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Generate impression based on findings. | 25-year-old explain seen headache, s/p hemispherectomy and EVD replacement x2. Redemonstrated are 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, unchanged in position. There is also a catheter that terminates within the atrium of the left lateral ventricle, also unchanged in position, with slight interval decrease in size of the adjacent lateral ventricle. Previously demonstrated pneumocephalus demonstrates some redistribution and slight decrease. As before, there is 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 in appearance. The visualized paranasal sinuses as well as mastoid air cells are clear. | 1.There is a catheter that terminates within the hemispherectomy cavity, unchanged in position.2.There is also a catheter that terminates within the atrium of the left lateral ventricle, also unchanged in position, with slight interval decrease in size of the adjacent lateral ventricle. |
Generate impression based on findings. | Female; 82 years old. Reason: 82 yo W with h/o early stage NSCLC s/p SBRT. Please assess for response History: occasional cough. CHEST:LUNGS AND PLEURA: Spiculated right upper lobe nodule is slightly decreased in size and measures 16 x 13 mm, previously 19 x 13 mm (series 4, image 52). Adjacent focal ground glass opacity is unchanged and measures 16 mm (series 4, image 33). Right lower lobe ground glass nodule is also unchanged and measures 4 mm (series 4, image 141). Stable 5 mm left upper lobe ground glass nodule (series 4, image 101).Stable 8mm right lower lobe ground glass nodule (series 4, image 157).Stable calcified and noncalcified micronodules but no new suspicious lesions identified. Additional subcentimeter lesions are unchanged.Mild peripheral and basilar scarring, right greater than left. Upper lobe predominant centrilobular and paraseptal emphysema. No focal airspace opacity or pleural effusion. MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. Dense aortic and moderate coronary artery calcifications. No mediastinal or hilar lymphadenopathy. Calcified hilar nodes are suggestive of prior granulomatous disease. Multiple surgical clips at the thoracic inlet, compatible with previous thyroid surgery. CHEST WALL: Calcified subpectoral and axillary lymph nodes are again noted. ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: Pancreatic calcifications and calcified peripancreatic lymph nodes unchanged. RETROPERITONEUM, LYMPH NODES: Scattered small calcified retroperitoneal lymph nodes. BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Postsurgical changes s/p right hemicolectomy. Left colonic diverticula. BONES, SOFT TISSUES: Degenerative disease affects the lumbar spine and both hips.OTHER: Severe atherosclerotic calcification of the abdominal aorta and its major branches. | 1.Slight interval decrease in size of spiculated right upper lobe nodule.2.Unchanged 16mm right apical lesion which is mostly groundglass density but may contain some internal solid component, suspicious for MIA/AIS . 3.Unchanged multiple ground glass nodules, which could represent additional indolent primary neoplasms. Continued follow-up recommended. 4.No new suspicious lesions identified. |
Generate impression based on findings. | Stroke, metastasis. There is extensive cortical and subcortical edema involving the bilateral superior frontal and cingulate gyri and bilateral occipital lobes. There is also a possible area of edema in the left cerebellar hemisphere. There is no midline shift or herniation. There is no evidence of acute intracranial hemorrhage or hydrocephalus. The imaged paranasal sinuses and mastoid air cells are clear. There are air-fluid levels in the bilateral maxillary and sphenoid sinuses. The mastoid air cells are clear. The patient is intubated. | Extensive edema in the the bilateral occipital lobes and possibly within the right cerebellar hemisphere without evidence of acute intracranial hemorrhage or midline shift may represent recent multi-territorial infarcts and less likely posterior reversible encephalopathy syndrome. Brain MRI and cerebral vascular imaging is recommended. Discussed with Blummer at 2:50 PM on 10/18/13. |
Generate impression based on findings. | Reason: 71 year old female with new diagnosis of colon adenocarcinoma. Staging. History: abdominal pain CHEST:LUNGS AND PLEURA: Left lower lobe pulmonary nodule measures 0.6 x 0.5 cm (series 4, image 52). Centrilobular emphysema. Left lower lobe basilar atelectasis/scarring. MEDIASTINUM AND HILA: Aneurysmal dilatation of the descending aorta measures 4.2 cm in maximal diameter (series 3, image 37). Heart size is normal without pericardial effusion. Coronary artery calcifications.No lymphadenopathy.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Multiple heterogeneous hepatic lesions measuring up to 2.0 x 1.6 cm (series 3, image 74). The common bile duct and pancreatic duct are prominent with nonspecific haziness at the ampulla.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Suboptimal phase of contrast for evaluating the kidneys. Given this limitation, there is a heterogeneous pedunculated mass in the superior pole of the right kidney extending centrally into the renal pelvis, measuring 4.8 x 3.2 cm (series 3, image 102). The left kidney is atrophic with extensive parenchymal scarring and nonobstructive calculi. Left lower pole simple cyst. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Scoliosis and degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy. Right adnexal cyst is poorly evaluated by CT.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postoperative changes about the rectum. No drainable fluid collections.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Hepatic metastases.2.Left lower lobe pulmonary nodule suspicious for metastasis.3.Probable renal cell carcinoma of the right kidney, however the phase of contrast is suboptimal. Dedicated renal CT or MRI may be helpful.4.Prominence of the common bile duct and pancreatic duct with nonspecific haziness at the ampulla. Recommend MRCP.5.Descending thoracic aortic aneurysm. |
Generate impression based on findings. | CTA TAVR CAP W; 3/21/2012 3:04 PM VESSELS:Sinus of Valsalva equals 2.9 x 2.9 x 3.1 cm Sinotubular junction: 3.0 x 2.9 cmProximal ascending thoracic aorta at the level of the main pulmonary artery: 3.0 x 3.3 cmAscending thoracic aorta immediately proximal to the innominate artery: 2.9 x 2.8 cmProximal descending thoracic aorta immediately distal to left subclavian artery: 2.0 x 2.1 cmDescending thoracic aorta immediately proximal to the hiatus: 2.0 x 1.9 cm Proximal abdominal aorta at level of celiac artery: 1.7 x 1.9 cmAbdominal aorta at the level of the renal arteries 1.3 x 1.6 cmInfrarenal abdominal aorta (most narrowed lumen): 1.3 x 1.4 cmRight proximal common iliac artery: 8.9 x 8.6 mmRight distal common iliac artery: 9.1 x 8.6 mmRight proximal external iliac artery: 8.7 x 8.3 mmRight mid external iliac artery: 6.9 x 6.1 mmRight distal external iliac artery: 7.3 x 7.5 mmRight proximal common femoral artery: 5.4 x 5.5 mm Left proximal common iliac artery: 8.7 x 9.5 mmleft mid common iliac artery 8.3 x 8.9 mmLeft proximal external iliac artery: 9.6 x 9.6 mm Left mid external iliac artery: 6.2 x 7.4 mmLeft distal external iliac artery: 7.3 x 6.7 mm. Left proximal common femoral artery: 6.7 x 5.8 mmCHEST:LUNGS AND PLEURA: No significant abnormalities identified. Minimal scarring.MEDIASTINUM AND HILA: No significant abnormalities identified. Prominent superior pericardial recess. No adenopathy. CHEST WALL: No significant abnormalities identified.ABDOMEN: The following observations are made given the limitations of an arterial weighted study.LIVER, BILIARY TRACT: No significant abnormality identifiedSPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Low density lesion in the intermittent pole left kidney consistent with cysts..RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small hiatal hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Duplicated right renal artery.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality identifiedLYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality identifiedOTHER: Proximal profunda femoris and superficial femoral arteries are widely patent. | No significant abnormalities identified. Preoperative measurements given above. |
Generate impression based on findings. | 47 year old female with eye pain, evaluate for facial fracture Previously described left frontal scalp laceration is above the field of acquisition for the current study.The orbits are unremarkable. The mastoids are clear. Limited view of the intracranial structure is unremarkable. The maxilla, mandible, sphenoid boned, nasal bones, zygoma, hard palates, pterygoid plates, visualized cervical spine and TMJs are intact, without fracture. The frontal sinuses, frontal-ethmoid recesses, anterior/posterior ethmoids, sphenoid sinuses, and maxillary sinuses are well developed and clear. The osteomeatal complexes are normal with intact uncinate processes and patent infundibuli. The intersphenoid septum is normal. The nasal turbinates are normal. There is a mild S-shaped configuration of the nasal septum. The cribriform plate, fovea ethmoidalis and lamina papyraceae appear normal. The osseous structures are unremarkable. | Negative noncontrast maxillofacial CT. Specifically, there are no CT findings to explain the patient's eye pain. |
Generate impression based on findings. | Assault. There is a 1 to 2 mm depressed fracture of the left frontal process of the maxilla with overlying soft tissue swelling. 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 orbits are unremarkable. | 1. No evidence of acute intracranial hemorrhage, mass, or cerebral edema.2. Acute 1 to 2 mm depressed fracture of the left frontal process of the maxilla. |
Generate impression based on findings. | Female; 89 years old. Reason: Slowly-progressive lung cancer with increased hoarseness; evaluate for recurrence. CHEST:LUNGS AND PLEURA: Nodular opacity in the right lower lobe along the previous wedge resection suture line is unchanged since the prior study and compatible with tumor recurrence, having increased from the patient's initial study of 6/27/2012 measuring 4.5 x 1.6 cm (series 4, image 170). Solid left lower lobe nodule measures 13 mm and is also unchanged (series 4, image 206). No new suspicious pulmonary lesions are identified. Subsegmental lingular atelectasis and upper lobe predominant centrilobular emphysema are stable. No focal consolidation or pleural effusion. MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. Enlarged main pulmonary trunk diameter is compatible with pulmonary hypertension. Extensive coronary calcifications. Heterogeneous left thyroid lobe is again noted. No mediastinal or hilar lymphadenopathy. Common origin of brachiocephalic and left common carotid arteries, a normal variant. CHEST WALL: Marked thoracic scoliosis and associated multilevel degenerative disease. ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Multiple hypodense liver lesions are unchanged, lesions in the right liver dome are indeterminate and do not meet the criteria for cysts. Cholelithiasis and possible gallbladder adenomyosis.SPLEEN: Small accessory splenule.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple large left renal cysts, unchanged. PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Infrarenal IVC filter. BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Stable nodular opacity along right lower lobe suture line is compatible with recurrent tumor. 2.Unchanged left lower lobe nodule, which may represent metastasis or new primary tumor. 3.Findings compatible with pulmonary arterial hypertension. 4.Unchanged hepatic lesions, some of which are indeterminate in etiology. |
Generate impression based on findings. | Female 71 years old Reason: 71 year old woman with history of early stage LUL NSCLC treated with stereotactic radiotherapy in 5/2013. Please evaluate for interval change and compare to pretreatment CT. History: surveillance CT CHEST:LUNGS AND PLEURA: Upper lobe ground glass nodule has slightly decreased in size now measuring 19 x 18 mm (image 71, series 5) comment previously 24 x 14 mm. Other previously described upper lobe ground glass lesions are larger and more distinct. Additionally, multiple new mostly ground glass nodules with solid components have arisen inferior to the reference nodule. These findings most likely reflect evolving radiation change.Previously described right upper lobe ground glass nodule is unchanged and may represent adenomatous hyperplasia or synchronous primary malignancy.Moderate centrilobular and paraseptal emphysema unchanged. No pleural effusion.MEDIASTINUM AND HILA: Prominent paratracheal lymph nodes unchanged. Mildy enlarged right hilar lymph node unchanged. Subcarinal lymphadenopathy not significantly changed.Normal heart size and no significant pericardial effusion.Moderate atherosclerosis of the coronary arteries.CHEST WALL: Multilevel degenerative changes of the thoracic and lumbar spine.Bilateral axillary and subpectoral lymphadenopathy unchanged.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Hepatic segment 2 & 7 hypodense foci incompletely characterized on this examination, unchanged.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Small left adrenal nodule incompletely characterized, but measured less than 10 Hounsfield units on I. prior noncontrast examination suggestive of an adrenal adenoma. Right adrenal thickening unchanged.KIDNEYS, URETERS: Small exophytic hypodense lesion arising off the lower pole of the right kidney incompletely characterized, unchanged examination.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Moderate atherosclerosis of the abdominal aorta and its branches. Mild diffuse lymphadenopathy.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Slightly increased size of multiple prominent mesenteric lymph nodes. Hazy infiltration of the mesenteric root is nonspecific but can be a sign of lymphoma.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Multilevel degenerative changes of the thoracic and lumbar spine. | 1. Decreased size of the left upper lobe nodule.2. Diffuse chronic lymphadenopathy with no significant change in axillary, subpectoral, mediastinal and hilar lymphadenopathy but slight interval increase in mesenteric lymphadenopathy. Indolent lymphoma cannot be excluded.3. Incomplete characterized left adrenal nodule suggestive of adrenal adenoma based on Hounsfield measurement on a prior examination.4. Right upper lobe ground glass nodule is unchanged and may represent adenomatous hyperplasia or synchronous primary malignancy. |
Generate impression based on findings. | Right lower quadrant pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. Appendix is not visualized. Lack of intra-abdominal fat limits optimal evaluation, however, there is no evidence of inflammation the right lower quadrant to suggest appendicitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No CT findings to explain patient's acute abdominal pain. |
Generate impression based on findings. | Female, 79 years old, leptomeningeal enhancement seen in the right parietal region on the prior MRI, history of lung cancer. Evaluate for vasculitis or other CNS vascular disease. Non-angiographic findings:In the region of the right parietal abnormality noted on prior MRI, there is mild gyriform hyperdensity which surrounds areas of relatively low attenuation. Additional patchy periventricular hypoattenuation is seen, a nonspecific finding which may simply represent age indeterminate small vessel ischemic disease.Volume loss of the left thorax is noted with a thick rind of peripheral soft tissue compatible with history of lung cancer and surgical change. Multiple areas of bony sclerosis are seen involving most thoracic vertebral bodies as well as the left-sided ribs, concerning for metastatic disease.Angiographic findings:Conventional aortic branching. Mild atherosclerotic calcification of the aortic arch and great vessel origins with no high grade stenosis seen.Mild atherosclerotic calcification at the bilateral carotid bifurcations resulting in no significant stenosis by NASCET criteria. The carotid circulation in the neck is otherwise unremarkable. The vertebral circulation is patent and unremarkable in the neck.Atherosclerotic calcification affects the right petrous, cavernous and supraclinoid ICA. This results in approximately 50% stenosis within the laceral segment and 50% stenosis in the supraclinoid segment. Less severe atherosclerotic disease affects the left ICA with no areas of high-grade stenosis.The ACA and MCA distributions are free of high-grade stenosis or vascular occlusion. A 2-mm by 2-mm aneurysm is evident arising from the right M1 segment directed posteriorly and laterally with a 2-mm neck. No additional aneurysms are detected.The ACOM artery is within normal limits. The right PCOM artery is small but unremarkable. The left PCOM artery is not clearly seen.The posterior circulation is free of significant vascular stenosis or occlusion. Regarding the abnormal finding on prior MRI, no evidence of large or anomalous venous structures, venous occlusion, or tangle of abnormal vessels is demonstrated. | 1. No specific vascular anomaly or vascular lesion is seen to account for the abnormal findings noted on a prior MRI.2. Incidental note is made of a 2 mm x 2 mm aneurysm arising from the right M1 segment.3. Mild atherosclerotic disease is seen at the carotid bifurcations with moderate atherosclerotic disease at the level of the intracranial ICAs. No high-grade stenosis or vascular occlusion is seen. |
Generate impression based on findings. | Left total hip arthroplasty, pain with osteolysis The left total hip arthroplasty is again observed with associated marked lucency involving the superior acetabulum extending into both the anterior and posterior columns. At its most superior, this suspicious lucency measures over 3 cm, Mild protrusio abnormality, however no discrete superimposed acute abdomen I such as a fracture. The remainder of the arthroplasty is otherwise unremarkable, specifically the femoral stem is well situated. Minimal heterotopic bone adjacent to the greater trochanterThe surround soft tissues are well visualized and normal. Pelvic contents are unremarkable. Mild degenerative changes of the SI joints and opposite hip are observed. | Suspected particle ostial lysis involving the left superior acetabulum, grossly unchanged from plain film. No associated superimposed acute process |
Generate impression based on findings. | Assess for infection prior to transplant. No evidence of sinusitis. Maxillary, sphenoid and ethmoid sinuses are aerated normally. There is no mucosal thickening. Ostiomeatal units are clear bilaterally. Visualized portions of the orbits are unremarkable and there are no bony abnormalities including fracture. Overlying soft tissues are unremarkable within the limits of technique. | No evidence of sinusitis. Unremarkable examination. |
Generate impression based on findings. | Reason: Appendiceal carcinoid and retro-cecal perforation peritonitis resected in March 2013 -- some perivascular invasion and nodes -- assess for change History: none except urgency discomfort ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No arterially enhancing lesions.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: Small retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.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: Interval resolution of right hemipelvis abscess.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No evidence of recurrent or metastatic disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Status post resection of a T1 right vocal cord cancer December 31, 2012 and re-resected margins in January 2013. The vocal cords appear essentially unchanged with persistent effacement of the right laryngeal vestibule and indistinctness of the left paraglottic fat. There is unchanged sclerosis of the right arytenoid and the laryngeal cartilages otherwise appear intact. There is unchanged effacement of the pyriform sinuses. The lymphoid tissue hyperplasia of the tongue base is unchanged. There is no significant cervical lymphadenopathy. The airways are patent. The parotid, submandibular, and thyroid glands are unremarkable. The carotid arteries and jugular veins are patent. The osseous structures are unremarkable. The imaged intracranial structures and orbits are unremarkable. The paranasal sinuses and mastoid air cells are clear. The imaged portions of the lungs are clear. | 1. Essentially unchanged appearance of the vocal cords.2. No significant cervical lymphadenopathy. |
Generate impression based on findings. | Reason: evaluate for disease progression. History: leiomyosarcoma. CHEST:LUNGS AND PLEURA: Pulmonary nodules increasing in size and number. Reference right apical nodule measures 5 mm (series 6, image 11), previously 4 mm.No pleural effusions.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. Mild coronary artery calcifications. No lymphadenopathy.CHEST WALL: Increasing T1 vertebral body the lesion. New T2 vertebral body lytic lesion.ABDOMEN:LIVER, BILIARY TRACT: Multiple hepatic metastases increasing in size and number. Reference right hepatic lobe lesion has increased in size measuring 1.3 x 1.3 cm (series 4, image 82).SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Chronic left hydronephrosis. Left nephroureteral stent terminates in the bladder. New bilateral nonobstructive renal calculi.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes. Atherosclerosis of the abdominal aorta and its branches.BOWEL, MESENTERY: Multiple dilated loops of small bowel compatible with small bowel obstruction, unchanged. A small bowel loop measures 3.4 cm (series 4, image 154) adjacent to the pelvic mass. BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Large pelvic mass has increased in size measuring 8.0 x 6.8 cm (series 4, image 148) extends to the left pelvic side wall and invades the adjacent small bowel loops, left ureter, and possibly the sigmoid colon.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Left lower quadrant colostomy with a herniated small bowel loop.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Increasing pelvic mass with extension to the left pelvic sidewall and invasion of adjacent small bowel loops, left ureter, and possibly the sigmoid colon.2.Increasing pulmonary, hepatic, and osseous metastases.3.Chronically obstructed left kidney. |
Generate impression based on findings. | 45 year man with a perfusion defect on nuclear stress test and prior non-diagnostic stress echo. He is being considered for liver transplant and is referred to rule out coronary artery disease.CPT Code: 75574 Coronary arteries: LM: The left main coronary artery arises normally from the left sinus of valsalva and bifurcates into the left anterior descending and left circumflex coronary arteries. There are no significant stenoses present in the left main.LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove, supplying the diagonal and septal branches. The proximal LAD is densely calcified and has an approximately 50% stenosis. The remainder of the LAD and its branches are free of significant stenosis.LCx: The left circumflex coronary artery is non-dominant. It courses normally in the left AV groove. It gives rise to the obtuse marginal branches. There are no significant stenoses in the LCx.RCA: The right coronary artery is large and arises normally from the right sinus of valsalva. It is the dominant coronary artery supplying a posterior descending artery and a posterolateral branch. There are no significant stenoses in the right coronary artery.Left Ventricle: The left ventricular late diastolic volume is mildly increased (LV volume 201ml).Right Ventricle: Visually the right ventricular late diastolic volume is within normal limits.Left Atrium: Visually, the left atrial volume is mildly increased. There are four distinct pulmonary veins which drain normally into the left atrium. There is no evidence of left atrial appendage thrombus.Right atrium, vena cavae, and coronary sinus: The right atrial volume appears to be normal in size. The superior and inferior vena cavae are grossly normal. The coronary sinus is normal in size. Valves: There is no calcification on the aortic or mitral valves.Great vessels: The visualized portions of the thoracic aorta demonstrate no evidence of dissection or aneurysm. The aortic arch is not seen. The main pulmonary artery is normal in size.Pericardium: The pericardium is normal in thickness. There is no pericardial effusion. | 1.There is a densely calcified plaque in the proximal LAD resulting in an approximately 50% stenosis. 2.The LV and LA are mildly dilated. 3.The RV and PA are normal in size.This portion of the report pertains to the heart and great vessels only. The remaining soft tissues of the thorax and upper abdomen will be interpreted by the attending chest radiologist and included as an addendum to this report. |
Generate impression based on findings. | Clinical question: Multiple sclerosis. Signs and symptoms: Primary hyperparathyroidism. Nonenhanced head CT:No detectable acute intracranial process.Diffuse foci of low-attenuation in the left hemisphere involving the cortex and subcortical white matter remains similar to prior brain MRI exam. In addition bilateral periventricular low attenuation of white matter grossly similar to prior study.No evidence of hemorrhage, mass effect, midline shift or hydrocephalus. CT however is insensitive for detection of acute nonhemorrhagic ischemic strokes.Unremarkable calvarium, paranasal sinuses and bilateral mastoid air cells/middle ear cavities.Unremarkable limited images through the orbits. There is absence of the left lens as was noted on prior brain MRI and may represent result of prior cataract surgery. | No acute intracranial findings. Stable exam since prior MRI study from April of 2013. A |
Generate impression based on findings. | Clinical question: Evaluate for subarachnoid hemorrhage. Signs and symptoms: Status post fall; aneurysm. Nonenhanced head CT:No detectable acute posttraumatic intracranial or calvarial findings.There is evidence of posttraumatic subgaleal hemorrhage and edema in the left posterior parietal high complexity.Small focus of parenchymal hyper attenuation demonstrate no convincing change since prior exam. It measures approximately 5.5 mm and likely represent a small focus of hemorrhage. No associated surrounding edema or any mass effect.Unremarkable images of the intracranial space otherwise.Unremarkable visualized paranasal sinuses, mastoid air cells, middle ear cavities and bilateral orbits. | 1.No acute posttraumatic intracranial or calvarial findings.2.Left parietal subgaleal hemorrhage and edema.3.Stable small focus of left posterior parietal parenchymal hemorrhage since prior exam.4.Unremarkable intracranial contents otherwise. |
Generate impression based on findings. | Clinical question: Bleed. Signs and symptoms: Headache and paresthesia. Nonenhanced head CT:There is no detectable acute intracranial process. CT is insensitive for detection of acute nonhemorrhagic ischemic stroke.Unremarkable cerebral cortex, cortical sulci and ventricular system.There is a slight prominence of cerebellar/vermis and folia for patient stated age of 33. Correlate with patient's history and risk factors.Calvarium demonstrate a stable focus of calvarial thickening and sclerotic changes of the left squamosal portion of temporal bone suggestive of fibrous dysplasia. This finding remains is stable since prior study.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells. | 1.Negative exam for acute intracranial or calvarial findings. 2.Fibrous dysplasia of the left squamous portion of temporal bone similar to prior exam from 2008. |
Generate impression based on findings. | Clinical question: Is there any evidence of CVA? Signs and symptoms cord left facial heavy sensation. Nonenhanced head CT:No detectable acute intracranial process. CT however is insensitive for detection of acute nonhemorrhagic ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation.Unremarkable calvarium and soft tissues of the scalp.Unremarkable mastoid air cells, middle ear cavities and all paranasal sinuses.Unremarkable orbits. | Negative nonenhanced head CT. |
Generate impression based on findings. | 54-year-old male with hypertension and blood loss This study is limited due to lack of IV contrastCHEST:LUNGS AND PLEURA: Bilateral pleural effusions and dependent atelectasis. The atelectasis has increased compared to previous study. Tracheostomy tube is in place. There are secretions and mucus in the right main bronchus and into trachea. Bronchiectasis and scarring in both lung bases, more prominent in the right side compared to the left.MEDIASTINUM AND HILA: Interval development of significant hemopericardium measuring up to thickness of 4.2 cm around the left ventricle. Both ventricles have tubular shape consistent with constrictive pericarditis physiology. Small amount of air in the pericardium may be secondary to patient's recent cardiac biopsy.CHEST WALL: No significant abnormality notedABDOMEN:Lack of IV contrast severely limits evaluation of the abdominal organs.LIVER, BILIARY TRACT: Chronic liver disease morphology name secondary to heart disease.SPLEEN: No significant abnormality notedPANCREAS: Coarse calcifications throughout the pancreas consistent with chronic pancreatitis.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: High density cyst in the upper pole of the left kidney is unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mild distention of the small bowel loops may be secondary to ileus. Significant amount of ascites. Left lower quadrant ostomy.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: Significant no ascites.BONES, SOFT TISSUES: Generalized anasarca.OTHER: Right lower quadrant renal transplant. | Interval development of significant hemopericardium causing constrictive physiology.Generalized anasarca. Bilateral pleural effusions and ascites.Bilateral dependent atelectasis. Superimposed infection cannot be excluded.Extensive atherosclerotic disease. CT findings suggestive of chronic liver disease.Chronic pancreatitis.Right renal transplant kidney.Mild ileus. |
Generate impression based on findings. | 60 year-old female with elevated d-dimer, shortness of breath and chest pain PULMONARY ARTERIES: Technically adequate study without evidence of pulmonary embolus.LUNGS AND PLEURA: Extensive right upper lobe and perihilar consolidation. No pleural effusions. The left lung is clear.MEDIASTINUM AND HILA: Scattered atherosclerotic calcifications of the aortic arch. Mediastinal lymphadenopathyCHEST WALL: Dense retroareolar tissue is only partially visualized, correlate with mammogram. Prominent bilateral hilar lymph nodes.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Replaced left hepatic. | 1. Technically adequate study without evidence of pulmonary embolus.2. Extensive right upper lobe consolidation suspicious for infection although a central obstructing lesion cannot be excluded and follow up imaging to document resolution is recommended. |
Generate impression based on findings. | 78 year-old female with tachycardia and hypotension, evaluate for PE. Exam was terminated following failure of the patient's IV.PULMONARY ARTERIES: Technically inadequate study without opacification of the pulmonary arteries.LUNGS AND PLEURA: Right pleural effusion.MEDIASTINUM AND HILA: Atherosclerotic changes of the thoracic aorta. Dilated esophagus. Prior granulomatous disease. Main pulmonary is dilated suggesting pulmonary arterial hypertension.CHEST WALL: No significant abnormality noted. | Technically inadequate study terminated following the timing bolus due to failure of the patient's IV. Dilated esophagus and right pleural effusion are noted. |
Generate impression based on findings. | Female 63 years old; Reason: ?Metastatic disease History: R leg pain x 5 days. No acute fracture or dislocation. Small focal areas of increased density are seen in the distal femoral diaphysis which may be due to red marrow reconversion. Metastasis is considered less likely since thyroid would more likely be lytic. The cortex is preserved. No soft tissue lesions or fluid collections. | Small areas of increased density within the intramedullary component of the distal femoral diaphysis which may be due to red marrow reconversion. Metastasis is considered unlikely and bone scanning may be helpful. |
Generate impression based on findings. | Female 65 years old; Reason: evaluate fracture pattern History: L distal femur fracture Comminuted distal femur fractures seen. The fracture extends into the lateral femoral condyle and into the knee joint at the lateral intercondylar notch. There is mild posterior medial displacement by 1 shaft width and anterior angulation of the largest distal fracture fragment. Small scattered chip fragments are noted immediately adjacent area. There is associated soft tissue swelling. Degenerative changes are noted in the medial tibiofemoral compartment with bone-on-bone apposition. | Comminuted distal femur fracture with mild posterior medial displacement and anterior angulation of the largest distal fracture fragment. |
Generate impression based on findings. | 59-year-old female with left upper quadrant abdominal pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left renal focal scarring in the upper pole and lower pole. Right upper pole focal scarring.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Bilateral focal renal scarring. |
Generate impression based on findings. | 70-year-old male with cough and productive sputum LUNGS AND PLEURA: Calcified nodules compatible with prior granulomatous disease. Right apical scarring. No evidence of infection.MEDIASTINUM AND HILA: Cardiomegaly. Moderate atherosclerotic calcifications of the aortic arch and coronary arteries with coronary stents noted. Scattered mediastinal and hilar lymph nodes, some of which are calcified, compatible with prior granulomatous disease.CHEST WALL: Sternal wires. Mild degenerative changes of the thoracic lumbar spine. UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Cholelithiasis without evidence of cholecystitis. Renal cortical scarring. | No evidence of pneumonia. |
Generate impression based on findings. | History of pancreatic cancer CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Multiple hepatic cysts are unchanged.SPLEEN: No significant abnormality notedPANCREAS: Postsurgical changes, secondary to Whipple surgery. Pancreatic calcifications in the residual pancreas with prominent irregular duct consistent with chronic pancreatitis. No evidence of recurrence or metastatic disease.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Borderline enlarged mesenteric lymph nodes are unchanged.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Focal lesion in the left peripheral zone is again noted. Correlation with prostate MRI is recommended.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No CT evidence of recurrent or metastatic disease. |
Generate impression based on findings. | 50 year-old female with history of breast cancer CHEST:LUNGS AND PLEURA: Interval increase in the size and number of pleural based and parenchymal lung lesions suspicious for metastatic disease. An index right middle lobe lung nodule measures one .two by 1.1-cm image number 41, series number 4. This lesion was measuring 6-mm in diameter image number 24, series number 3.In addition there is diffuse and is nodular thickening of the right-sided pleura, more prominent compared to previous study.MEDIASTINUM AND HILA: Mediastinal and hilar adenopathy. Right retrocrural adenopathy. All of these lesions have increased in size compared to previous study. Right retrocrural adenopathy now measures 2.5 by 1.8-cm on image number 72, series number 3. It was previously measuring 1.6 x 1.1 cm on image number 42, series number 3.CHEST WALL: Interval increase in the size of the left anterior rib metastases. Lytic lesions involving the upper thoracic vertebra and right humerus have also increased in size.ABDOMEN:LIVER, BILIARY TRACT: Interval increase in the size of the left lobe metastatic lesion. The lesion now measures 2.1 x 1.7 cm on image number 88, series number 3. Previously, it was measuring 1.3 x 1.1 cm image number 51, series number 3. Additional, new, subtle small lesions in the right lobe liver suspicious for metastatic disease.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Right adrenal presumed adenoma is unchanged.KIDNEYS, URETERS: Bilateral punctate stones without hydronephrosis, unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Extensive pericardial nodules consistent with carcinomatosis are more prominent compared to the previous study.BONES, SOFT TISSUES: Lytic lesions involving the lumber vertebral bodies, most prominent in the L1 vertebral body and increased in size within the internal.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Left inguinal adenopathy is increased in size. Index left inguinal node now measures 1.5-cm in diameter on image number 187, series number 3. Previously, the same node was measuring 1 cm in diameter.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Large, destructive bone metastases involving bilateral pelvic bones,, sacrum and increased in size compared to previous study.OTHER: No significant abnormality noted. | Interval progression of disease with interval increase in the size and number of lung and liver lesions and interval worsening of peritoneal carcinomatosis and extensive bone metastases as described above. |
Generate impression based on findings. | 76 year-old male with head and neck cancer, evaluate for lung lesions LUNGS AND PLEURA: Moderate centrilobular emphysema. Mild basilar scarring.MEDIASTINUM AND HILA: Scattered small subcentimeter mediastinal lymph nodes. Moderate atherosclerotic calcifications of the aortic arch and coronary arteries.CHEST WALL: Age indeterminate T12 and T8 vertebral body compression fractures.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Postsurgical changes of the upper abdomen without acute abnormality identified. Enteric tube extends to the stomach. | 1. No evidence of metastatic disease.2. Age indeterminate T12 and T8 vertebral body compression fractures.3. Moderate centrilobular emphysema. |
Generate impression based on findings. | 63-year-old male with history of chronic pancreatitis ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Mild fat stranding around the pancreatic head can be compatible with mild focal pancreatitis involving the pancreatic head.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | CT findings compatible with mild focal pancreatitis involving the pancreatic head. |
Generate impression based on findings. | 63-year-old female with history of metastatic thyroid cancer presenting with new right thigh pain PELVIS:UTERUS, ADNEXA: There is an ill-defined hypodensity in the uterus. This may represent a fibroid, however, further evaluation with pelvic ultrasound is recommended.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 | Pelvic ultrasound is recommended for further evaluation of the uterus. No CT findings in the right thigh to explain patient's pain. |
Generate impression based on findings. | 34-year-old female with possible bleeding around the right kidney This study is limited due to lack of IV contrastABDOMEN: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: Patient's known indeterminate right renal mass is again noted in the right mid kidney measuring 2.5 by 1.6-cm image number 15, series number 3, not significantly changed from previous study.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mild wall thickening associated with diverticulosis and pericolic fat stranding involving the proximal ascending colon consistent with acute diverticulitis. No evidence of peridiverticular abscess.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Right sided acute diverticulitis without peridiverticular abscess.Patient's known indeterminate right adrenal mass is unchanged. |
Generate impression based on findings. | 37 year-old female with right-sided flank pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No CT findings to explain patient's right-sided flank pain. No evidence of nephrolithiasis. |
Generate impression based on findings. | 66-year-old male with history of left lower quadrant pain ABDOMEN:LUNG BASES: Dissection involving the distal descending aorta.LIVER, BILIARY TRACT: Multiple hypodense lesions in the liver likely representing a combination of cysts and hemangiomas.SPLEEN: Hypodense benign splenic lesion is unchanged.PANCREAS: No significant abnormality notedADRENAL GLANDS: Nodular left adrenal gland is unchanged.KIDNEYS, URETERS: Scarring and multiple new wedge-shaped hypodense lesions in the left kidney are incompletely evaluated due to single phase CT. these likely present small infarcts, however, further evaluation with renal mass protocol CT is recommended.RETROPERITONEUM, LYMPH NODES: The dissection extends from distal descending thoracic aorta and its superior extent is incompletely imaged. Inferiorly the dissection extends into the aortic bifurcation and down into the left common iliac artery, left internal and left external iliac arteries and left common femoral artery. The dissection also extends to the origin of the SMA and right renal artery.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Dissection involving the distal descending thoracic aorta extending all the way down to left common femoral artery as described above.Benign appearing lesions within the liver, spleen and adrenal gland are unchanged.New focal lesions in the left kidney likely represent infarcts, however, further evaluation with a dedicated renal mass protocol CT is recommended. |
Generate impression based on findings. | 66 year old female, evaluate for renal vein thrombosis ABDOMEN:LUNG BASES: Unremarkable.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Again noted several millimeter stone in the right proximal ureter causing moderate right-sided hydronephrosis. Interval development of delayed nephrogram on the right side associated with perinephric fat stranding.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | CT findings suggestive of an obstructing stone in the right proximal ureter. |
Generate impression based on findings. | 40 year-old male with HCC, evaluate for SVC syndrome, concern for varices on EGD. LUNGS AND PLEURA: Left lower lobe consolidation/atelectasis. Bilateral small pleural effusions. Right basilar scarring/atelectasis.MEDIASTINUM AND HILA: Patent vasculature without narrowing, dilatation, or evidence of SVC syndrome.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Stable appearing right inferior hepatic lesion. | 1. Patent central vasculature without evidence of SVC syndrome.2. Left lower lobe consolidation suspicious for infection or aspiration. |
Generate impression based on findings. | 60 year-old male with base of tongue cancer, reevaluate. CHEST:LUNGS AND PLEURA: Scattered nonspecific pulmonary nodules. No suspicious pulmonary nodules.MEDIASTINUM AND HILA: Right port catheter tip at the SVC/atrial junction. Hypodense right thyroid nodule.CHEST WALL: Mild degenerative changes of the thoracolumbar spine.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Mild degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality noted. | No evidence of metastatic disease. |
Generate impression based on findings. | Distal femur fracture A comminuted intra-articular fracture of the distal right femoral diaphysis extending into the metaphysis and epiphysis is identified. Fracture fragment is impacted and significant for extension into the intercondylar notch, allowing the lateral femoral condyles to angulate mildly laterally. The distal femur is otherwise angulated posteriorly and only minimally displaced laterally less than one third of a bone width; however the larger distal diaphyseal fragment is displaced posteriorly. Surrounding moderate soft tissue swelling and suspected hematoma.Superimposed moderate to near severe degenerative osteoarthritic changes of the knee, greater in the lateral compartment. More moderate osteoarthritic changes of the hip are observed proximally.No gross lower pelvic abdomen abnormality is observed in this partial view. | Extensive impacted and angulated comminuted distal femoral fracture with extension to the articular surface and intercondylar notch. Fracture fragments are as described. |
Generate impression based on findings. | 76-year-old male with massive hemoptysis LUNGS AND PLEURA: Severe centrilobular emphysema. Complete filling of the right bronchus extending from the carina to the right lower lobe with debris, which may represent hemorrhage. Bilateral lower lobe masses and left lower lobe consolidation are again noted. Calcified pleural plaques are reidentified. Resolution of right pleural effusion.MEDIASTINUM AND HILA: Mediastinal and hilar adenopathy appears similar to prior study. Enteric tube courses to the stomach. And atherosclerotic changes of the aorta and coronary vessels and left coronary artery stent. ET tube tip approximately 4 cm above the carina. CHEST WALL: Sternal wires. No axillary adenopathy.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Left adrenal mass and presumed hepatic metastases are partially visualized. | 1. Complete filling of the right bronchus extending from the carina to the right lower lobe with debris, which may represent hemorrhage. 2. Bilateral large lower lobe masses and left lower lobe consolidation and hepatic and adrenal metastases appear similar to the prior study.3. Resolution of right pleural effusion. |
Generate impression based on findings. | 86-year-old female, follow up right lower lobe and hilar nodules. CHEST:LUNGS AND PLEURA: Post surgical change and volume loss in the left lung. Mild centrilobular emphysema. Right lower lobe nodule measures 1.4 x 0.7 cm (image 65, series 5), suspicious for primary carcinoma. Additional nonspecific scattered micronodules are noted.MEDIASTINUM AND HILA: Extensive atherosclerotic calcification of the coronary arteries. Scattered prominent mediastinal lymph nodes are again noted.CHEST WALL: Extensive infiltration of the left axilla extending along the chest wall and above the clavicle has progressed from the prior exam. The left subclavian artery is attenuated. Edema of the left breast and visualized upper extremity has progressed as well.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: Small left renal cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. 1.4-cm right right lower lobe nodule suspicious for primary carcinoma, especially when correlated with recent PET/CT.2. Marked soft tissue infiltration extending along the left chest wall has progressed from the prior exam and is suspicious for confluent tumor or possibly infection. Correlation with contrast enhanced MRI is recommended.. |
Generate impression based on findings. | 56-year-old female with history of pneumonia versus vasculitis LUNGS AND PLEURA: Extensive groundglass opacity asymmetrically distributed throughout both lungs, more prominent on the right. Scattered patchy groundglass opacities particularly in the right middle lobe have progressed from the prior study. Multiple small cysts are noted on a background of centrilobular emphysema. Basilar honeycombing and traction bronchiectasis is unchanged. Subpleural nodules are not significantly changed.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy. Moderate coronary arterial calcification.CHEST WALL: Chronic left lateral sixth rib fracture. Lower thoracic spine degenerative changes.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Status post cholecystectomy. Surgical clips are again noted about the stomach. | 1. Extensive bilateral groundglass opacities and small cysts with interval progression of groundglass opacities, particularly in the right middle lobe. The differential diagnosis includes atypical infection(pneumocystis), vasculitis with associated hemorrhage, mixed connective tissue disease, and DIP.2. Stable basilar fibrosis and centrilobular emphysema. |
Generate impression based on findings. | Possible acute cerebrovascular occlusive disease patient with new onset of left-sided numbness and subtle gait instability some suspicious for vertebrobasilar thromboembolic event status post stent-assisted aneurysm coiling Neck CTA: There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.There are degenerative changes present in the cervical spine with loss of disk space height, endplate and uncovertebral osteophytes present at C5-6 and C6-7 where there is neural foraminal encroachment bilaterally. This is a stable when compared to the prior exam.Brain CTA: The patient status post right internal carotid artery aneurysm clipping and stent assisted basilar artery coiling. The presence of the stent and the aneurysm coils obscures the distal basilar artery and the proximal posterior cerebral arteries. Based on the MRA examination these vessels are patent.There is opacification of the distal internal carotid arteries, the distal vertebral arteries and the proximal anterior middle and posterior cerebral arteries. No aneurysms or intracranial stenosis is appreciated.The anterior communicating artery and the posterior communicating arteries are identified and are tiny but intact.CT head:The CSF spaces are appropriate for the patient's stated age with no midline shift. The multiple punctate foci diffusion restriction identified on the recent MRI of the brain are for the most part not visible on this exam with the exception of a small left cerebellar lesion measuring 9 x 7 mm in the right cerebellar lesion measuring 7 mm. The small punctate lesions representing embolic shower are best seen on the recent MRI of the brain there is no evidence for hemorrhagic conversion.There is a significant amount of artifact associated with aneurysm coils in the basilar and posterior cerebral artery stents and a right internal carotid clip which obscures local structuresThere is redemonstration of a focus of encephalomalacia in the anterior-aspect of the right temporal lobe.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.No evidence for cerebrovascular occlusive disease in the neck.2.The intracranial vasculature is partially obscured by artifact. Based on combined assessment of the CTA and MRA, there does not appear to be any convincing evidence for a basilar artery or posterior cerebral artery occlusion. Of note, the posterior communicating arteries are relatively small suggesting that if there was a posterior cerebral artery occlusion or basilar artery occlusion a significant infarction along the posterior cerebral artery territories would be expected and this was not the case.3.small lesions are identified in the inferior aspects of the cortical portions of the cerebellar hemispheres compatible with acute infarctions. There were a number of punctate lesions identified on the MRI of the brain suggestive of embolic shower which are not readily visible on this exam which to a large degree is due to their punctate size. The mid brain is obscured by metal artifact.4.degenerative changes are present in the cervical spine5.status-post right-sided craniotomy for aneurysm clip placement6.status post stent-assisted coiling for basilar tip aneurysm7.encephalomalacia in the right anterior temporal lobe8.findings were discussed with Dr. Ardelt at the time the exam was performed |
Generate impression based on findings. | Male 59 years old Reason: metastatic spread? History: lung cancer CHEST:LUNGS AND PLEURA: Multifocal poorly marginated nodular opacities scattered throughout the left lower lobe lobe and several in the upper lobe. For baseline purposes the largest lesion which is located in the left lower lobe series 5 image 57/111 measures 2.6 x 1.8 cm. At least one of the nodules in the left upper lobe has some cavitation, image 47 there are a few small nodules also the suggestion of cavitation in the right lower lobe.There is a background mild paraseptal emphysema. No effusions. MEDIASTINUM AND HILA: Scattered mediastinal adenopathy right paratracheal, prevascular, AP window, subcarinal. A right paratracheal disease may represent necrotic node with associated fluid tracking along the vascular structures. For this reason baseline measurements provided the largest prevascular node series 4 image 36 measuring 2.9 x 1.8 cm.Small pericardial effusion.Left thyroid nodule 1.6 by 1cm. series 4 image 5.CHEST WALL: Clusters of small bilateral axillary nodes suspicious for metastatic disease.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Right adrenal nodule 2.2 x 1.3 cm series 4 image 85. This is nonspecific could represent an incidental adenoma or a metastatic focus. The left adrenal gland is normal.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications aorta with no evidence of aneurysm. No pathologic size nodes. Small shotty left periaortic nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Colonic diverticulosis. Small nonpathologic mesenteric nodes.BONES, SOFT TISSUES: No significant abnormality noted. No lytic or blastic disease.OTHER: Atherosclerotic calcifications, enlarged caliber iliac arteries with no evidence of focal aneurysm. | Multifocal lung masses and mediastinal adenopathy as described. Other findings as above. |
Generate impression based on findings. | Female 67 years old Reason: infectious source in pelvis/abd. History: elevated WBCs ABDOMEN:LUNG BASES: Atherosclerotic calcification coronary arteries. Implant right breast.LIVER, BILIARY TRACT: Status post cholecystectomy. No focal liver lesions. No evidence of vascular thrombus or biliary dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Redemonstration of multifocal scarring and decreased size left kidney. Bilateral renal cysts. Few punctate calcifications seen in the right kidney likely vascular in nature.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification diffusely comment no evidence of aneurysm. Heavy calcification at the origin of the right renal artery.BOWEL, MESENTERY: Questionable thickening of the right and transverse colon of uncertain significance. Colon is not well distended. Correlate clinically for any evidence of infectious colitis in addition to the radiation related changes described in the pelvis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: Fat stranding in the vulvar area. No evidence of abscess. Surgical clip in the cul-de-sac. Previously seen gas bubbles along the left pelvic sidewall abutting the bone of resolved.BLADDER: Foley catheter in place.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diffuse thickening rectum, rectosigmoid and sigmoid colon are all measuring about 5 to 6 mm in thickness circumferentially. Given history of radiation therapy this likely represents a combination of chronic and possibly subacute changes in the colon and rectum secondary to radiation. However, there is no evidence of pericolonic fluid, intramural air or free air.BONES, SOFT TISSUES: Interval improvement in appearance of decubitus ulcer in the right buttock. Soft tissue edema and fat stranding persists most prominently around the sacrum but no discrete measurable abscess. No discrete lytic foci in the bone.OTHER: No significant abnormality noted | Improvement in appearance of decubitus ulcer and resolution of gas bubbles along the left pelvic sidewall. Diffuse thickening rectum and sigmoid likely radiation colitis. Questionable thickening right and transverse colon correlate for infectious colitis. Other findings as above. No evidence of discrete abscess. |
Generate impression based on findings. | Clinical question: History of hypertension. Signs and symptoms: Headache with elevated blood pressure. Nonenhanced head CT:No detectable acute intracranial process. CT is insensitive for detection of acute nonhemorrhagic ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white differentiation.Calvarium, soft tissues of the scalp, paranasal sinuses and orbits are unremarkable. | Unremarkable nonenhanced head CT. |
Generate impression based on findings. | Clinical question: Evaluate for intracranial hemorrhage. Signs and symptoms: Fall, on anticoagulation. Nonenhanced head CT: No detectable acute intracranial process. CT however is insensitive for detection of acute nonhemorrhagic ischemic strokes.There is a focus of well demarcated low-attenuation in the right paramedian pons highly suspected of a chronic lacunar infarct.Additional foci of very well demarcated low-attenuation in bilateral basal ganglial as well is believed to represent chronic lacunar infarcts.Periventricular and subcortical low attenuation white matter consistent with age indeterminate small vessel ischemic strokes. There is also in addition a focus of encephalomalacia consistent with a chronic ischemic stroke in the left posterior frontal -- parietal region with associated adjacent widening of the cortical sulci.Unremarkable calvarium, soft tissues of the scalp, visualized orbits, paranasal sinuses and mastoid air cells. | 1.No acute intracranial process.2.Age indeterminate small vessel ischemic strokes and a chronic left MCA territory ischemic stroke as detailed. |
Generate impression based on findings. | Male 69 years old Reason: dissection History: aneurysm seen on osh CT. Additional history per emergency room etiology motor vehicle accident. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Minimal atherosclerotic calcifications aorta. Approximately 6 mm thick high density mural thrombus is seen involving the aortic arch and descending aorta commencing distal to the left subclavian artery. There is a bovine arch.On the arterial phase is good flow into the coronary arteries. The supravalvular aorta and descending aorta appear normal. Diameter of the supravalvular aorta 3.1-cm coronal image 31/79 series 80635.Left ventricular wall thickening. Descending aorta caliber in the mid descending aorta 4.2-cm of the enhancing lumen measuring 3-cm coronal image 56/79.CHEST WALL: No significant abnormality notedABDOMEN: The exam is not sensitive for detecting lesions in the solid organs due to the lack of oral contrast or portal venous phase. Given the limitations, the following observations made:LIVER, BILIARY TRACT: Cholelithiasis. No evidence of biliary dilatation or cholecystitis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Small multifocal lesions bilaterally likely renal cysts.RETROPERITONEUM, LYMPH NODES: The mural thrombus enlarges just below the diaphragm where there is a dissection seen involving the proximal abdominal aorta with a maximal dimension of approximately 4.6-cm is seen on coronal image 38/79. The dissection appears spiral in configuration with a the celiac artery being slightly attenuated near its origin supplied by the true lumen and the superior mesenteric artery supplied by the false lumen. There are 3 right renal arteries supplied by the true lumen. There is one left renal artery supplied by the true lumen.The false lumen spirals from the left side in the upper abdomen to the right side in the lower abdomen with the dissection continuing to the aortic bifurcation. The is superior mesenteric artery is tortuous and angulated and supplied by both the true and false lumen. I am uncertain if an intentional fenestration was placed in the superior mesenteric artery. See series 9 image 144. The inferior mesenteric artery is supplied by the left sided true lumen series 9 image 193.There is a small amount of mural thrombus involving the right common iliac artery. There may be a small focal flap in the proximal right common iliac artery seen on arterial coronal image 34/79. The caliber of the right common iliac artery is 1.3-CM on that same image. There is also some mural thrombus involving the left internal iliac artery. More extensive mural thrombus and calcification is seen in the left internal iliac artery. The remaining iliac arteries are of normal caliber without evidence of dissection.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 | High density mural thrombus involving the thoracic aorta distal to the left subclavian artery. Bovine arch.Fenestrated abdominal aortic dissection with details as described above. Possible fenestration in the superior mesenteric artery. Flow is seen in the major branches of the abdominal aorta.Other findings as described above. |
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 strokes.Extensive periventricular and subcortical low attenuation of white matter concerning for age indeterminate small muscle ischemic stroke. There is mild ex vacuo dilation of the lateral ventricles.Focus of encephalomalacia in the left posterior temporal -- occipital consistent with chronic ischemic stroke.Unremarkable calvarium and soft tissues of the scalp. Unremarkable orbits, paranasal sinuses and mastoid air cells. | 1.No acute intracranial process. 2.Moderate age indeterminate small vessel ischemic strokes and a chronic left posterior temporal -- occipital ischemic stroke as detailed. |
Generate impression based on findings. | 51 year-old male with history of hepatitis B virus. Evaluate for lesions. ABDOMEN:LUNG BASES: Bibasilar atelectasis.LIVER, BILIARY TRACT: Liver contour: The liver contour is nodular..there is no intrahepatic or extra hepatic biliary ductal dilatation. The gallbladder is normal. Portal vein: Patent Hepatic veins: Patent Hepatic artery: Normal anatomy and patentLesions: No contrast enhancing lesion demonstrated. No hyperdense nodules on precontrast images to suggest siderotic nodules. SPLEEN: SplenomegalyPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple subcentimeter left renal lesions, too small to characterize although likely cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Cirrhotic changes of the liver with mild hepatosplenomegaly but with no contrast enhancing masses or lesions. |
Generate impression based on findings. | Clinical question: Rule out infection; left face/neck. Signs and symptoms: Swelling, trauma. Nonenhanced maxillofacial CT:There is no detectable maxillofacial posttraumatic bony fractures of the maxillofacial region.All paranasal sinuses and bilateral mastoid air cells and middle acute cavities are well pneumatized and unremarkable.Unremarkable images through the orbits.Examination demonstrates soft tissue swelling and subcutaneous fat stranding overlapping the left zygomatic arch (no bony abnormality of the zygomatic arch in particular no fracture ) is noted. No convincing evidence of any fluid accumulation on this nonenhanced the study. Without intravenous contrast possibly to infection cannot be ruled out. The finding however can represent posttraumatic changes. Correlate with history and physical exam.Unremarkable mandible and including bilateral mandibular condyles.Unremarkable images through the nasopharynx, nasal passage and oropharynx/bilateral parapharyngeal soft tissues. | 1.No evidence of maxillofacial fracture.2.Subtle soft tissue edema and subcutaneous fat stranding overlapping in the left zygomatic arch as detailed. |
Generate impression based on findings. | Clinical question: Assess for hemorrhage. Signs and symptoms: Fall, uncoordinated. Nonenhanced head CT:No detectable acute intracranial process CT however is insensitive for detection of acute non-hemorrhagic ischemic strokes.Examination demonstrates extensive periventricular and subcortical low attenuation of white matter concerning for age indeterminant small vessel ischemic strokes. In addition a focus of encephalomalacia in the right anterior frontal lobe consistent with a chronic cortical stroke. Mild prominence of cerebellar and vermian folia is noted.Unremarkable calvarium and soft tissues of the scalp.Unremarkable orbits, paranasal sinuses and mastoid air cells. | 1.No acute intracranial process.2.Age indeterminate small vessel ischemic strokes and a chronic right frontal cortical stroke as detailed. |
Generate impression based on findings. | Clinical question: Status post craniotomy. Signs and symptoms: Status post craniotomy. Nonenhanced head CT:Postoperative changes of a wide suboccipital bunionectomy and cranioplasty is noted. Patchy foci of low attenuation in the right medial and posterior cerebellum with minimal internal foci of acute hemorrhage without significant change since prior exam is again noted.A cavitating high density mass or hemorrhage and containing multiple small surgical metallic fragments in the right middle cerebellar peduncle and inseparable from the fourth ventricle also remains similar to prior exam. Fairly extensive edema all mid brain and extending superiorly into the right thalamus remains nearly identical to prior exam as well. Since prior exam there is noticeable interval decreased postoperative pneumocephalus. No change in the position of right posterior temporal -- occipital approach ventricular catheter and with the tip of the catheter in the body of right lateral ventricle similar to prior exam. No evidence of ventriculomegaly. There is mild interval decreased size of left lateral ventricle.No detectable pneumothorax parenchymal edema or hemorrhage. Midline is maintained. | 1.No detectable acute new findings since prior exam.2.Stable extensive postoperative changes of posterior fossa and a small fluid in result hemorrhage and extensive residual edema and associated mass-effect remains fairly similar to prior study.3.Mild interval decreased size of left lateral ventricle and stable normal size of right lateral ventricle and right-sided ventricular catheter.4.Interval further absorption of postoperative pneumocephalus since prior study. |
Generate impression based on findings. | Clinical question: Status post craniotomy for posterior fossa hemorrhage. Signs and symptoms: Status post craniotomy. Nonenhanced head CT:Examination he demonstrate a large bilateral suboccipital craniectomy and postoperative cranioplasty despite placement of prostatic device. There is significant widening of the subarachnoid space posterior and medial to bilateral cerebellar hemispheres containing high density material consistent with serosanguineous fluid. The density of this widened space is new since prior exam and represent interval hemorrhage.There is significant interval increase in the focus of hemorrhage in the right cerebellum, right middle cerebellar peduncle and extending into the mid brain. This new hematoma measures approximately 39 x 31 mm in transaxial dimensions compared to prior study measurement of 10 x 11.5-mm.There is near complete effacement of the fourth ventricle with evidence of intraventricular hemorrhage. Minimal hemorrhage in the left cerebellum along the dorsal and medial aspect is also new since prior exam.There is also effacement of all CSF spaces in the posterior fossa. Images through supratentorial space demonstrate shunted lateral ventricles without change in the position of ventricular catheter tip in the right lateral ventricle. No appreciable change in the size of normal appearing ventricular system. | 1.Interval increased size of hemorrhage in the right cerebellum measuring up 31.5 x 39-mm on the current exam.2.Minimal new hemorrhage in the medial aspect of left cerebellum since prior exam.3.Serosanguineous density of widened subarachnoid space within the posterior fossa consistent with redistribution of blood into the subarachnoid space and evidence of hemorrhage in the fourth ventricle.4.Stable supratentorial shunted lateral ventricles without evidence of ventriculomegaly.5.Interval decreased post operative pneumocephalus since prior study. |
Generate impression based on findings. | Clinical question: Rule out bleed. Signs and symptoms: Headache. Nonenhanced head CT:Examination demonstrates a large focus of low-attenuation in the white matter of left posterior frontal -- parietal region with associated subtle mass effect and effacement of adjacent cortical sulci. Findings views are present in the tumoral edema of patient's previously known mass in outside hospital. The outside exams are not available for comparison and if are provided to the radiology department an addendum to this report will be submitted after review of exams.Ventricular system remain within normal size and midline is maintained.Diffuse patchy foci of periventricular and subcortical low attenuation are concerning for mild small vessel ischemic strokes.No evidence of intracranial hemorrhage.Unremarkable calvarium and soft tissues of the scalp.Unremarkable visualized orbits, paranasal sinuses and mastoid air cells. | 1.No acute intracranial process CT however is insensitive for detection of acute non-hemorrhagic ischemic strokes.2.Focus low attenuation in the left hemispheric white matter representing tumor and peritumoral edema of patient's known mass from an outside study.3.Normal-size ventricular system and maintained midline.4.Age indeterminate mild small vessel ischemic strokes. |
Generate impression based on findings. | Female 23 years old; Reason: right staghorn calculus History: right staghorn calculus Evaluation is slightly limited by streak artifact from spinal fusion instrumentation. The absence of intravenous and oral contrast limits evaluation of the solid organs and of the bowels. Given these limitations, the following observations were made:ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: A 3.1 x 2.0 cm, staghorn calculus is seen in the right renal pelvis. No hydronephrosis seen.No stranding in the perirenal fat is noted.No ureteral stone, or ureteritis is noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Right thoracolumbar curve is present. Posterior spinal fusion instrumentation is identified. The right femur is abducted and the left is adducted.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: The bladder is compressed by the rectum distended with stool.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: The rectum is distended and there is a marked amount of stool in the rectum. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Large stone in the right renal pelvis without hydronephrosis or perinephric stranding. The lack of IV contrast limits evaluation of the renal parenchyma, and infection (Xantho Granulomatous Pyelonephritis) cannot entirely be excluded.2. Marked scoliotic changes with spinal fusion rods and retained stool compatible with neurogenic constipation.3. Cholelithiasis. |
Generate impression based on findings. | Clinical question: Acute subdural follow. Signs and symptoms: Dysphagia. Nonenhanced head CT:Examination demonstrate a left holohemispheric acute subdural collection. Subdural along the left falx measures approximately 8.8 mm in its thickest portion not significantly changed since prior exam.A smaller component of hemispheric subdural on the left in the left posterior temporal -- parietal region measures approximately 9 mm without significant change since prior exam. Subtemporal component of subdural measures a 14.5 mm size without convincing areas of interval change since prior exam. Subdural in the left posterior temporal measures approximately 6 mm unchanged since prior exam. The smallest component of subdural is in the left anterior frontal and measuring approximately 3.3 mm unchanged since prior study. There is near complete effacement of left hemispheric cortical sulci and partial effacement of left sylvian fissure and mass effect on the left lateral ventricle and with resultant mild midline shift to the right of approximately 4.5 mm without significant change since prior exam.There is redemonstration of a small amount of hemorrhage in the fourth ventricle and in the left cerebellopontine angle cistern inferiorly. | 1.Stable left holohemispheric acute subdural collection in its overall mass effect and midline shift to the right of approximately 4.5 mm. the largest component of subdural is in the sup temporal region and along the left side of falx.2.Stable size of ventricular system. |
Generate impression based on findings. | Clinical question: Acute subdural hematoma follow. signs and symptoms: Dysphasia. Nonenhanced head CT:Examination dose rate a left holohemispheric acute subdural. In high convexity left parietal subdural along the left side of falx measures at 10.2 mm sized. Subdural has a large component in the sup temporal region with maximum measurement of 12.6-mm.The subdural in the left posterior temporoparietal region measures approximately 8mm. The subdural in the left anterior frontal measures approximately 3 mm.There is generalized effacement of cortical sulci of the left hemisphere, subtle mass effect on the left lateral ventricle and midline shift to the right of approximately 5.5 to 6-mm. No evidence of hydrocephalus.No evidence of parenchymal hemorrhage or edema.Unremarkable calvarial, soft tissues of the scalp, all paranasal sinuses and bilateral mastoid air cells and middle ear cavities which are well pneumatized. | Acute left-sided holohemispheric subdural with resultant effacement of left hemispheric cortical sulci and approximately 6 mm midline shift to the right. No prior exams for comparison. |
Generate impression based on findings. | Male 46 years old; Reason: pre-transplant imaging History: pre-renal-transplant ABDOMEN: The absence of intravenous and oral contrast limits evaluation of the solid organs and of the bowels. Given these limitations, the following observations were made:LUNGS BASES: No significant abnormality noted. Bibasilar atelectasis noted in the lung bases.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: The native kidneys are atrophic, compatible with end-stage renal disease.RETROPERITONEUM, LYMPH NODES: There is no significant calcification noted in the abdominal aorta or common iliac vessels. Approximately 180 degrees medial opacification of the right internal iliac artery. The right external, and left internal and external iliac arteries demonstrate no significant calcification.BOWEL, MESENTERY: Diverticulosis without diverticulitis.BONES, SOFT TISSUES: Degenerative disease noted throughout the spineOTHER: Peritoneal dialysis catheter is noted in the left hemiabdomen. Moderate ascites.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diverticulosis without diverticulitis.BONES, SOFT TISSUES: Degenerative disease noted throughout the spine.OTHER: Bilateral inguinal hernias, with the right containing fluid, left containing fat. | 1.Changes compatible with end-stage renal disease and peritoneal dialysis, without significant arterial calcification as described above. |
Generate impression based on findings. | Female 75 years old Reason: infection History: vomiting The exam is not sensitive for detecting lesions in the solid organs, or vasculature due to lack of intravenous contrast. Given note is that limitation, the following observations are made onABDOMEN:LUNG BASES: Basilar atelectasis. Atherosclerotic calcifications and aortic root and descending thoracic aorta.LIVER, BILIARY TRACT: No significant abnormality noted. No evidence of fatty liver.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Both adrenal glands appear thickened and there is likely a left adrenal nodule 2 x 1.6 cm, measuring 20 Hounsfield units in density. This is nonspecific and does not meet low density criteria for diagnosis of adenoma.KIDNEYS, URETERS: Numerous large and small hypodense lesions throughout both kidneys. Probable renal cysts.RETROPERITONEUM, LYMPH NODES: Severe tortuosity of the aorta correlate for hypertension. No evidence of aneurysm. Caval filter. Small shotty retroperitoneal nodes not pathologic in size.BOWEL, MESENTERY: Severe extensive colonic diverticulosis right and left sided. No evidence of diverticulitis. No free or loculated intraperitoneal fluid. No evidence for obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: Atrophic or surgically absent.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Severe extensive colonic diverticulosis right and left sided. No evidence of diverticulitis. No free or loculated intraperitoneal fluid. No evidence for obstruction. Lipoma cecum, series 2 image 91 without evidence of intussusception or obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Atherosclerotic calcifications no evidence of aneurysm. | No acute findings to explain vomiting. Severe colonic diverticulosis. Adrenal thickening of the left adrenal nodule, nonspecific. Incidental colonic lipoma |
Generate impression based on findings. | 18 year old female, chest pain, wheezing, rule out pulmonary embolus. PULMONARY ARTERIES: The quality of this examination is adequate for the evaluation of pulmonary embolism to the segmental level. No pulmonary embolus is present.LUNGS AND PLEURA: Mild bronchial wall thickening. No focal lung consolidation. No pleural effusion.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. No mediastinal or hilar lymphadenopathy.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 PE.2.Mild bronchial wall thickening. |
Generate impression based on findings. | 58-year-old male with hypoxia, tachycardia, dyspnea. Evaluate for PE. PULMONARY ARTERIES: Multiple small segmental and subsegmental pulmonary artery emboli are seen involving the left upper, and left lower lobe branches. The main pulmonary artery is mildly enlarged, compatible with pulmonary artery hypertension.LUNGS AND PLEURA: Small right pneumothorax measures 23 mm, previously 11 mm (image 43 series 9), of uncertain significance.Redemonstration of extensive necrotizing right upper lobe consolidation, and right middle lobe atelectasis with obstruction of the bronchus intermedius appearing similar to prior exam. Nodular opacities in the right lung are again present, suggestive of infection. Necrotic perihilar mass (series 8 image 184) and left upper lobe pulmonary nodule are unchanged (image 49, series 9). Persistent mild tracheal narrowing.Moderate centrilobular and paraseptal emphysema.MEDIASTINUM AND HILA: Esophageal wall thickening and edema is unchanged. Mildly enlarged mediastinal, and right hilar lymph nodes, most likely reactive in etiology are unchanged. Right inferior pulmonary vein is again occluded by tumor. Small retrocrural lymph nodes are again present. Heart size is mildly enlarged.CHEST WALL: Old left rib fractures are again noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.Multiple small segmental and subsegmental pulmonary emboli on the left as detailed above.2.Right upper lobe necrotizing consolidation in multifocal airspace opacities, which remain suspicious for pneumonia, tumor considered less likely, appearing similar to prior exam.3.Left upper lobe nodule and right perihilar necrotic mass, unchanged.4.Small right pneumothorax, slightly increased in size.Findings discussed with Dr. Jelinek via phone at 9 a.m. on 10/20/13. |
Generate impression based on findings. | Clinical question: Stroke. Signs and symptoms: Stroke. Nonenhanced head CT:No detectable acute intracranial hemorrhage, mass effect, midline shift or hydrocephalus. CT however is insensitive for detection of acute nonhemorrhagic ischemic strokes.There are extensive periventricular and subcortical low attenuation white matter as well as mild ex vacuo dilatation of lateral ventricles concerning for extensive age indeterminate small was ischemic strokes.Images through posterior fossa demonstrate a small chronic left pica territory ischemic stroke. No detectable cerebral hemispheric chronic ischemic stroke.Unremarkable calvarium and soft tissues of the scalp.Unremarkable orbits.Unremarkable paranasal sinuses.Brain CTA:Widely patent dominant left vertebral artery and a smaller nondominant patent right vertebral artery.Patent basilar artery, superior cerebellar arteries and bilateral posterior cerebral arteries. Mild atherosclerotic disease of bilateral posterior cerebral zone noted.Patent bilateral internal carotid arteries across the skull base and in their supraclinoid segments.Patent bilateral middle cerebral arteries and anterior cerebral. There is anatomical variation of mildly hypoplastic right A1 and resultant slightly larger left A1 segment of anterior cerebral artery.Unremarkable anterior communicating artery. Unremarkable images at the level of MCA bifurcations. | 1.Nonenhanced head CT demonstrates extensive age indeterminate small vessel ischemic stroke and a small chronic left pica territory stroke. Mild ex vacuo dilatation of lateral ventricles. No acute intracranial hemorrhage, mass-effect or midline shift or hydrocephalus.2.Unremarkable CTA of intracranial circulation with the exception of mild atherosclerotic disease without evidence of any foci of significant vascular lumen compromise or occlusion. |
Generate impression based on findings. | Female 83 years old Reason: eval for intraabd process History: LLQ pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Granuloma posterior aspect liver unchanged. No definite focal lesions. Perihepatic fluid consistent with a small amount of ascites.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Redemonstration of mild perinephric fat stranding bilaterally, small left kidney. High density left upper pole renal cysts another nonspecific hypodensities likely cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Increasing soft tissue and fat stranding involving the right lateral abdominal level and possibly the posterior pararenal space concerning for retroperitoneal or sub-peritoneal loculated fluid or hematoma.Atherosclerotic calcifications no discrete aneurysm. No pathologic size nodes.BOWEL, MESENTERY: No colonic opacification. No evidence of obstruction. Colonic diverticulosis Small amount of fat stranding and free intraperitoneal fluid.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: Atrophic or surgically absent.BLADDER: Foley catheter in place.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Unopacified loops of small bowel in the pelvis. Unopacified: The diverticulosis.Large high density collection seen along the left pelvic sidewall and anteriorly underneath the right and left rectus muscles could represent hematoma or a combination of hematoma and unopacified bowel. It should be clarified with follow-up CT pelvis with good bowel opacification. Correlate for signs of bleeding. These findings were related to Dr. Kallepalli at about 12:30pm by the ROC and documented in Stat consult at 3:40am as a change from the initial reading.BONES, SOFT TISSUES: Left hip surgical appliance.OTHER: No significant abnormality noted | Large high density collection seen along the left pelvic sidewall and anteriorly underneath the right and left rectus muscles could represent hematoma or a combination of hematoma and unopacified bowel. It should be clarified with follow-up CT pelvis with good bowel opacification. Correlate for signs of bleeding. These findings were related to Dr. Kallepalli at about 12:30pm by the ROC and documented in Stat consult at 3:40am as a change from the initial reading.Other findings as above. |
Generate impression based on findings. | Female 52 years old; Reason: pt is s/p 2 cycles chemotherapy please assess response to therapy and compare to previous imaging History: met melanoma CHEST:LUNGS AND PLEURA: Again noted are multiple pulmonary masses, which are slightly smaller in size since the prior exam. The index mass in the right lower lobe now measures 1.9 x 1.7 cm (series 3 image 46) previously 2.3 x 2.4 cm. Non-reference lesions are stable in size and morphology.MEDIASTINUM AND HILA: Mediastinal lymphadenopathy is again noted and appears slightly smaller in size, with the reference subcarinal lymph node measuring 2.8 x 2.0 cm (series 3 image 45) previously 2.4 x 3.1 cm. The right hilar and non-reference lesions are also stable.CHEST WALL: Left axillary clips are stable. No new axillary lymphadenopathy noted..Multiple subcutaneous nodules are seen in the soft tissues of the shoulder and back. The nodules appear approximately stable in size and number.ABDOMEN:LIVER, BILIARY TRACT: There is no evidence of intrahepatic biliary ductal dilatation or focal mass lesion. Hepatic vasculature appears patent and there is evidence of cholelithiasis without evidence of choledocholithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS:No significant abnormality noted. KIDNEYS, URETERS: There is no evidence of hydronephrosis or hydroureter.RETROPERITONEUM, LYMPH NODES: Subcentimeter retroperitoneal lymph nodes are again noted and appear unchanged in size, not enlarged by CT criteria. No significant abnormality noted.BOWEL, MESENTERY: Mesenteric lymphadenopathy is again noted, with the reference lesion now measuring 1.1 x 0.5 cm (image 127, series 11), previously the same.BONES, SOFT TISSUES: Multiple subcutaneous nodules are again seen, without significant interval change in size. The previously measured index node nodule now measures 0.6 cm (series 3 image 69) previously 0.7 cm.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: The previously demonstrated pelvic subcutaneous soft tissue nodule has slightly decreased in size since the previous examination, and now measures 1.6 x 1.3 cm (series 3 image 172) previously 1.8 x 1.6 cm.OTHER: No significant abnormality noted. | 1.Stable to slightly smaller appearing lung masses, compatible with metastatic disease.2.Stable to slightly smaller mediastinal and mesenteric adenopathy.3.Numerous subcutaneous nodules, with interval decrease in size of the reference pelvic nodule.4.Cholelithiasis. |
Generate impression based on findings. | Female 65 years old Reason: pelvic abscess, head thrombus? History: AMS, increased WBCs"Diagnosis: Backache, unspecified Hypoxemia Bacteremia Malignant neoplasm of corpus uteri, except isthmus Tachycardia, unspecified Shortness of breath Backache, unspecified Hypoxemia Bacteremia Malignant neoplasm of corpus uteri, except isthmus Tachycardia, unspecified Shortness of breath" CHEST:LUNGS AND PLEURA: Diffuse upper lobe predominant ground glass opacities with scattered areas of consolidation, bilateral but right greater than left which are new since the previous chest CT of 9/17/13. One of the left upper lobe nodular densities may have some central cavitation series 6 image 20. For baseline purposes this lesion measures approximately 2.1 x 2.7 cm. Differential diagnosis includes infection, drug reaction. Some of the nodular densities could also represent metastatic disease.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: Scattered retroperitoneal nodes are demonstrated. Index left para-aortic node, series 4 image 107 measures 1.9 x 1.3 cm. Previously 2.2 x 1.7 cm.BOWEL, MESENTERY: Marked decrease in previously seen ascites. Small amount of ascites process. Index focus of carcinomatosis in the right abdominal wall is remeasured on series 4 image 125, 9.5 x 4.7 cm. Previously 13.9 x 6.7 cm.BONES, SOFT TISSUES: Anasarca.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Large bilateral adnexal masses are demonstrated.BLADDER: No significant abnormality noted.LYMPH NODES: Index left external iliac node series 4 image 161 measures 1.5 x 0.9 cm. Previously 1.5 x 1.1 cm.BOWEL, MESENTERY: Marked decrease in ascites. Carcinomatosis redemonstrated. Previously measured index focus of carcinomatosis the left abdomen seen on series 2 image 73 of the 9/15 exam is no longer visible. Small foci of carcinomatosis in the right abdomen redemonstrated decreased in size. Additional index measurements provided on the pelvis.BONES, SOFT TISSUES: Anasarca.OTHER: No significant abnormality noted. | Decrease in ascites and carcinomatosis. Redemonstration bilateral adnexal masses. Lymphadenopathy. Anasarca.Bilateral groundglass opacities, nodules and pleural effusions. Correlate or infection or drug reaction superimposed on possible metastatic disease. |
Generate impression based on findings. | 48 year old female, bleeding from tracheostomy site, assess for pulmonary hemorrhage. LUNGS AND PLEURA: Chronic elevation of the left hemidiaphragm with associated left basilar atelectasis/consolidation, which is increased from prior exam with new small left pleural effusion. Right basilar subsegmental atelectasis. Centrilobular emphysema.MEDIASTINUM AND HILA: Cardiac size is normal. No pericardial effusion. Mildly enlarged mediastinal lymph nodes. Tracheostomy is present. Deformity of the superior mediastinum, and subglottic soft tissue due to large head/neck tumor are again present. Beyond the tracheostomy tube, distally there is narrowing of the trachea (image 20, series 6). Abscess cannot be entirely excluded, but we suspect enlarged lymph nodes are compressing the trachea.CHEST WALL: Bilateral axillary lymphadenopathy, greatly increased from prior exam. Diffuse anasarca.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Nasogastric tube tip in the stomach. Faint densities in the gallbladder, possibly representing radiolucent stones. | 1.Chronic elevation of left hemidiaphragm with increased left basilar atelectasis/consolidation, and new small left pleural effusion, overall concerning for developing infection.2.Narrowing of the trachea, distal to the tracheostomy tube. While abscess cannot be entirely excluded, but we suspect enlarged lymph nodes are compressing the trachea.3.Axillary lymphadenopathy, significantly increased from prior exam.Findings discussed with Dr. Adjei-Twum via phone at 9:50 a.m. on 10/20/13. |
Generate impression based on findings. | Female 52 years old; Reason: asess for metasttaic leioyosarcoma uterus History: chest discomfort, enlarged lymph ndoes neck CHEST:ABDOMEN:LUNG BASES: No significant abnormality detected. LIVER, BILIARY TRACT: Normal hepatic contour, without evident suspicious lesion. Stable subcentimeter hepatic hypodensities too small to characterize. Hemangioma in the right posterior liver, unchanged. SPLEEN: Unchanged subcentimeter splenic hypodensity.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable subcentimeter hypodensities too small to characterize.No hydronephrosis. Mild residual left hydroureter. RETROPERITONEUM, LYMPH NODES: Stable borderline enlarged para-aortic and aortocaval lymph nodes. Reference left para-aortic lymph node (series 5 image 46) measures 1.1 cm x 0.8 cm, previously 1.3 x 0.8 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy. Thickened appearance of the vaginal cuff on the left (series 3 image 116), not significantly changed.BLADDER: No significant abnormality noted.LYMPH NODES: No evident pelvic lymphadenopathyBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Previously noted dilatation of the left distal ureter is no longer evident. | 1.Stable postsurgical changes of hysterectomy; unchanged thickened appearance of the vaginal cuff on the left.2.No definite evidence of metastatic disease in the chest, abdomen, or pelvis. Stable borderline-enlarged retroperitoneal lymph nodes.3.Mild residual dilatation of the proximal and mid left ureter. |
Generate impression based on findings. | 78-year-old male, desaturation, and hypoxemia. Evaluate for PE. PULMONARY ARTERIES: Tiny possible filling defects in subsegmental right lower lobe pulmonary arteries (series 8 image 255), which most likely are artifactual in nature, but may represent nonocclusive pulmonary emboli of questionable clinical significance. No evidence of PE in larger pulmonary arteries.LUNGS AND PLEURA: Mild centrilobular emphysema. No focal lung consolidation.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. Atherosclerotic calcification of the aorta and coronary arteries.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Fat-containing right adrenal nodule, compatible with adenoma. Hyperdense left renal lesion, is incompletely characterized due to the phase of contrast enhancement in the study. | 1.Possible tiny filling defects in right lower lobe pulmonary artery subsegmental branches, most likely artifactual, but could represent nonocclusive pulmonary emboli of questionable clinical significance.2.Mild centrilobular emphysema.3.Hyperdense left renal lesion is incompletely characterized. Recommend further evaluation with dedicated imaging.Findings discussed with Dr. Polster via phone at 10 a.m. on 10/20/13. |
Generate impression based on findings. | Female 55 years old; Reason: metastatic carcinoid to liver on treatment History: none CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Hypodense nodule in the right thyroid lobe, unchanged.ABDOMEN:LIVER, BILIARY TRACT: Examination is limited due to lack of arterial phase on this examination. The previously referenced segment 8 no hypoattenuating lesion is unchanged in size measuring 1.1 x 0 .7 cm, previously 1.0 x 0.8 cm.SPLEEN: No significant abnormality noted..PANCREAS: No significant abnormality noted..ADRENAL GLANDS: No significant abnormality noted..KIDNEYS, URETERS: Subcentimeter hypoattenuating lesion in the superior pole of the left kidney, too small to characterize, but unchanged and likely benign..RETROPERITONEUM, LYMPH NODES: No significant abnormality noted..BOWEL, MESENTERY: Postoperative changes from distal small bowel resection. No evidence of tumor recurrence at this site..BONES, SOFT TISSUES: No significant abnormality noted..OTHER: No significant abnormality noted..PELVIS:UTERUS, ADNEXA: Decreased size of left adnexal cystic lesion, which was likely physiologic in nature. 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..OTHER: No significant abnormality noted.. | 1.No interval change in patient's known hepatic lesions, as evaluated on portal venous phase. 2.No new sites of disease. |
Generate impression based on findings. | Female 50 years old Reason: Rule out diverticulitis History: Rectal bleed ABDOMEN:LUNG BASES: Somewhat wedge shaped area of fluid density in the right cardiophrenic angle Series III image #1 measuring 4.8 x 2.2 cm. I am uncertain if this represents focal fluid or low density adenopathy. Other possibilities include a pericardial cyst possibly with an associated low density lymph node. This could be evaluated further with ultrasound. No comparison CT available.LIVER, BILIARY TRACT: Cholecystectomy clips. No focal liver lesions or biliary 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: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: A focal thickening of the sigmoid colon without discrete leading-edge and associated fat stranding in the adjacent mesentery. This most likely represents focal diverticulitis rather than neoplasm. It should be followed to resolution. See series 2 image 54 and coronal image 43-46. No evidence of ascites. No intramural air or free air.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Sigmoid thickening with associated fat stranding. Favor diverticulitis. Should be followed to resolution.Fluid versus adenopathy versus pericardial cyst right cardiophrenic region. |
Generate impression based on findings. | Male 27 years old; Reason: evaluate for abscess History: IBD with fevers ABDOMEN:LUNGS BASES: Wedge-shaped opacification noted in the left lower lobe, correlate for pneumonia.LIVER, BILIARY TRACT: Liver contour is normal. No herpetic or extra hepatic biliary ductal dilatation noted. Gallbladder is normal.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: Subcentimeter retroperitoneal lymph nodes noted not enlarged by CT criteria.BOWEL, MESENTERY: There is marked loss of haustration, with prominent vasa recta and increased mesenteric fat extending from the rectum to splenic flexure. This is compatible with patient's known history of Crohn's disease. No fistula, pericolonic of perianal abscess or obstruction noted. The terminal ileum appears patent without evidence of stenosis.Few non-pathologically enlarged mesenteric nodes noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is marked loss of haustration, with prominent vasa recta and increased mesenteric fat extending from the anus to splenic flexure. This is compatible with patient's known history of Crohn's disease. No fistula, pericolonic of perianal abscess or obstruction noted. The terminal ileum appears patent without evidence of stenosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Changes compatible with Crohn's disease extending from the rectum to the splenic flexure. No fistula, abscess, or obstruction noted. 2. Opacification in the left lower lobe which could represent pneumonia.Dr. Saunders was notified of the findings at 9:45 am on 10/20/13 |
Generate impression based on findings. | Female 70 years old Reason: infection vs abscess in setting of known GVHD History: abd pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: A single small none specific hypodensity likely cyst in the lateral segment left lobe. No other focal lesions.SPLEEN: No significant abnormality notedPANCREAS: Multifocal fluid density is seen in the pancreas, one in the region of the neck largest in the region of the mid body small one in the distal body. These are likely IPMNs. The largest lesion in the body and lesion in neck appear to connect to the pancreatic duct.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Irregular contour left kidney possibly due or areas of old infection or infarction.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic disease no evidence of aneurysm.BOWEL, MESENTERY: Small sliding type hiatal hernia.Diffusely thickened bowel with some sparing of the proximal jejunum. No intramural air or free air. No significant free or loculated intraperitoneal fluid. Given the history, these findings are most consistent with graft-versus-host disease.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diffusely thickened bowel with some sparing of the proximal jejunum. No intramural air or free air. No significant free or loculated intraperitoneal fluid. Given the history, these findings are most consistent with graft-versus-host disease.The colon normal.BONES, SOFT TISSUES: No significant abnormality noteddOTHER: No significant abnormality notedd | Marked thickening mostly in the small intestine consistent with versus host disease. Less likely infectious etiology.Main duct type pancreatic IPMNs.. |
Generate impression based on findings. | Female 79 years old Reason: nephrolithiaisis History: L flank pain and hematurea Exam is not sensitive for detecting lesions in the bowel, solid organs of vasculature due to lack of oral or intravenous contrast. Given nodes that limitation, the following observations are made:ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Calcific granuloma. No evidence of fatty liver. The gallbladder is not seen and might be collapsed. No surgical clips are seen. There is no obvious biliary dilatation given the limitation of no IV contrast.SPLEEN: No significant abnormality notedPANCREAS: Very questionable subcentimeter hypodensities. Interdigitating fat and possible small lipoma in the proximal body.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No evidence of nephrolithiasis, hydronephrosis hydroureter, or perinephric fat stranding.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic calcification aorta. No evidence of aneurysm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: Multifocal masses or calcifications consistent with uterine fibroids.BLADDER: Bladder is distended.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Atherosclerotic calcifications femoral arteries. | No evidence of nephrolithiasis. No specific findings to explain left flank pain. Uterine masses likely fibroids. Questionable small hypodensities pancreas. |
Generate impression based on findings. | Male 80 years old Reason: please perform a CT UROGRAM to evaluate the etiology of hematuria History: hematuria. Exam is not sensitive for detecting lesions in the bowel to the lack of oral contrast. Given that limitation, the following observations are made:ABDOMEN:LUNG BASES: Small lipoma right chest wall. Basilar atelectasis or fibrosis. No nodules or effusions. Atherosclerotic calcification seen in the visualized aortic root and portions of the coronary arteries. Possible ulcerated plaque in the distal thoracic aorta series 8 image 17.LIVER, BILIARY TRACT: A few small scattered hypodensities in all phases probably cysts some could represent small hemangiomas.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral hydronephrosis likely related to massively distended urinary bladder. A focal calcification right kidney consistent with nonobstructive nephrolithiasis series 3 image 42. Calcification measures approximately 8 x 7 mm. A punctate calcification seen in the left lower pole cyst image 48. Other hypodensities in the kidney likely cysts bilaterally.RETROPERITONEUM, LYMPH NODES: Atherosclerotic changes aorta. No discrete aneurysm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Markedly enlarged prostate gland could be compressing urinary bladder. Coronal planes cephalocaudad dimension 7.6-cm transverse dimension 6.4-cm as seen on series 81172 image 43.BLADDER: Massively distended urinary bladder with evidence of wall thickening and trabeculation. Calcification and urinary bladder are abutting an enlarged prostate which impresses on the bladder. I favor this being a bladder calculus. This calcification measures about 1.5 cm in diameter as measured on series 8 image 102.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Marked degenerative changes especially right hip.OTHER: No significant abnormality noted | Nonobstructive bilateral renal calculi and a bladder calculus. Markedly enlarged prostate massively distended urinary bladder with associated hydronephrosis likely related to the distended bladder. Baseline ultrasound may be obtained the bladder and a collapsed state after voiding replacement of Foley catheter. Atherosclerotic disease.Other findings as above. |
Generate impression based on findings. | Clinical question: Cerebral infarct. Signs and symptoms: Speaking disorder. 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 bilateral mastoid air cells, middle ear cavities and visualized paranasal sinuses.Unremarkable images through the orbits. | No acute intracranial process. |
Generate impression based on findings. | 31-year-old evaluate for progression of cerebral edema When compared to the prior exam, the cytotoxic edema involving the gray and white matter in both cerebral hemispheres and in the distribution of the anterior and posterior circulation is more visually apparent, consistent with normal progression of a subacute infarction. There is no midline shift. Ventricles and basilar cisterns appear unchanged in appearance. | Progression and as expected better delineation of subacute infarctions in the distribution of the anterior and posterior circulation bilaterally. No midline shift. |
Generate impression based on findings. | Male 47 years old; Reason: markedly dilated bowel loops an xray. compare to CT 10/15/13 - assess for progression of SBO History: increased abdominal pain / retching ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Redemonstration of postsurgical changes multiple bowel resections. Mild small bowel dilatation is stable and probably chronic in nature. There are probably some nonobstructive or minimally obstructed adhesions. No free or loculated intraperitoneal fluid. No intramural air or free airBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: As above, expected postsurgical changes. Probable minimally obstructive adhesions. No frank obstruction. No free or loculated intraperitoneal fluid. No intramural or free air.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Postsurgical changes with some areas of chronic mild to moderate dilatation of small bowel likely minimally obstructive adhesions. No free or loculated intraperitoneal fluid.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Female 56 years old; Reason: eval for necrotizing pancreas resolution History: abd pain, vomiting, weight loss ABDOMEN:LUNG BASES: Interval resolution of the bilateral pleural effusions. Stable bibasilar atelectasis.LIVER, BILIARY TRACT: There is no evidence of focal mass lesion within the hepatic parenchyma or intrahepatic biliary ductal dilatation. Hepatic vasculature appears patent. There is cholelithiasis without evidence of cholecystitis. There is no evidence of choledocholithiasis or extra hepatic biliary ductal dilatation. SPLEEN: No significant abnormality notedPANCREAS:Interval decrease in pancreatic size and inflammation is noted, with residual heterogeneously attenuating parenchyma. There are 3 distinct areas of hypoattenuation seen within the pancreatic parenchyma in the pancreatic head (series 9 image 61), neck (series 9 image 52) and body (series 9 image 50) likely representing necrotic foci. These hypoattenuating foci were evident on the prior exam but appear to have decreased in size and conspicuity on this exam. There is a focus of notable loss of pancreatic parenchyma within the pancreatic body. There is less than 25% necrosis of the pancreas. There is decrease in the amount of peripancreatic fluid and mesenteric fat stranding. There is residual thickening of the anterior left pararenal fascia also decreased since previous exam. Small residual fluid collection at the tail of pancreas extending superiorly to the gastropancreatic ligament, likely a small residual pseudocyst.The splenic vein is normal caliber at the confluence of the splenic vein and SMV. The the splenic vein is patent throughout its course, however slightly attenuated. There is no evidence of splenic artery aneurysm or other vascular complications of pancreatitis. ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Several shotty retroperitoneal lymph nodes are evident.BOWEL, MESENTERY: Interval removal of the Dobbhoff.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: There is a left adnexal fluid collection, which measures 7.3 x 5.3 cm without wall enhancement, likely representing an ovarian cyst; however, CT evaluation of the adnexa is limited and pelvic ultrasound can be considered in the appropriate clinical setting.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.Findings consistent with necrotizing pancreatitis, decreasing since previous exam, with less than 25% necrosis of the pancreatic parenchyma. No hemorrhage or calcifications noted on the precontrast noted. 2.No evidence of drainable peripancreatic fluid collection. Small residual pseudocyst at the tail.3.Subtle narrowing of the splenic vein as it passes posterior to the pancreatic body, without evidence of complete occlusion. 4.Stable left adnexal fluid collection which may represent an ovarian cyst; however, CT evaluation of the adnexa is limited and pelvic ultrasound can be considered in the appropriate clinical setting. |
Generate impression based on findings. | 59 year old male, follow-up from previous CT angiography with concern for SVC thrombus. Chest pain. LUNGS AND PLEURA: Bilateral, multifocal patchy air space opacities, increased from prior exam.MEDIASTINUM AND HILA: Cardiac size is normal. No pericardial effusion. Mild to moderately large mediastinal lymph nodes are unchanged. No thrombus is evident in the SVC, previous finding most likely due to mixing of contrast.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Subcentimeter hepatic hypoattenuating lesions, most likely cysts. | 1.No evidence of SVC thrombus, prior findings most likely due to mixing of contrast.2.Increasing bilateral multi-focal patchy air space opacities, compatible with infection. |
Generate impression based on findings. | Male 52 years old; Reason: History of renal cell cancer s/p Robotic-assisted laparoscopic right partial nephrectomy; Evaluate for metastases History: none CHEST:LUNGS AND PLEURA: No significant abnormality noted. Oozing noted right lower lobe consolidation has resolved in the interim. No new nodule or mass detected.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post partial right nephrectomy. Sutures noted in the right nephrectomy bed. Decreasing heterogeneous collection within the surgical bed in the upper pole measuring about 6.4 x 4.9 previously 7.5 x 4.8 cm compatible perinephric hematoma. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Interval resolution of the small fluid in the right pericolic gutter.No obstruction.BONES, SOFT TISSUES: Midline thickening compatible with recent surgery and/or injection sites. Mild anasarca.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Resolution of the right lower lobe consolidation. 2. Decrease in size and morphology of the fluid in partial nephrectomy surgical bed suggesting continued healing. Resolution of the previously noted hemoperitoneum. |
Generate impression based on findings. | Clinical question: Status post craniotomy for posterior fossa hemorrhage. Signs and symptoms: Status post craniotomy. Nonenhanced head CT:Examination demonstrates interval decreased density of widened CSF space between the cerebellar hemispheres at the site of surgery representing decreased blood product within the CSF at this space.There is also significant interval debulking all patient's known hematoma since prior exam. The remaining blood in the right pons and right middle cerebellar peduncle, right cerebellum demonstrate lower density and significantly smaller in size. It measures approximately 9 times 12 mm sized which is significantly smaller than prior exam. There is also better visualization of the fourth ventricle with interval decreased intraventricular hemorrhage.There is a small new focus of right inferior paramedian cerebellar hemorrhage measuring at 9 times 5 mm size.There is evidence of multiple new metallic densities at the site of partially evacuated hematoma since prior study.Evidence of new increased postoperative pneumocephalus in the supratentorial space.Stable normal size of the supratentorial ventricular system and a right posterior approach ventricular catheter with the tip in the right lateral ventricle. | 1.Significant interval decreased size of acute hematoma in the posterior fossa since prior exam.2.Significant interval the crease in hemorrhage in the fourth ventricle and decreased density of widened CSF spaces as well representing decreased intracranial blood.3.Tiny focus of right paramedian cerebellar hemorrhage.4.Stable normal size of the supratentorial ventricular system and a right-sided ventricular catheter.5.Increased supratentorial postoperative pneumocephalus. |
Generate impression based on findings. | Clinical question: Dizzy, in balance. Signs and symptoms: As above. Nonenhanced head CT:No detectable acute intracranial process. CT however is insensitive for detection of acute nonhemorrhagic ischemic strokes.There is paucity of cortical sulci in supratentorial space which is nearly identical to prior exam. The ventricular system also appear small and midline maintained as well similar to prior study. The fourth ventricle also appear small and in midline as was noted on multiple prior exams including study from August of 2011. Cannot entirely exclude the possibility of pseudotumor cerebri.Unremarkable calvarium and soft tissues of the scalp.Unremarkable orbits.Paranasal sinuses demonstrate evidence of minimal acute right sphenoid sinusitis and minimal chronic sinus disease of other sinuses. Well pneumatized bilateral mastoid air cells and minute cavities. | No acute intracranial process. Please see above comments. |
Generate impression based on findings. | Melanoma, patient has had chemotherapy. Follow-up Numerous soft tissue nodules throughout the left upper extremity are all unchanged and remain compatible with known metastatic disease from underlying melanoma. Beginning distally the multiple reference nodules.Reference measurements: Along the radial aspect of the distal forearm: 24 x 28 mm (series 6, image 411), previously 25 x 28 mm unchanged. Along the radial aspect of the more proximal forearm: 31 x 24 mm (image 280, series 6), previously 31 x 25 mm, unchanged. Along the distal humerus: 39 x 32 mm (image 136, series 6), previously 43 x 33 mm. Changes most compatible with changes in position, tumor appears similar.Along the mid humerus: 39 x 32 mm (image 136, series 6), previously 43 x 33 mm. Changes most compatible with changes in position, tumor appears similar. Along the subcutaneous soft tissues at the level of the proximal humerus: 13 x 9 mm (image 74, series 6), previously 13 x 12 mm.Along the subcutaneous soft tissues at the level of the proximal humerus: 12 x 12 mm (image 42, series 6), previously 13 x 12 mm. Subcutaneous lesion at the level of the humeral head: 14 x 12 mm (image 25, series 6), previously 14 x 12 mm. Surgical clips again noted in the left axilla. No osseous lesions or fractures identified. Numerous pulmonary metastases are currently not included in the field of view. | Interval stability in the numerous left arm metastatic foci. Reference measurements above and mild differences are thought to represent differences in patient positioning |
Generate impression based on findings. | Male 61 years old. Reason: post-op fever History: Malignant neoplasm bilateral. Malignant neoplasm of rectum. Postop fever. CHEST:LUNGS AND PLEURA: Bilateral pleural effusions, moderate in size. Associated bibasilar atelectasis. No lung nodules.MEDIASTINUM AND HILA: Coronary artery calcifications. Postsurgical changes mediastinum.CHEST WALL: Postsurgical anatomy.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Post surgical changes. Bilateral nephroureterostomy catheters.RETROPERITONEUM, LYMPH NODES: Caval filter. Normal caliber aorta. Small retroperitoneal nodes.BOWEL, MESENTERY: NG tube is been removed. No evidence of obstruction. No significant free or loculated intraperitoneal fluid.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Surgically absent.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Right lower quadrant ileal conduit. Left lower quadrant colostomy. No evidence of bowel thickening or dilatation. No free or loculated intraperitoneal fluid.Bouncing a nonobstructive left inguinal hernia.BONES, SOFT TISSUES: Post surgical changes anterior abdominal wall. Mild nonobstructive parastomal hernia containing small bowel.OTHER: Drain previously seen in left ischio rectal fossa and presacral spaces been removed. No evidence of recurrent fluid collection. | Postsurgical changes. Nonobstructive left inguinal hernia. No evidence of bowel obstruction or abscess. |
Generate impression based on findings. | Check for osteomyelitis. Extensive deformity of the distal tibia with severe degenerative changes of the distal mortise. Appearance similar to the plain film with the associated discrete lucent area in what represents the metaphysis. Sclerotic margins are partially observed with a questionable sequestrum like density in the inferior aspect (image 41 series 80333). This lucency with a suspected sinus tract extending medially measures 4.0 x 3.2 cm (image 42 series 80333).Overlying moderate soft tissue swelling and inflammation with associated ulcerations medially. Hardware fixation of the distal fibula with associated artifact similar to the plain film | Overall nonspecific appearance and extreme difficulty to identify an acute process superimposed upon extensive deformities from a prior remote injury. Overall appearance suggests a previous IM rod is fixed distally with screws traversing the medial cortical margin. No overt findings to suggest an acute process, however subtle findings can be missed in comparison with prior imaging or serial imaging is again needed if suspicion remains high clinically. |
Generate impression based on findings. | Female 54 years old; Reason: Please eval for colitis History: BRBPR ABDOMEN: The absence of intravenous and oral contrast limits evaluation of the solid organs and of the bowels. Given these limitations, the following observations were made:LUNGS BASES: A significant abnormality detected.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: Scattered diverticula are noted. Surgical sutures are noted in the sigmoid colon from a previous end to side anastomosis. No definite colitis, mass, obstruction, or diverticulitis noted. Rectal tube noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Foley catheter within the bladder.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Scattered diverticula are noted. Surgical sutures are noted in the sigmoid colon from a previous and to side anastomosis. No definite colitis, mass, obstruction, or diverticulitis noted. Rectal tube noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.No acute inflammatory process detected. Previous surgical site in the sigmoid colon with sutures suggesting an end to side anastomosis noted. |
Generate impression based on findings. | Clinical question: Rule-out pharyngeal abscess. Signs and symptoms: Stridor and drooling. Enhanced neck CT:No detectable partially visualized intracranial space abnormalities.Unremarkable images through the skull base and including cavernous sinuses and bilateral petrous bone.Unremarkable nasopharynx, nasal cavity, oropharynx, oral cavity, parapharyngeal fat pads and retropharyngeal space. There is no detectable retropharyngeal edema/enhancement or cavity formation to suggest presence of an infectious process.Preserved all fracture planes.Unremarkable all salivary glands.Unremarkable images through the oral cavity, floor of the mouth and submental region and without detectable edematous changes or abnormal enhancement. The airway remains widely patent.There is unusual expansion of the air space at the level of the hypopharynx and supraglottic region which was not present on prior plain radiographs of soft tissues of neck on October 20, 2013. The clinical significance of this finding is not certain. Correlate with history. | 1.No detectable findings to suggest an infectious process and in particular no evidence of plain gel, retropharyngeal or peritonsillar abscess formation. No detectable fashion a plain edematous changes a/effacement.2.Enlarged air space in the hypopharynx and supraglottic region of unknown exact etiology. This appearance was not present on prior plain radiographs of soft tissues of neck from October 20, 2013. |
Generate impression based on findings. | Clinical question: CVA. Signs and symptoms: CVA. Nonenhanced head CT:No evidence of acute intracranial process CT however is insensitive for detection of acute nonhemorrhagic ischemic strokes.Examination demonstrate periventricular and subcortical low attenuation white matter consistent with age indeterminate mild small vessel ischemic strokes.There is a large focus of encephalomalacia in the right mid to posterior temporal lobe and extensive renal molding the right occipital lobe consistent with a chronic right PCA territory ischemic stroke.There is also evidence of bilateral (right greater than left) chronic cerebellar strokes. There is evidence of a previously placed vascular stent in the basilar artery and a large cluster of coils from prior endovascular embolization of basilar tip aneurysm. | 1.No evidence of acute intracranial process CT however is insensitive for detection of acute nonhemorrhagic ischemic strokes.2.Mild age indeterminate small vessel ischemic strokes.3.Large chronic right PCA territory ischemic stroke in the right temporal and occipital lobe.4.Coils within a previously embolized basilar tip aneurysm and evidence of a vascular stent in the basilar artery. |
Generate impression based on findings. | Male 79 years old; Reason: rising WBC s/p chest wall reconstruction History: rising WBC s/p chest wall. Per Epic history there is extensive angiosarcoma the right posterior chest wall status post excision of lung wedge resection, scapula/removal, reconstruction with the pedicled serratus latissimus muscle flaps on 10/10/2013. LUNGS AND PLEURA: Postsurgical changes of a right lung wedge resection and resection of the posterior right chest wall. Right-sided chest tube with its tip in the right lung base. There is decreased lung volume with consolidation in the right apex and in the superior aspect of the right lower lobe. The consolidation in the superior aspect of the right lower lobe likely represents infection. A small loculated pleural effusion is visualized in the posterior right lung base which could be from recent surgery. However infection cannot be ruled out. A loculated small left pleural effusion is not significantly changed. Increased bronchial/bronchiolar wall thickening with tree in bud opacities in the left lower lobe compatible with aspiration bronchiolitis versus endobronchial extension of presumed right sided pneumonia. The previous left lower lobe cavitary lesion with wall thickening is not appreciated on today's exam. Right basilar nodular opacity is not definitely seen on this exam and may have been inflammatory/infectious.MEDIASTINUM AND HILA: Endotracheal tube tip is just below the thoracic inlet. Nasogastric tube terminates in the stomach. No cardiomegaly or pericardial effusion. Atherosclerotic calcifications are noted about the thoracic aorta. CHEST WALL: Again seen are postsurgical changes from resection of the right posterior chest wall angiosarcoma. There is subcutaneous air in keeping with recent surgery and possibly post procedurally from the chest tube. Collateral vessels in the anterior chest wall secondary to SVC occlusion is redemonstrated. Degenerative changes are noted about the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Renal hypodensities too small to characterize.Stable periaortic and gastrohepatic enlarged lymph nodes. | 1.Post surgical changes from a recent right lung wedge resection and posterior chest wall resection with flap reconstruction.2.Consolidation in the superior aspect of the right lobe of with air bronchograms suspicious for pneumonia. Bronchial/bronchiolar wall thickening with tree in bud opacities in the left lower lobe compatible with aspiration bronchiolitis versus endobronchial extension of pneumonia.3.Loculated small right pleural effusion could be from recent surgery. However infection cannot be excluded.4.Small loculated left pleural effusion is not significantly changed. |
Generate impression based on findings. | Malignant neoplasm of the colon CHEST:LUNGS AND PLEURA: Multiple micronodules bilaterally, largest measuring 5 mm in the right lower lobe (image 84, 5) . No pleural effusion.MEDIASTINUM AND HILA: Few calcified right hilar lymph nodes identified.CHEST WALL: Tip of a left-sided Port-A-Cath at the junction of right atrium and SVC.ABDOMEN:LIVER, BILIARY TRACT: Multiple hypodense lesions of varying sizes identified in both lobes of liver highly suspicious for metastases disease. Referenced lesion in left lobe of the liver measures 3 x 2.5 cm (image 109 , 3). Most of the lesions are peripheral in location. Lesion in segment 8 of right lobe of liver appears to coalesce with other adjacent lesions with peripheral wedge-shaped hypodensities suggestive of small peripheral infarct. Portal vein is patent. Background liver parenchyma appears unremarkable.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right hypodense lesion in the upper pole most represents a cyst. No hydronephrosis or hydroureter in either kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post ex- laparotomy with resection and left sided colostomy. No evidence of bowel obstruction. Sutures noted in the rectosigmoid junctionBONES, SOFT TISSUES: No significant abnormality notedOTHER: No ascitesPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Status post ex- laparotomy with resection and left sided colostomy. No evidence of bowel obstruction. Sutures noted in the rectosigmoid junctionBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Multiple micronodules, largest measuring 5 mm in right lower lobe. Continued surveillance is recommended.2. Multiple hypodense bilobar liver lesions consistent with metastatic disease.3. Hypodensity in the upper pole of the right kidney most likely representing a cyst.4. No evidence of bowel obstruction |
Generate impression based on findings. | 62 year old female with known CNS mass. CHEST:LUNGS AND PLEURA: Small calcified nodules consistent with prior granulomatous disease.MEDIASTINUM AND HILA: Calcified mediastinal and hilar lymph nodes consistent with prior granulomatous disease.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: Atherosclerotic calcification and plaque of the abdominal aorta and its branches.BOWEL, MESENTERY: Thickening of the gastric antrum, correlate for gastritis.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: A nonspecific soft tissue mass in the soft tissues of the lower pelvis measures 2.0 x 1.5 cm (image 24, series 3).OTHER: No significant abnormality noted. | 1. Nonspecific subcutaneous soft tissue nodule in the left mons pubis, correlate clinically. No evident primary or metastatic neoplasm. |
Generate impression based on findings. | 74-year-old female patient with flank pain. Evaluate for kidney stone. Note that lack of intravenous contrast limits visualization of vasculature, lymph nodes and solid organs.ABDOMEN:LUNG BASES: Trace bibasilar atelectasis.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis. Right perinephric fat stranding. Small calcification within the hilum of the right kidney likely represents vascular calcification (series 60268, image 52).RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Uterus with calcified fibroid. Adnexa within normal limits.BLADDER: No bladder calculi.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Sigmoid diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Calcified aorta and iliac arteries, consistent with atherosclerosis.Presacral soft tissue mass posterior to the rectum with punctate calcifications measures 4.6 x 3.8 cm (series 3, image 105). | 1.No hydronephrosis or evidence of renal calculi.2.Incidental presacral soft tissue mass posterior to the rectum suspicious for malignancy. Recommend further evaluation with MRI.Finding of presacral mass was communicated to Dr. Eric Shappell via telephone at 9:35 AM on 10/21/13 by Dr. Stephanie McCann. |
Generate impression based on findings. | 83-year-old female concern for hematoma versus fluid collection in the right abdomen, pelvis. ABDOMEN:LUNG BASES: Right pleural effusion and bilateral basilar consolidation and atelectasis as well as bronchial wall thickening.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: Nonspecific, bilaterally renal lesions are incompletely evaluated on this study, some of which are hyperdense.RETROPERITONEUM, LYMPH NODES: High density density tracking along the posterior pararenal space consistent with hemorrhage.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Moderate degenerative change of the thoracolumbar spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Large high-density collections present anteriorly within the pelvis consistent with hematoma/hemorrhage.BONES, SOFT TISSUES: Comminuted, mildly displaced fracture of the right superior and inferior pubic rami. Left hip total arthroplasty. Moderate degenerative changes of the lumbar spine.OTHER: No significant abnormality noted. | 1. Comminuted mildly displaced right pubic rami fractures with large associated pelvic hematomas tracking superiorly into the abdomen.2. Bilateral renal cysts, some of which do not meet the criteria for simple cysts, are incompletely evaluated on this study.3. Basilar consolidation and atelectasis. |
Generate impression based on findings. | 79-year-old female with multiple strokes on heparin status post fall, evaluate for hemorrhage Very subtle mild hyperattenuation in the interhemispheric aspect of the left frontoparietal region corresponding to the evolving subacute hemorrhagic infarct seen on the same day MRI. No interval foci of new hemorrhage are evident.Expected interval evolution of left posterior temporal-occipital region cortical stroke which is more hypoattenuating on the current examination.Redemonstration of extensive periventricular and subcortical low attenuation compatible with chronic small vessel ischemic disease on the comparison MRI. Hypoattenuating regions in the right frontoparietal and inferior frontal lobes likely represent chronic ischemic disease, unchanged. Chronic cerebellar strokes.Mild prominence of the cerebellar and vermin folia, unchanged.No change in appearance of the ventricles. No significant mass effect.No abnormal mass lesions are appreciated intracranially. The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1. No new interval hemorrhagic foci are identified.2. Expected evolution of left temporal-occipital region cortical stroke.3. Very subtle mild hyperattenuation in the interhemispheric aspect of the left frontoparietal region corresponds to the evolving subacute hemorrhagic infarct seen on the same day MRI. |
Generate impression based on findings. | Fever, headache, HIV patient. 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. Maxillofacial: There is mild mucosal thickening within the right maxillary sinus and minimal opacification of the left maxillary sinus and right sphenoethmoid recess. The mastoid air cells are clear. The imaged portions of the dentition are intact. The orbits are unremarkable. The facial skeleton and soft tissues are unremarkable. | 1. No evidence of intracranial hemorrhage, mass, or cerebral edema.2. No evidence of sinusitis. |
Generate impression based on findings. | Male 65 years old; Reason: assess for obstruction History: vomiting, abd pain, distention, constipation. ABDOMEN:LUNGS BASES: Left lower lobe pulmonary nodule measures 8-mm (image 3 series 4), unchanged.LIVER, BILIARY TRACT: Diffuse fatty infiltration of the liver. Hypodense lesion near segment one has increased in size measuring 1.5 x 1.2 cm (image 33/series 3). Previously the lesion measures under 1cm.Diffuse fatty infiltration of the liver. The hepatic and portal veins are patent . Biliary system is normal in caliber.SPLEEN: No significant abnormality noted.PANCREAS: Fatty atrophy of the pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small bilateral renal cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Calcific arteriosclerotic disease of the aorta.BOWEL, MESENTERY: Small bowel is normal in caliber. Colon is decompressed. Submucosal fat deposition which is nonspecific. Findings of chronic colitis involving the sigmoid and rectum with fibrofatty proliferation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Findings of chronic colitis changes involving the colon, colonoscopy is suggested2.The nonspecific hypodensity in the liver adjacent to the caudate, follow-up MRI is suggested.3.Fatty infiltration of the liver.4.Nonspecific left lower lobe pulmonary nodule, unchanged. |
Generate impression based on findings. | 38-year-old female with abdominal pain. ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Left hypoattenuating hepatic lesion, likely representing a cyst is unchanged.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: Resolution of previously noted right cystic adnexal lesion. The uterus and adnexa appear unremarkable in this noncontrast study.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No specific findings to account for the patient's pain. |
Generate impression based on findings. | 75 year-old female with altered mental status CHEST:LUNGS AND PLEURA: Pleural effusions, larger on the right, with associated basilar atelectasis and consolidation. A cystic lesion. in the left lower lobe with associated nodule is unchanged.MEDIASTINUM AND HILA: Right central venous catheter. Thrombus is again noted in the right IJ. Mediastinal lymphadenopathy appears similar to the prior study.CHEST WALL: Right chest wall fluid collection with surrounding surgical clips is unchanged.ABDOMEN:LIVER, BILIARY TRACT: Scattered hypodensities, too small to characterize, are again noted. Hepatomegaly.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy with fluid in the surgical bed, unchanged. Atrophic left kidney with cysts. Left upper pole lesion does not meet the criteria for simple cyst and is suspicious for a neoplasm.RETROPERITONEUM, LYMPH NODES: Atherosclerosis of the abdominal aorta and its branches.BOWEL, MESENTERY: Right lower quadrant ileostomy. A drain extends from the left lower abdomen into the pelvis with small residual associated fluid collection. Stranding of the mesenteric fat is noted. Enteric tube extends to the proximal duodenum. Small pockets of fluid adjacent to the bowel with enhancing rims suspicious for abscesses are also unchanged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Absent.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Right lower quadrant ileostomy. A drain extends from the left lower abdomen into the pelvis with small residual associated fluid collection. Stranding of the mesenteric fat is noted. Enteric tube extends to the proximal duodenum. Small pockets of fluid adjacent to the bowel with enhancing rims suspicious for abscesses are also unchanged. Fluid is noted in the rectum.BONES, SOFT TISSUES: Degenerative changes of the lumbar spine.OTHER: No significant abnormality noted. | 1. Multiple small abdominal and pelvic fluid collections consistent with abscesses, similar to the prior study.2. Right IJ thrombus and anterior chest wall fluid collection are again noted.3. Nonspecific mediastinal adenopathy.4. Basilar atelectasis and consolidation with pleural effusions.5. Left upper pole renal lesion does not meet the criteria for a simple cyst and is suspicious for neoplasm, incompletely evaluated on this study. |
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