnormality seen.OTHER: No significant abnormality noted | 1. Anterior abdominal ventral wall hernia containing small bowel without complication. 2. Right inguinal hernia containing only mesenteric fat. No other significant abnormalities seen. |
Generate impression based on findings. | Reason: breast cancer History: breast cancer CHEST:LUNGS AND PLEURA: Interval improvement in the right upper lobe subpleural opacity in the summer presented post radiation changes.Redemonstration of branching tubular opacity in the left lower lobe with surrounding hyperlucency compatible with bronchial atresia. Minimal right pleural thickening similar in appearance to the prior exam. pleural thickening.No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy. Iscardiac size is normal without evidence of a pericardial effusion.CHEST WALL: Subtle focal thickening involving the inferior right posterior chest wall (image 81 series 401) corresponds to the area of increased area of increased activity in the recent PET scan most likely represents tumor involvement. Sclerotic loci in the T11 and L2 vertebrae are compatible with metastatic disease.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: Small peripancreatic lymph node (image 96 series 41) corresponds to a focus of increased FDG in recent PET scan and is compatible with metastatic disease.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Sclerosis in the left iliac wing compatible with metastatic disease.OTHER: No significant abnormality noted. | 1.Interval increasing extrapleural soft tissue within the right inferior posterior chest wall corresponds to the focus of increased FDG activity noted on the recent PET scan and is compatible with progression of metastatic disease. 2.No suspicious pulmonary nodules or lymphadenopathy within the chest.3.Prominent peripancreatic lymph node corresponding to the focus of increased FDG on recent PET scan and compatible with metastatic disease. |
Generate impression based on findings. | Back pain with metastatic angiosarcoma. This focal kyphosis centered at a burst fracture of the T4 vertebral body which demonstrates approximately 50% height loss when compared to adjacent vertebral bodies. There is 4 mm of retropulsion into the spinal canal with mass effect primarily on the right anterolateral aspect of the thecal sac. There are also expansile lytic lesions involving the T3 vertebral body including pedicular/transverse process expansion and heterogeneity of the vertebral body. There is also a subtle lytic lesion in the T5 vertebra, which is more conspicuous on the recent MRI. There are no other pathologic fractures. There are degenerative endplate changes at T8-9 and vacuum phenomena demonstrated within disks from T6-7 through T11-12. There a densely sclerotic focus within the inferior T12 vertebral body, which likely represents an enostosis. There is an unchanged calcified mass within the mediastinum, which is better characterized on the separately dictated CT of the chest. | 1.Focal kyphosis centered at the pathological T4 burst fracture with 50 % loss of height and impingement upon the right anterolateral aspect of the thecal sac. 2.Lytic lesion in the anterior and posterior elements of the T3 vertebra and subtle lytic lesion in the T5 vertebral body are compatible with metastases and more conspicuous on the recent MRI.3.Mild degenerative spondylosis in the inferior thoracic spine.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Non-Hodgkin's lymphoma CHEST:LUNGS AND PLEURA: Stable biapical scarring. Stable 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: Stable retroperitoneal adenopathy. Reference aortocaval lymph node best seen on image 97 of series 3 measures 1 x 1.3 cm.BOWEL, MESENTERY: Slight interval decrease in size of reference mesenteric lymph nodes. Reference lymph node best seen on image 123 of series 3, now measures 3.1 x 1.7 cm; this is in comparison to 3.2 x 2.1 cm on 4/18/2013.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. | Slight interval decrease in size of mesenteric adenopathy; otherwise, stable examination. No new adenopathy. |
Generate impression based on findings. | Reason: Pancreas Cancer: Restaging History: none CHEST:LUNGS AND PLEURA: Bilateral bulla in apices. Calcified granuloma in the right upper lobe. Bibasilar atelectasis, left greater than right. Left lower lobe air space disease is improved from prior exam. Subcentimeter left supraclavicular lymph node with interval growth since prior exam.MEDIASTINUM AND HILA: Scattered hilar lymph nodes.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No suspicious focal liver lesions. Mild, persistent intrahepatic biliary ductal dilatation. No evidence of cholelithiasis. Hepatic vasculature appears patent.SPLEEN: No significant abnormality notedPANCREAS: A hypodense mass centered uncinate process appears slightly enlarged compared to prior exam measuring 3.2 x 3.4 cm (series 10, image 137) previously measuring 3.1 x 2.9 cm. It is difficult to accurately measure the infiltrating mass process -- however, previously, the first medial branch off the SMA was the lateral demarcation of tumor and there is now tumor past that border encasing this vessel and documenting growth. Also previously, there was a fat plane between the tumor and the psoas muscle and there is now loss of fat plane also confirming growth.ADRENAL GLANDS: Stable nodular thickening of the left adrenal gland. Interval new nodularity of the right adrenal gland.KIDNEYS, URETERS: Mild interval improvement of right hydronephrosis and proximal hydroureter.RETROPERITONEUM, LYMPH NODES: Reference gastrohepatic lymph node is no longer visualized due to marked interval enlargement of the stomach.BOWEL, MESENTERY: Interval marked distension of the stomach and duodenum proximal to the duodenal stent, suggestive of an obstructive process involving the level of the duodenal stent. No oral administered contrast is seen distal to the stent. Duodenal stent unchanged in position. There is diffuse small bowel desiccation as evidenced by the small bowel contents simulating feces, which may corroborate the diagnosis of obstruction at the level of the duodenal stent. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Slight interval increase in size of the mass arising from the uncinate process.2.Interval improvement of left lower lobe opacities and atelectasis.3.Interval marked distension of the stomach and proximal duodenum proximal to the duodenal stent worrisome of an obstructive process. 4.Slight interval improvement of right hydronephrosis and proximal hydroureter. |
Generate impression based on findings. | Relapsed Hodgkin's lymphoma status post two cycles of chemotherapy. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Decreased mediastinal lymphadenopathy. The reference right paratracheal lymph node measures 2.0 x 1.2 cm (axial series 701, image 31), previously 2.8 x 2.1 cm.CHEST WALL: No axillary lymphadenopathy.ABDOMEN: LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Incidental note of a splenule. 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. No retroperitoneal or mesenteric lymphadenopathy.BOWEL, MESENTERY: No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality noted. No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality noted | Decreased mediastinal lymphadenopathy. No new sites of disease are seen. |
Generate impression based on findings. | Female; 55 years old. Reason: Any evidence of pulmonary disease? History: Woman with NF1 who smokes and has cough and marked clubbing. LUNGS AND PLEURA: Moderate upper lobe predominant centrilobular and paraseptal emphysema. No suspicious pulmonary nodules or masses. Mild bronchial wall thickening is compatible with bronchitis. Mild basilar scarring. No focal consolidation or pleural effusion.MEDIASTINUM AND HILA: Heterogeneous thyroid with multiple hypodense nodules. Normal heart size without pericardial effusion. No significant mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Calcified lesion near the liver dome, seen on prior MRI exams dating back to 2003, is unchanged and presumably benign. Status post right adrenalectomy. | 1.Moderate upper lobe predominant centrilobular and paraseptal emphysema.2.Mild bronchial wall thickening, compatible with bronchitis. |
Generate impression based on findings. | Male 66 years old Reason: COPD, h/o lung nodules LUNGS AND PLEURA: Scattered pulmonary micronodules unchanged since 4/2012.Reference right lower lobe nodule now measures 5 mm (image 138 series 4), previously 5 mm.Unchanged right middle lobe linear opacity now likely representing scarring (image 217, series 4). Lingular atelectasis/scarring unchanged.Moderate centrilobular and paraseptal emphysema.No new suspicious pulmonary or masses.MEDIASTINUM AND HILA: Mild hilar and mediastinal lymphadenopathy, likely reactive in etiology.Normal heart size and no pericardial effusion.Mild/moderate coronary calcifications. CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Diffusely increased hepatic parenchymal attenuation without signs of cirrhosis compatible with iodine deposition from treatment with amiodarone, or less likely hemachromatosis. Hypodense lesion arising off the inferior pole of right kidney (image 113, series 3), incompletely visualized on this examination and corresponds in location to a previously described cyst. | 1. Pulmonary micronodules and reference nodule unchanged since 4/2012, likely benign and postinfectious in etiology.2. Findings compatible with iodine deposition in the liver from treatment with amiodarone. |
Generate impression based on findings. | Status post renal pancreas transplant with abdominal pain; please evaluate for incisional hernia defect 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: Stable native renal atrophy.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multiple small ventral and umbilical fat containing hernias without bowel involvementOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Unremarkable right iliac fossa renal transplant | Multiple small fat containing ventral and umbilical herniations without bowel involvement. |
Generate impression based on findings. | 74-year-old with metastatic gastric cancer. Reason: Stage IV esophago-gastric cancer. Please provide index lesion measurements for RECIST prior to start of chemotherapy. LUNGS AND PLEURA: No focal air space opacity or consolidation.Multiple bilateral subpleural nodules are stable, measuring up to 4 x 7 mm at image 42 of series 4. While these may represent benign peri-fissural lymph nodes, close follow-up is recommended.Scattered nonspecific pulmonary micronodules. A 6-mm right lower lobe pulmonary nodule is also nonspecific (image 82, series 4) and stable in size, but close interval follow up is recommended.No pleural effusion or pneumothorax.MEDIASTINUM AND HILA: Multifocal mediastinal and hilar lymphadenopathy. For reference a left hilar node is stable and measures 1.2 cm in diameter at image 50, series 3. The etiology of this lymphadenopathy is uncertain. The distribution is atypical for the patient's primary malignancy, however the possibility of metastatic disease cannot be entirely excluded.The heart is normal in size. No pericardial effusion. Left chest AICD with leads in expected position.CHEST WALL: Moderate to severe degenerative changes affect the lower thoracic spine. No definite osseous metastases. No axillary lymphadenopathy.ABDOMEN:LIVER, BILIARY TRACT: Multiple hypodense lesions within the liver are stable. The largest in the right lobe measures 1.4 x 1.4 cm (series 3 image 102). These are incompletely evaluated on single phase CT, but are suspicious for metastatic lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Numerous prominent intraperitoneal lymph nodes suspicious for metastatic disease. For reference a portacaval node measures 1.3 cm in short axis (series 3 image 99) and is unchanged. There is a left paraaortic lymph node that measures 4 cm long axis on coronal image 45, and 2 x 3 cm at axial image 118, series 3. BOWEL, MESENTERY: Mucosal thickening in the gastric cardia is difficult to precisely measure in a nondistended stomach, but is compatible with the patient's history of gastric cancer. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: The prostate is very large and there is a prominent median lobe. BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Multifocal mediastinal, hilar, mesenteric and left paraortic lymphadenopathy. Suspicious for metastatic disease.2. Multiple prominent pulmonary nodules are stable.3. Gastric mucosal thickening with intra-abdominal lymphadenopathy and liver lesions are suspicious for metastatic disease.4. Stable examination. No new lesions. |
Generate impression based on findings. | Reason: ild, pe History: sob cough PULMONARY ARTERIES: Technically adequate examination with no sign of pulmonary embolism.LUNGS AND PLEURA: Volume loss and scarring with pleural thickening in the left lower lung.Diffuse bronchial thickening suggestive of asthma or chronic bronchitis. There is a mild mosaic perfusion pattern with mild air trapping. Very mild reticular and nodular interstitial opacities, mainly in the upper lungs, which may be smoking related (respiratory bronchiolitis) if the history is consistent.MEDIASTINUM AND HILA: Moderately enlarged lymph nodes measuring up to 12 mm in short axis diameter, some of which are calcified.Severe coronary artery calcification.Enlargement of the right atrium and right ventricle with some straightening of the intraventricular septum. The main pulmonary artery is also moderately enlarged measuring 33 mm in diameter. These findings raise the question of pulmonary hypertension and right heart strain.No pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. No pulmonary embolism.2. Diffuse bronchial thickening suggestive of asthma or chronic bronchitis with mild air trapping, and possibly respiratory bronchiolitis if the patient is a current smoker. |
Generate impression based on findings. | 47-year-old female with jejunal thickening. Concern for posttransplant lymphoproliferative disease. ABDOMEN:LUNG BASES: Cardiomegaly, similar to the prior exam.LIVER, BILIARY TRACT: Few scattered subcentimeter hypoattenuating foci in the liver, which are too small to characterize though likely representing cysts.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: The previously measured left adrenal nodule is not well visualized on this study.KIDNEYS, URETERS: Atrophic native kidneys. Right iliac fossa transplant kidney, without hydronephrosis.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Evaluation of the bowel is limited by lack of oral contrast in the jejunum. The jejunal wall thickening in the left upper abdominal quadrant appears stable to minimally decreased (coronal series 80332, image 54). The previously seen air-fluid collection, which may represent an atypical diverticulum or perforation, appears smaller than prior (coronal series 80332, image 50). No evidence of bowel obstruction. No pneumatosis.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Leiomyomatous uterus.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted. | 1. Limited evaluation of the bowel due to lack of oral contrast in the jejunum. 2. Persistent jejunal bowel wall thickening, with possible minimal improvement. No evidence of bowel obstruction. |
Generate impression based on findings. | 74 year old male. Reason: treated 2 years ago for CLL on a CALGB trial. Re-evaluate for residual disease. History: CLL CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Diffuse mediastinal and hilar adenopathy. For reference, there is a subcarinal lymph node in the midline that measures 2.3 x 4.6 cm at image 57 of series 3. There is a 2.4 x 3.1 cm left hilar lymph node at image 57 of series 3.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis.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. Normal appendix in the right lower quadrant.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Diffusely enlarged prostate.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Diffuse hilar and mediastinal lymphadenopathy. |
Generate impression based on findings. | Female 94 years old; Reason: left foot and ankle CT to r/o fracture History: 94 yo osteoporotic pt with plantar arch and medial foot/ ankle pain, hurt foot when rolling over in bed 4 weeks ago. Diffuse demineralization and moderate to severe osteoarthritic changes are noted, especially about the midfoot and hindfoot, but no acute fracture is evident. Soft tissue swelling is noted in the anterior aspect of the ankle. Calcifications are noted at the attachment of the achilles tendon and within the medial and peroneal tendons of the ankle. The tibialis anterior demonstrates swelling consistent with tendinopathy. | Osteoarthritis and tendinopathy of the tibialis anterior but no evidence of fracture. |
Generate impression based on findings. | 46 year old female. Reason: NMO - neuromyelitis optica with myelopathy and sensory loss. To evaluate for occult malignancy. History: Weakness of LE, bowel and bladder incontinence CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: 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: 3 cm uniloculated thin walled right adnexal cyst. BLADDER: Foley catheter in a mildly dilated urinary 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. | No measurable metastatic disease. No suspicious lesions were found. |
Generate impression based on findings. | Breast carcinoma with abnormal LFT ABDOMEN:LUNG BASES: Interval appearance of multiple subcentimeter left basilar lung nodules.LIVER, BILIARY TRACT: Dramatic interval appearance of numerous confluent bilobar hepatic metastases. A representative segment 5 right lobe lesion as seen on image 51 of series 3 measures 1.9 x 2.2 cm. No ductal dilatation. Hepatic vessels patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable left renal cystsRETROPERITONEUM, 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: Uterus absent or atrophicBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Trace ascitesBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Interval appearance of extensive confluent bilobar hepatic metastatic lesions. No ductal dilatation. Hepatic vessels patent. Trace ascites. Interval appearance of multiple subcentimeter left basilar lung nodules; these lesions are worrisome for new metastatic foci. |
Generate impression based on findings. | 49 year old female. Reason: right flank pain, known hx of right sided UPJ stone. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Splenomegaly. The spleen is more than 13 cm in length. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right hydronephrosis. There is a partially obstructing calculus at the right ureterovesical junction with associated hydronephrosis. This calculus measures approximately 1.4 cm in long axis. The there is a 3-mm calculus in the left upper renal pole without associated obstruction.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: The urinary bladder is decompressed.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Moderately severe right hydronephrosis with 1.4-cm long calculus at the right ureteropelvic junction. |
Generate impression based on findings. | Reason: looking for source of neutropenic fever History: neutropenic fever LUNGS AND PLEURA: Previously seen opacity medially in the right middle lobe has improved but not completely resolved.No other evidence of infection is present.Mild dependent atelectasis is stable, right greater than left, with a small right pleural effusion. MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.A left PICC terminates in the azygos vein.Low attenuation of the blood pool is consistent with known anemia.A small pericardial effusion may be new.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. A prior hepatic cyst like hypodensity is no longer visible.Mild upper abdominal lymphadenopathy is present, unchanged. | Near resolution of right middle lobe opacity, but there is dependent atelectasis and a new small right pleural and pericardial effusion. |
Generate impression based on findings. | Reason: eval colitis History: L-sided abd pain, h/o Crohn's, h/o recent Clostridium difficile colitis - fever, elevated WBC, diarrhea ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No focal liver lesions. No evidence of intrahepatic or extrahepatic biliary ductal dilatation. No evidence of cholelithiasis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Scattered subcentimeter are retroperitoneal lymph nodes.BOWEL, MESENTERY: Scattered mesenteric lymph nodes. Diffuse colonic wall edema extending from the rectum to the cecum. There is engorgement of the vasculature with no significant surrounding fat stranding. There is no evidence of loculated fluid collections. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Physiologic cyst in the right ovary.BLADDER: No significant abnormality notedLYMPH NODES: Scattered pelvic lymph nodes bilaterally.BOWEL, MESENTERY: Scattered mesenteric lymph nodes. Diffuse colonic wall edema extending from the rectum to the cecum. There is engorgement of the vasculature with no significant surrounding fat stranding. There is no evidence of loculated fluid collections. No evidence of abscess or perforation. No bowel obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Pancolitis favoring infectious etiology such Clostridium difficile infection although a diffuse inflammatory etiology cannot be completely excluded. No evidence of complications such as perforation, abscess, fluid collections, or obstruction. |
Generate impression based on findings. | 67-year-old male with cholangiocarcinoma and hepatocellular cancer. Needs to have a CT to reassess. Effect of RFA and restage. CHEST:LUNGS AND PLEURA: A lobular nodule in right upper lobe (series 10, image 25) measuring 0.8 x 0.7 cm.. No other lung nodules, masses, infiltrates or effusions seen.MEDIASTINUM AND HILA: No adenopathy. Vascular coronary artery calcification to moderate degree seen.CHEST WALL: Lytic, destructive lesions, indicative of metastatic disease is seen in the left first rib proximally (series 12, image 4, and series 80736, image 60) and in the T4 vertebral body (series 12, image 26, series image 73 and series image 67).ABDOMEN:LIVER, BILIARY TRACT: Liver, again shows a cirrhotic morphology. Similar appearance to outside MR. Large mass in right lobe of liver segments 7 and 8 is minimally changed in size (series 9, image 39) measuring 9.3 x 5 .1 cm, compared with 9.9 x 4.0 on prior MR examination. The lesion shows predominant enhancement pattern of peripheral enhancement gradually progressing centrally in a pattern more often seen with cholangiocarcinoma than HCC. While the primary mass is not changed significantly in size, many new lesions are seen in the right lobe, particularly at the dome of the liver (see series 9, image 17) were innumerable lesions are seen, particularly medially, where a 2.2 x 2.3 cm lesion is. The largest such new lesion. Additional new lesion seen at the base of the caudate lobe (series 12, image 80) measures 2.3 x 1.8 cm..Hepatic veins are not well seen and cannot be assessed. Left portal vein appears normal. Right posterior branch is well seen and normal -- the anterior branch extending towards the large right lobe mass cannot be visualized.Patient is status post cholecystectomy -- no intrahepatic or extrahepatic biliary duct dilatation is seen.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Marked increase in size of a portacaval lymph node (series 9, image 52) is seen with marked enhancement typical of metastatic disease -- this measures 3.1 x 2.0 cm and on prior MR measured 1.3 x 0.9 cm. Other mildly prominent periaortic, pericaval lymph nodes are seen, which have increased in size since the prior MR examination.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Extensive degenerative changes seen throughout. The bony skeleton without focal abnormality in the abdominal musculature.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Extensive degenerative is seen throughout the pelvic skeletal system without focal abnormality to suggest metastatic disease. OTHER: No significant abnormality noted | 1. Progressive intrahepatic disease extension with many new foci of tumor in the liver. 2. New enlarged portacaval lymph node and other smaller periaortic enlarged nodes with enhancement indicative of metastatic disease. 3. Lytic lesions in the left first rib and T4 vertebral body indicative of metastatic disease |
Generate impression based on findings. | 54-year-old male with right-sided flank pain, urinary tract infection -- rule out kidney stone. Within the limits of a non-IV contrast enhanced examination which limits evaluation of vascular structures and solid parenchymal organs, the following observations can be made:ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Lack of IV contrast limits ability to evaluate parenchyma -- the uncinate process appears more bulbous than expected although is abutting the duodenum and without oral or IV contrast it is difficult to determine the boundaries of each of these organs. Within the best estimate of this noncontrast examination, the uncinate process appears to measure 3.7 x 2 .9 cm, which would be enlarged. I would recommend a detailed. Pancreatic CT or MR examination to evaluate this further.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right kidney shows a 1.0 cm, hypodense lesion in the cortex midpole, lateral right kidney (series 3, image 57), which is too small to characterize, but may represent a benign cyst. No other lesions are seen in the kidney -- without IV contrast, small to moderate size, renal masses cannot be appreciated.No abnormal calcifications are seen in either kidney. No hydronephrosis is seen. The ureters are not dilated and no calcifications are seen in the expected course of the ureters. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. No urinary tract calculi are seen and no signs of urinary tract obstruction or perinephric fluid collections. 2. 1.0-cm hypodensity right renal cortex -- while this most likely represents a cyst, without IV contrast, the lesion cannot be characterized. 3. Enlarged uncinate process of the pancreas -- without IV or oral contrast is difficult to ascertain the significance of this and a detailed pancreatic CT or MR examination is recommended.Findings discussed with readout with Dr. Bales at 3:10 p.m. |
Generate impression based on findings. | Male 58 years old Reason: Hx of SCCA of the tongue, now with painful fullness over right inferior rib cage, rule out lesion History: above LUNGS AND PLEURA: Nodular density seen along the right major fissure compatible an intrapulmonary lymph node. Scattered pulmonary micronodules some of which are calcified, unchanged.Minimal dependent atelectasis.MEDIASTINUM AND HILA: Calcified mediastinal and hilar lymphadenopathy compatible prior granulomatous disease. The heart size is normal and there is no pericardial effusion.Small hiatal hernia.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Multiple punctate calcific foci in the splenic and hepatic parenchyma compatible with prior granulomatous disease. | No chest wall lesion or other significant abnormality. |
Generate impression based on findings. | 72-year-old female with microscopic hematuria. Renal cyst on ultrasound. ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted. Status post cholecystectomy.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No renal mass or calculus is seen. The renal cyst on previously seen on ultrasound is not visualized on this study. There is no ureteral lesion or filling defect.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mild to moderate atherosclerotic calcification of the abdominal aorta, without aneurysm.BOWEL, MESENTERY: No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS: Evaluation of the pelvis is limited by streak artifact from a left hip arthroplasty device.UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality noted. No bladder mass or stone is seen.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Sigmoid diverticulosis without evidence of diverticulitis. No significant abnormality noted otherwise.BONES, SOFT TISSUES: Left hip arthroplasty. No significant abnormality noted otherwise.OTHER: Chunky calcifications in the pelvis at midline, likely residing in lymph nodes. | 1. No specific findings to account for the patient's microscopic hematuria.2. The left renal cyst seen on prior ultrasound is not distinctly visualized on this study. |
Generate impression based on findings. | Left temporal scalp melanoma. The region of the left scalp melanoma is not included in the field of view of this exam. There are mildly prominent left level 2 lymph nodes, the largest of which measures 8 x 13 mm. However, there was no corresponding hypermetabolism on the prior PET. There are left palatine tonsilloliths. The oropharynx, oral cavity, nasopharynx, hypopharynx, and larynx are otherwise unremarkable. The major salivary glands are unremarkable. The thyroid gland is unremarkable. The major cervical vessels are patent. The imaged intracranial structures and orbits are unremarkable. There are no lytic or blastic lesions suspicious for metastases. The imaged portions of the lungs are clear. | 1. Mildly prominent left level 2 lymph nodes, the largest of which measures 8 x 13 mm, without corresponding hypermetabolism on the prior PET from September 2013. 2. The region of the left scalp melanoma is not included in the field of view of this exam. |
Generate impression based on findings. | Shunted hydrocephalus. There is an unchanged right transparietal shunt catheter that terminates in the collapsed left ventricle with its tip possibly extending into the adjacent parenchyma and an unchanged left transparietal shunt catheter that terminates in the collapsed right lateral ventricle with an apparent discontinuation of the left parietal shunt catheter at the entry point through the calvarium. The brain parenchyma appears dysmorphic. There is no mass effect, midline shift, or acute hemorrhage. The osseous structures are unremarkable. The imaged paranasal sinuses and mastoid air cells are clear. The orbits are unremarkable. | Stable decompressed ventricular system with biparietal ventricular shunt catheters including apparent disconnection of the left parietal VP shunt catheter at its entry into the burr hole. |
Generate impression based on findings. | Renal cell carcinoma status post partial nephrectomy ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Stable bilobar too small to characterize low-attenuation fociSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Interval increase in size of right upper pole cyst best seen on image 39 of series 7, now measuring 4.1 x 4.1 cm; this is in comparison to 3 x 2.6 cm on 10/27/2010. This cyst demonstrates no evidence for complexity or enhancement. Other cystic foci stable bilaterally.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Right inguinal hernia with small bowel involvement.OTHER: No significant abnormality noted | Interval increase in size of right upper pole renal cyst. This cyst demonstrates no complexity or enhancement. Other bilateral renal cysts, stable.Right inguinal hernia with small bowel involvement. No bowel wall edema or obstruction. |
Generate impression based on findings. | Neutropenic fever. There is minimal mucosal thickening within the left maxillary sinus. The right maxillary sinus is clear. There is mild scattered mucosal thickening within the ethmoid sinuses.There is a small retention cyst within the right frontoethmoid recess. The frontal sinuses are otherwise clear. There is minimal mucosal thickening within the left sphenoid sinus. There are no air fluid levels. There is partial opacification of the bilateral olfactory recesses. There nasal cavity is otherwise clear. There is moderate nasal septal deviation with narrowing of the left nasal valve. There are several periodontal lucencies surrounding treated teeth. There is minimal opacification of the left mastoid air cells. Although only partially imaged, the Waldeyer ring structures appear to have decreased in size. The imaged intracranial structures and orbits are grossly unremarkable. | 1. No evidence of acute sinusitis.2. Although only partially imaged, the Waldeyer ring structures appear to have decreased in size. |
Generate impression based on findings. | Vocal cord paralysis CHEST:LUNGS AND PLEURA: Calcified granulomas. MEDIASTINUM AND HILA: Calcified mediastinal lymph nodesCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Probable subcentimeter nonobstructing renal stones bilaterally.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Mildly enlarged prostateBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Negative for acute, inflammatory, or neoplastic process. |
Generate impression based on findings. | History of CLL. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Multiple subcentimeter mediastinal lymph nodes, similar to prior exam. Normal sized heart without pericardial effusion. Mild coronary artery calcifications.CHEST WALL: Stable bilateral axillary lymphadenopathy. The reference right axillary lymph node measures 1.9 x 1.4 cm (series 3, image 23), previously 2.1 x 1.4 cm.ABDOMEN: LIVER, BILIARY TRACT: A bilobed hypoattenuating segment 8 lesion is unchanged at 3.6 x 2.6 cm (series 3, image 35). Additional subcentimeter hypodense lesions are unchanged.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: Stable retroperitoneal lymphadenopathy. The reference left para-aortic lymph node is unchanged at 1.6 x 1.0 cm (series 3, image 111). BOWEL, MESENTERY: No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Stable lymphadenopathy. The reference right obturator lymph node is unchanged at 6.0 x 1.7 cm (series 3, image 162).BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality noted | Stable lymphadenopathy throughout the chest abdomen and pelvis. No new sites of disease are seen. |
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