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Generate impression based on findings. | 67-year-old male with renal cell cancer status post partial left nephrectomy 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: Status post left heminephrectomy. Peripheral left hypodense lesion is too small to characterize.Poorly enhancing 2.9 x 4.2 cm (image 65, series 3) right renal mass highly suspicious for renal cell carcinoma. Additional hyperdense lesion likely represents a complex cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Extensive colonic diverticulosis.BONES, SOFT TISSUES: Marked degenerative changes of the thoracic spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Extensive colonic diverticulosis.BONES, SOFT TISSUES: Marked degenerative changes of the lumbar spine.OTHER: No significant abnormality noted | 1. Poorly enhancing right renal mass, highly suspicious for renal cell carcinoma.2. Status post left heminephrectomy with subcentimeter hypoattenuating left lesion too small to characterize. 3. No evidence of metastatic disease. |
Generate impression based on findings. | 28 year-old female patient with history of Gartner's vaginal cyst on the right. Evaluate vaginal cyst and renal collecting system. ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: 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: Hypoattenuating focus in the right lateral wall of the vagina measures 1.9 x 1.9 cm (series 7 image 139), consistent with patient's history of Gartner's vaginal cyst. No fistula tract visualized. Otherwise, uterus and adnexa are unremarkable.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted | 1.Hypoattenuating focus in the vagina consistent with Gartner's vaginal cyst.2.No significant abnormalities of the kidneys or collecting system. |
Generate impression based on findings. | 68-year-old male with head and neck cancer (tonsil). CT brain:The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, midline shift, intra- or extra-axial fluid collection/acute hemorrhage, or abnormal contrast enhancement.The orbits are unremarkable. Mild mucosal thickening of the maxillary sinuses. Partial opacification of the left mastoid air cells.CT neck:Extensive postoperative changes are again seen. There is fatty atrophy of the right side of the tongue. Stable nodularity in the left paramedian base of the tongue, just cranial to the anterior hyoid bone. Thickening of both aryepiglottic folds, right more than left, unchanged. Asymmetry at the level of the glottis is more pronounced with dilatation of the right laryngeal ventricle. This is nonspecific and may be treatment related.In the region of the right upper neck, numerous soft tissue surgical clips and multiple heterogeneously enhancing right neck masses are again identified with central necrotic regions. There are stable appearing lymph nodes.Slight interval decrease in the necrotic component of the right parapharyngeal space nodal conglomerate mass measuring 4.3 x 2.5 cm (series 7 image 25), previously measured 2.7 x 5.1 cm. This may represent progressive ulceration. Stable mass effect upon the adjacent oropharyngeal airway. The overall extent of the mass has not significantly changed from the comparison study.Right level 2 necrotic nodal conglomerate measures 5.0 x 4.0 cm (series 7 image 38), previously measured 5.3 x 4.0 cm.Right level Ia necrotic lymph node measures 1.3 x 1.4 cm (series 7 image 38), previously measured 1.5 x 1.3 cm.Similar to the prior study, fat planes between the right neck masses and right carotid as well as the right submandibular gland are obscured, suspicious for tumor invasion. The left salivary glands are unremarkable. The thyroid gland is unremarkable.Multilevel degenerative changes of the cervical spine. Sclerotic T1 vertebral body lesion is unchanged and likely benign. Redemonstration of irregularity at the posterior aspect of the hyoid bone which may represent osseous extension of disease.Similar to the prior study, the right internal jugular vein is effaced secondary to tumoral mass effect. The right common and internal carotid arteries remain patent.Partially visualized right central venous catheter. The visualized lung apices are unremarkable, please see dedicated chest CT from today's date for further evaluation. | 1. Bulky right parapharyngeal necrotic mass may show progressive ulceration but otherwise has not significantly changed from the prior examination.2. Necrotic right neck lymph nodes are similar in size to the prior examination. No new sites of disease are identified.3. No evidence of intracranial metastatic disease. |
Generate impression based on findings. | Female 36 years old; Reason: alpha 1 antitrypsin deficiency/evaluate for emphysema or bronchiectasis History: cough. LUNGS AND PLEURA: No evidence of emphysema. Scattered bilateral pulmonary micronodules, which are nonspecific. No suspicious pulmonary nodules or masses. No pleural effusions. No evidence of interstitial lung disease. No evidence of air trapping.MEDIASTINUM AND HILA: Normal size heart without a pericardial effusion. No significant mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | No evidence of emphysema. No significant pulmonary or pleural abnormalities. |
Generate impression based on findings. | Reason: T1N2A L tonsil SCC s/p excisional biopsy with ECE. Given TFHX completed 4/27/12. please re-eval for recurrent dz History: as above CHEST:LUNGS AND PLEURA: Apical scarring. Calcified granulomas. Linear scarring at left lung base. No new pulmonary nodules.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Subcentimeter hypodensity left lobe of liver (image 93/134) too small to characterize but stable and presumably benign.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Distended left ovarian vein, unchanged. | No evidence of metastatic disease. |
Generate impression based on findings. | Reason: 62 yo male with h/o cutaneous lymphom on new therapy with new dyspnea on exertion; r/o PE, pneumonitis, ? PNA History: dyspnea PULMONARY ARTERIES: No evidence of PE.LUNGS AND PLEURA: Emphysema. Linear scarring or atelectasis at the lung bases. Mild nonspecific bronchial wall thickening which is nonspecific but most commonly seen with asthma or bronchitis.MEDIASTINUM AND HILA: Scattered small subcentimeter lymph nodes. CHEST WALL: Degenerating change involving thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Hiatal hernia. Scattered small upper abdominal lymph nodes. | 1. No evidence of PE.2. Emphysema.3. Mild nonspecific bronchial wall thickening which is nonspecific but most commonly seen with asthma or bronchitis. |
Generate impression based on findings. | 44-year-old female with foul drainage, evaluate for fistula ABDOMEN:LUNG BASES: Mild basilar atelectasis.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Nonspecific hypoattenuating splenic lesion is unchanged.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small bowel loops are noted adherent to the anterior abdomen adjacent to the wound. A fistula cannot be excluded although no oral contrast reaches these loops.BONES, SOFT TISSUES: Midline abdominal/pelvic wound with skin thickening and infiltration as well as two small foci of gas.OTHER: None.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality notedLYMPH NODES: Large inguinal lymph nodes are noted bilaterally.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Midline abdominal/pelvic wound demonstrates evidence of interval healing with decreased associated gas and increased soft tissue density likely representing inflammation and/or fibrous tissue. No evidence of fistula is demonstrated.OTHER: Trace pelvic fluid. | Healing mid abdominal wall wound with adherent adjacent small bowel loops and two foci of gas. A fistula cannot be excluded, although is not definitively demonstrated. |
Generate impression based on findings. | 49-year-old female with history of breast cancer, baseline exam. CHEST:LUNGS AND PLEURA: Right medial pulmonary mass measures 2.9 x 2.4 cm (image 39, series 5). Multiple additional small bilateral pulmonary nodules are identified, suspicious for metastatic disease.MEDIASTINUM AND HILA: Port catheter extends to the SVC. No mediastinal lymphadenopathy.CHEST WALL: Left chest wall port. Posttreatment change of the right axilla with soft tissue infiltration and fluid noted. Status post right mastectomy.ABDOMEN:LIVER, BILIARY TRACT: One small medial right hepatic hypoattenuating lesion likely represents a cyst. No intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Status post right mastectomy with multiple pulmonary lesions consistent with metastatic disease.2. Post treatment change of the right axilla and chest wall. |
Generate impression based on findings. | Female 67 years old; Reason: rule out PE History: tachycardia. PULMONARY ARTERIES: No evidence of pulmonary emboli.LUNGS AND PLEURA: Small bilateral pleural effusions are seen with overlying consolidation, likely atelectasis. Within the right lung base are mild centrilobular opacities consistent with aspiration. Small focal ground glass opacities in the right lung base and right middle lobe are nonspecific, compatible with edema or infection . Scattered micronodules are present throughout the lungs bilaterally.MEDIASTINUM AND HILA: Scattered subcentimeter mediastinal and hilar lymph nodes, likely reactive. No cardiomegaly or pericardial effusion. Coronary artery calcifications and calcifications of the mitral annulus.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Free air and a small amount of ascites is visualized in the abdomen compatible with recent surgery. Mild intra and extra-hepatic biliary ductal dilatation status post cholecystectomy. | 1.No pulmonary emboli2.Bilateral small pleural effusions with atelectasis.3.Free air in the abdomen compatible with recent surgery. |
Generate impression based on findings. | 45-year-old male with history of bladder cancer status post 5 cycles of chemo. CHEST:LUNGS AND PLEURA: 4-mm right upper lobe pulmonary nodule is unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Retroperitoneal lymphadenopathy appears similar to the prior study with index left periaortic lymph node measuring 1.6 x 2.0 cm (image 135, series 4) and previously measuring 1.9 x 1.6 cm.BOWEL, MESENTERY: Right lower quadrant ileostomy.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post cystoprostatectomy.BLADDER: Status post cystoprostatectomy.LYMPH NODES: Index left common iliac lymph node measures 1.1 x 0.9 cm and previously measured 1.1 x 1.2 cm (image 151, series 4), not significant changed. Large inguinal lymph nodes are again noted with reference lesion measuring 2.5 x 2.1 cm and previously measuring 2.6 x 2.1 cm (image 214, series 4).BOWEL, MESENTERY: Left pelvic lymphocele, which extends inferiorly into the pelvis measures, 8.0 x 4.9 cm and previously measured 8.7 x 5.2 cm (image 180, series 4), mildly decreased in size. An additional small right pelvic lymphocele is unchanged.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Abdominal and pelvic lymphadenopathy as detailed above, not significantly changed from the prior study. Mild decrease in size of pelvic lymphoceles. |
Generate impression based on findings. | Clinical question: Evaluate for mass/CVA. Signs and symptoms: Syncope/periods of unresponsiveness. 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 visualized orbits, paranasal sinuses and mastoid air cells. | Unremarkable nonenhanced head CT. |
Generate impression based on findings. | Clinical question: Evaluate VP shunt, history of migraine headache. Signs and symptoms: Headache and photophobia. Nonenhanced head CT:Images through posterior fossa are unremarkable and is stable since prior exam.Images through supratentorial space demonstrate nearly completely collapsed left lateral ventricle similar to prior exam. Normal size of right lateral ventricle as well as stable since prior study.A right-sided approach ventricular catheter with the tip in the left basal ganglia remain similar to prior exam.No detectable acute intracranial process CT however is insensitive for detection of acute nonhemorrhagic ischemic strokes.Calvarium and soft tissues of the scalp as well as bilateral orbits, paranasal sinuses and mastoid air cells are unremarkable. | No evidence of any new finding since prior exam in particular a stable collapsed left lateral ventricle and normal size of right lateral ventricle as well as right-sided approach ventricular catheter remains stable since prior exam. |
Generate impression based on findings. | Clinical question: Rule out hemorrhage. Signs and symptoms: Syncope with head injury. Nonenhanced head CT:No detectable acute intracranial process. CT however is insensitive for detection of acute nonhemorrhagic ischemic strokes.Very minimal subtle areas of low attenuation in the periventricular and subcortical white matter are concerning for mild age indeterminate small vessel ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation.Unremarkable calvarium, soft tissues of the scalp, orbits, visualized paranasal sinuses and mastoid air cells. | Mild age indeterminate small vessel ischemic strokes. |
Generate impression based on findings. | Clinical question: History of posterior head injury due to fall. Assess for hemorrhage. Signs and symptoms: Headache and dizziness. Nonenhanced head CT:Examination demonstrate a focus of increased density in the left cerebellopontine angle (axial image 7, coronal reformatted images 51 and sagittal reformatted image 16). This lesion appears fairly round on coronal reformatted images and although it could represent a focus of acute hemorrhage possibility of an extra axial mass such as a meningioma also should be considered. Recommend follow up with MRI examination. In addition on coronal images measures approximately 13.8 mm size. It results on very subtle mass effect on the adjacent left cerebellum however without evidence of parenchymal edema. No areas of mass effect on the fourth ventricle which is in midline.Unremarkable cerebral cortex, cortical sulci, ventricular system Thomas CSF cisterns and gray -- white matter differentiation otherwise.Unremarkable calvarium, soft tissues of the scalp, orbits, paranasal sinuses and mastoid air cells.Findings on this exam were discussed by phone with Dr. Carter Keme # 8427 at the time of review of study. | 1.Extra axial high density lesion measuring at 13.5-mm on coronal reformatted images concerning for an extra axial meningioma and or less likely a posttraumatic extra axial hematoma.2.Unremarkable nonenhanced head CT otherwise. |
Generate impression based on findings. | Clinical question: Rule out hemorrhage. Signs and symptoms: Rule-out hemorrhage. Status post fall. Nonenhanced head CT:Examination demonstrate no detectable acute posttraumatic calvarial or intracranial findings.Extensive left anterior frontal and left basal ganglia encephalomalacia consistent with a chronic ischemic stroke remain similar to prior exam from 2008.There is ex vacuo dilatation of left frontal horn of lateral ventricle secondary to chronic ischemic stroke.Examination also demonstrate additional foci of encephalomalacia along the bilateral ACA in the posterior frontal -- parietal region as well similar to prior study.Prominence of cortical sulci and ventricular system for patient's stated age concerning for underlying parenchymal volume loss.Examination demonstrate a hematoma measuring at 24 times 15-mm in the soft tissues of the scalp in the left supraorbital and laterally without evidence of underlying osseous abnormalities.There is also no detectable retro-orbital abnormalities.Visualized maxillofacial region remains otherwise unremarkable and with well pneumatized paranasal sinuses.Mastoid air cells and middle ear cavities are unremarkable. | 1.Left supra-and lateral frontal scalp hematoma and edema as detailed.2.Stable extensive chronic ischemic strokes and underlying parenchymal volume loss since prior study from 2008. |
Generate impression based on findings. | 64-year-old female with shortness of breath. PULMONARY ARTERIES: Diagnostic quality exam with no evidence of pulmonary embolus.LUNGS AND PLEURA: Mild basal atelectasis. Mild pleural thickening in the lung apices and along anterior aspect of right middle lobe. No consolidation or pleural effusions. Scattered bilateral lung micronodules, with largest nodule located along the floor of right lower lobe and measuring 3 mm (series 10, image 64).MEDIASTINUM AND HILA: No pathologically enlarged mediastinal lymph nodes. No pericardial effusion. Mild atherosclerotic calcifications in the aortic arch.Large hiatal hernia with most of stomach located intra-thoracically.CHEST WALL: Degenerative changes in thoracic spine with mild dextroscoliosis.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Status post cholecystectomy. | 1.No pulmonary embolus.2.Large hiatal hernia.3.Scattered benign appearing bilateral pulmonary micronodules. |
Generate impression based on findings. | Clinical question: Evaluate for intracranial injury. Signs and symptoms: Intoxication/alteration of mental status. Nonenhanced head CT:No detectable acute posttraumatic intracranial or calvarial/soft tissues of the scalp findings.The ventricle and subcortical low attenuation of white matter is believed to represent age indeterminate small muscle ischemic strokes.Mildly prominent supratentorial ventricular system likely is still within normal range for patient's stated age however subtle underlying parenchymal volume loss cannot be entirely excluded.Unremarkable calvarium and soft tissues of the scalp.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells. | 1.No accurate posttraumatic findings.2.Age indeterminate mild small vessel ischemic strokes. |
Generate impression based on findings. | Clinical question: History of pseudotumor cerebri. Signs and symptoms cord headache and double vision. Nonenhanced head CT:Nonenhanced head CT:No detectable acute intracranial process. CT however is insensitive for detection of acute non-hemorrhagic ischemic strokes.Paucity of cortical sulci and the small size of ventricular system is within normal range for patient's stated age of 41. This pattern is also often seen in patients with pseudotumor cerebri.Unremarkable cortex, ventricular system, CSF spaces and gray -- white matter differentiation otherwise.Unremarkable calvarium, soft tissues of the scalp, visualized orbits, paranasal sinuses and mastoid air cells. | Negative nonenhanced head CT. |
Generate impression based on findings. | Clinical question: 54 year-old female with hyperglycemia and persistent vertigo. Evaluate for any lesions. Signs and symptoms: Vertigo and blurry vision. Nonenhanced head CT:No detectable acute intracranial process. CT is insensitive for detection of acute nonhemorrhagic ischemic stroke.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation.Unremarkable calvarium, soft tissues of the scalp, partially visualized orbits, paranasal sinuses and mastoid air cells. | Negative nonenhanced head CT. |
Generate impression based on findings. | 50 year-old male with nausea and vomiting. History of lung cancer and pericarditis. PULMONARY ARTERIES: Diagnostic quality exam with no evidence of pulmonary embolism.LUNGS AND PLEURA: Postsurgical changes in the left lung with associated pleural thickening and volume loss.Interval improvement in previously seen left lung consolidation and groundglass opacities. Again seen are loculated pleural fluid collections in the left base and along the left aspect of the upper mediastinum.Scattered nodules and opacities in the right lung, which are not significantly changed. MEDIASTINUM AND HILA: No significant change in mediastinal adenopathy. AP window lymph node measures 1.3 cm, previously measured 1.3 cm (series 6, image 112). Left cardiophrenic node measures 1.1 cm, previously measured 1.1 cm (series 6, image 257).Stable heterogeneous left thyroid nodule.CHEST WALL: Multiple mixed lytic and sclerotic lesions in vertebral bodies, manubrium and left ribs, compatible with metastases, gradually worsening since 7/5/2013.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Again seen are multiple liver hypodensities compatible with metastases. Left adrenal gland mass is increased, measuring 1.7 cm, previously medical 1.2 cm (series 6, image 283). | 1.No pulmonary embolus.2.Postsurgical changes in the left lung, with interval improvement in left lung consolidation and ground glass opacities.3.No significant change in mediastinal lymphadenopathy.4.No significant change in loculated fluid collections along the left mediastinum and left base.5.Multiple worsening skeletal and stable hepatic metastases.6.Mild increase in size of left adrenal lesion. |
Generate impression based on findings. | Clinical question: Rule out metastases. Signs and symptoms: Headache and a taxi a period Nonenhanced head CT: Examination demonstrate a high density/likely hemorrhagic and necrotic mass in the left cerebellum measuring 32 x 22-mm in its transaxial dimensions. There is evidence of surrounding vasogenic edema. Mass-effect from combination of above findings results in near complete effacement of the fourth ventricle and significant compromise of all CSF spaces in the posterior fossa and including mild supratentorial port herniation and slight crowding of the cerebellar tonsils.There is also evidence of supratentorial acute hydrocephalus with evidence of transependymal exudate of CSF and partial effacement of cortical sulci. Midline is maintained and basal cistern remains widely patent. No detectable additional foci of parenchymal abnormal density.Calvarium and soft tissues of the scalp are unremarkable.Limited images through the orbits, paranasal sinuses and mastoid air cells are unremarkable. | 1.Hemorrhagic necrotic left cerebellar mass measuring at 22 x 32-mm size and with diffuse surrounding edema.2.Mass-effect in the posterior fossa results in complete effacement of the fourth ventricle and supratentorial acute hydrocephalus with subependymal exudate of CSF. |
Generate impression based on findings. | 58-year-old female, evaluate GI bleed. ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Diffuse severe hepatic steatosis, which limits the evaluation for hypervascular liver masses. Nodular cirrhotic liver contour and perihepatic ascites. The hepatic vasculature is patent. Cholelithiasis without evidence of inflammation.SPLEEN: No significant abnormality noted.PANCREAS: The native pancreas is atrophic. A right lower quadrant pancreatic transplant is noted with normal morphology and enhancement.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: Degenerative changes of the thoracolumbar spine.OTHER: Mild abdominal ascites.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Catheter with inflated balloon extends to the collapsed bladder.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: A rectal tube is noted.BONES, SOFT TISSUES: Diffuse soft tissue edema.OTHER: Mild pelvic ascites. | 1. No evidence of GI bleed.2. Cirrhotic liver morphology and severe diffuse hepatic steatosis, limiting the evaluation for hypovascular liver masses.3. Mild abdominal and pelvic ascites. |
Generate impression based on findings. | Confusion and difficulty with word finding. There is slight nonspecific prominence of the ventricles. There is no intracranial mass, fluid collection, hemorrhage or CT evidence of acute ischemia. Gray-white matter differentiation is maintained bilaterally and the midline is intact.Bones, orbits and visualized portions of the sinuses are normal. | No acute intracranial abnormality. |
Generate impression based on findings. | 85 year-old female with lupus, Sjogren's disease, and pulmonary fibrosis, now with dyspnea and are compared LUNGS AND PLEURA: Basilar predominant interstitial fibrosis with honeycombing and traction bronchiectasis, consistent with UIP-like pattern. However, there are ground glass opacities in the lung bases. No superimposed consolidation or pleural effusions.MEDIASTINUM AND HILA: Atherosclerotic calcifications in aorta and coronary arteries. Heart size normal. No pericardial effusion. Multiple mildly enlarged mediastinal lymph nodes, all measuring less than 1 cm in short axis dimension.Hiatal hernia.Right thyroid lobe nodule located at thoracic inlet (series 3, image 16).CHEST WALL: Degenerative changes affect the spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Multiple splenic calcifications consistent with prior granulomatous infection. Left renal cyst. | Pulmonary fibrosis in UIP-like pattern, or fibrosing NSIP, likely secondary to known SLE. |
Generate impression based on findings. | 19-year-old female patient with right lower quadrant abdominal pain. Evaluate for appendicitis. ABDOMEN:LUNG BASES: Lung bases and pleural spaces are clear.LIVER, BILIARY TRACT: Predominately hypoattenuating, well circumscribed subcapsular lesion in the posterior right liver that measures 1.2 x 1.9 cm (series 3, image 27). Lesion demonstrates foci of peripheral nodular enhancement. No cholelithiasis. No biliary dilatation.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: Oral contrast rapidly progressed through normal appearing stomach, small bowel and colon. Normal appearing appendix without adjacent inflammatory changes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Oral contrast rapidly progressed through normal appearing stomach, small bowel and colon. Normal appearing appendix without adjacent inflammatory changes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of free fluid within the cul-de-sac is within normal physiological limits. | 1.No abnormality seen to account for patient's symptomatology.2.Well-circumscribed lesion within liver with peripheral nodular enhancement most likely represents a hemangioma. |
Generate impression based on findings. | Female, 70 years old, altered mental status, history of MCA rupture status post cranioplasty. Postoperative changes are demonstrated consistent with right pterional craniotomy. There is a surgical clip within the right middle cranial fossa in stable position.Extensive encephalomalacia is identified involving the right MCA territory. Associated ex vacuo dilatation of the right lateral ventricle is also unchanged.Hyperdense foci within the encephalomalacic brain are reidentified, similar to prior exam. These are most suggestive of dystrophic calcification, however blood product cannot be entirely excluded.Scattered vague areas of hypoattenuation are redemonstrated in the left cerebral hemisphere, unchanged and perhaps representative of age indeterminant small vessel ischemic disease.No generalized mass-effect is seen. No new extra axial fluid collections are demonstrated. The left lateral ventricle and third ventricle remain prominent, similar to prior. The fourth ventricle is normal in size. | 1. Redemonstration of craniotomy change with surgical clip placement in the right middle cranial fossa.2. Stable right MCA distribution encephalomalacia.3. Hypodense foci within the encephalomalacic region have not significantly changed. These are suggestive of areas of dystrophic calcification, though as before, blood product cannot be entirely excluded.4. No significant interval changes. |
Generate impression based on findings. | 80 year-old female with hypoxia and shortness of breath. PULMONARY ARTERIES: No evidence of pulmonary embolus with diagnostic quality exam down to subsegmental pulmonary artery branches.LUNGS AND PLEURA: Mild centrilobular emphysema, predominantly affecting lung apices. No consolidation or pleural effusions. Scattered bilateral calcified and noncalcified micronodules, all measuring less than 4 mm .There is a nidus of dilated vessels in the left costophrenic angle supplied by pulmonary artery and associated with a large draining vein, consistent with arteriovenous malformation; the artery supplying AVM measures 7 mm in diameter (series 80629, image 97). MEDIASTINUM AND HILA: No lymphadenopathy. Heart size normal. No pericardial effusion. Mild left chronic calcifications affecting the coronary arteries and aorta.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.No pulmonary embolus.2.Pulmonary arteriovenous malformation in left lower lobe.3.Mild emphysema.4.Bilateral benign appearing pulmonary micronodules; in low risk patient, no follow-up is recommended. |
Generate impression based on findings. | Reason: shortness of breath, recent DVT, eval for PE History: shortness of breath PULMONARY ARTERIES: There is no evidence of pulmonary embolus. The pulmonary artery is enlarged measuring 3.4 cm consistent with pulmonary arterial hypertension.LUNGS AND PLEURA: Severe upper lobe predominant fibrosis, traction bronchiectasis, with cystic changes in the right apex similar appearance the prior exam.Mild pleural thickening at the lung bases.No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Enlarged subcarinal and hilar lymph nodes are unchanged.Patulous esophagus with evidence of the small hiatal hernia.Cardiac size is normal without evidence of a pericardial effusion.CHEST WALL: Old fracture deformity involving right fifth rib.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.No evidence of pulmonary embolus.2.Stable severe upper lobe predominant fibrosis and traction bronchiectasis compatible with known sarcoidosis. |
Generate impression based on findings. | Reason: PE History: SOB, CP PULMONARY ARTERIES: No filling defect to suggest pulmonary embolus. The main pulmonary artery is normal in size.LUNGS AND PLEURA: Small right pleural effusion has not significantly changed.Progressive coarse groundglass patchy consolidation in the lower lobes, concentrated within the left lower lobe. Interval reduction of the patchy ground glass within the right middle lobe. A peripheral, wedge-shaped opacities in the posterior lower lobes favor that of subsegmental atelectasis, less likely resolving pulmonary infarcts, if there is history of prior embolus. The constellation of findings raises the question of ongoing pulmonary hemorrhage with possible infection. A component of edema is suspected.MEDIASTINUM AND HILA: Persistent cardiomegaly with biatrial and left ventricular chamber enlargement. No interval pericardial effusion or calcification.Previous described mediastinal lymphadenopathy has not significantly changed in the prevascular and paratracheal locations. A reference subcarinal lymph node has increased in size, 31 mm (series 7 image 138), as compared to 23 mm. Bilateral hilar lymphadenopathy is also stable.CHEST WALL: Diffuse body wall edema.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Bilateral renal atrophy. Reflux of contrast into a dilated suprahepatic IVC and dilated hepatic veins suggestive of a tricuspid regurgitation and possibly right heart failure. Reflux hepatopathy is a consideration. | 1.No pulmonary embolus.2.Shifting groundglass opacities, increased within the left lower lobe, raising a question of ongoing pulmonary hemorrhage and possible infection. Severe cardiomegaly with right atrial and left ventricular chamber dilation, small right pleural effusion consistent with a component of edema.3.Mediastinal and hilar lymphadenopathy. Overall, this has been stable except for increased size of the subcarinal lymph node. |
Generate impression based on findings. | Facial trauma from fall. There is patchy periventricular and subcortical hypoattenuation most prominent in the right parietal region where there has been interval development of a hypoattenuating focus since the prior MRI examination. There is no evidence of acute ischemia, intracranial mass, fluid collection or hemorrhage. Gray-white matter differentiation is maintained bilaterally and the midline is intact. Orbits, mastoid air cells and bony structures are unremarkable. There are postoperative changes to the maxillary and ethmoid sinuses with some soft tissue attenuation likely representing mucosal thickening. | 1.No acute intracranial hemorrhage.2.Patchy white matter hypoattenuation consistent with minimal chronic small vessel ischemic disease, with interval development of findings in the right parietal region which are age-indeterminate. |
Generate impression based on findings. | 67 -year-old female with with tachycardia and abdominal pain -- rule-out infection. Reported history of colon resection 4 days prior with colocolonic anastomosis and diverting loop ileostomy. ABDOMEN:LUNG BASES: Bibasilar pleural effusions and right basilar atelectasis.LIVER, BILIARY TRACT: Liver parenchyma appears homogeneous without mass lesions. Portal and hepatic veins appear normal. Mild dilatation of the intrahepatic and extra hepatic bile ducts are seen, unchanged from 12/13/12, although no pneumobilia seen on the current examination as demonstrated on prior. Patient is status post cholecystectomy.SPLEEN: No spleen present.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: New since 12/13/12 is bilateral hydronephrosis right greater than left. Both ureters are seen. Mildly dilated throughout their entire course into the pelvis where streak artifact from right hip prosthesis obscures visualization, but it does appear that they extend to the bladder bilaterally. Enhancing walls are seen to the ureters bilaterally more prominent than usually seen. This is of uncertain significance, but inflammation, infection or chronic obstruction could cause this finding.Renal parenchyma shows no significant masses. No perinephric fluid collections are seen..RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Orally administered contrast rapidly progresses through stomach and small bowel to the left lower quadrant ileostomy. Patient has had partial resection of stomach with unchanged appearance to the expected postoperative changes.More distally in the pelvis, surgical anastomosis is seen in the sigmoid colon. Adjacent to this region are fluid collections in both on the right and left sides of the pelvis and adjacent to the anastomosis. The collection on the right does not appear loculated and there is air within it, to be expected 4 days postoperative. The collection to the left (series 16, image 113) does appear more loculated, with with debris and mild air. While this may represent postoperative necrosis, hematoma, and debris, the possibility of an abscess or leak cannot be differentiated. Anterior to the bladder and extending laterally adjacent to the cecum, is another fluid collection (see series 16, image 108) which also has air fluid levels and a slightly thickened wall .Small amount of free peritoneal fluid and fluid in the presacral space. 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: Orally administered contrast rapidly progresses through stomach and small bowel to the left lower quadrant ileostomy. Patient has had partial resection of stomach with unchanged appearance to the expected postoperative changes.More distally in the pelvis, surgical anastomosis is seen in the sigmoid colon. Adjacent to this region are fluid collections in both on the right and left sides of the pelvis and adjacent to the anastomosis. The collection on the right does not appear loculated and there is air within it, to be expected 4 days postoperative. The collection to the left (series 16, image 113) does appear more loculated, with with debris and mild air. While this may represent postoperative necrosis, hematoma, and debris, the possibility of an abscess or leak cannot be differentiated. Anterior to the bladder and extending laterally adjacent to the cecum, is another fluid collection (see series 16, image 108) which also has air fluid levels and a slightly thickened wall .Small amount of free peritoneal fluid and fluid in the presacral space.BONES, SOFT TISSUES: Right hip prosthesis. Again seen -- this creates extensive streak artifact across the internal pelvis and obscures visualization of the bladder and distal ureters.OTHER: No significant abnormality noted | 1. Interval left lower quadrant ileostomy and colocolonic sigmoid anastomosis. 2. Free mesenteric fluid seen scattered throughout the abdomen, but 3 collections of which are loculated in the pelvis in general vicinity of recent surgery with debris and air-fluid levels. Four days postoperative air can appear in these collections, however, these findings cannot exclude leak or abscess. 3. Bilateral hydronephrosis and dilated ureters with enhancing ureter walls -- visualization of distal ureters is obscured due to streak artifact from right hip prosthesis. |
Generate impression based on findings. | Male, 42 years old, with backache, evaluate for spinal metastases. Thoracic:Alignment is anatomic. Vertebral body heights are preserved. No fractures are detected. Bone mineral density is preserved. No concerning focally destructive lesions are seen to suggest the presence of metastatic disease.The bony spinal canal is patent throughout. No significant bony encroachment of the neural foramina is detected. Please note that CT is insensitive for soft tissue/disk encroachment.Small Schmorl's nodes are evident at many levels. Anterior osteophytes are seen from T7 through T9.Lumbar:Alignment is anatomic. Vertebral body heights are preserved. No fractures are detected. Bone mineral density is preserved. No concerning focally destructive lesions are seen to suggest the presence of metastatic disease.The bony spinal canal is patent throughout. There may be mild bony encroachment of the L5-S1 neural foramina. Otherwise, the bony foramina are patent. As above, CT is insensitive for soft tissue/disk encroachment.Again, small Schmorl's nodes are demonstrated at many levels of the lumbar spine.Incidental note is made of free fluid within the peritoneum. The portal veins within the liver seem to be distended. These findings are new relative to the prior body CT. | 1. No evidence of destructive osseous lesions to suggest the presence of metastatic disease. Please note that in some instances, bony metastatic disease can be occult on CT. MRI would provide a more sensitive evaluation if clinically warranted.2. Incidental note is made of free fluid within the peritoneum and apparent distention of the hepatic portal veins. These findings are new relative to the prior body CT. Dedicated abdominal imaging would better assess these findings. |
Generate impression based on findings. | 36 year old female with history of colonic Crohn's disease presenting with pain, nausea and vomiting. ABDOMEN: Exam limited by limited oral contrast intake.LUNG BASES: Mild basilar scarring/atelectasis.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Distal ileal and cecal submucosal fat deposition and deformity of the cecum, as well as prominent right lower quadrant mesenteric lymph nodes, consistent with the history of Crohn's disease. Three to four small bowel loops in the right lower quadrant near the ileocecal valve appear tethered and possibly narrowed but the lack of adequate fluid distention of the bowel lumen precludes full evaluation (image 103 series 3). Fistulization cannot be excluded. No loculated fluid or evidence of right lower quadrant inflammation.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Uterus and adnexa appear physiologic for age.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Distal ileal and cecal submucosal fat deposition and deformity of the cecum, as well as prominent right lower quadrant mesenteric lymph nodes, consistent with the history of Crohn's disease. Three to four small bowel loops in the right lower quadrant near the ileocecal valve appear tethered and possibly narrowed but the lack of adequate fluid distention of the bowel lumen precludes full evaluation (image 103 series 3). Fistulization cannot be excluded. No loculated fluid or evidence of right lower quadrant inflammation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Evidence of chronic distal/terminal ileal and cecal inflammation as detailed above with tethering of bowel loops in the right lower quadrant, incompletely evaluated due to limited oral contrast intake. No evidence of active right lower quadrant inflammation or loculated collection. |
Generate impression based on findings. | 28-year-old female, evaluate for signs of pancreatitis ABDOMEN: Exam limited due to lack of IV and oral contrast.LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Atrophic native pancreas. Right lower quadrant pancreatic transplant is poorly visualized due to lack of IV contrast but remains thickened. There is no surrounding infiltration of the fat or associative fluid collection.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Atrophic native kidneys. Left iliac fossa renal transplant with perinephric ascites.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Mild abdominal ascites.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Distended bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Moderate pelvic ascites. | 1. Pancreatic transplant remains thickened without evidence of associated fluid collection or surrounding inflammation.2. Abdominopelvic ascites again noted. |
Generate impression based on findings. | Reason: respirophasic chest pain History: chest pain respirophasic PULMONARY ARTERIES: The pulmonary arterial tree is adequately opacified to the segmental level. No pulmonary embolus can be identified. There is no evidence of enlargement of the pulmonary artery.LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | No evidence of a pulmonary embolus to the segmental level. No significant pulmonary or pleural abnormalities. |
Generate impression based on findings. | 54-year-old female with question of intracranial hemorrhage. There is no evidence of extra-axial fluid collection or intracranial bleeding.There are postoperative changes of right parietal craniotomy with hypodensity representing encephalomalacia of the right temporal lobe which has slightly increased from prior study. Again seen is a subtle hypoattenuating focus in the posterior right thalamus which correlates to an enhancing focus evident on prior planning MR.The ventricles and basal cisterns are normal in size and configuration.Postoperative changes of right parietal craniotomy, otherwise the calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. | 1. No evidence of intracranial bleeding.2. Expected postsurgical changes with slightly increased encephalomalacia in the right temporal lobe.3. Hypoattenuating lesion in the posterior right thalamus correlating with an enhancing focus on prior MR. |
Generate impression based on findings. | Blunt trauma. Evaluate left orbit. There is soft tissue density associated with the left sided ethmoid and maxillary sinuses as well as overlying cortical irregularity consistent with left medial and orbital floor blow out fractures. There is no significant displacement of ossific fragments comprising the medial wall which has a nondisplaced fracture line running in the axial plane (coronal series 8048 image 39). There are displaced bony fragments including a 7 x 7 mm fragment of the central orbital floor inferiorly displaced into the maxillary sinus associated with a 15 (AP) x 7mm (trans) bony defect. A 6 x 6 mm fragment is displaced in an angulated fashion into the superior aspect of the sinus anteriorly.The soft tissue attenuation associated with this defect which could represent hematoma and/or inflamed fat, though the inferior oblique muscle is not clearly visualized and herniation/entrapment cannot be excluded. The inferior rectus is well delineated and does not extend into the defect. The muscle is minimally ill-defined and slightly more rounded than the contralateral side, likely relating to inflammation from the adjacent traumatic process. Left maxillary contents more inferiorly likely represent a combination of hemorrhage and secretions.The globe demonstrates normal contour and position of the lens. There is soft tissue stranding overlying the left zygoma. The right orbit is normal. Ostiomeatal units are patent bilaterally. The right orbit and sinuses are normal.There is a nondisplaced but minimally medially angulated fracture of the left nasal bone. There is a sigmoid configuration of the nasal septum with a superior right-sided spur which contacts the right lateral wall of the nasal cavity (coronal series 8048 image 39) and a left sided spur inferiorly which contacts the left inferior turbinate (image 60). | 1.Left orbital blowout fractures of the medial and inferior walls. The medial wall is nondisplaced while there are displaced fragments associated with a defect of the orbital floor. Entrapment of the inferior oblique muscle cannot be excluded and should be assessed clinically.2.Nondisplaced fracture of the left nasal bone.3.Sigmoid configuration of the nasal septum associated with spurs as described. |
Generate impression based on findings. | Reason: s/p thoracentesis; Loculated left hydropneumothorax on xray History: fever, sob CHEST:LUNGS AND PLEURA: Interval removal of a left chest tube. Large left hydropneumothorax with moderate amount of pleural fluid and mild thickening of the visceral pleura. In the superior left hemithorax (series 5 image 28), a component of this fluid may be loculated, as it does not layer dependently. The majority of the left upper lobe is aerated. The left lower lobe is atelectatic. No filling defect within the central left lower lobe bronchus. The segmental and subsegmental bronchi appear compressed. While there is minimal enhancement of the parietal pleura posteriorly, no enhancement of the visceral pleura is identified.On the right, within all lobes, there are clustered nodules that are new from 5/26/13 and appear inflammatory in origin. A moderate right pleural effusion with compressive atelectasis of the right lower lobe is also present.MEDIASTINUM AND HILA: The heart size remains normal. No interval pericardial effusion. Mild interval enlargement of a right cardiophrenic lymph node that now measures 9 mm (series 3 image 73), as compared to 4 mm.CHEST WALL: A right port catheter terminates in the central superior vena cava. Mildly enlarged left axillary lymph node, increased from prior.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: Diffuse, mild anasarca.OTHER: Ascites has increased with centralization of bowel loops. Periportal edema is also increased. | 1.Moderate left hydropneumothorax following removal of a chest tube. A loculated component is suspected superiorly. While there is minimal enhancement of the parietal pleura posteriorly, no significant visceral pleural enhancement is identified.2.Clustered nodules are noted throughout the right lung which are suspected to be inflammatory in origin. Associated moderate right pleural effusion.3.Progressive ascites and periportal edema. |
Generate impression based on findings. | Female 36 years old; Reason: history of breast cancer, starting new treatment regimen - baseline scan required. Please use measurements if applicable History: see above CHEST:LUNGS AND PLEURA: There is new scarring and parenchymal nodules involving the right lung. A right upper lobe mass measures 2.8 x 1.7 cm (image 52/series 5). There are multiple other parenchymal masses. The pleural spaces are clear.MEDIASTINUM AND HILA: Heart size is normal. Extensive poorly enhancing mediastinal lymphadenopathy. A right paratracheal mass measures 2.4 x 1.7 cm (image 39/series 3). CHEST WALL: Bilateral mastectomies with postoperative changes in the axilla.Rest chest wall port terminates at the cavoatrial junction.ABDOMEN:LIVER, BILIARY TRACT: There is a smooth contour. There are several subcentimeter hypodense hepatic foci which are too small to characterize.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Multiple pulmonary lesions and mediastinal lymphadenopathy suspicious for metastatic disease. |
Generate impression based on findings. | Male, 71 years old, with lower back pain and weakness, and confusion, history of stroke. Head:Encephalomalacia is redemonstrated in the left MCA territory consistent with chronic infarct. The geographic extent of this abnormality has very slightly increased from the prior exam.Extensive periventricular hypoattenuation is demonstrated bilaterally, perhaps mildly progressed relative to the prior examination. This is a nonspecific finding but compatible with age indeterminate small vessel ischemic disease.No evidence of focal parenchymal edema, loss of the gray-white distinction, or other evidence of acute territorial ischemia in the remainder of the brain. No evidence of intracranial hemorrhage or new abnormal extra-axial fluid collections. Ventricular system is prominent which, on the left, is partly an ex vacuo effect.No concerning osseous lesions are seen. Paranasal sinuses and mastoid air cells are clear. Bilateral hearing aids are in place.Lumbar spine:Alignment is anatomic. Mild wedging of the T11 vertebral body is likely degenerative in nature. Otherwise, vertebral body heights are preserved. No focally destructive osseous lesions are seen.The lower spinal canal is congenitally slender. Superimposed upon this is evidence of disk bulging at L4-5. This encroaches upon the thecal sac to a moderate degree. Significant facet and ligamentum flavum hypertrophy is also evident at L4-5 and L5-S1.Some degree of bony encroachment upon the neural foramina is evident at all levels. This is particularly severe at L4-5 and L5-S1. Please note that MRI would provide a more sensitive evaluation for soft tissue and disk encroachment upon the spinal canal and the neural foramina.The kidneys are small and there is a cyst arising from the right kidney. | 1. Evidence of chronic left MCA distribution stroke.2. Extensive age indeterminate small vessel ischemic disease.3. No concerning or focally destructive osseous lesions are seen in the lumbar spine.4. Disk bulging and posterior element hypertrophy contribute to a narrowing of the spinal canal L4-5.5. Significant bony encroachment upon the neural foramina is seen at L4-5 and L5-S1. |
Generate impression based on findings. | 66-year-old male patient with obstipation. Evaluate for obstruction. Note that the lack of intravenous contrast limits evaluation of the vasculature, lymph nodes, solid and hollow viscera.ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Moderately enlarged.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right kidney is atrophic with evidence of mild nephrosis.Left kidney is within normal limits.RETROPERITONEUM, LYMPH NODES: Matted, bulky lymphadenopathy in the bilateral periaortic, right common iliac, right external iliac and left femoral regions.BOWEL, MESENTERY: Oral contrast progressed through normal appearing stomach and small bowel. Large bowel normal caliber. Moderate stool burden within the sigmoid colon and rectum.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Lipoma within the right chest wall adjacent to ribs 9 and 10 measures 2.7 x 5.7 cm (series 2, image 175). Atherosclerotic changes in the abdominal aorta and iliac arteries.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: Urinary bladder is poorly distended with Foley catheter in place.LYMPH NODES: Matted, bulky lymphadenopathy in the bilateral periaortic, right common iliac, right external iliac and left femoral regions.BOWEL, MESENTERY: Oral contrast progressed through normal appearing stomach and small bowel. Large bowel normal caliber. Moderate stool burden within the sigmoid colon and rectum.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Bulky lymphadenopathy in the retroperitoneal region and right iliac chain likely contributing to patient's right-sided hydronephrosis.2.Moderate stool burden in sigmoid colon and rectum without evidence of obstruction.Finding of lymphadenopathy and hydronephrosis communicated to Dr. Floyd via telephone at 8:20 AM on 10/22/13 by Dr. Trilisky. |
Generate impression based on findings. | Reason: HNC History: HNC CHEST:LUNGS AND PLEURA: Multiple scattered calcified granulomata. Right apical post radiation fibrosis unchanged.No suspicious pulmonary nodules or interval pleural effusion.MEDIASTINUM AND HILA: The heart remains normal size. No interval pericardial effusion. Several calcified lymph nodes are indicative of prior granulomatous infection. Minimal coronary arterial calcification is noted within the left anterior descending artery.CHEST WALL: No axillary lymphadenopathy.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Nonspecific low density within the left hepatic lobe may represent artifact (series 4 image 96). No other hepatic lesions are identified.SPLEEN: Calcified granulomata.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable right renal cyst.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. | No evidence of metastases. |
Generate impression based on findings. | Reason: interstitial lung disease? will need high res scan History: crackles on exam, persistent despite diuresis. pulmonary hypertension patient who may have some component of interstitial disease that is worsening? LUNGS AND PLEURA: Interval increase in the diffuse groundglass opacities and mosaic attenuation particularly in the right middle lobe, lingula, and left lower lobe.There is evidence of bronchial/bronchiolar wall thickening and centrilobular opacity compatible with small airway and/or reactive airway disease. Stable area of scarring/discoid atelectasis in the right upper lobe.Marked prominence of the pulmonary arterial vasculature with the pulmonary artery measuring 3.9 cm in diameter representing an interval increase in size from the prior exam.No significant pleural effusions or septal thickening.. No evidence of air trapping.No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Mildly enlarged mediastinal lymph nodes.Markedly enlarged pulmonary artery.Moderate cardiac enlargement with evidence of a mild/moderate pericardial effusion new from the prior exam.CHEST WALL: Degenerative changes in the thoracic spine..UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Stable hypodensity in left lobe of the liver. | 1.Evidence of pulmonary arterial hypertension with interval increase in size of the central pulmonary artery.2.Increasing diffuse groundglass opacities and mosaic attenuation without evidence of septal lines or pleural effusions compatible small vessel and or small airways disease.3.Bronchial and bronchiolar wall thickening with no evidence of significant air trapping. This may represent a small airway and/or reactive airway disease.4.Cardiac enlargement with new mild/moderate pericardial effusion. |
Generate impression based on findings. | Male, 29 years old, motor vehicle accident. The cerebral and cerebellar hemispheres and brainstem are normal in attenuation and morphology. No intracranial hemorrhage or abnormal extra-axial fluid collection is seen. There is no evidence of mass effect or midline shift. The ventricles and basal cisterns are patent and normal in size. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.The bones of the calvarium and skull base are intact. Mild reversal of the normal cervical lordosis likely positional. Otherwise, alignment is anatomic. No fractures are seen.The bony spinal canal and neural foramina are patent. The prevertebral soft tissues are within normal limits. | 1. No acute intracranial abnormality.2. No cervical spine fracture or acute dislocation. |
Generate impression based on findings. | Fall and pain. This examination confirms the presence of an L1 vertebral body fracture with the fracture line extending from the anterior vertebral body wall through the superior endplate with minimal inferior/anterior displacement of the fracture fragment. There is no definite involvement of the posterior cortex or canal compromise. There is mild focal concavity of the superior endplate at this level. There is minimal stranding of the prevertebral tissues. There is bony fragmentation associated with the tip of the L1 spinous process, though fragments are well corticated and this likely represents sequela of prior trauma. There is decreased physiologic lumbar lordosis without significant vertebral body height loss elsewhere. There is minimal intervertebral disk height at L2-3 and L4-5. There is degenerative disk disease with multilevel disk bulges most prominent at L4-5 where there is moderate bilateral neural foraminal stenosis and at least mild to moderate central spinal canal stenosis. Degenerative facet changes are demonstrated at L4-5 and L5-S1 as well as degenerative changes at the right SI joint. | 1.Fracture of the anterior aspect of L1 with minimal displacement of the fracture fragment and no definite involvement of the posterior cortex. Mild associated compression deformity of the superior endplate.2.Multilevel degenerative disease most prominent at L4-5. |
Generate impression based on findings. | Reason: heart transplant workup - crackles on exam, ILD? History: crackles LUNGS AND PLEURA: Predominantly paraseptal with associated centrilobular emphysema.Moderate right pleural effusion. With prone inspiratory imaging, the displaced pleural fluid reveals a posterior pleural based focus of consolidation (series 10 image 27) with associated atelectasis. There is no significant pleural thickening associated with this. Considerations include early rounded atelectasis; however, focus of consolidation (infection) is a consideration. As this is a baseline examination, adenocarcinoma cannot be excluded. Short interval follow-up (8 weeks) is recommended to ensure resolution.No evidence of fibrosis or airtrapping is noted.MEDIASTINUM AND HILA: Mild cardiac enlargement without pericardial effusion. There is dense material involving the left anterior descending and diagonal branches. Due to the dense nature of this, these may represent intravascular stents or heavy coronary artery calcification.No mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Small quantity of ascites. | 1. Moderate right pleural effusion. With prone inspiratory imaging, the displaced pleural fluid reveals a posterior pleural based focus of consolidation. Considerations include early rounded atelectasis; however, focus of consolidation (infection) is a consideration. As this is a baseline examination, adenocarcinoma cannot be excluded. Short interval follow-up (8 weeks) is recommended to ensure resolution.2. Predominantly paraseptal with associated centrilobular emphysema.3. No evidence of fibrosis or airtrapping is noted. |
Generate impression based on findings. | 39-year-old male with malignant neoplasm of the spinal cord, grade 1 astrocytoma and CSF dissemination to the meninges now unresponsive with right eye deviation Interval increase in size of the ventricular system with interval increase in amount of extensive periventricular and subcortical white matter hypoattenuation, particularly in the left occipital region. Interval increase in hypoattenuation along the right trans-frontal ventriculostomy catheter. Cannot exclude transependymal spread of CSF based on these findings.Additionally, there is interval development of partial effacement of the cortical sulci. Similar to the recent comparison examination, there is a suggestion of increased soft tissue density anterior to the interpeduncular cistern and extending leftward. This process may involve the left third cranial nerve.Redemonstration of a right trans-frontal ventriculostomy catheter that terminates in the expected region of the right foramen of Monro, unchanged. No evidence of intracranial hemorrhage.The osseous structures are unremarkable. Left maxillary mucus retention cyst, otherwise the paranasal sinuses and mastoid air cells are clear. | Interval increase in ventricular size, increase in periventricular and subcortical white matter hypoattenuation and development of effacement of cortical sulci. This constellation of findings may be secondary to increased intracranial pressure or progression of leptomeningeal carcinomatosis.These findings were discussed with Dr. Slangini at 9:30 a.m. on 10/22/2013. |
Generate impression based on findings. | 60 year-old male with metastatic melanoma and treatment, evaluate for disease progression. CHEST:LUNGS AND PLEURA: Tiny right upper lobe ground glass nodular opacity, unchanged (image 32, series 5).MEDIASTINUM AND HILA: Scattered small mediastinal lymph nodes are unchanged. No lymphadenopathy.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Status post right segmentectomy. Reference hypodense lesion in the posterior right liver is not significantly changed and measures 1.4 x 1.1 cm (image 85, series 3) and previously measured 1.6 x 1.2 cm. This is unchanged since 2010 and thus benign and no longer needs to be measured.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: Multiple prominent retroperitoneal lymph nodes are not changed. The reference aortocaval lymph node measures 1.2 x 0.7 cm (image 145, series 3) and previously measured 1.0 x 0.7 cm.BOWEL, MESENTERY: A small umbilical hernia containing small bowel is again noted without evidence of obstruction.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: Unchanged left external iliac lymph node measures 1.7 x 1.2 cm (image 21, series 3) and previously measured 2.0 x 1.3 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No interval change in reference lesions or new evidence of metastatic disease. |
Generate impression based on findings. | Female, 31 years old, hoarseness of voice, no mass is palpated, no history of neck surgery. CT head:The cerebral and cerebellar hemispheres and brainstem are normal in attenuation and morphology. No intracranial hemorrhage or abnormal extra-axial fluid collection is seen. There is no evidence of mass effect or midline shift. The ventricles and basal cisterns are patent and normal in size. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. The bones of the calvarium and skull base are intact. CT neck:Without the benefit of intravenous contrast, no masses or pathologic lymph nodes are detected.The right laryngeal ventricle is more prominent on the left. This is a nonspecific finding and can be normal. However it has also been associated with vocal cord dysfunction. The vocal cords, however, are not significantly asymmetric. The aryepiglottic folds are within normal limits. The remainder of the aerodigestive tract is unremarkable.Please note that the undersurface of the aortic arch is not included within the field of view, and as such, the full course of the left recurrent laryngeal nerve is not assessed.The salivary glands and the thyroid are free of focal lesions. Mild apical cystic change is seen in the right lung.No worrisome osseous lesions are detected. There is degenerative disk disease in the cervical spine, most conspicuously at C5-6 where a disk osteophyte complex causes some degree of thecal sac effacement. | 1. Unremarkable noncontrast CT of the head.2. Asymmetric prominence of the right laryngeal ventricle is a nonspecific finding and can be normal. However, it may also be a secondary sign of vocal cord dysfunction. If clinical concern persists, direct visualization of the cords would be able to confirm this possibility.3. Elsewhere in the neck, and without the benefit of IV contrast, no additional specific abnormalities are seen. |
Generate impression based on findings. | 51-year-old male with head and neck cancer The visualized portions of the intracranial fossa are unremarkable. The skull base is unremarkable including the frontal sinuses, paranasal sinuses, and ethmoid air cells. The orbits are unremarkable.The soft tissues of the pharynx are unremarkable. The larynx is unremarkable.The visualized salivary glands are somewhat atrophied but otherwise unremarkable. The thyroid gland is unremarkable. There is atrophy of the left SCM and effacement of the fat planes, left more than right, which is unchanged and expected posttreatment.There is no evidence of cervical lymphadenopathy.There is biapical scarring in the lungs.There is mild degenerative disease of the cervical spine, bony structures of the neck and upper thorax are otherwise unremarkable. | Expected posttreatment changes without evidence of recurrent disease. |
Generate impression based on findings. | 54-year-old female patient with left lower quadrant abdominal pain and blood in stool. Evaluate for diverticula. ABDOMEN:LUNG BASES: Minimal subsegmental atelectasis versus scarring in the bilateral lung bases.LIVER, BILIARY TRACT: Prominence of intrahepatic biliary ducts. Status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: Diffuse calcifications throughout the pancreatic parenchyma. No pancreatic ductal dilatation or other significant abnormalities.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Oral contrast rapidly progressed through normal appearing stomach, small bowel and proximal large bowel. There is mild distention and moderate stool burden within the descending and transverse colon. There are no mural abnormalities or evidence of diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is dependent subcutaneous edema as well as diffuse edema throughout the intraperitoneal fat.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Urinary bladder is distended.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Oral contrast rapidly progressed through normal appearing stomach, small bowel and proximal large bowel. There is mild distention and moderate stool burden within the descending and transverse colon. There are no mural abnormalities or evidence of diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is dependent subcutaneous edema as well as diffuse edema throughout the intraperitoneal fat. | 1.Diffuse pancreatic parenchymal calcifications without pancreatic duct dilatation and prominent intrahepatic bile ducts. Findings consistent with chronic pancreatitis.2.No diverticulosis.3.Diffuse edema. |
Generate impression based on findings. | 48-year-old male with history of rectal cancer CHEST:LUNGS AND PLEURA: Calcified nodules and micronodules some calcified and consistent with prior granulomatous disease are unchanged.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesion. No intra-or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Hypodense renal lesions, too small to characterize, likely represent cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Posttreatment changes in the pelvis are identified. Presacral tissue thickening measuring 1.2 cm (image 23, series 3) appears similar to the prior study.BONES, SOFT TISSUES: Small periurethral 3.6 x 1.6 cm fluid attenuating lesion likely representing a diverticulum is more prominent than on the prior study (image 212, series 3). Left fat-containing inguinal hernia.OTHER: No significant abnormality noted | 1. Post surgical and treatment changes in the pelvis appear similar to the prior study without evidence of metastatic disease. |
Generate impression based on findings. | 73-year-old male with abdominal bleeding -- drop in hemoglobin. Within the limits of an IV contrast enhanced examination limiting evaluation of solid parenchymal organs and vascular structures. The following observations can be made:ABDOMEN:LUNG BASES: Left pleural effusion and bibasilar atelectasis.LIVER, BILIARY TRACT: No significant abnormality noted in liver parenchyma. Gallstones without other complication. No intrahepatic or extrahepatic biliary duct dilatation is seen to suggest obstruction.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right nephrectomy. Left kidney is within limits of non-IV contrast. Examination shows no morphologic abnormalities. Kidney is displaced anteriorly by new posterior retroperitoneal/psoas collection at level of the spinal metastasis surgery (series 3, image 68) which measures 8.8 x 3.8 cm and in light of rapid appearance of this lesion at level of surgery, most likely represents postoperative hematoma. There is a 5-mm very high attenuation focus medially in this collection which is of such high attenuation. It most likely represents a bony fragment from recent surgery and not a focus of acute hemorrhage. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Prior noted lytic lesion in L2 vertebral body has undergone surgery and internal fixation.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. Postop changes at L2 lytic lesion vertebral body with metallic rods in posterior elements and internal fixation screws. 2. Adjacent mass/collection consistent with contained hematoma. 3. Left pleural effusion. |
Generate impression based on findings. | 72 year old female with laryngeal cancer. LUNGS AND PLEURA: Stable scarring in both lung apices and centrilobular emphysema.Sub-solid left lower lobe nodule not significantly changed, measuring 5 mm, previously measured 4 mm (series 4, image 68). Sub solid nodule in the right lung base is also unchanged (series 4, image 84).MEDIASTINUM AND HILA: No mediastinal lymphadenopathy. Atherosclerotic calcifications in coronary arteries and aorta again noted. Small amount of debris in trachea. CHEST WALL: Status post neck dissection and voice prosthesis.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Stable bilateral adrenal nodules. Splenic granulomas. Right renal cyst. | 1.No evidence of metastases.2.Stable bilateral lower lobe sub-solid nodules. Continued annual follow-up is recommended. |
Generate impression based on findings. | 63-year-old male with history of appendiceal cancer CHEST:LUNGS AND PLEURA: Pleural thickening at the right lung base. A subpleural nodule measures 8 mm (image 66, series 5), appearing similar to the prior study. Additional nodularity is noted along the pleura and fissures not visualized on the prior body CT.MEDIASTINUM AND HILA: Center venous catheter tip in the SVC.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Diffuse hepatic steatosis, limits evaluation for focal lesions. A poorly visualized hypodense segment IVb lesion measures 2.2 x 1.9 cm and previously measured 2.4 x 2.5 cm (image 92, series 3). Hypoattenuation along the inferior right hepatic lobe is unchanged. Cholelithiasis without complication.SPLEEN: Nonspecific hypodense lesion is unchanged.PANCREAS: No significant abnormality notedADRENAL GLANDS: Unchanged left adrenal thickening, and small adenoma.KIDNEYS, URETERS:Bilateral hypoattenuating renal lesions likely representing simple cysts are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis. Status post appendectomy.BONES, SOFT TISSUES: Diffuse omental soft tissue infiltration and nodularity as well as ascites consistent with peritoneal carcinomatosis, appearing similar to the prior study.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Colonic diverticulosis without evidence of inflammation. Status post appendectomy.BONES, SOFT TISSUES: Diffuse omental soft tissue infiltration and nodularity as well as ascites consistent with peritoneal carcinomatosis.OTHER: No significant abnormality noted | 1. Findings consistent with diffuse peritoneal carcinomatosis, appearing similar to the prior study.2. Diffuse hepatic steatosis, limiting evaluation for focal lesions. Hypodense liver lesion appears similar to the prior study. |
Generate impression based on findings. | Clinical question: 52-year-old male with history of lymphoma, pre-stem cell transplant evaluation. Signs and symptoms: Evaluate sinuses. Non-enhanced maxillofacial CT:Frontal sinuses.Normal anatomical variation of small bilateral frontal sinuses however without evidence of sinusitis.Ethmoid sinuses.No additional sinusitis. There is suggestion of prior chronic healed lamina papyracea blow out fracture.Sphenoid sinus.No evidence of sinusitis.Maxillary sinuses.Extensive (left greater than right) chronic mucoperiosteal thickening of bilateral maxillary sinuses. There is resultant partially compromised bilateral ostiomeatal units. No evidence of acute sinusitis.Nasal passage.There is mild to moderate rightward nasal septum deviation and a small bony septal spur projecting to the right measuring at 3-mm length. There is associated deformity of the adjacent mucosal of the right inferior turbinate. Mild diffuse mucosal thickening of bilateral nasal passages.Only partial visualization of medullary cavities which appear well pneumatized. The mastoid air cells are not visualized on this study. | Extensive bilateral maxillary chronic sinusitis (left greater than right) and unremarkable other paranasal sinuses. Please see above comments. |
Generate impression based on findings. | 55 year-old female with rectal cancer resected in 2009. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable left renal cyst.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Soft tissue nodule along right posterior pararenal space, stable since 2009 (series 3, image 115). No lymphadenopathy.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Left lower quadrant ostomy.BONES, SOFT TISSUES: Stable lucency in L3 vertebral body, which may represent benign hemangioma.OTHER: No significant abnormality noted. | Stable exam without evidence of metastases. |
Generate impression based on findings. | 52-year-old female with history of CHF, DM, peripheral arterial disease, acute kidney injury -- leukocytosis -- evaluate for source of leukocytosis. CHEST:LUNGS AND PLEURA: Bilateral small pleural effusions and basilar atelectasis. No parenchymal masses, nodules, or air space consolidation.MEDIASTINUM AND HILA: No significant abnormality noted. NG tube traverses the esophagus with tip of tube in the fundus of stomach.CHEST WALL: No significant abnormality noted.ABDOMEN: Within the limits of a non-IV contrast enhanced examination which limits evaluation of solid parenchymal organs and vascular structures, the following observations can be made:LIVER, BILIARY TRACT: Liver parenchyma shows no change and no focal parenchymal abnormalities. Gallstone is again seen without other complication. No intrahepatic or extrahepatic biliary duct dilatation seen.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: Large bulbous uterus, with calcified masses most indicative of multiple leiomyomata.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: About these cysts sacrococcyx and more inferiorly is soft tissue thickening and infiltration with air centrally consistent with patient's clinical diagnosis of decubitus ulcer. This extends fairly deep into the presacral fat with air and suggests deep necrosis with density not that of fluid, but slightly higher and may represent phlegmons or necrotic debris -- it does not appear as a well-defined fluid collection and covers the region of approximate 5.1 x 6.4 cm... Extensive air collection seen in the posterior dependent soft tissues involving the gluteus muscle on the right (series 3, image 23) and extending to the midline decubitus ulcer region suggests extension of necrotic tissue approximately 9 cm laterally into the gluteus muscle.. Improvement in the diffuse subcutaneous anasarca seen previously, with mild residual. In addition, new soft tissue density in the anterior pelvic soft tissue subcutaneous fat (series 3, image 156), most likely benign in nature and perhaps injection residual.OTHER: No significant abnormality noted. | 1. New since 8/18/13 there is extensive infiltration into the pre-sacrum/coccyx fat up to and abutting the levator ani, but not extending into the perirectal region - decubitus ulcer with deep extension. 2. Extension of inflammatory changes with necrosis laterally into the right gluteus muscle with necrotic air debris.Discussed with Dr. Callender at 10:40 AM with readback. |
Generate impression based on findings. | Female 52 years old; Reason: history of scalp melanoma, s/p surgical excision and history of hepatitis. Status post liver transplant History: scalp melanoma CHEST:LUNGS AND PLEURA: No dominant lung lesions. The pleural spaces are clear. The central airways are patent.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Liver contour is mildly irregular. There are calcified left hepatic lobe lesions most likely represent granulomata.The liver is diffusely hypoattenuating compatible with fatty infiltration but no evident hepatic lesion. The hepatic and portal veins are patent.SPLEEN: The spleen is absent.PANCREAS: Status post resection of the pancreatic tail.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Focal area of the poor enhancement involving the posterior aspect of the right kidney which is unchanged. No hydronephrosis in either kidney. No evident renal mass.RETROPERITONEUM, LYMPH NODES: Small aorta caval lymph nodes, unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Findings suggestive of chronic liver disease. Follow up is suggested.2.Status post splenectomy and distal pancreatectomy.3.No evident findings of metastatic disease.4.Poorly enhancing area in the posterior aspect of the interpolar region of the right kidney of unclear etiology but unchanged |
Generate impression based on findings. | Clinical question: Stroke. Signs and symptoms: Hemiplegia. Nonenhanced head CT:The examination redemonstrates previously known subacute right MCA territory of right parietal lobe without evidence of hemorrhagic conversion since prior exam. The lesion similar to prior exam results in subtle regional mass-effect/effacement of cortical sulci and without mass effect on the lateral ventricle or midline shift.Extensive periventricular and subcortical low attenuation white matter consistent with age indeterminate small vessel ischemic strokes remains grossly similar to prior exam.Chronic right cerebellar pica territory ischemic stroke as was noted on prior study. | 1.Stable right parietal subacute nonhemorrhagic ischemic stroke in extent, size and overall regional mass effect.2.Grossly stable age indeterminate extensive small vessel ischemic strokes. |
Generate impression based on findings. | Reason: eval for metastatic disease; h/o tongue cancer History: none LUNGS AND PLEURA: Severe centrilobular and paraseptal emphysema. The nodular opacity in the left lower lobe is not significantly changed in size, again measuring 4 x 7 mm (series 5 image 75), compared to 4 x 8 mm. This is most likely due to scarring. Associated atelectasis and left pleural thickening not significantly changed. Multiloculated cyst in the left lower lobe not significantly changed and does not have any new or solid nodular component. Other scattered areas of scarring and atelectasis are noted. No new or suspicious lungnodule. A few scattered 1-2 mm sized micronodules are not significantly changed. No new pleural effusion.MEDIASTINUM AND HILA: The heart size remains normal. No pericardial effusion. Severe triple vessel coronary artery calcification and aortic valvular calcification. Atherosclerotic disease affects the distal transverse arch and descending thoracic aorta.No mediastinal or hilar lymphadenopathy.CHEST WALL: No mediastinal lymphadenopathy.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Stable nodularity within the left lower lobe, likely related to scarring. No specific evidence of metastatic disease. |
Generate impression based on findings. | 57-year-old female patient with pancreatic neuroendocrine tumor on octreotide Holliday. Evaluate for interval tumor progression. CHEST:LUNGS AND PLEURA: Right lung pulmonary micronodules identified. MEDIASTINUM AND HILA: Left supraclavicular lymph node measures 1.1 by 2.1 cm (series 10 image 8), previously 2.1 x 1.2 cm.CHEST WALL: Bilateral breast implants, stable.ABDOMEN:LIVER, BILIARY TRACT: There is redemonstration of numerous arterially enhancing hepatic lesions. Reference lesion along medial margin of the liver adjacent to the resection site measures 2.5 x 2.3 cm (series 7 image 27), previously 2.4 x 2.4 cm.Reference left lateral hepatic lesion measures 0.8 x 1.2 cm (series 7 image 37), previously 0.8 x 1.3 cm.Stable postoperative changes from right lobectomy and cholecystectomy.SPLEEN: Status-post splenectomy.PANCREAS: Stable postoperative changes from partial pancreatectomy.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Numerous bilateral hypodense renal lesions, stable and mostly representing cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.Reference left para-aortic lymph node measures 2.8 x 3.1 cm (series 8 image 108), previously 3.6 x 2.6 cm.inferior para-aortic lymph node measures 1.0 x 1.6 cm (series 8 image 115), previously 0.9 x 1.5 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable L2 vertebral body sclerotic lesion.OTHER: Situs inversus.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: Interval resolution of nodular lesions in the bilateral posterior subcutaneous fat at the level of the gluteal muscle and proximal thighs.OTHER: No significant abnormality noted. | 1.Stable hypervascular hepatic metastases.2.Stable lymphadenopathy. |
Generate impression based on findings. | Clinical question: Chronic sinusitis right maxillary sinus. Signs and symptoms: Chronic right maxillary sinusitis. Medtronic fusion sinus CT:Frontal sinuses are well pneumatized and unremarkable.Sphenoid sinus is well pneumatized and unremarkable.Ethmoid sinuses are well pneumatized and unremarkable.Right maxillary sinus demonstrate diffuse mucosal thickening and reaches all 10th compromise of right ostiomeatal unit. There is suggestion of a small air-fluid level present on axial images and sagittal reformatted images.There is significant interval improvement of sinus disease since prior exam which was entirely opacified.Left maxillary sinus is well pneumatized. There is however a small focus of mucosal thickening with resultant left ostiomeatal unit compromise.Images through the nasal passage are unremarkable.All mastoid air cells and bilateral middle ear cavities are well pneumatized. | 1.Extensive residual mucosal thickening in the right maxillary sinus with resultant compromise right ostiomeatal unit. There is interval improvement since prior exam. There is suggestion of air-fluid level present.2.Minimal focal mucosal thickening in the left maxillary sinus and with resultant left ostiomeatal unit compromise without change since prior exam.3.Unremarkable paranasal sinuses otherwise.4.Unremarkable bilateral mastoid air cells and middle ear cavities. |
Generate impression based on findings. | 62-year-old male. Screening for lung cancer. LUNGS AND PLEURA: Mild dependent atelectasis. No new or suspicious nodules. Several scattered bilateral calcified and noncalcified punctate nodules are unchanged, likely due to prior granulomatous infection. No consolidation or pleural effusions.MEDIASTINUM AND HILA: Soft tissue material is present along right distal aspect of trachea, which appears to be associated with mild thickening of the trachea (series 3, image 35). Mild to moderate atherosclerotic calcifications in the coronary arteries and aorta. Heart size normal. No lymphadenopathy. There is subendocardial fat density present in the cardiac septum; in the setting of coronary artery calcifications, this is suspicious for prior infarction.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.No suspicious pulmonary nodules.2.Nodularity in distal trachea which appears associated with mild tracheal wall thickening; since this may represent underlying tracheal lesion, either short term follow-up CT in approximately 3 months or bronchoscopy is recommended. Findings were discussed with Dr. Todd Stern 10/22/2013 at 11:25 am. |
Generate impression based on findings. | Reason: question of ild, other infiltrative disease History: left sided crackles, sob LUNGS AND PLEURA: Moderate basilar predominant subpleural reticular opacities and mild groundglass opacification.Moderate traction bronchiectasis is present.Only minimal honeycombing is seen.There is no evidence of air trapping on expiration series.Previously seen pleural effusions have completely resolved.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.Severe coronary artery calcifications predominantly affecting the LAD.CHEST WALL: Degenerative abnormalities affect the thoracic spine.High density material in the anterior chest wall unchanged.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Cholecystectomy clips. | Moderate interstitial lung disease, possible UIP pattern. |
Generate impression based on findings. | Reason: Metastatic breast cancer, receiving chemotherapy, restaging. History: n/a CHEST:LUNGS AND PLEURA: Progressive decrease size of previously described right middlelobe nodular opacities with mild residual ground glass opacities and a more nodular focussuperiorly (series 4, image 42). Interval resolution of right base opacities. No newsuspicious pulmonary nodules or masses. Stable calcified granuloma left lower lobe.No pleural effusion.MEDIASTINUM AND HILA: The heart size remains normal. No pericardial effusion.No mediastinal or hilar lymphadenopathy.CHEST WALL: There has been a right mastectomy.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis and layering sludge within the gallbladder without evidence of inflammation.The hepatic lesion previously identified is not well visualized on this examination.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: Diffuse osseous metastases throughout the thoracolumbar spine unchanged. Stable callus of a chronic posterior inferior right rib fracture. Osseous deformity of the right glenoid and scapula unchanged.OTHER: No significant abnormality noted. | 1. Progressive decrease size of pulmonary metastasis.2. Previously identified hepatic lesion is not well visualized on this examination.3. Stable osseous metastases. |
Generate impression based on findings. | 73 year old female with history of larynx cancer. No intracranial abnormalities are identified on limited intracranial views. Limited views of the paranasal sinuses are clear. The mastoid air cells are clear.Redemonstration of postsurgical changes including a laryngectomy and tracheostomy with placement of a tracheoesophageal prosthetic device. Paucity of fat in the anterior neck and possible atrophy of the submandibular glands compatible with radiation treatment, unchanged. No exophytic mass or focal effacement that can be identified in the aerodigestive tract to suggest recurrent tumor. No cervical lymphadenopathy based on imaging criteria. Scattered nonaggressive subcentimeter nodes identified in the neck similar to the prior.Remaining left thyroid lobe again demonstrates a small hypodensity compatible with a small cyst, unchanged. The salivary glands are unremarkable aside from the submandibular gland atrophy. No focal parotid lesions.Cervical vascular structures are notable for retropharyngeal course of the internal carotid arteries and moderate to severe calcified and soft plaque in the carotid bifurcations, unchanged. Poor visualization of the right vertebral artery, unchanged since 2011.Emphysematous changes again identified at the lung apices with some scarring, left greater than right. Calcified mediastinal lymph nodes, unchanged.Posterior disk osteophyte complexes at C4-C5, C5-C6 and C6-C7. No suspicious osseous metastatic lesions are identified. | No evidence of recurrent neck mass or cervical lymphadenopathy on a background of treatment-related changes. |
Generate impression based on findings. | 69 year old female with non-Hodgkin's lymphoma and history of bladder cancer. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Small hypoattenuating right hepatic lesion, likely representing a cyst.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No hydronephrosis. There is mild dilatation of the distal right ureter prior to its anastomosis, unchanged. No suspicious collecting system filling defects on the delayed images.RETROPERITONEUM, LYMPH NODES: Scattered small retroperitoneal lymph nodes are again noted. Reference portocaval node measures 1.5 x 1.0 cm (image 34, series 7), and previously measured 1.3 x 1.7 cm.BOWEL, MESENTERY: Right ileocecectomy and Indiana pouch.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Retroperitoneal lymph nodes at the bifurcation of the iliac arteries measures 1.1 x 0.7 cm (image 78 series 7) and previously measured 1.2 x 0.7 cm. BOWEL, MESENTERY: See above.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Stable reference lesions without evidence of recurrent or metastatic disease. |
Generate impression based on findings. | 53-year-old female patient with history of hepatitis C virus and small echogenic peripheral mass seen on ultrasound. ABDOMEN:LUNG BASES: Bibasilar atelectasis.LIVER, BILIARY TRACT: Liver with smooth contour. Small hypoattenuating lesion seen on portal venous phase imaging in the posterior right liver measures 7 x 9 mm (series 11 image 19). Lesion does not demonstrate hypervascularity on arterial phase imaging and is not visible on noncontrast imaging. No biliary dilatation.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 varices. No ascites. | Nonspecific hypodensity within the posterior right liver is nonspecific and may represent atypical hemangioma versus cyst. |
Generate impression based on findings. | 51 year-old male with epidural abscess. There is unchanged anterior wedge deformity of the C6 vertebral body with approximately 50% height loss. The C6 and C7 vertebral bodies are sclerotic without evidence of edema. There is complete loss of the C6/C7 intravertebral disk space and both anterior and posterior aspects of the C6 and C7 vertebral bodies are fused. There is widening of the C6/C7 facet joints and spinous processes, and reversal of cervical lordosis all of which is stable from prior.At C3/4, when compared to prior nonenhanced CT, there is calcification of the C3/4 intravertebral disk without compromise of the spinal canal or neural foramina.At C4/5, when compared to prior nonenhanced CT, there is calcification of the intravertebral disk with disk extrusion and central spinal canal narrowing similar to prior. There is no neural foraminal narrowing.At C5/6 there is a disk osteophyte complex resulting in central spinal canal narrowing similar to prior. There is no neural foraminal narrowing.At C6/7 there is retropulsion of C6 vertebral body resulting in central spinal canal narrowing. There is no neural foraminal narrowing.There is no enhancement of the spinal cord, however CT imaging is suboptimal for imaging of the cord.There is no enhancement of the anterior vertebral soft tissues.Surgical artifacts in the superior right thyroid bed are incidentally noted. | 1.Unchanged wedge deformity of the C6 vertebral body with fusion of the C6 and C7 vertebral bodies.2.Unchanged retropulsion of the C6 vertebral body with central spinal canal narrowing.3.No evidence of soft tissue, intravertebral disk, or vertebral body enhancement. |
Generate impression based on findings. | 60 year-old male in with history of GIST, evaluate for progression CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Unchanged small hypodense lesion along the dome of the liver measures 6 mm (image 79, series 8) and previously measured 6 mm.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Unchanged left renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Index peritoneal lesion adjacent to the stomach measures 4.0 x 1.9 cm (image 8 series 99) and previously measured 4.1 x 2.4 cm. Postsurgical change along the greater curvature and adjacent soft tissue mass is also unchanged.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 | Unchanged reference measurements without new lesion identified. |
Generate impression based on findings. | Female, 55 years old, recurrent sinusitis, nasal congestion. The frontal sinuses and frontoethmoidal recesses are clear. The sphenoid sinuses and sphenoethmoidal recesses are clear. The ethmoid air cells show very mild scattered mucosal thickening.The maxillary sinuses are free of significant mucosal thickening and debris. The maxillary outflow pathways are patent bilaterally.The nasal cavity is clear. The nasal septum is intact and deviates gently to the right. The left inferior nasal turbinate is larger than the rest, but otherwise, the turbinates are unremarkable.The mastoid air cells and middle ear cavities are clear. | No evidence of active sinusitis. |
Generate impression based on findings. | 74 year-old female with metastatic colon cancer, restaging and chemo. CHEST:LUNGS AND PLEURA:. Reference right lower lobe nodule measures 8 mm and previously measured 4 mm (image 36, series 5), suspicious for metastatic disease. Scattered nonspecific pulmonary micronodules are again noted.MEDIASTINUM AND HILA: Hypodense nonspecific bilateral thyroid lesions are again noted. Prominent mediastinal and hilar lymph nodes are unchanged.CHEST WALL: Vertebral body hemangiomas and small bone islands are again noted.ABDOMEN:LIVER, BILIARY TRACT: Multiple hypodense liver lesions are not significantly changed in size, but decreased in attenuation, which may represent necrosis/treatment change. Reference segment 2/3 lesion measures 2.1 x 1.9 cm and previously measured 2.2 x 1.5 cm (image 87, series 4).SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Renal cysts are unchanged.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Wall thickening and narrowing of the transverse colon with prominent infiltration of the adjacent fat extending to nearby bowel loops with gas-filled tracks, likely representing sinus tracts, possible fistulization to small bowel. No loculated fluid collections. Multiple prominent mesenteric lymph nodes/soft tissue implants adjacent to the transverse colon are again identified.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: See above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Wall thickening of transverse colon with extensive adjacent soft tissue infiltration, sinus tracts and possibly fistulization to adjacent small bowel. These findings were discussed with Dr. Racette (pager 6881) at the time of dictation. 2. Multiple liver metastases with interval treatment change.3. Enlarging right lower lobe lung nodule. |
Generate impression based on findings. | 83-year-old male with history bladder cancer. Status post cystectomy, ileal conduit. Evaluate for recurrent/metastatic disease. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Scattered, benign hepatic cyst seen unchanged. Liver parenchyma otherwise appears homogeneous and normal. Portal and hepatic venous structures appear normal.Gallbladder and biliary tract appear normal.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No renal parenchymal masses identified. No abnormal calcifications on precontrast imaging. Prompt and symmetric excretion of contrast into symmetric pyelocalyceal systems bilaterally. Mild hydronephrosis is seen bilaterally, left slightly greater than right, but unchanged. Rapid progression of contrast on that delayed excretory phase images were seen through normal appearing ureters as they extend to the ileal loop conduit. Good opacification of the ureters are seen without abnormality.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy or other abnormalities.BOWEL, MESENTERY: Postoperative expected changes seen as demonstrate on prior examinations. No other abnormalities seen.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prior cystoprostatectomy -- no residual abnormalities in surgical bed.BLADDER: Prior cystoprostatectomy -- no residual abnormalities in surgical bedLYMPH NODES: No lymphadenopathy. No other abnormality seen.BOWEL, MESENTERY: Postoperative changes seen as demonstrate on prior examinations -- no other abnormality.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Stable examination post cystoprostatectomy and ileal loop conduit bladder. No evidence of recurrent or metastatic disease. |
Generate impression based on findings. | Male, 22 years old, disk degeneration, 6 month follow-up. Since the prior examination, posterior fusion hardware has been placed at L5 and S1. Bilateral transpedicular screws are well positioned. No evidence of loosening or other hardware complication is seen. An intervertebral device has been placed in the L5-S1 disk space.Again seen is a grade 1 anterolisthesis of L5 relative to S1. This is similar in degree to the preoperative study. Endplate sclerosis has developed in the interval, likely reactive to the disk space device. Bilateral chronic pars interarticularis defects are redemonstrated at L5.Elsewhere, spinal alignment is anatomic. Vertebral body heights are preserved. No focal destructive bony lesions are seen.The spinal canal is not significantly compromised at any level. Again, at L5-S1, there is evidence of disk uncovering. The L5-S1 neural foramina remain mildly narrowed, similar to prior. | 1. Interval posterior fusion of L5-S1. No evidence of hardware complication is seen.2. Grade 1 anterolisthesis of L5 relative to S1, similar to prior. Bilateral L5 pars interarticularis defects are redemonstrated.3. Stable mild narrowing of the neural foramina at L5-S1. |
Generate impression based on findings. | 41 year old female with ASD referred to evaluate coronary anatomy prior to possible ASD repair.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. There is a non-calcified, non-obstructive plaque (<20% stenosis) in the left main.LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove, supplying the diagonal and septal branches. There is a non-calcified, non-obstructive plaque (40-60% stenosis) in the mid LAD. The distal LAD is relatively small in caliber.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. The distal LAD is small.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. A moderate amount of motion artifact is present making image interpretation challenging.Left Ventricle: The left ventricular late diastolic volume is normal (LV volume 110ml).Right Ventricle: The right ventricular late diastolic volume is severely dilated (280ml).Left Atrium: Visually, the left atrial volume appears to be normal in size. There are four distinct pulmonary veins which drain normally into the left atrium. There is no evidence of left atrial appendage thrombus. There is a large, somewhat inferiorly located, secundum type ASD (17x19mm).Right atrium, vena cavae, and coronary sinus: The right atrial volume is severely increased. The superior vena cava is grossly normal. The IVC is dilated. The coronary sinus is normal in size. Valves: There is no calcification on the aortic or mitral valves.Great vessels: The thoracic aorta demonstrates no evidence of dissection or aneurysm. The main pulmonary artery is moderately dilated.Pericardium: The pericardium is normal in thickness. There is no pericardial effusion. | 1.There is a <20% stenosis in the left main coronary artery. 2.There is a 40-60% stenosis in the mid LAD; however, image interpretation is challenging due to the presence of motion artifact. 3.There is a secundum type atrial septal defect associated with significant dilation of the right atrium, right ventricle, and main pulmonary artery. 4. The thoracic aorta is unremarkable.This portion of the report pertains to the heart and great vessels only. The remaining soft tissues of the thorax and upper abdomen will be interpreted by the attending chest radiologist and included as an addendum to this report. |
Generate impression based on findings. | Male 50 years old; Reason: re-evaluate patient with Stage IV NED CRC s/p perioperative chemotherapy CHEST:LUNGS AND PLEURA: No suspicious lesions. The pleural spaces are clear.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. No mediastinal lymphadenopathy. Left chest wall port terminates at the cavoatrial junction.CHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: Post operative right hepatic lobectomy. The remainder of the liver is undergone mild compensatory hypertrophy; the left portal vein and hepatic vein are patent.No new lesion in the remainder liver. Mild soft tissue thickening along the surface of the liver without evident lesion.SPLEEN: The spleen is enlarged measuring 16-cm.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Right lower abdominal ostomy with few prominent vessels suggesting peristomal varices. No bowel obstruction.Status post colectomy.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: The rectum is collapsed. Status post colectomyBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Stable exam without evident metastatic disease. |
Generate impression based on findings. | Clinical question: Evaluate for subdural hematoma. Signs and symptoms: Alteration of mental status. Nonenhanced head CT:Examination demonstrate an acute mixed density left hemispheric subdural hematoma in the left temporal lobe, left occipital and parietal region and within the distal extension of subdural along the left aspect of falx in the occipital and parietal and frontal.The subdural in left posterior temporal region measures maximum of 12-mm, 4.8-mm in the left anterior temporal, and 5.6-mm along the interhemispheric aspect in the left parietal region.There is subtle effacement of the adjacent cortical sulci in the left posterior temporal parietal region. No areas of parenchymal or subarachnoid hemorrhage. There is noted some mass effect on the ventricular system which are normal in size and with midline maintained. Examination also demonstrate widening of the space containing the peritoneum and the right frontal lobe related primarily CSF density however with internal subtle foci of minimal increased density which is suspect the of a chronic and subacute right frontal subcutaneous rule. Possibility of a prominent subarachnoid space is considered less likely. This finding measures maximum of 6.7-mm in size.Recommend follow-up with an MRI or enhanced head CT for better assessment of this finding.Very minimal subcortical low attenuation of white matter considering patient's stated age of 85 likely represent age indeterminate mild small vessel ischemic strokes.Calvarium and soft tissues of the scalp are unremarkable.Unremarkable images through the orbits.Minimal chronic pansinusitis.When pneumatized bilateral mastoid air cells and minimally or cavities.There are small foci of mixed air and soft tissue density in bilateral external auditory canals representing secretions/wax. | 1.Left total hemispheric acute subdural measuring maximum of 12-mm in the left posterior temporal region. There is associated effacement of adjacent cortical sulci however no midline shift is present.2.There is also highly suspected chronic/subacute right frontal subdural collection measuring maximum of 6.7-mm in size.3.Minimal age indeterminate small vessel ischemic stroke. |
Generate impression based on findings. | 62-year-old male with history of prior leiomyosarcoma resected in August, 2010. Evaluate for recurrence. CHEST:LUNGS AND PLEURA: Nonspecific pulmonary micronodules are again seen, unchanged in the right upper and lower lobes. No new nodules, infiltrates, masses, or effusions are seen.MEDIASTINUM AND HILA: No significant abnormality noted without adenopathy or other masses.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted in liver parenchyma. Portal and hepatic venous structures appear normal. Gallbladder and biliary tract show no abnormalities.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No, adenopathy or other abnormalities seen. The small aorta caval lymph node measured in past (series 3, image 126) is unchanged and measures 0.7 x 0.7 cm.BOWEL, MESENTERY: Orally administered contrast rapidly progresses to normal. Stomach, small bowel to the right common without abnormality seen. No free mesenteric fluid is seen. The mesenteric misty stranding seen in the root of mesentery just inferior to the pancreas is unchanged over the past several years.BONES, SOFT TISSUES: Diffuse degenerative changes seen in the bony structures without significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No, adenopathy or other masses seen.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Postoperative changes along the retroperitoneum, and adjacent to inferior vena cava, unchanged. 2. No evidence of recurrent, residual or metastatic disease. Subcentimeter aortocaval reference node, unchanged in size. |
Generate impression based on findings. | Clinical question:Status post stroke. Signs and symptoms: As above. Unenhanced head CT:The examination redemonstrates a very large nearly involving the entire right MCA territory subacute nonhemorrhagic ischemic stroke. There is significant effacement of cortical sulci at the site of subacute stroke. There is also mass effect on the right lateral ventricle in particular at the level of frontal horns secondary to involvement of right caudate nucleus. Compared to prior exam there is evidence of matter delineation of region of stroke and increased mass effect indicating progression of stroke to subacute phase. The right lateral ventricle appears smaller than prior exam secondary to mass effect. There is however trace leftward midline shift on this exam.Compared to prior exam there is a suspect a small focus of left pontine low attenuation which could be artifactual considering portable technique and suboptimal image quality. The findings appreciated on axial image 20 and as mentioned above it could represent an artifact. | 1.Revisualization of a large subacute nonhemorrhagic right MCA territory stroke without the meniscal hemorrhagic conversion. This stroke however is better delineated and applies more mass effect (however trace midline shift to the left) since prior exam indicating its progression to subacute phase.2.Artifact and less likely a true finding/stroke is a new foci of low-attenuation in the left pons as detailed above.3.Smaller size of right lateral ventricle secondary to increased mass effect compared to prior study. |
Generate impression based on findings. | Male 72 years old; Reason: hematuria History: hematuria 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.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: Complex and simple Cysts are noted in the kidneys bilaterally. The largest measures 4.4 x 3.5 cm in the midpole left kidney. Smaller hyperattenuating exophytic cyst is noted off of the midpole left kidney, incompletely characterized, follow up suggested.There is no hydronephrosis, or renal stones detected.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: The prostate is markedly enlarged measuring 5.8 x 5.6 cm. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Surgical sutures are noted in the cecum from prior resection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.No hydronephrosis, or renal stone to suggest hematuria.2.Indeterminate hyperattenuating exophytic lesion of the midpole left kidney, follow up suggested.3.Enlarged prostate |
Generate impression based on findings. | Reason: eval for metastatic disease History: none LUNGS AND PLEURA: Paraseptal emphysema. Calcified granuloma right middle lobe. Basilar subsegmental atelectasis. Interval resolution of tree in the opacities left lower lobe.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. No mediastinal or hilar lymphadenopathy. Small amount of calcification at the aortic valve.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Stable nodularity left adrenal gland. Stable calcified perihepatis lymph nodes. | No specific evidence of metastatic disease. |
Generate impression based on findings. | Female, 53 years old, fibrous dysplasia and orbital mass. Redemonstrated is ground glass bony expansion affecting the left greater and lesser sphenoid wings, the left squamous temporal bone and the floor of the left middle cranial fossa. Bony expansion may be very slightly increased, by at most 1 or 2 mm.The optic canal is not significantly affected by this process. The superior and inferior orbital fissures are narrowed. The foramen rotundum and pterygopalatine fossa are unaffected. Foramen ovale and foramen spinosum seem to be preserved.Proptosis is redemonstrated on the left. Bony expansion results in medial displacement of the lateral rectus muscle as well as the optic nerve, similar to prior. Lateral rectus muscle remains thickened and, as before, soft tissue is evident occupying the space between the lateral and superior recti, of uncertain etiology. There has been no significant interval change.This examination is not tailored for evaluation of brain parenchyma, but given this limitation, no discrete abnormalities are seen. | 1. Redemonstration of findings compatible with fibrous dysplasia affecting the greater and lesser sphenoid wings and the squamous temporal bone on the left. It is possible the bony expansion has increased in the interval, but no more than 1 or 2 mm.2. Bony expansion results in left-sided proptosis, narrowing of the superior and inferior orbital fissures, medial displacement of the lateral rectus muscle and the optic nerve. Findings are similar to prior.3. Soft tissue is also evident within the superolateral orbit in the space bordered by the superior and lateral recti muscles, similar to prior. As before, this abnormality may represent a vascular structure or a mass and is incompletely evaluated on this study. |
Generate impression based on findings. | 72-year-old male with history of metastatic kidney cancer on therapy. CHEST:LUNGS AND PLEURA: Again, multiple pulmonary, parenchymal metastatic lesions are seen with the distribution size, predominantly, unchanged. The reference right lower lobe lesion (series 4, image 67) is slightly smaller 1.6 x 1 .3 cm, previously 1.9 x 1.4-cm.. No new masses or effusions seen.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Right anterior chest wall Port-A-Cath system with tip of catheter in the distal superior vena cava.ABDOMEN:LIVER, BILIARY TRACT: Prior referenced segment 5 lesion has increased in size and now measures 2.0 by 1.7-cm (series 3, image 85) compare with previous 1.2 x 1.2 cm. Other new lesions are now seen in segment two (series 3, image 76 and in the right lobe (series 3, image 72). Gallbladder and biliary tract appear normal.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Low density right adrenal gland nodule, most likely represents adenoma and is unchanged. Left adrenal gland is not well visualized in the postoperative changes.KIDNEYS, URETERS: Status post left nephrectomy -- the nodular soft tissue in the left nephrectomy bed is now difficult to identify and residual tissue has decreased in size and measures 1.5 x 1.8 cm, Compared with 2.1 x 2.1 cm previously.RETROPERITONEUM, LYMPH NODES: Prior reference left para-aortic lymph node (series 3, image 109) is slightly increased in size and measures 2.6 x 2 .0 cm, previously 2.1 x 1.9 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: The prior noted suspicious lytic lesion involving the L5 vertebral body has now tripled in size (series 3, image 142) consistent with progressive metastatic disease. In addition, numerous other small lytic lesions are seen throughout the lumbar spine and in the ribs and left iliac bone (series 3, image 150) are consistent with worsening metastatic lytic disease.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: The prior noted suspicious lytic lesion involving the L5 vertebral body has now tripled in size (series 3, image 142) consistent with progressive metastatic disease. In addition, numerous other small lytic lesions are seen throughout the lumbar spine and in the ribs and left iliac bone (series 3, image 150) are consistent with worsening metastatic lytic disease.OTHER: No significant abnormality noted | 1. Numerous new and enlarging lytic bone lesions indicative of progressive metastatic disease. 2. Minimal decrease in size of reference right lower lobe lung nodule, but no change in the numerous other smaller nodules in the lungs. 3. Slight increase in size and left periaortic adenopathy. 4. Apparent decrease in size of soft tissue density in left nephrectomy bed. 5. Right adrenal adenoma, unchanged. |
Generate impression based on findings. | Female 66 years old Reason: RCC History: surveillance. CHEST:LUNGS AND PLEURA: Non-index right upper lobe nodule series 5 image 28 increased somewhat in size. Index 4-mm nodule in the middle lobe is unchanged series 5 image 47.Scattered granulomata. Few other scattered micronodules are probably unchanged one minimally more prominent since 5 image 60 on the right.MEDIASTINUM AND HILA: Granulomata. No pathologic size nodes. Coronary artery calcifications.CHEST WALL: Mild loss of height of T12. No discrete lytic or blastic disease.ABDOMEN:LIVER, BILIARY TRACT: Index lesions are ill-defined and not accurately measured. Previously seen reference lesion in segment 8 is associated with a peripheral wedge-shaped area of high density consistent with vascular flow phenomenon. The lesion itself cannot be measured.Rounded hypervascular focus in the caudal aspect of the liver near the gallbladder fossa series 4 image 97 is of uncertain significance but is unchanged. Similarly hypervascular focus in the posterior subcapsular portion of the right lobe seen on series 4 image 105 is also unchanged. These may represent areas of sparing of the diffuse fatty infiltration. No new lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal gland surgically absent. Right adrenal gland normal.KIDNEYS, URETERS: Status post left nephrectomy. No evidence of recurrence in the renal fossa.Right kidney is normal.RETROPERITONEUM, LYMPH NODES: Small shotty retroperitoneal nodes redemonstrated, unchanged. No pathologic size nodes. Atherosclerotic changes aorta without evidence of aneurysm.BOWEL, MESENTERY: Duodenal diverticulum off the third portion of the duodenum. No evidence of bowel wall thickening or dilatation. Prominence of mucosal fat deposition seen primarily in the right colon unchanged. No evidence of ascites or carcinomatosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Probably stable disease but some of the lung lesions more conspicuous and minimally changed in size. Index liver lesion not measurable. Diffuse fatty liver with areas of focal sparing. Other findings as above. |
Generate impression based on findings. | Clinical question: Rule out chronic sinusitis. Signs and symptoms: Nasal structure, rhinorrhea, PND; cannot see left OMU on exam. Medtronic fusion sinus CT:Maxillary sinuses demonstrate very minimal mucosal thickening (right greater than left). No evidence of acute sinusitis.There is complete occlusion of right ostiomeatal unit and partially compromise the left.Ethmoid sinuses demonstrate very minimal bilateral ethmoid mucosal thickening.Sphenoid sinus is well pneumatized however there is minimal mucosal thickening at the level of bilateral sphenoethmoidal recess (right greater than left) with resultant occlusion of lateral recess bilaterally.Frontal sinuses are well pneumatized and unremarkable.Nasal cavity demonstrate mild nasal septum deviation to the left which is in contact with the mucosa of left inferior turbinate.Bilateral middle ear cavities and all mastoid air cells remain well pneumatized.Unremarkable images through the orbits. | 1.Minimal bilateral maxillary mucosal thickening (right greater than left). Occluded right ostiomeatal unit and compromised left.2.Very minimal mucosal thickening at the level of bilateral sphenoethmoidal recess with resultant occlusion.3.Mild to moderate nasal septum deviation to the left which is in contact with the left inferior turbinate mucosa.4.Bilateral mastoid air cells and middle ear cavities remain well pneumatized. |
Generate impression based on findings. | Male, 60 years old, history of tonsil cancer status post surgery. The aerodigestive tract is within normal limits. No masses or pathologic lymph nodes are detected. Reference left level 2 node measures 10 x 6 mm (image 26 series 5), previously 8 x 6 mm.The salivary glands and the thyroid and free of focal lesions. The cervical vessels remain patent. Lung apices are remarkable for mild scarring and mild peripheral cystic change.No concerning osseous lesions are demonstrated. Again seen is reversal of the normal cervical lordosis with a grade I anterolisthesis of C4 relative to C5 and C3 relative to C4.Mucosal thickening is redemonstrated in the partially visualized maxillary sinuses, similar to prior. | No evidence of active disease in the neck. |
Generate impression based on findings. | Reason: recent cxr showed Ill-defined 1.5-cm left lower lung zone nodule which may be an artifact of a rib or met. Please evaluate History: none LUNGS AND PLEURA: There is a micronodule within the superior segment left lower lobe (series 5 image 45) measuring 3 x 4 mm. This is smaller than the identified abnormality on prior radiograph. No suspicious nodule of this size is identified on this imaging examination.Nodular opacity that is flat on coronal imaging within the antero-apex. Scattered pulmonary micronodules of various sizes throughout the lungs. Subsegmental atelectasis involves both lower lobes.MEDIASTINUM AND HILA: Nearly the entire stomach is herniated through the hiatus. The heart size is anteriorly displaced but within limits of normal size. No pericardial effusion. Moderate coronary artery calcification. No mediastinal or hilar lymphadenopathy.There is a conglomerate of soft tissue density at the right cardiophrenic angle, superior to the diaphragm of uncertain etiology, possibly lymphadenopathy. This does appear slightly smaller when compared to prior.CHEST WALL: T9 compression fracture.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. | Pulmonary micronodule superior segment left lower lobe 3 x 4 mm. If the patient is at high risk, such as having as smoking or malignancy history, follow up in one year is recommended.Nodular opacity previously noted on the radiograph is not identified on this examination.Right cardiophrenic tissue density may represent conglomerate lymphadenopathy. Continued follow up is recommended. |
Generate impression based on findings. | Male 62 years old; Reason: left pleural effusion, bile leak, pelvic fluid collection History: left pleural effusion, bile leak, pelvic fluid collection CHEST:LUNGS AND PLEURA: Ill-defined area of ground glass opacity involving the right upper lobe (image 45 series 5). Subcentimeter solid nodule on the right minor fissure (image 55 series 5) there are other few scattered nodules along the fissures.Left basilar peripheral atelectatic changes and trace bilateral effusions. MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. There are small mediastinal lymph nodes.CHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: Intrahepatic pneumobilia. Metallic stent in the common bile ductRight perihepatic fluid has decreased. Its exact margins are difficult to ascertain without contrast; the residual fluid measures 7.2 x 2.2cm (image 82/series 3). A drain terminates within the collectionStatus post cholecystectomy.SPLEEN: The peri-splenic collection has a drain within it. The collection measures about 5.4 x 2.8 cm (image 84/ series 3) previously, 8.4 x 4.9 cmPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Calcific arteriosclerotic disease affects the aorta.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: The fluid collection has decreased and due to the rectum measuring 3.6 x 2.0 cm previously, 5.3 x 2.7 cmBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Decrease in the size of the perihepatic, splenic and pelvic collections.2.Decrease in the pleural effusions and basilar atelectasis/consolidation. |
Generate impression based on findings. | 69-year-old male -- reevaluation of GIST, currently on treatment. CHEST:LUNGS AND PLEURA: Dense right lung micronodule (series 9, image 36), most likely old inflammatory. No other nodules, masses, infiltrates or effusions.MEDIASTINUM AND HILA: Scattered, subcentimeter lymph nodes in the anterior mediastinum and pretracheal and subcarinal space. These are nonspecific and prior examinations did not include chest for comparison to evaluate for any changes. No other masses or abnormalities.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Hypodense solid mass with peripheral arterial enhancement seen in segment 7 and extending into the isthmus of the caudate lobe (series 7, image 95) measuring 3.4 x 4 .5 cm, unchanged since 7/22/13 when it measured 4.3 x 3.3 cm, but substantially decreased from 11/24/12 outside examination when this measured 6.1 x 4.7 cm.SPLEEN: No spleen identified.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postoperative changes about the stomach from prior partial resection, most likely site of primary tumor, although older scans preoperative are not available. Oral administered contrast progresses rapidly through normal-appearing small and large bowel to the right colon without evidence of obstruction. There is a large mesenteric mass seen in the left anterior abdomen (series 6, image 43) measuring 8.3 x 6.7 cm. This was present on 7/22/13, but smaller in size when it measured 7.8 x 5.2 cm. the mass was substantially smaller than that on earlier exams. The mass remains of predominately low attenuation (15HU) throughout most of the lesion indicating central necrosis -- similar to its appearance on 7/22/13. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Postoperative changes about stomach. 2. Solitary, solid liver mass unchanged in size since 7/22/13, but decreased in size since 4/10/13. 3. Large anterior mesenteric mass, predominantly necrotic, but with enhancing portions, peripherally, which is increased in size since 7/22/13. 4. Nonspecific findings in the chest as described above -- these most likely are benign. Inflammatory changes, but without old prior chest examinations, this cannot be confirmed. |
Generate impression based on findings. | Headache, seizure. There are postoperative changes including suboccipital midline craniotomy and C1 posterior arch resection related to the patient's known Chiari malformation. There is a low-density fluid collection which is extradural, extending along the surgical site, beyond the visualized field caudally, measuring up to 4.7 (trans) x 1.3 (AP) x 5.1 (CC) cm. Cerebellar tonsils are slightly more superiorly positioned than on the preoperative examination, which may be partly positional. There is no hydrocephalus, mass, hemorrhage or CT evidence of acute ischemia. The midline is intact. Orbits, paranasal sinuses and mastoid air cells are unremarkable. | Postoperative changes related to Chiari decompression including a nonspecific extradural fluid collection without acute intracranial abnormality demonstrated. Please correlate with physical exam to exclude a developing pseudomeningocele. |
Generate impression based on findings. | 90 year-old male with left facial skin cancer. LUNGS AND PLEURA: Mild subpleural reticular opacities with atelectasis or scarring. No suspicious nodules. No lung consolidation or pleural effusions.MEDIASTINUM AND HILA: Moderate to severe atherosclerotic calcifications affect the coronary arteries and to a lesser extent the aorta. Valvular calcification is also noted. No mediastinal lymphadenopathy. Heart size normal.CHEST WALL: Mild deformity of lateral aspect of right ninth rib, likely representing prior injury (coronal series 80224, image 45).UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Left renal cyst. Calcifications are seen in the splenic hilum, likely vascular in nature. | No evidence of metastatic disease. |
Generate impression based on findings. | 73-year-old male with melanoma. CHEST:LUNGS AND PLEURA: Scattered areas of focal ground glass opacities are seen throughout the left lung and to a much lesser degree in the right lung without solid components, new since outside CT examination 6/14/13.. These areas show increased activity on the PET scan today. These would not be typical of melanoma and most likely relate to inflammatory or infectious changes. Small subcentimeter solid lung nodules seen at the left lung base (series 5, image 75) measuring 5 mm, and right lower lobe (series 5, image 51) at 6-mm unchanged in size and appearance since 6/14/13. Smaller right lung micronodules calcifying indicates presence of old granulomatous disease -- all these nodules may represent prior inflammatory disease. They do not appear to show increased activity on today's PET examination. No other solid nodules or masses are seen. MEDIASTINUM AND HILA: Normal size, lymph nodes scattered throughout. The mediastinum. No abnormal enlarged nodes or masses seen.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Hiatal hernia. Stomach, and jejunum appear normal. In the ileum. There is marked wall thickening and aneurysmal dilatation of a loop of jejunum. Typical appearance of metastatic melanoma (series 3, image 168). This extends over approximately a 4.6-cm long segment with wall thickening approximately 1.1 cm. In retrospect, there was minimal wall thickening in this region on outside CT examination of 6/14/13 which is now markedly progressed. Another loop of ileum in the right abdomen (series 3, image 139) shows nearly circumferential wall thickening to a mild degree and this area shows increased activity on PET. As well and is worrisome for a second foci of intestinal involvement by melanoma., 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: Posterior to the right femoral neck and abutting the femur (series 3, image 199) is an enhancing lymph node measuring 1.5 x 2.0 cm it shows increased activity on PET scan and most likely represents metastatic focus of melanoma.Left inguinal hernia containing only mesenteric fat.OTHER: No significant abnormality noted | 1. Two foci of tumor masses in the ileum, consistent with metastatic melanoma. 2. Abnormal enhancing lymph node about right hip, most likely, metastatic melanoma. 3. Scattered bilateral pulmonary foci of groundglass disease -- these do not have an appearance typical of metastatic melanoma and most likely represent inflammatory or infectious disease -- see above discussion. 4. Scattered small pulmonary nodules some of which are calcified and well. These are nonspecific, and in light of calcified nodules, these may all represent prior inflammatory nodules. |
Generate impression based on findings. | 53-year-old female patient with history of relapsed Hodgkin's disease status post 11 cycles of chemotherapy. Pre-transplant evaluation. CHEST:LUNGS AND PLEURA: Bibasilar dependent atelectasis. No pleural effusions.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Redemonstrated are post surgical changes in the right axilla. Retropectoral lymph node that has been measured on recent studies appears to be predominantly muscle. This area appeared to contain both muscle and adjacent lymph node on studies dating back to 2012. Currently, there is a soft tissue focus abutting the posterior aspect of the muscle that measures 1.1 x 0.5 cm (series 401 image 25).Stable right axillary lymph nodes.Left chest port with tip at the cavoatrial junction.ABDOMEN:LIVER, BILIARY TRACT: Diffuse fatty infiltration of the liver parenchyma.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Two stable lower pole hypoattenuating lesions within the left kidney are stable compared to examination in 6/2012 and most likely represent cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Reference left periaortic lymph node measures 7 x 4 mm (series 401 image 125), previously 7 x 11 mm.BOWEL, MESENTERY: There is rapid progression of oral contrast through normal-appearing stomach and small bowel. Clonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: L4 vertebral body lytic lesion is stable compared to prior examination.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 rapid progression of oral contrast through normal-appearing stomach and small bowel. Clonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: L4 vertebral body lytic lesion is stable compared to prior examination.OTHER: No significant abnormality noted. | 1.Stable right axillary and chest lymph nodes with slight interval decrease in periaortic lymph node.2.Fatty liver. |
Generate impression based on findings. | 67-year-old male status post cystectomy with ileal conduit, evaluate left hydro-ureteral nephrosis. ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Right adrenal nodule is unchanged from the prior study.KIDNEYS, URETERS: Atrophic kidneys with cortical scarring and multiple bilateral hypodense lesions some too small to characterize, but likely representing cysts. A nephroureteral catheter and a nephrostomy tube are coiled in the left renal pelvis. Blunting of the left calices consistent with mild hydronephrosis. Symmetric bilateral perinephric fat stranding is noted.RETROPERITONEUM, LYMPH NODES: Moderate atherosclerotic calcification and plaque of the abdominal aorta and its branches, including moderate narrowing of the right renal arterial origin.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes of the abdominal wall are again noted.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post cystoprostatectomy.BLADDER: Status post cystoprostatectomy.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Deformity likely representing a healed right inferior pubic ramus fracture.OTHER: No significant abnormality noted | Status post cystoprostatectomy and ileal conduit urinary diversion without evidence of recurrent or metastatic disease. Mild left hydronephrosis. |
Generate impression based on findings. | 53-year-old male with history of relapsed Hodgkin's disease, status post 11 cycles. Redemonstration of scattered small lymph nodes within the neck including some in the right subpectoral space and in the partially visualized right axilla. None of these meets the imaging criteria for pathologic enlargement. Previously referenced lymph nodes are as follows:1) Right supraclavicular lymph node 5 mm short axis (series 1202 image 63), unchanged.2) Left level 3 lymph node 3 mm short axis (series 1202 image 54), unchanged.Aerodigestive tract is unremarkable. The salivary glands and thyroid are free of focal lesions. Cervical vessels remain patent. Lung apices are unremarkable. No suspicious osseous lesions are identified.Limited intracranial views show no gross abnormality. Chronic deformity of the right laminae papyracea, unchanged. Mucosal thickening of the maxillary sinuses similar to the prior.Partially visualized left chest port. | No pathologic adenopathy in the neck by size criteria. No other significant abnormalities or interval changes. |
Generate impression based on findings. | Reason: right lung nodule History: h/o recurrent pleomorphic adenoma of the parotid LUNGS AND PLEURA: There is a 3-mm micronodule in the left lower lobe(series 5, image 44), new since prior exam. Stable 4-mm micronodule in the left lower lobe (series 5, image 45). Interval increase in size of right lower lobe micronodule currently measuring 4 mm, previously measuring 2 mm (series 5, image 49).MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. Heart size is normal. Mild atherosclerotic calcifications of the coronary arteries and aorta.CHEST WALL: Stable degenerative disease of the upper thoracic vertebra. Stable severe degenerative joint disease of the L1 and L2 disk space with disk osteophyte complex.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Stable hypodense lesion in the right lobe of the liver.Stable hypodense lesion in the upper pole of the left kidney. | Interval increase in size of previously noted micronodule and appearance of new micronodule may represent metastatic or inflammatory disease. Follow-up is recommended in 3 months. |
Generate impression based on findings. | 90 year-old male with left face squamous cell carcinoma, status post surgery, rule out recurrence. Skin thickening with induration of the subcutaneous fat along the left preauricular face and posterior auricular scalp is non-specific but likely postsurgical given history of interval surgery. Surgical clips are noted along the surgical site.No pathological adenopathy is detected on either side of the neck by CT size criteria. The aerodigestive spaces are within normal limits. The remaining salivary glands are unremarkable. The thyroid gland is unremarkable.The cervical vessels remain patent with atherosclerotic calcifications at the carotid bifurcations.Limited intracranial views demonstrate no gross abnormalities. Intracranial atherosclerotic calcifications of the internal carotid arteries. Mucosal thickening of the ethmoid air cells.Peripheral reticulation at the lung apices similar to the prior. No suspicious osseous lesions are identified. Multilevel degenerative changes of the cervical spine. | 1. Skin thickening with induration of the subcutaneous fat along the left preauricular face and posterior auricular scalp is likely postsurgical given history of interval surgery. 2. No cervical lymphadenopathy by CT size criteria. |
Generate impression based on findings. | 46-year-old female with acute mental status change. There is no evidence of intracranial hemorrhage, mass or edema. However, a nonenhanced CT is suboptimal for evaluation of acute ischemic stroke.There are prominent cortical sulci, ventricles, and cerebellar folia which suggestive of diffuse volume loss disproportionate to the patient's age.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. | 1.No evidence of intracranial hemorrhage, mass, or edema, however acute ischemic stroke cannot be completely excluded based on CT imaging.2.Diffuse volume loss disproportionate to the patient's age suggestive of underlying chronic disease. |
Generate impression based on findings. | 55-year-old male, colorectal cancer restaging. CHEST:LUNGS AND PLEURA: Right upper lobe nodule measures 1.2 x 0.9 cm (image 36, series 5), and previously measured 1.2 x 0.7 cm. Additional nodules along the fissures are unchanged.MEDIASTINUM AND HILA: A large heterogeneous left thyroid nodule is not significantly changed and measures 2.5 x 2.8 cm (image 6, series 3) and previously measured 2.5 x 2.5 cm. Left central venous catheter tip at the cavoatrial junctionCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Reference right hepatic lesion at the resection margin measures 3.1 x 4.3 cm and previously measured 2.8 x 4.0 cm when measured similarly, not significantly changed in size (image 89, series 3). No new hepatic lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Small hypoattenuating lesions likely represent cysts, unchanged.RETROPERITONEUM, LYMPH NODES: Multiple large calcified retroperitoneal lymph nodes, likely representing posttreatment change are similar to the prior study.BOWEL, MESENTERY: Prominent mesenteric lymph nodes are not significantly changed in size, with the reference mesenteric node measuring 1.6 x 0.7 cm (image 136, series 3) and previously measuring 1.4 x 0.8 cm.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 notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No significant interval change in reference lesions as detailed above. No new lesions. |
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