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Generate impression based on findings. | 69-year-old female with scleroderma and Sjogren's disease -- weight loss and splenomegaly. ABDOMEN:LUNG BASES: Chronic lung disease bases with blebs and fibrous scarring.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, adenopathy or other retroperitoneal mass is seen.BOWEL, MESENTERY: Orally administered contrast passes through a normal stomach into the small bowel. The proximal jejunum has a relatively featureless appearance, whereas the more distal small bowel into the ileum shows prominent valvulae conniventes -- an uncommon appearance and suggesting reversal of fold pattern. This can be seen in patients with celiac disease.In addition, there is evidence of desiccation in the very distal small bowel with a pseudo-feces sign with thick intraluminal contents trapping near (series 4, image 90, for example). This suggests poor motility and stasis as no obstructive phenomena or signs are seen.No free mesenteric fluid seen.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No enlarged lymph nodes seen.BOWEL, MESENTERY: The proximal jejunum has a relatively featureless appearance, whereas the more distal small bowel into the ileum shows prominent valvulae conniventes -- an uncommon appearance and suggesting reversal of fold pattern. This can be seen in patients with celiac disease.In addition, there is evidence of desiccation in the very distal small bowel with a pseudo-feces sign with thick intraluminal contents trapping near (series 4, image 90, for example). This suggests poor motility and stasis as no obstructive phenomena or signs are seen.No free mesenteric fluid seen.BONES, SOFT TISSUES: Scattered small calcified nodules throughout the subcutaneous tissues about the buttocks -- most likely these represent injection granulomas.OTHER: No significant abnormality noted | 1. No evidence of malignancy seen in abdomen or pelvis. 2. Suggestion of reversal of fold pattern between jejunum and ileum raising question of celiac disease. 3. Suggestion of stasis in distal small bowel with a pseudo-feces sign -- this may relate to patient's existing scleroderma/Sjogren's syndrome. |
Generate impression based on findings. | Transient ischemic attack. Unenhanced/Enhanced CT head: There is motion artifact. There is an unchanged pattern of diffuse patchy hypoattenuation within periventricular and subcortical white matter, in addition to a more focal region of hypoattenuation within the left occipital and temporal lobes closely related to the posterior left lateral ventricle, which is slightly prominent likely on the basis of mild ex vacuo dilatation. There is no intracranial hemorrhage or fluid collection. There is no pathological enhancement. Orbits, paranasal air sinuses, mastoid air cells and bony structures are unremarkable.CTA Neck: There is a normal 3 vessel aortic arch. The proximal right common carotid is deviated by a mass within the right thyroid lobe. There is atherosclerosis with focal calcification at the carotid bifurcation without significant stenosis by NASCET criteria. The left proximal common carotid artery is deviated by a large heterogeneous mass associated with the left thyroid lobe. There is no significant stenosis at the bifurcation by NASCET criteria although there is atherosclerotic calcification along the carotid bulb. The left vertebral artery origin is obscured by beam hardening artifact. The right is normal. Vertebral arteries demonstrate normal morphology and course without significant stenosis or aneurysm. There is a right dominant vertebral system with mild irregularity of the right vertebral lumen at its distal portion.CTA brain: The basilar artery is dolichoectatic, measuring 6 mm in greatest diameter and demonstrating a significant amount of atherosclerotic calcification and irregularity of its luminal wall, especially along the proximal half. The basilar tip demonstrates a normal configuration and the PCAs are unremarkable. PICA, AICA and SCAs are unremarkable. There is calcification of the bilateral cavernous and right supraclinoid ICA segments with asymmetric mild ectasia of the right supraclinoid ICA. MCAs and ACAs demonstrate normal course without significant stenosis or aneurysm. Other findings: The left and right thyroid lobes are enlarged and heterogeneous bilaterally measuring 4.5 x 4.0 and 3.7 x 3.7 cm in maximum axial dimensions, respectively. There is no significant airway narrowing or deviation. There are multilevel degenerative changes of the spine in addition to a developmentally slender canal. | Significant burden of age-indeterminate white matter hypoattenuation, as well as left occipital/temporal lobe infarct most likely chronic, although superimposed more acute changes cannot be entirely excluded1.Dolichoectatic especially proximal to mid basilar artery which demonstrates atherosclerosis and luminal irregularity without focal stenosis or aneurysm.2.Atherosclerotic calcification within the cavernous ICAs bilaterally and the right supraclinoid ICA.3.No aneurysm or flow-limiting stenosis. 4.Incidental note of heterogeneous, enlarged thyroid. This most likely represents multinodular goiter; if there is concern, correlation with biochemical assay and/or thyroid ultrasound could be considered. |
Generate impression based on findings. | 66-year-old male patient with gross hematuria. 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: Hypoattenuating, nonenhancing lesion in the superior pole of the left kidney measures 0.9 x 0.7 cm (series 8 image 39), consistent with simple cyst.Both kidneys demonstrate normal contour without solid mass identified. No calcifications in the kidneys or collecting system.On delayed imaging, there is normal excretion into normal appearing pelvicaliceal systems bilaterally with good opacification of the entire left ureter and good opacification of the right ureter with the exception of the distal 2 to 3 cm.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multilevel degenerative changes throughout the thoracic and lumbar spine.OTHER: Atherosclerotic changes in the abdominal aorta and iliac arteries.PELVIS:PROSTATE, SEMINAL VESICLES: Status post prostate brachytherapy.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Atherosclerotic changes in the abdominal aorta and iliac arteries. | No abnormality seen to account for patient's hematuria. No evidence of solid renal masses or abnormalities within the collecting system. |
Generate impression based on findings. | 56 year old female with history of metastatic renal cell cancer CHEST:LUNGS AND PLEURA: Reference right middle lobe nodule measures 7 mm and previously measured 7 mm (image 59 series 10237). Right apical nodule measures 6 mm and appears to measure 5 mm (image 25 series 10237).MEDIASTINUM AND HILA: Atherosclerotic calcification of the coronary arteries and aorta. Residual thymic tissue is again noted. No mediastinal or hilar adenopathy.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Ill-defined hepatic lesions are unchanged. Reference segment 6 lesion measures 1.2 x 1.1 cm and previously measured 1.2 x 1.1 cm (image 92, series 4). Reference lesion along the right hepatic vein measures 1.4 x 2.3 cm and previously measured 1.2 x 2.2 cm (image 79, series 4). Additional hypoattenuating lesions in the liver are not significantly changed.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Large left renal mass measures 9.8 x 8.9 cm and previously measured 9.9 x 8.7 cm (image 103, series 4), not significantly changed. Unchanged filling defect within the left renal vein. Right renal cysts are unchanged.RETROPERITONEUM, LYMPH NODES: Dense atherosclerotic calcification of the abdominal aorta and its branches. Reference para-aortic lymph node measures 1.1 x 2.2 cm and previously measured 1.6 x 1.0 cm (image 123 series 4).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. | Left renal mass and metastatic lesions are not significantly changed. No new sites of disease. |
Generate impression based on findings. | 67-year-old male with CLL on therapy for evaluation. CHEST:LUNGS AND PLEURA: Although the prior reference to right lung base nodule (series 4, image 76) has slightly decreased in size, measuring 1.2 x 1 .0 cm, previously 1.5 x 1 .1 cm, the numerous other nodules have not changed in size or distribution. No new nodules, masses, infiltrates or effusions are seen. Some of these are calcified and represent changes from prior granulomatous disease -- these nodules remain nonspecific in their appearance.MEDIASTINUM AND HILA: Multiple small mediastinal nodes some of which are calcified are again seen. The largest node is seen in the right hilum and referenced previously and now measures 1.6 x 1.7 cm (series 3, image 65) slightly decreased from prior exam. Measurement of 2.5 x 1.6 cm. No new enlarged lymph node nodes are identified.CHEST WALL: Bilateral axillary lymphadenopathy has decreased in size. The prior referenced left axillary lymph node now measures 1.6 x 2.3 cm (series 3, image 12), previously 3.2 x 2.2 cm.ABDOMEN:LIVER, BILIARY TRACT: Parenchyma appears normal -- patient status post cholecystectomy with no abnormality seen in the remaining, biliary tract.SPLEEN: Splenomegaly again seen with calcifications from prior granulomatous disease and probable prior peripheral infarcts. No lesions seen to suggest malignant changes.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Decreasing, retroperitoneal, periaortic adenopathy is noted throughout. The prior referenced, lymph nodes (series 3, image 165) has decreased in size, measuring 0.9 x 1.7 cm currently, previously 1.3 x 2.0 cm. The remaining lymph nodes shows similar distribution, with no new areas of lymph node involvement.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Large prostate, without focal abnormality.BLADDER: Bladder calculi (2) seen, which, on last examination were abutting each other simulating one stone. No new stones are seen. No other significant abnormality.LYMPH NODES: Bilateral pelvic adenopathy has decreased in size. The referenced left common iliac lymph node now measures 2.3 x 1 .8 cm, previously 2.9 x 2.2 cm. Other bilateral iliac chain nodes are similarly slightly decreased in size. No new foci of lymph node enlargement are seen.BOWEL, MESENTERY: No significant abnormality noted in the bowel. Mesenteric lymph nodes have decreased in size.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Decreasing size of axillary, abdominal and pelvic lymphadenopathy with reference measurements as above. 2. Bladder calculi. 3. Slight decrease in size of right hilar lymph node -- other small mediastinal lymph nodes some of which are calcified. May be due to granulomatous changes and are unchanged. 4. Numerous parenchymal lung nodules unchanged -- some of these are calcified and represent prior granulomatous disease. All of these nodules remain nonspecific. |
Generate impression based on findings. | History of metastatic hemangiopericytoma. Recent T5 transpedicular corpectomy and T3 through 7 bilateral posterior instrumented fusion with subsequent leg weakness. Postoperative findings including right lateral extracavitary approach for T5 corpectomy with resected right rib heads, T3-7 laminectomy, and bilateral transpedicular screws at T3 to T4 and T6 to T7 levels. The tip of the right T7 screw is in unchanged position, extending through the endplate with its tip in the intervertebral disk. Bilateral embolization material is again noted. The cage within the T5 vertebral body is also in unchanged position. Staples are noted along the skin. The previous soft tissue mass on the right at the T5 level has been resected, with heterogeneous density in the resection cavity as well as foci of air, likely representing postoperative fluid and/or blood products.Alignment of the thoracic spine is normal. Vertebral body and intervertebral disk heights are maintained, with the exception of the T5 vertebral body which is supplemented by the implanted cage. There is robust opacification of the spinal canal to the C7-T1 level. There is no abnormal morphology or cord impingement.C7-T1: The destructive soft tissue mass associated with the right first rib measures 5.4 x 3.9 cm in maximum axial dimension. This abuts the C7-T1 right neural foramen and truncates the exiting nerve root sleeve. Left neural foramen and spinal canal are patent.T1-2: The destructive soft tissue mass extends 7 mm through the right neural foramen and truncates the exiting nerve root at this level as well. The spinal canal and left foramen are patent.T2-3: There is slight effacement of the thecal sac and moderate right sided neural foraminal stenosis on the basis of right facet degeneration. More mild left facet degeneration results in mild left neural foraminal stenosis. The spinal canal is widely patent. T3-4: No significant canal or neural foraminal stenosis within the limits of hardware artifact.T4-5: There is air within soft tissues from prior surgery. There is no significant canal or neural foraminal stenosis at this level.T5-6: There are postop changes without significant canal stenosis.T6-7: The left pedicular screw abuts the thecal sac but there is no spinal significant stenosis at this level. There is slight focal convexity of the posterior/inferior margin of the vertebral body resulting in right-sided neural foraminal stenosis without significant left. T7-8: There is no significant spinal canal or neural foraminal stenosis at this level.T8-9: There is no significant spinal canal stenosis. There is mild right neural foraminal stenosis on the basis of degenerative change.T9-10: There is no significant spinal canal or neural foraminal stenosis at this level.T10-11: Left-sided facet degeneration results in effacement of the thecal sac dorsally without significant canal stenosis. There is mild-moderate left neural foraminal stenosis.T11-12: There is no significant spinal canal or neural foraminal stenosis at this level.There are small bilateral pleural effusions and associated atelectasis. Previously described lung nodules are also unchanged. | 1.Postoperative changes related to the T5 corpectomy and a T3-7 laminectomy/fixation and prior embolization.2.No significant spinal canal stenosis.3.Destructive soft tissue mass centered at the right first rib which results in right-sided neural foraminal stenosis at C7-T1 and T1-2. 4.Degenerative facet changes which result in mild-moderate multilevel neural foraminal stenosis as described.5.Small stable bilateral pleural effusions/atelectasis and stable lung nodules. |
Generate impression based on findings. | 38 year-old male with shortness of breath. Prior CT showed right upper lobe ground glass opacities, please reevaluate prior to treatment. LUNGS AND PLEURA: The previously seen groundglass opacity in the left apex has resolved, however, there is a new peripheral groundglass opacity along the lateral aspect of the right upper lobe (series 4, image 16). Moderate bilateral pleural effusions, left greater than right, are increased since prior exam, and associated with basilar consolidation/atelectasis.MEDIASTINUM AND HILA: No mediastinal lymphadenopathy. Heart size normal.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Ascites has increased since prior exam. Gallstones noted. | Waxing and waning right upper lobe opacities, which are nonspecific, however, in the context of increasing pleural effusions and ascites these most likely represent atypical shifting edema. Inflammatory or infectious process is considered less likely. |
Generate impression based on findings. | 37-year-old male with a history of fifth metacarpal fracture 6 weeks ago. BONES: None is made of deformity of the base of the fifth metacarpal, likely related to prior remote trauma. No evidence of acute fracture or malalignment. SOFT TISSUES: No significant abnormality noted.ADDITIONAL | Deformity of the base of the fifth metacarpal most consistent with prior remote trauma. No acute fracture or malalignment. |
Generate impression based on findings. | Female 64 years old Reason: Must use water only for oral contrast prep. Must include arterial phase Chest and Upper Abdomen. IRB12-2221, call HIRO for questions 2-9172, re evaluate disease after systemic therapy, compare to previous CT History: stage IV metastatic melanoma CHEST:LUNGS AND PLEURA: Postsurgical changes right chest. Soft tissue density in the region of the right lower lobe surgical scar of uncertain significance, image 74, 1.8 x 1.2 cm. On the 7/17 study series 5 image 70 measured 1.8 x 1.1 cm.In the region of the scar in the right upper lobe associated soft tissue density in the scar as measured on series 9 image 33, 2 x 1 cm. This compares to 7/17 series 5 image 28, 1 0.9 x 1 cm.No new nodules. No effusions.MEDIASTINUM AND HILA: Small mediastinal nodes not pathologic in size criteria and unchanged in the prior exam.CHEST WALL: Lesion in the left posterior chest wall subcutaneous fat is change character and is primarily cystic with a thin soft tissue rim. This may represent treatment effect. Its overall size however is increased on series 7 image 84 measuring 2.3 x 1.7 cm. This compares to 7/17/13 series 6 image 120 where it measured 1.8 x 1.3 cm.Lesion in the right posterior chest wall series 7 image 85 measures 1.6 x 1.1 cm. On the 7/17 study series 6 image 119 it measured 1.4 x 0.9 cm.No new chest wall lesions.ABDOMEN:LIVER, BILIARY TRACT: Multifocal liver lesions are identified. On the 1/23/13 study the lesion in the lateral segment of the left lobe which is only slightly hypodense relative to surrounding liver with central hypodense somewhat stellate scar like appearance was measured on series 4 image 88 on 1/23 as 4.9 x 4.8 cm. On the current exam, series 7 image 93/1 the number of lesions in the liver is stable. The other lesions are also a roughly stable in size. 15 it measures 5 x 4.6 cm. On the more recent previous of 7/1713 in series 6 image 136 it measured 4.7 x 5.6 cm.Several small hypodense lesions are seen scattered in the liver. Lesion in segment 8 and an eccentric mural nodular appearance is measured on series 7 image 88, 1.1 x 0.9 cm. On 7/17/13 series 6 image 127 it measures 1 x 0.8 cm.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mass in the subcutaneous tissues of the anterior abdominal wall in the midline series 7 image 121 redemonstrated a slightly larger.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Several small lymph nodes are demonstrated. The largest node is in the right external iliac distribution and series 7 image 172 measuring 1.8 x 1.7 cm. Although it may not have been completely imaged it appeared smaller on 7/17/13 series 6 image 256 where it measures 1.5 x 1.2 cm. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Lesion in the subcutaneous fat abutting the right gluteus possible as measured on series 7 image 161, 1.8 x 1.3 cm. In 7/17/13 series 6 image 227 and measured 1.7 x 1.3 cm. No new lesions are seen.OTHER: No significant abnormality noted. | Increase in size in several index lesions as measured. |
Generate impression based on findings. | 31-year-old male found unresponsive by paramedics, no previous clinical history. There is significant vasogenic edema in the left inferior frontal lobe with mass effect, effacement of the anterior left lateral ventricle, and midline shift of approximately 6 mm from left to right. A small hyperdense focus in the anterior left frontal lobe is suggestive of small hemorrhage. There is also an isodense lesion which may represent an area of spared cortex or possible underlying mass. There is no soft tissue swelling or calvarial fractures to suggest trauma.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. | 1.Significant area of vasogenic edema in the left anteroinferior frontal lobe with mass-effect, effacement of the left lateral ventricle, and midline shift of approximately 6 mm.2.Small focus of hemorrhage in the anterior left frontal lobe.3.These findings are highly suspicious for possible underlying mass lesion and should be further evaluated with enhanced MR imaging. These results were discussed with the ER housestaff at 14:25 on 10/22 by phone. |
Generate impression based on findings. | 63-year-old male patient with history of right renal angiomyolipoma status post embolization. Evaluate occlusion of blood vessels. Note that the lack of intravenous contrast limits evaluation of vasculature, lymph nodes and solid and hollow viscera.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: Hypoattenuating right renal lesion is predominantly isodense compared to fat with areas of soft tissue density and measures 5.0 x 5.5 cm (series 4 image 46), previously 6.0 x 5.8 cm on outside MRI.Exophytic lesion in the lower pole of the left kidney measures 1.3 x 0.9 cm (series 4 image 50) and measures zero Hounsfield units.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild multilevel degenerative changes of the thoracic and lumbar spine.OTHER: No significant abnormality noted | 1.Right renal lesion, previous a characterized as angiomyolipoma, is stable to slightly decreased in size compared to prior MR.2.Small left renal exophytic lesion measures water density. However, without intravenous contrast, the lesion cannot be characterized. |
Generate impression based on findings. | 58-year-old male with PTLD Hodgkin lymphoma status post two cycles of chemotherapy and need of restaging. CHEST:LUNGS AND PLEURA: Right apical scarring, unchanged and postop changes from heart and lung transplant again seen. No parenchymal lung nodules seen. No infiltrates, masses, or effusions identified.MEDIASTINUM AND HILA: lymphadenopathy has diffusely decreased throughout. The prior referenced mediastinum lymph node now measures 0.7 cm, previously 1.7 cm. No new areas of lymphadenopathy are seen. CHEST WALL: Right anterior chest wall Port-A-Cath new since prior examination. Tip of the catheter is seen in the superior vena cava. There is a nonocclusive thrombus in the superior vena cava, new since prior examination.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted in liver. Solitary gallstone seen without complication. No other biliary tract abnormality.SPLEEN: Splenomegaly without focal abnormality.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Renal calcifications, unchanged. Benign bilateral cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Marked decrease in the prior noted marked lymphadenopathy throughout the abdomen. Example reference measurements are as follows:Left gastrohepatic ligament: previously measured 1.7 x 2.1 cm (series 3, image 31) now measures 1.1 x 0.9 cm (series 3, image 95).Left retroperitoneum, abutting left renal vein: Previously (series 3, image 46) measured 3.4 x 2 .7 cm, currently measures 1.6 x 1.4 cm (series 3, image 114).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. Marked reduction in lymphadenopathy in chest and abdomen, as measured and reported above. 2. New superior vena cava nonocclusive thrombus in association with Port-A-Cath catheter. 3. No change renal calcifications. 4. solitary gallstone.Findings conveyed to Mary Lappe at 3:45 p.m. |
Generate impression based on findings. | Male, 67 years old, history of chronic lymphoid leukemia, on ofatumumab, for reevaluation. Scattered adenopathy seen on the prior examination, involving all spaces of the neck as well as the sub-pectoral and axillary regions, has improved with reference measurements as follows:1. Right submental (image 44 series 6): 9 x 8 mm, previously 12 x 10 mm.2. Right level 2/3 (image 47 series 6): 13 x 7 mm, previously 17 x 11 mm.3. Left level 3 (image 54 series 6): 12 x 8 mm, previously 18 x 13 mm.The aerodigestive mucosa is unremarkable. Salivary glands and thyroid are within normal limits. Cervical vessels remain patent. Lung apices are unremarkable. No concerning osseous lesions are seen.Limited intracranial views are unremarkable. Interval progression of right maxillary sinus mucosal thickening is noted. | Improving lymphadenopathy. |
Generate impression based on findings. | 74-year-old male with history of pancreatic carcinoma status post common bile duct stent, evaluate for obstruction or cholangitis. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Distended gallbladder with wall thickening and edema. There is discontinuity of the enhancing gallbladder mucosa with high density contrast extruding into the gallbladder wall suggesting wall necrosis/gangrenous cholecystitis. The common bile duct stent extends into the proximal duodenum. Persistence of high density bile from the prior exam raises the question of cystic duct occlusion. Expected pneumobilia is noted.SPLEEN: No significant abnormality notedPANCREAS: Dilatation of the pancreatic duct extending to the pancreatic head which is enlarged and hypoenhancing. The pancreatic head measures 2.2 cm but the known pancreatic mass is poorly defined The SMA, SMV, portal vein, splenic vein, and celiac axis are patent.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification and plaque of the abdominal aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Findings concerning for gangrenous cholecystitis with breakdown of the gallbladder wall as detailed above, discussed with Dr. Kamm (pager 4495) at the time dictation.2. Poorly enhancing pancreatic head mass consistent with the history of pancreatic carcinoma. |
Generate impression based on findings. | Female 51 years old Reason: Metastatic breast cancer. Restaging. History: Increase in fatigue CHEST:LUNGS AND PLEURA: Multifocal lung nodules redemonstrated. Index nodules measure as follows:Posterior aspect right lung probably lower lobe series 4 image 56 measures 1.2 x 1 cm. Previously 1 x 0.8 cm.Right lower lobe mass series 4 image 69 measures 2 x 1.3 cm. Previously 1.6 x 1.2 cm.No new lesion seen. No effusions.MEDIASTINUM AND HILA: No pathologic size nodes.CHEST WALL: Status post mastectomy bilaterally. Breast implant on the right. Surgical clips axillary. No pathologic size axillary nodes. Node definite lytic or blastic disease.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, 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: Benign appearing sclerotic focus right femur unchanged. No definite lytic or blastic disease.OTHER: No significant abnormality noted. | No new sites of disease. Measurements as above |
Generate impression based on findings. | 38 year-old female with melanoma of skin -- reevaluate disease status following additional systemic therapy. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Small subcentimeter lymph nodes again seen scattered in the mediastinum. The prior reference pretracheal lymph node (series 3 , image 36) now measures 0.8 x 0.5, compared with previous 0.9 x 0.5. No new and spell masses are seen.CHEST WALL: Stable appearing postoperative changes in the right axilla are again seen. The. Reference soft tissue focus in the right axilla seen on series 3, image 25 is unchanged and measures 1.0 x 0.6 cm compare with 1.1 x 0.7 cm previously. No new abnormalities are identifiedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Right adrenal gland is normal. Left adrenal gland is slightly plump, but unchanged compared with exam dating back to 6/18/12 in this most likely is normal.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. No new sites to suggest metastatic disease. 2. Small residual foci in the anterior mediastinum and right axilla previously referenced and measures have remained stable or minimally decreased. 3. No other abnormalities in the chest, abdomen or pelvis. |
Generate impression based on findings. | Male, 6 months old, hearing loss. Right temporal bone:The external auditory canal is hypoplastic. There is an anomalous curving bone which extends inferiorly from the base of the temporal bone which may represent a dysmorphic styloid process. The middle ear cavity is malformed and opacified. The malleus and incus are dysmorphic. The stapes is not clearly seen.The oval window is not clearly present. The round window is present and patent but it gives on to a cavity which is separate from the dysmorphic middle ear cavity and which also seems to receive the tympanic portion of the facial nerve canal.The cochlea is almost fully formed. The apical turn may be mildly dysplastic. The modiolus is prominent. The cochlear aperture is small. The vestibule is dysmorphic. The superior and posterior semicircular canals are present. The lateral semicircular canal is not discretely formed. The vestibular aqueduct is short and seems to run only to the level of the crus communis.The internal auditory canal is narrow. The labyrinthine portion of the facial nerve canal is unremarkable, and does appear to connect with the tympanic portion which is short and demonstrates an unusual course as above. A discrete mastoid portion is not clearly visualized.Left temporal bone:The external auditory canal is atretic. There is an anomalous curving bone which extends inferiorly from the base of the temporal bone which may represent a dysmorphic styloid process. The middle ear cavity is small, dysmorphic and opacified. A dysmorphic, small ossicle or ossicles are identified. They cannot be more discretely identified.The oval window is not present. The round window is present and patent but, as on the right, gives on to a small cavity which is separate from the middle ear and which also receives the tympanic facial nerve canal.The cochlea is almost fully formed. The apical turn may be mildly dysplastic. The modiolus is prominent and the cochlear aperature is not clearly patent.The vestibule is dysmorphic. The superior and posterior semicircular canals are present. The lateral semicircular canal is not discretely formed. The vestibular aqueduct is wide at its aperture measuring over 2 mm, then becoming extremely narrow and extending to the level of the vestibule.The internal auditory canal is very narrow. The labyrinthine portion of the facial nerve canal is present but does not discretely link with what seems to be a dysplastic tympanic portion. A mastoid portion is not clearly visualized.Other findings:Choanal atresia is again seen. Limited views of the brain parenchyma demonstrates prominence of the extra-axial CSF, particularly at the skull base and in the basilar cisterns. The inferior frontal lobes and the anterior temporal lobes seem to be atrophic. There are likely anomalies of the craniocervical junction and upper cervical spine, but these are incompletely evaluated. | Highly dysmorphic temporal bone anatomy bilaterally with choanal atresia and brain parenchymal abnormalities as above. Constellation of findings is likely syndromic and most suggestive of CHARGE syndrome. |
Generate impression based on findings. | 71 year old female with 3-day history of headache. There is no evidence of intracranial hemorrhage, mass or edema, however nonenhanced CT is suboptimal for evaluation of acute ischemic stroke. There is a nonspecific punctate calcification of the right putamen.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. | Normal brain CT. |
Generate impression based on findings. | 58 year-old male status post subdural hemorrhage evacuation, evaluate Interval evacuation of a right subdural hematoma with layering residual blood products along the posterior half of the right cerebral hemisphere. Postsurgical changes include a right frontoparietal burr hole, subcutaneous emphysema underlying the right frontoparietal scalp and pneumocephalus. Interval decrease in leftward midline shift which measures approximately 3 mm. No new sites of hemorrhage are identified.Redemonstration of mild periventricular and subcortical white matter hypodensities which most likely represent the sequela of ischemic small vessel disease of indeterminate age. Cerebellar volume loss.Postsurgical changes identified in the left globe, unchanged. Minimal mucosal thickening of the left maxillary sinus, unchanged. The mastoid air cells are clear.The visualized portions of the orbits are intact. | Postsurgical changes of a right frontoparietal subdural hematoma evacuation with slight interval improvement of leftward midline shift. |
Generate impression based on findings. | Clinical question: Rule out subdural. Signs and symptoms: Trauma and headache. Nonenhanced head CT:There is no detectable acute posttraumatic intracranial, calvarial or soft tissues of the scalp findings.Irregular subcortical low attenuation of white matter representing age indeterminate mild to moderate small vessel ischemic strokes. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation otherwise.Unremarkable calvarium and soft tissues of the scalp.Unremarkable visualized paranasal sinuses and maxillofacial region.Minimal times bilateral mastoid air cells and middle ear cavities. | 1.No detectable acute posttraumatic intracranial, calvarial or soft tissues of the scalp findings.2.Age indeterminate small vessel ischemic strokes. |
Generate impression based on findings. | 51-year-old male with esophageal cancer status post 3 cycles of chemotherapy. CHEST:LUNGS AND PLEURA: No suspicious pulmonary nodules.MEDIASTINUM AND HILA: Previously seen peri-esophageal mass is decreased in size, measuring approximately 1.4 x 2.4 cm, previously measured 1.8 x 4 cm (series 3, image 52). No mediastinal lymphadenopathy.Left central venous catheter with tip at SVC/RA junction.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Numerous liver metastases are decreased in size. Reference right hepatic lobe lesion measures 1.4 x 1.4 cm, previously measured 2.0 x 2.4 cm (series 3, image 89).SPLEEN: Stable peripheral splenic hypodensity (series 3, image 91).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Multiple retroperitoneal lymph nodes have decreased in size. The reference gastrohepatic node is ill-defined and difficult to measure approximately 1.6 x 2.1 cm, previously measured 2.4 x 2.6 cm (series 3, image 84). Reference aortocaval node measures 0.9 x 0.9 cm, previously measured 1.1 x 1.1 cm (series 3, image 122).BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Interval decrease in size of GE junction mass, which is difficult to measure, however, measures approximately 3.6 x 3 .7 cm, previously measured 5.3 x 6.6 cm (series 3, image 72).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Interval decrease in size of GE junction mass, paraesophageal mass, liver lesions, and retroperitoneal lymphadenopathy. |
Generate impression based on findings. | Clinical question: Newly diagnosed lung cancer. Signs and symptoms: Evaluation prior to initiation of therapy. Nonenhanced head CT:The examination demonstrates no evidence of acute intracranial process.The cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation remains be normal.Lack of intravenous contrast significantly reduces the sensitivity of the exam for detection of small metastatic lesions or leptomeningeal carcinomatosis.Minimal bilateral cavernous carotid vascular calcification is noted.Calvarium and soft tissues of the scalp are unremarkable.Limited images through the orbits are unremarkable.Bilateral petrous bones, mastoid air cells, middle ear cavities are unremarkable | Negative nonenhanced head CT. |
Generate impression based on findings. | Male 48 years old; Reason: assess for ischemic gut History: pain out of proportion to exam, lactate ABDOMEN:LUNGS BASES: No significant abnormality detected.LIVER, BILIARY TRACT: Hypoattenuating lesion in segment 4 A., 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. Specifically, no dilation, obstruction, fluid in the bowel or ascites noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.No evidence of acute intra-abdominal process detected. |
Generate impression based on findings. | Clinical question: Evaluate brain lesion given history of HIV. Signs and symptoms: History of HIV, dizziness and syncope. Nonenhanced head CT:Examination demonstrates extensive regions of cortical low attenuation involving bilateral temporal lobes, bilateral occipital lobes and bilateral high convexity frontal -- parietal cortex and symmetrical bilateral involvement of basal ganglia and thalami. There is resultant subtle associated mass-effect and effacement of adjacent cortical sulci. There is also highly suspected unit for bilateral low attenuation of the cerebellar hemispheres with result in smaller size of the fourth ventricle compared to prior exam and decreased size of CSF spaces in the posterior fossa and including the quadrigeminal plate cistern.All of the above findings are consistent with regions of ischemia. The pattern is suggestive of global ischemic event. The lateral ventricles are smaller than prior exam likely secondary to mass effect. There is also decreased size of third ventricle secondary to edematous changes of bilateral basal ganglia and thalami. | Extensive regions of cortical edema of bilateral cerebral hemispheres, bilateral basal ganglia, thalami and highly suspected extensive edematous changes of bilateral cerebellar hemispheres all suggestive of global ischemic event. No areas of intracranial hemorrhage or midline shift. |
Generate impression based on findings. | Female, 52 years old, pain and numbness along the right mandible, nasal congestion and frontal headaches. There is a small amount of fluid within the left frontal sinus. Frontal sinuses and frontoethmoidal recesses are otherwise clear. The sphenoid sinuses and sphenoethmoidal recesses are clear. The ethmoid air cells are clear.The maxillary sinuses are free of significant mucosal thickening and debris. The maxillary outflow pathways are patent.The nasal cavity is clear. The nasal septum is intact. The left middle nasal turbinate is pneumatized.The mastoid air cells and middle ear cavities are normally pneumatized.Please note that only the rami and angles of the mandible are included in the field of view, and these are unremarkable. | Small amount of nonspecific fluid in the left frontal sinus. Otherwise no significant paranasal sinus abnormalities. |
Generate impression based on findings. | Female, 48 years old, headache. 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. | No acute intracranial abnormalities. |
Generate impression based on findings. | ETT in place, no air leak when cuff deflated, evaluate for vocal cord or laryngeal pathology. There is an endotracheal tube and an enteric tube in position, which are partially imaged. There is associated fluid within the nasal cavity, nasopharynx, oropharynx, oral cavity, hypopharynx, and upper trachea. The vocal cords are difficult to assess in the setting of intraluminal fluid and intubation and may be edematous, but no gross mass lesions are identified. There is a right internal jugular venous catheter that contains a small amount of air and a left internal jugular veinous catheter. The major cervical vessels are otherwise patent. There is no significant cervical lymphadenopathy. The thyroid gland has a prominent pyramidal lobe, but is otherwise grossly unremarkable. There is mild multilevel degenerative spondylosis. There are multiple carious teeth. There is partially imaged cerebral volume loss and cerebral white matter hypoattenuation that likely represents microangiopathy. The imaged portions of the upper lungs are clear. Refer to the separate chest radiograph for additional chest findings. | Partially imaged endotracheal tube and enteric tubes in position, with associated fluid within the nasal cavity, nasopharynx, oropharynx, oral cavity, hypopharynx, and upper trachea. The vocal cords are difficult to assess in the setting of intraluminal fluid and intubation and underlying edema cannot be excluded, but no gross mass lesions are identified. |
Generate impression based on findings. | Clinical question: 47-year-old female with respiratory failure, acute mental status changes. Evaluate for interval change. Signs and symptoms: As above. 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. There are very subtle foci of subcortical low attenuation which are nonspecific findings however are in proper clinical setting it could represent age indeterminate minimal small vessel ischemic strokes. Correlate with history and consider MRI clinically deemed necessary. There are no prior exams available for comparison.Unremarkable calvarium and soft tissues of the scalp.Unremarkable orbits.Unremarkable paranasal sinuses and mastoid air cells. | No acute intracranial process. |
Generate impression based on findings. | Clinical question: Signs of intracranial trauma? Signs and symptoms: Head trauma with loss of consciousness. Nonenhanced head CT:Examination demonstrate no detectable acute intracranial process. CT however is insensitive for detection of acute nonhemorrhagic ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation.Unremarkable calvarium and soft tissues of the scalp.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells. | Unremarkable nonenhanced head CT. |
Generate impression based on findings. | Clinical question: Evaluate for stroke/bleed. Signs and symptoms: Altered mental status. Nonenhanced head CT:There is no detectable acute intracranial process. CT however is insensitive for detection of acute non-hemorrhagic ischemic stroke.There are extensive periventricular and subcortical low attenuation white matter consistent mid age indeterminate small vessel ischemic strokes.Slight prominence of cortical sulci and ventricular system is likely secondary to underlying parenchymal volume loss considering the extensive small vessel ischemic stroke present.Moderate bilateral cavernous carotid and vertebral calcification.Unremarkable calvarium and soft tissues of the scalp.Unremarkable visualized orbits.Paranasal sinuses demonstrate mild chronic sinus disease. | Extensive age indeterminate small was ischemic strokes. |
Generate impression based on findings. | Clinical question: Left facial droop. Signs and symptoms: Left facial droop. Nonenhanced head CT:No detectable acute intracranial process CT however is insensitive for detection of acute nonhemorrhagic ischemic strokes.Unremarkable cerebral cortex on the cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation for patient's stated age of 79. Unremarkable calvarium and soft tissues of the scalp. Extensive left maxillary acute on chronic sinusitis and mild chronic sinusitis of the left ethmoid air cells. | 1.No acute intracranial findings.2.Acute on chronic left maxillary and mild chronic left ethmoid sinus disease. |
Generate impression based on findings. | 23-year-old male patient with history HIV and abscess. Evaluate for perirectal abscess. 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: Pathologically enlarged left common iliac node measures 1.5 x 1.6 cm (coronal series 80284 image 52).BOWEL, MESENTERY: There is an area of hypoattenuation posterior to the umbilicus that likely represents a loop of unopacified small bowel.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Pathologically enlarged left common iliac node measures 1.5 by 1.6 cm (coronal series 80284 image 52).BOWEL, MESENTERY: There is a left-sided perianal area of hypoattenuation that measures 0.7 x 1.7 cm (series 3 image 150) with no wall enhancement, consistent with abscess.Superiorly, there is a right-sided perirectal fluid collection within the sling muscle with early wall enhancement that measures 1.6 x 2.3 cm (series 3 image 133), consistent with abscess. There is no extension into the ischiorectal fossa fat, no fat stranding in the presacral area or peritoneal fluid.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Left-sided perianal abscess.2.Right-sided perirectal abscess without extension into surrounding structures. |
Generate impression based on findings. | Clinical question: Subdural hematoma. Signs and symptoms: Subdural hematoma. Nonenhanced head CT:The examination redemonstrates left holohemispheric acute subdural collection. There is a slight interval increased size of subdural in the left occipital and posterior temporal region. The subdural in the left posterior temporal -- occipital measures approximately 15.4 mm in size compared to prior study measurements of approximately 12.6 mm. The measurements of subdural A. anterior temporal, along the interhemispheric fissure and posterior parietal remains nearly identical to prior study. Extra-axial CSF-like density in the right frontal region suspected of subacute subdural remains identical to prior exam.Ventricular system remain within normal size and midline is maintained.No evidence of new hemorrhage or any detectable abnormality of cerebral hemispheres.Unremarkable images through posterior fossa. | 1.Minimal interval increased size of left posterior temporal -- occipital component of left sided holohemispheric subdural and stable otherwise.2.Suspected right frontal CSF density subdural in size and extent since prior exam.3.Stable normal size of supratentorial ventricular system and the maintained midline. |
Generate impression based on findings. | Clinical question: Follow-up resection. Signs and symptoms: As above. Nonenhanced head CT:Examination demonstrates interval removal of previously placed electrodes from the left side.There is evidence of expected postoperative changes of a large left anterior temporal lobectomy. Air and fluid within the surgical cavity is noted. There is no evidence of any parenchymal or subarachnoid hemorrhage.There is widening of the epidural space containing serosanguineous fluid and air under the left anterior temporal -- frontal craniotomy flap which is within expected postop changes.Combination of above findings result in increased intracranial pressure on the left with resultant partially effaced left lateral ventricle and trace midline shift to the right at the level of septum pellucidum. This appearance is nearly identical to prior exam from 10 -- 10 -- 13. Stable and unremarkable exam otherwise. | 1.Expected postoperative changes of left anterior temporal partial lobectomy as detailed.2.Minimal expected postoperative epidural collection under the craniotomy flap in the left anterior temporal -- frontal region.3.Mass-effect of postoperative changes results in trace midline shift to the left which is not significantly different than prior preoperative study while patient's left hemispheric electrodes were in place. |
Generate impression based on findings. | Pain. Salter-Harris II fracture at the medial aspect of the distal tibia, in near-anatomic alignment. No associated soft tissue hematoma. Overlying cast is noted. | Salter-Harris II fracture of the distal tibia. |
Generate impression based on findings. | Clinical question: Subdural hematoma. Signs and symptoms: Subdural hematoma. Nonenhanced head CT:Examination demonstrate interval left posterior temporal and parietal craniotomy. There is extensive postoperative air within the partially drained left hemispheric subdural. Minimal residual subdural at the surgical site remains. There is no significant change however in the size and extent of subdural in the posterior temporal -- occipital region. The remaining subdural at the side measures approximately 16 mm (axial image 9 of 37) which is not significantly different than prior exam.There is also mild interval decreased in the interhemispheric component of subdural since prior exam.There is apparent parenchymal low attenuation of the left posterior temporal region (axial images 10 212) which may represent an artifactual finding or edema. Further follow up is needed.Stable normal size of ventricular system and maintained midline.Stable prominence of subarachnoid space/chronic subdural in the right frontal and temporal region. Examination also demonstrate expected postoperative changes of scalp in the region of craniotomy in including a small surgical drain under the scalp at the surgical site. | 1.Interval expected postoperative changes of a left temporal -- parietal craniotomy as detailed.2.Interval decreased size of subdural in the left frontal and left anterior/mid temporal and along the interhemispheric fissure.3.No significant change in the size of residual subdural in the left posterior temporal and occipital region. Remaining subdural at this site measures approximately 16 mm.4.There is suggestion of lower density of the left posterior temporal occipital parenchymal (axial image 10 and 11 and coronal reformatted images 61 through 63). Further follow-up is recommended. This finding could represent either edema or an artifactual finding. |
Generate impression based on findings. | 35-year-old female patient with lower back pain and right lower extremity pain. Evaluate for masses. ABDOMEN:LUNG BASES: Bibasilar dependent atelectasis.LIVER, BILIARY TRACT: There is a well-circumscribed, hypoattenuating, nonenhancing lesion in the posterior right liver that measures 0.6 x 0.6 cm (series 3 image 19) and is 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: Uterus measures 2.0 x 4.3 cm (sagittal series 80245 image 57) with numerous noncalcified masses. There is a dominant exophytic mass without calcifications near the left adnexa, presumptively a noncalcified uterine fibroid. There is a well-circumscribed hypoattenuating mass in the left vaginal wall and likely represents a Bartholin's cyst.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.Enlarged uterus with multiple noncalcified masses, presumably uterine fibroids.2.Subcentimeter, well circumscribed hypoattenuating lesion within the liver is too small characterize.3.Bartholin's cyst. |
Generate impression based on findings. | 47 year old female with open abdominal wound, hypoxic, respiratory failure ABDOMEN:LUNG BASES: Basilar scarring and atelectasis.LIVER, BILIARY TRACT: Cirrhotic liver morphology. No focal hepatic lesions. Mild perihepatic ascites. The gallbladder is poorly distended, if there is concern for cholecystitis right upper quadrant ultrasound is recommended. Patent hepatic vasculature.SPLEEN: Mild perisplenic ascites.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted..BOWEL, MESENTERY: Right lower quadrant ostomy. No evidence of bowel obstruction. Bowel loops are adherent to the anterior abdominal wall but the known fistula is not demonstrated. Several loops of small bowel in the midabdomen demonstrate wall thickening and edema increased from the prior study which may be infectious, inflammatory, or ischemic in etiology. Surgical clips and suture are noted in the lower abdomen. Enteric tube in the gastric antrum.BONES, SOFT TISSUES: Large anterior abdominal wound with pooling high-density material.OTHER: Mild abdominal ascites.PELVIS:UTERUS, ADNEXA: Multiple surgical clips are present around the uterus and adnexa. Left adnexal cystic lesion is again noted, unchanged.BLADDER: Foley catheter in the bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Anasarca. | 1. Large anterior abdominal wound with adherent bowel loops, the known fistula is not demonstrated on this study.2. Edematous small bowel loops in the midabdomen of unclear etiology, possibly infectious, inflammatory, or ischemic.3. Collapsed gallbladder with apparent wall thickening, if there is clinical concern for cholecystitis correlation with right upper quadrant ultrasound is recommended. |
Generate impression based on findings. | Chest pain history of breast C. A. currently being treated with daily radiation. Concern for PE versus radiation pericarditis. PULMONARY ARTERIES: Technically adequate study no filling defects to suggest presence of acute pulmonary embolus. Main pulmonary artery is upper limits of normal in size.LUNGS AND PLEURA: 4-mm subpleural nodule in the anterior aspect of the left upper lobe occurs within the expected radiation field however in isolation this is a nonspecific finding. In the right upper lobe there are several groundglass opacity spherical nodules ranging from 3 to17-mm in size and (series 10 images 28, 30, 36, 43, 56 and 60). Few scattered foci of emphysema. Mild compressive atelectasis at the lung bases. Densely calcified pulmonary nodule right lower lobe most suggestive of a granuloma.MEDIASTINUM AND HILA: Mild thyroid gland enlargement, right greater than left. Internal areas of heterogeneity suggestive of cysts or nodules which may be further assessed with ultrasound and/or nuclear scintigraphy if clinically warranted. There is a single focus of calcification seen posteriorly on the right on image 28. Please note that benign or malignant thyroid pathology cannot be differentiated on the basis of CT.Subcarinal lymph nodes containing calcifications and a right segmental level calcified peribronchial lymph node are most consistent with healed granulomatous infection.The pericardium appears normal in thickness and there is a physiologic volume of pericardial fluid. Mild cardiomegaly.No significant intrathoracic lymphadenopathy.CHEST WALL: No internal mammary chain lymphadenopathy is appreciated. No axillary lymphadenopathy. Postsurgical change consistent with left mastectomy and axillary lymph node dissection. Nonspecific faint calcifications are seen in the right breastUPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. Subcentimeter hypoattenuating lesions in the liver are too small to accurately characterize. 14-mm right adrenal gland nodule measures 31 Hounsfield units and is not meet the criteria for a benign adenoma, indeterminate. Small sclerotic focus in the T10 vertebral body posteriorly and scattered sclerotic foci in the ribs (annotated on the sagittal series) are nonspecific without comparison to remote prior studies and may be further characterized by bone scan to exclude metastatic lesions. | 1. No evidence of acute pulmonary embolus. No significant pericardial thickening or fluid.2. Multiple ground glass density nodules in the right upper lobe are not in the expected distribution for radiation pneumonitis and do not have the typical appearance of radiation-related lesions. Hematogenous spread of atypical infection is possible if the patient is immunocompromised though isolation to one lobe would be unusual. Given the patient's age these are suspicious for areas of atypical adenomatous hyperplasia (lesions under 5-mm) and and small primary pulmonary adenocarcinoma in situ or a minimally invasive adenocarcinoma. Six-week follow-up CT is recommended to assess for resolution. Lesions would be beyond the resolution of PET scan. If the referring clinical service can obtain and submit remote outside studies for comparison to determine stability or growth of these lesions, an addendum can be provided if formally requested.3. Indeterminate sclerotic skeletal lesions, suggest correlation with with bone scan to rule out metastases.4. Nonspecific subcentimeter hepatic lesions. Though statistically more likely to be benign rather than malignant, these are incompletely assessed and metastatic lesions cannot be excluded without either a hepatic MRI or dedicated triple phase hepatic CT scan. 5. Nonspecific lesions in the thyroid gland can be further assessed by ultrasound and/or nuclear scintigraphy.6. Subcentimeter nodule in the left upper lobe occurs within the expected radiation field and most likely represents an early manifestation of radiation pneumonitis. This may be further assessed at the time the patient 6-week follow-up scan.7. Indeterminate right adrenal gland nodule, which does not meet the imaging criteria for a benign adenoma. MRI suggested to differentiate atypical benign lesion from metastasis. |
Generate impression based on findings. | Worst headache of life. Unenhanced head: There is no intracranial mass, fluid collection, hemorrhage, hydrocephalus or CT evidence of acute ischemia. Gray-white matter differentiation is maintained bilaterally and the midline is intact. Bony structures, mastoid air cells and orbits are unremarkable. There is a round soft tissue density within the right maxillary sinus most likely representing a mucus retention cyst.CT Angiogram: The vertebral arteries and branches including PICA, AICA and SCA are normal bilaterally. There is fenestration of the proximal basilar artery which is normal more distally. There is a fetal origin of the left PCA, the right is normal. There are no steno-occlusive lesions or aneurysms within the posterior circulation.ICAs are normal along their visualized extent and MCAs and ACAs are normal bilaterally. There is no aneurysm or steno-occlusive lesion demonstrated within the anterior circulation. | No intracranial pathology demonstrated including subarachnoid hemorrhage, aneurysm or steno-occlusive lesion. Incidental note of basilar artery fenestration and fetal origin left PCA. A verbal report was given to Dr. Checkett (ERP) at the time of reporting (8:50 a.m.) |
Generate impression based on findings. | 57-year-old male with intracranial bleed. There is an unchanged large right hemispheric hematoma with intraventricular extension and surrounding edema. The right to left midline shift is stable, measuring 12 mm. There is an unchanged lacunar infarct in left corona radiata. There are there is a left ventriculostomy catheter which is unchanged in position, terminating in the left lateral ventricle. The left lateral ventricle is dilated but stable in size. There is an unchanged small amount of hemorrhage in the occipital horn of the left lateral ventricle. There is persistent effacement of the right lateral and third ventricles. The calvaria and skull base are radiographically normal. There is fluid in the sphenoid sinus, bilateral mastoid air cells, and a mucosal thickening in the left maxillary sinus which is unchanged. | Unchanged large right hemispheric hematoma with stable right to left midline shift. Dilated left lateral ventricle ventriculostomy tube, stable in appearance. |
Generate impression based on findings. | 51-year-old male patient with history of IBD, 5 days postop from end ileostomy and J-pouch excision presents with decreased ileostomy output. Evaluate for obstruction. ABDOMEN:LUNG BASES: Multiple scattered subcentimeter blebs with peripheral distribution. Otherwise, no parenchymal abnormalities.LIVER, BILIARY TRACT: No significant abnormality noted within the liver. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The stomach and distal esophagus are distended with fluid and contrast. No progression of oral contrast into the small bowel. Mildly dilated loops of small bowel that terminate at the ileostomy site. No stomal or parastomal hernia.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumbar spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The stomach and distal esophagus are distended with fluid and contrast. No progression of oral contrast into the small bowel. Mildly dilated loops of small bowel that terminate at the ileostomy site. No stomal or parastomal hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate amount of intraperitoneal free air and subcutaneous emphysema in the anterior pelvic wall, likely postsurgical.Hypoattenuating fluid collection at the site of the excised J-pouch measures 3.0 x 2.5 cm (series 3 image 88). Trace pockets of free air in this region most likely secondary to postsurgical changes, although early focal leak cannot be ruled out. | 1.Findings consistent with obstruction at ileostomy.2.Fluid collection at excised J-pouch and intraperitoneal air likely secondary to postsurgical changes. |
Generate impression based on findings. | Headache. There has been continued interval improvement in dimensions of the left occipital subgaleal hematoma and the 8mm focus of intraparenchymal left occipital blood . The associated intraparenchymal edema is slightly more prominent on today's exam. There is no new intracranial hemorrhage. There is no intracranial mass, fluid collection, hydrocephalus or CT evidence of acute ischemia. The recently described right MCA aneurysm is not clearly visualized on this unenhanced exam.The bones, orbits and the visualized portion of the paranasal sinuses are unremarkable. | Some interval improvement in the appearance of the left right occipital subgaleal hematoma and intracranial focus of hemorrhage likely representing sequela of contusion. |
Generate impression based on findings. | S.O.B. and cancer question PE. PULMONARY ARTERIES: Technically adequate study. No evidence of acute pulmonary embolus. Very small eccentric filling defect within a subsegmental branch of the posterior right lower lobe (8/151) is suspicious for a chronic, recanalized thrombus, new from previous. Main pulmonary artery mildly enlarged.LUNGS AND PLEURA: Small right pleural fluid collection appears slightly heterogeneous and has increased compared to the previous study. Small amount of pleural fluid which may be loculated at the right lung apex.Centrilobular and subpleural emphysema. At the lung bases, especially on the right mild traction bronchiectasis is noted. Background of ground glass abnormality within the lung interstitium diffusely. Consolidation and bronchiectasis in the right upper lobe with underlying nodule. New area of ground glass opacity within the right middle lobe (10/97) nonspecific but may be related to evolving radiation fibrosis.MEDIASTINUM AND HILA: Severe atherosclerotic calcification of the aorta and its branches, including the coronary arteries. Mild cardiomegaly. Large hiatal hernia. Subcarinal lymphadenopathy slightly worse, 19-mm compared to 13-mm previously (8/103). Mild interlobar lymphadenopathy on the left. Right paratracheal lymphadenopathy difficult to see due to artifact it appears mild. There is new soft tissue in the low right paratracheal region (8/80 abutting the trachea, difficult to discern from the azygos arch but suspicious for lymphadenopathy.CHEST WALL: Moderate degenerative change of the spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. Left adrenal gland thickening and nodularity indeterminate but unchanged, this was previously suggested to be adrenal gland hyperplasia by PET scan. Mild nodularity of the medial limb of the right adrenal gland also unchanged. | 1. Very small chronic recanalized thrombus in a subsegmental branch of the posterior right lower lobe, unlikely to be clinically significant. No evidence of acute pulmonary embolus.2. Increase in small volume of heterogeneous pleural fluid on the right more likely to be post inflammatory than metastatic. 3. Increased post therapeutic change in the right lung, please refer to recent staging CT for further details. Please note that superimposed pneumonia may not be discernible radiographically.4. Slight worsening of lymphadenopathy in the mediastinum. |
Generate impression based on findings. | Status post fall. Rule out fracture. There is normal overall lordosis of the cervical spine with very slight (2 mm) of retrolisthesis of C4 on C5. There is minimal disk height loss at C5-6 and C6-7. Cerebellar tonsils are in appropriate position. There are no fractures. Prevertebral soft tissues are normal.C2-3: There is a left uncovertebral joint osteophyte resulting in mild left foraminal stenosis. Right neural foramina and spinal canal are widely patent.C3-4: There is disk osteophyte complex resulting in bilateral (right moderate-severe, left mild) neural foraminal stenosis. The spinal canal is patent. C4-5: There is disk osteophyte complex resulting in bilateral moderate-severe neural foraminal stenosis. The spinal canal is patent.C5-6: There is disk osteophyte complex resulting in bilateral (right moderate-severe, left moderate) neural foraminal stenosis. The spinal canal is patent.C6-7: There is a disk osteophyte complex resulting in bilateral moderate neural foraminal stenosis. The spinal canal is patent.C7-T1: The spinal canal is patent. The neural foramina are patent bilaterally. | Spondylosis including multilevel disk osteophyte complexes resulting in bilateral neural foraminal stenosis at each level from C3-4 through C6-7. No fracture. |
Generate impression based on findings. | Reason: 47 yo F with Acute hypoxic RF, know DVTs, assess for PE History: as above PULMONARY ARTERIES: There is adequate opacification of the pulmonary arterial tree to the segmental level. No pulmonary embolus can be identified.The pulmonary arteries normal caliber.LUNGS AND PLEURA: Bilateral basilar subsegmental atelectasis.Tracheostomy tube in place with a considerable amount of debris identified within the right mainstem bronchus.No pleural effusion.No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of the pericardial effusion.NG tube in place with its tip in the stomach.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Small amount of perihepatic ascites. | 1.No evidence of a pulmonary embolus to the segmental level.2.Debris in the central airways and bilateral basilar subsegmental atelectasis suggestive of aspiration. |
Generate impression based on findings. | 40 year-old male with history of HBV, MDS, w/ fever of unknown origin ABDOMEN:LUNG BASES: Bilateral pleural effusions with associated compressive atelectasis and consolidation.LIVER, BILIARY TRACT: Hypodense segment 5 lesion compatible with treated HCC. No new focal hepatic lesion.SPLEEN: Wedge shaped splenic hypodensities may represent evolving infarctions.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Distal esophageal wall thickening and dilated esophagus, raising the possibility of esophagitis. 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: Trace pelvic fluid. | 1. Distal esophageal wall thickening suggestive of esophagitis, correlation with EGD is suggested if clinically warranted.2. Findings suggesting evolving splenic infarctions.3. Bilateral pleural effusions with compressive atelectasis and consolidation.4. Unchanged treated HCC lesion. |
Generate impression based on findings. | 77 -year-old male with a history of pneumonia versus mass at outside hospital. LUNGS AND PLEURA: Since the 5/2012 exam, there is new centrally necrotic mass in the left upper lobe, which is located along the major fissure and extends into the superior aspect of the left lower lobe; this mass measures approximately 4.8 x 6.9 cm (series 5, image 41). The mass abuts the left pulmonary artery and comes in contact with the proximal descending aorta (series 5, image 44, image 36).No other masses or suspicious nodules identified. Mild dependent atelectasis.Centrilobular emphysema, predominantly affecting the upper lobes.MEDIASTINUM AND HILA: Although evaluation of the mediastinum is suboptimal due to lack of IV contrast, several mildly enlarged lymph nodes are identified (series 3, image 55, 41, 50).Focal nodularity along the right aspect of the trachea is of unclear significance and may represent lesion or adherent mucous (series 5, image 25).Moderate atherosclerotic calcifications are seen in the aorta and coronary arteries. There is also a possible pericardial lesion located along the aortic root (series 3, image 55).CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Gastric distention with food material. Prominent lymph nodes are noted in the upper retroperitoneum. | 1.Large necrotic mass centered in the left upper lobe with invasion of superior aspect of left lower lobe through the major fissure as well is abutment of the pulmonary artery, presumably neoplastic in nature. 2.Several mildly enlarged mediastinal lymph nodes, which may be better characterized with PET/CT. |
Generate impression based on findings. | Reason: eval for PE, patient s/p PEA arrest History: PEA arrest PULMONARY ARTERIES: The exam was terminated following extravasation of saline into the left forearm. The patient was evaluated by Dr. McCann with appropriate discharge instructions given.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. | Exam was terminated prior to the intravenous administration of contrast due to extravasation of saline. |
Generate impression based on findings. | 61 year-old male with hematemesis, possible mass in abdomen. CHEST:LUNGS AND PLEURA: Scattered punctate micronodules bilaterally.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Dextroscoliosis.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Subcentimeter hypodensity in the right lobe of the liver is too small to characterize.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cyst.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No pathologically enlarged lymph nodes.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Centrally necrotic mass arises from gastric cardia wall and measures 4.2 x 5.6 cm (series 3, image 83); this may represent a gist tumor or esophageal carcinoma.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Necrotic mass arising from the gastric cardia is suspicious for gastrointestinal stromal tumor (GIST); differential also includes gastric carcinoma. Follow-up with endoscopy is recommended. Nonspecific hypodensity in right lobe of liver can be better assessed with MRI if indicated. |
Generate impression based on findings. | Left preauricular cyst. Neck: There is a heterogeneous soft tissue attenuation mass in the left preauricular subcutaneous tissues that contacts the epidermis and extends to the squamous portion of the temporal bone, which measures 20 AP X 9 RL X 20 SI mm. There is no evidence of erosion into the skull. The mass is separate from the parotid gland, which appears unremarkable. The thyroid gland also appears unremarkable. There is no significant cervical lymphadenopathy. There is partial opacification of the incompletely developed tympanomastoid cavities. The major cerebral vessels appear patent. The imaged portions of the lungs are clear.Head: There is no evidence of intracranial hemorrhage, mass, or cerebral edema. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull appears intact. | Heterogeneous soft tissue mass in the left preauricular subcutaneous tissues that contacts the epidermis and extends to the squamous portion of the temporal bone, which measures up to 20 mm. Differential considerations include a chronically infected first branchial apparatus anomaly, a vascular tumor, as well as benign and malignant neoplasms, such as desmoid tumor or rhabdomyosarcoma. |
Generate impression based on findings. | 55 year old female with weight loss, decreased functional status, evaluate for CHEST:LUNGS AND PLEURA: Interval development of pleural effusions, larger on the right. Multiple pulmonary nodules and micronodules with the largest nodule in the left lower lobe measuring 8 mm (image 39, series 5) suspicious for metastatic disease.MEDIASTINUM AND HILA: Prominent mediastinal lymph nodes and supraclavicular lymphadenopathy are noted, poorly evaluated on this noncontrast study. Postsurgical change of heart transplant.CHEST WALL: Sternal fixation wires.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Large right cystic solid renal mass measures 9.2 x 9.5 cm and previously measured 9.9 x 9.2 cm. Multiple left renal lesions are incompletely evaluated on this noncontrast study.RETROPERITONEUM, LYMPH NODES: Confluent retroperitoneal adenopathy in the upper abdomen is poorly evaluated, but suspicious for metastatic disease.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. New pulmonary nodules consistent with progression of metastatic disease2. Right cystic solid renal cell carcinoma and thoracoabdominal lymphadenopathy, poorly evaluated due to lack of IV contrast, but not significantly changed. If further characterization is clinically warranted, MRI may be considered. |
Generate impression based on findings. | 72 year old female with history of lung cancer now off therapy. Evaluate status of disease, especially retrocrural lymph nodes. CHEST:LUNGS AND PLEURA: Right upper lobe nodule measures 5 x 7 mm, unchanged (series 5, image 13). No new suspicious nodules.Status post left upper lobectomy with associated volume loss. Stable scarring in the left apex and left base. Stable emphysema. Stable right paramediastinal consolidation and architectural distortion consistent with radiation fibrosis.Mucus is noted in the right mainstem bronchus.MEDIASTINUM AND HILA: Left infraclavicular nodes are not significantly changed (series 3, image 20). Moderate coronary artery calcifications.CHEST WALL: Callus formation along posterior aspect of left rib consistent with prior fracture.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Stable right lobe hemangioma.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Stable left adrenal nodule measures 1 cm (series 3, image 83).KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Stable retrocrural adenopathy, with reference right retrocrural node measuring 2.2 cm, previously measured 2.3 cm (series 3, image 84).Severe atherosclerotic disease affects the aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Persistent dilated loops of small bowel with diffuse pneumatosis, not significantly changed. Small amount of intraperitoneal free air also appears similar.BONES, SOFT TISSUES: Heterogeneity of the bone marrow appears unchanged, most compatible with diffuse osteopenia.OTHER: No significant abnormality noted. | 1.Stable posttreatment changes in the lungs and stable retrocrural lymphadenopathy.2.Persistent dilation of multiple small bowl loops, diffuse pneumatosis, and small amount of pneumoperitoneum. |
Generate impression based on findings. | 79 year-old female with headache, rule out bleed. CT head: Redemonstration of a left frontal dural-based mass and a right temporal dural based mass which are better demonstrated on the comparison study and likely represent meningiomas.Small space occupying process along the anterior left frontal lobe (series 4 image 19) which follows CSF signal intensity on the comparison MRI and is of uncertain etiology, but may represent an incidental developmental cyst. This finding is unlikely to be of clinical significance. Lucent scattered calvarial lesions likely represent venous lakes and prominent diploic vessels.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Postsurgical changes of prior sinus surgery. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.CT orbits:The globes, lenses, extraocular muscles, optic nerves, and intraconal space are symmetric and normal. No radiopaque foreign body is identified. The orbital soft tissues are normal. The osseous structures are unremarkable with no evidence of fracture. Postsurgical changes of previous sinus surgery. The visualized paranasal sinuses are clear. The nasal septum demonstrates no significant deviation. The cribriform plates are intact. The osseous structures are unremarkable. | 1. No acute intracranial abnormalities or fractures.2. Redemonstration of dural-based lesions likely representing meningiomas.3. Small space occupying lesion along the left frontal lobe may represent a developmental cyst and is unlikely to be of current clinical significance. |
Generate impression based on findings. | 17-year-old male with history of GCT, status post orchiectomy. Evaluate for recurrence. CHEST:LUNGS AND PLEURA: Micronodules in the fissures bilaterally likely represent lymph nodes. Subcentimeter ground glass opacity abutting the pleura in the right lower lobe is unchanged since 5/24/13 (series 4, image 69). No pleural effusions.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Normal-sized heart without pericardial effusion.CHEST WALL: No significant abnormality noted. No axillary lymphadenopathy.ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. No intrahepatic or extrahepatic biliary ductal dilatation. Normal appearing gallbladder.SPLEEN: Normal in appearance, without focal lesions.PANCREAS: Normal in appearance, without focal lesions.ADRENAL GLANDS: Normal in appearance.KIDNEYS, URETERS: Normal symmetric enhancement without pelvicaliceal dilatation, focal lesions, or nephrolithiasis.RETROPERITONEUM, LYMPH NODES: No retroperitoneal or mesenteric lymphadenopathy.BOWEL, MESENTERY: Non-dilated loops of bowel without any associated soft tissue mass, mesenteric stranding, or fluid collection.BONES, SOFT TISSUES: No osseous lesions.PELVIS:PROSTATE, SEMINAL VESICLES: Normal in appearance.BLADDER: Normal in appearance.LYMPH NODES: Subcentimeter pelvic lymph nodes.BOWEL, MESENTERY: Non-dilated loops of bowel without any associated soft tissue mass, mesenteric stranding, or fluid collection.BONES, SOFT TISSUES: No osseous lesions.OTHER: No ascites. | Stable right lower lobe opacity. No specific evidence of metastatic disease in the chest, abdomen, or pelvis. |
Generate impression based on findings. | Recurrent sinus infections. There is a 4 mm wide left maxillary sinus retention cyst. The paranasal sinuses are otherwise clear. The nasal cavity is also clear. There is no significant nasal septal deviation. The ethmoid roofs are nearly symmetric and intact. The carotid grooves and optic canals are covered by bone. The orbits and facial soft tissues are unremarkable. The mastoid air cells are hyperpneumatized and clear. The brain parenchyma is grossly unremarkable. | No evidence of sinusitis. |
Generate impression based on findings. | 43 old male status post heart transplant. Evaluate for groundglass opacity is seen in bronchiolitis changes. LUNGS AND PLEURA: Interval decrease in previously seen bilateral upper lobe predominant centrilobular groundglass opacities/nodularity, with mild persistent nodularity, predominately in the left upper lobe, with mild associated bronchial wall thickening..No consolidation or pleural effusions.MEDIASTINUM AND HILA: Status post heart transplant. The heart size is normal. No mediastinal lymphadenopathy.CHEST WALL: Status post sternotomy.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Partially visualized spleen appears enlarged. | Interval improvement in upper lobe predominant bronchiolitic pattern. |
Generate impression based on findings. | Male, 72 years old, ischemic stroke. Redemonstrated is a large subacute stroke involving much of the right MCA territory. The geographic extent of the abnormality is similar to what was seen on the prior examination. The degree of parenchymal hypodensity is also not substantially changed. The zone of infarct includes portions of the right temporal, parietal and frontal lobes as well as the right caudate head and body, the right putamen and the right insula. No areas of new ischemia are suspected.No evidence of hemorrhagic conversion is seen at this time. Regional mass-effect is redemonstrated with sulcal effacement, effacement of the right lateral ventricle and a mild 2 to 3-mm midline shift to the left. These findings have not substantially changed. The caliber of the left lateral ventricle is unchanged and within normal limits. | No significant interval change in the appearance of a large right MCA distribution infarct. |
Generate impression based on findings. | 85 year-old female patient with history of CLL on ibrutinib and lymphadenopathy. Please restage. CHEST:LUNGS AND PLEURA: Redemonstrated is a right lower lobe bronchial wall thickening and bronchiectasis.Right middle lobe lesion measures 2.7 x 1.1 cm (series 6 image 209), previously 2.1 x 1.1 cm.Left upper lobe nodule is stable and measures 0.8 x 0.5 cm (series 6 image 133).MEDIASTINUM AND HILA: Mediastinal and hilar lymph nodes stable compared prior examination.CHEST WALL: Stable bilateral axillary lymphadenopathy. Reference left axillary node measures 1.4 x 0.6 cm (series 4 image 23), previously 1.4 x 0.7 cm. Unchanged right axially lipoma.Stable enlarged thyroid with bilateral hypoattenuating foci.ABDOMEN:LIVER, BILIARY TRACT: Hepatomegaly, measuring 20.7 cm in craniocaudal dimension, previously 23.6 cm.Small, dense gallstone within the gallbladder.SPLEEN: Splenomegaly, measuring 13.0 cm in the craniocaudal dimension, previously 15.3 cm. Stable scattered hypoattenuating lesions within the spleen. Reference lesion measures 1.4 x 1.4 cm (series 4 image 96), previously 1.5 x 1.3 cm sparedPANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral multiple fluid density lesions in the kidneys consistent with renal cysts and stable.RETROPERITONEUM, LYMPH NODES: Grossly stable retroperitoneal and mesenteric adenopathy. Reference aortocaval confluent adenopathy measures 3.1 x 1.3 cm (series 4 image 113), previously 3.6 x 1.5 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable compression fracture at L2 and mild degenerative changes to the lumbar spine.OTHER: Stable abdominal aortic tortuosity and calcification. Mild aneurysmal dilatation of the level of L3 vertebral body measures 2.8 cm (coronal series 80264 image 43), previously 3.0 cm in diameter.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Stable pelvic lymphadenopathy. Reference right internal obturator lymph node measures 1.5 x 0.5 cm (series 4 image 171), stable.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Minor decrease in hepatomegaly and splenomegaly compared to prior.2.Slightly increased right middle lobe pulmonary lesion, most likely drug related versus chronic infectious, as opposed to neoplastic.3.Stable mediastinal, axillary, retroperitoneal and pelvic lymphadenopathy.4.Stable mild aneurysmal dilatation of the abdominal aorta. |
Generate impression based on findings. | 74-year-old male with history of renal cell carcinoma status post partial right nephrectomy ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Distal gallbladder wall thickening, with sparing of proximal wall, suggesting adenomyomatosis although correlation with ultrasound may be considered if clinically warranted. Fat interspersed between the hepatic dome and diaphragm from surgical placement (per operative note).SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Interval partial right upper pole nephrectomy. Nonspecific soft tissue filtration adjacent to the right upper pole without abnormal enhancement, likely postoperative in etiology. Bilateral perinephric stranding, somewhat more pronounced on the right. Bilateral peripelvic cysts. Small solid exophytic left renal mass measures 1.1 x 0.8 cm (image 64, series 80416).RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the thoracic spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prominent prostate.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: L4 through S1 spinal rods and screws.OTHER: Right inguinal hernia containing fat and sigmoid colon, without evidence of obstruction. | 1. Interval right upper pole partial nephrectomy without evidence of recurrent or metastatic disease. Small exophytic solid left renal mass is unchanged from the prior MR.2. Thickening of the distal gallbladder wall, likely representing adenomyomatosis, although correlation with ultrasound may be considered if clinically warranted. |
Generate impression based on findings. | 62-year-old male with squamous cell carcinoma of the skin. LUNGS AND PLEURA: Scattered punctate calcified and noncalcified micronodules. Stable apical scarring. No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Left-sided port catheter tip at SVC/RA junction. Heart size normal. No lymphadenopathy. Scattered atherosclerotic calcifications in aorta and coronary arteries. CHEST WALL: Left chest wall port.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Gastrostomy tube in place. | No evidence of metastatic disease. No interval change. |
Generate impression based on findings. | 74-year-old male with history of metastatic prostate cancer status post 3 cycles of therapy. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without evidence of inflammation. No focal hepatic lesions. The hepatic vasculature is patent.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Retroperitoneal lymphadenopathy is again identified with the reference left periaortic lymph node measuring 1.3 x 1.8 cm (image 121, series 3) and previously measuring 1.7 x 0.9 cm.Second reference lymph node measures 1.1 x 0.5 cm and previously measured 1.1 x 0.5 cm (image 129, series 3).BOWEL, MESENTERY: Right lower quadrant ostomy again noted. The bowel is normal in caliber. BONES, SOFT TISSUES: Chronic compression deformity of L1 vertebral body. Degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post cystoprostatectomy.BLADDER: Status post cystoprostatectomy.LYMPH NODES: Status post bilateral pelvic lymph node dissection. Reference left pelvic lymph node is no longer measurable.BOWEL, MESENTERY: Right lower quadrant ostomy again noted. The bowel is normal in caliber. BONES, SOFT TISSUES: Mild retrolisthesis of L5 on S1 and moderate associated degenerative disk disease.OTHER: No significant abnormality noted | Unchanged reference retroperitoneal lymph nodes as detailed above without new lesion identified. |
Generate impression based on findings. | Thymic CA status post chemo since 2012. CHEST:LUNGS AND PLEURA: Right paramediastinal traction bronchiectasis and consolidation consistent with evolving radiation fibrosis. Scattered subpleural micronodules less than 3-mm in size are unchanged in appearance, favoring benign lesions over metastases. Previously seen micronodules at the right apex medially has resolved, consistent with a postinflammatory lesion.MEDIASTINUM AND HILA: Nonspecific nodule right thyroid gland, not visualized previously.Intrathoracic portion of the left brachiocephalic vein, right brachiocephalic vein and SVC are occluded.Anterior mediastinal mass extending from the sternum to the carina level measures 3 x 2.3 cm, previously 3.5 x 2.3 cm.Soft tissue thickening surrounding the distal trachea and right mainstem bronchus unchanged.Heterogeneous subcarinal soft tissue better seen in today's study and may reflect diffuse thickening of and enlarged, flattened esophagus with opacification of collateral vasculature and mucosa. Extensive vascular collateral opacification seen throughout the mediastinum, chest wall and upper abdomen related to SVC occlusion. Areas of pericardial thickening unchanged. Proximal left subclavian artery stenosis unchanged.CHEST WALL: Lymphadenopathy at the right thoracic inlet is now confluent and partially necrotic; the index lesion is no longer clearly separable (3/9).Median sternotomy with areas of osseous nonunion. Sternal wires. Chronic fractures of the right 8th, 11th and 12th ribs. Focal left superior endplate depression of the T11 vertebral body is new from previousABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: System the left hepatic lobe. Unchanged subcentimeter hypoattenuating lesions in the hepatic dome, too small to characterize.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Right adrenal gland metastasis now necrotic, routine by 19-mm compared to 12 x 16 mm previously (3/83). Left adrenal gland unremarkable.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the aorta and its branches. A small peri-pancreatic lymph node appears minimally more prominent (3/85), possibly due to differences in scan variability but should be monitored on subsequent studies.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Gastric antrum is thickened, unchanged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Slight decrease in measurement of the anterior mediastinal mass. 2. Right supraclavicular index lymph node is now inseparable from the adjacent mass, please refer to separately reported CT neck for measurements.3. Right adrenal gland metastasis measures larger.4. New asymmetric endplate depression of the T11 vertebral body. Although no metastasis is visible on the prior examination in this area, the position and asymmetry of the fracture is suspicious for a radiographically occult pathologic lesion. |
Generate impression based on findings. | Male, 62 years old, squamous cell carcinoma, status post CRT. Postsurgical changes are demonstrated compatible with prior right parotidectomy. There is soft tissue volume loss in this region of the face, similar to the prior exam. Enhancing nodules which were newly seen on the prior examination within and around the resection bed are no longer distinctly evident on today's study. No discrete masses are seen within the surgical bed or the adjacent masticator space. No pathologic adenopathy is detected by size criteria. Extensive treatment related changes are seen throughout the neck, more so on the right, including reticulation of the subcutaneous fat and infiltration through the fascial planes. There is a mild degree of supraglottic edema with effacement of the piriform sinuses. The aerodigestive tract is otherwise unremarkable. The remaining salivary glands and the thyroid are free of focal lesions. Atherosclerotic calcification affects the carotid bifurcations, but the vessels are patent. Mild apical lung scarring is demonstrated. No concerning osseous lesions are seen. | 1. Previously seen enhancing nodules within and around the right parotidectomy bed are no longer clearly demonstrated. No new masses or pathologic adenopathy is detected.2. Otherwise, surgical and treatment related findings in the neck have not substantially changed. |
Generate impression based on findings. | 54-year-old female patient with history of polycystic kidneys. Evaluate kidneys for surgical consideration. Exam is not sensitive for detecting lesions in the bowel and solid organs due to the lack of oral and intravenous contrast. There is also limited evaluation of vasculature. Given those limitations, the following observations are made:ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Numerous hypoattenuating, fluid density lesions replacing nearly all the liver parenchyma. Some lesions with atypical hyperattenuation.Status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Numerous hypoattenuating fluid density lesions replacing nearly all renal parenchyma, lesions consistent with cysts. Some cysts with hyperattenuating walls.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate abdominal ascites and free fluid in the pelvis. Mild atherosclerotic changes in the abdominal aorta and iliac arteries.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: Moderate abdominal ascites and free fluid in the pelvis. Mild atherosclerotic changes in the abdominal aorta and iliac arteries. | 1.Bilateral renal parenchyma nearly completely replaced by cysts. Note that renal vasculature cannot be evaluated without intravenous contrast.2.Near complete replacement of liver parenchyma with numerous cysts.3.Moderate abdominal ascites and free fluid. |
Generate impression based on findings. | 72-year-old female with malignant neoplasm of the thymus status post chemotherapy in 2012, reevaluate Interval increase in size of a right supraclavicular mass measuring approximately 3.5 x 2.4 x 2.5 cm (series 6 image 54, series 8020 image 35), previously measured 3.2 x 1.8 by 1.8 cm. Soft tissue density is identified in the anterior/superior mediastinum, please see dedicated chest CT for further details.Elsewhere in the neck, no pathologic lymph nodes are detected by size criteria. The aerodigestive mucosal spaces are within normal limits. The salivary glands are unremarkable. Heterogeneous hypodense nodule in the right thyroid lobe is unchanged.The lung apices are clear. Right superior parahilar incomplete visualized ground glass opacity, please see dedicated chest CT for further details. No suspicious osseous lesions are identified.Limited intracranial views demonstrate no gross abnormalities. The carotid arteries and jugular veins are patent. | 1. Interval increase in size of reference right supraclavicular conglomerate mass.2. No new sites of disease are identified. |
Generate impression based on findings. | Breast cancer, follow-up CHEST:LUNGS AND PLEURA: Small trace loculated pleural effusion again on the right unchanged. The multiple inferior pleural modules are also again identified and grossly unchanged given differences in breathing however mild interval improvement is suggested it difficult to measure. The reference pleural lesion apically remains 6 mm (image 16 series 3) with decreased enhancement observed, however this may be secondary to bolus timing. The second and more inferior reference measurement (image 51 series 3) remained essentially unchanged, currently 16 mm, previously 17 mm; however overall pleural thickening, particularly along the medial pleural surface and for tubal structures appears decreased and less bulky.Interval near complete resolution of the previously described diffuse patchy groundglass opacities and scattered semisolid nodules observed bilaterally but greater in the left upper lobe. Specifically the marked nodular 5-mm focus in the right lower lobe is currently not appreciated.MEDIASTINUM AND HILA: The reference right hilar region remains 12 mm unchanged (image 44 series 3). Specifically the small focus of metastases involving the pericardium and parietal pleura (image 61 series 3) also appears less bulky.The cardiac and pericardium are otherwise unchanged and within limits.CHEST WALL: Mild internal mammary chain lymphadenopathy again observed and unchanged. Left mastectomy.Please see described tumor adjacent to the T11 and T12 vertebral bodies and neural foramina remains near but does not encroach the actual foramen. Stable appearing T10 and L3 mixed sclerotic and lytic lesions.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: IVC filter unchangedBOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: L3 superior endplate lytic lesion unchangedOTHER: No significant abnormality noted. | 1. Moderate interval improvement of the visceral and parietal pleural metastatic disease previously described. Reference measurements provided.2. Interval improvement and near resolution of the nonspecific intrapulmonary groundglass changes suggesting edema and or drug reaction. |
Generate impression based on findings. | 81 year-old female with history of lung cancer status post right lower lobectomy 5 years ago. LUNGS AND PLEURA: Status post right lower lobectomy. Moderate emphysema.No consolidation or pleural effusions. Stable calcified and noncalcified bilateral micronodules, likely due to prior granulomatous infection. No new nodules.MEDIASTINUM AND HILA: Stable mediastinal lymph nodes, with reference precarinal node measuring 5 mm (series 3, image 45). Moderate coronary artery and aortic calcifications. CHEST WALL: Stable sclerotic foci in right ribs, likely reflecting prior fractures (series 8028, image 42). Stable kyphosis.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Splenic granulomas. Stable subcentimeter hypodensity in hepatic segment 4, likely cyst. | Postsurgical changes in right lung without specific evidence of recurrence or metastatic disease. |
Generate impression based on findings. | Pulmonary hypertension assess for lung disease. LUNGS AND PLEURA: Motion artifact the degrades image quality. Small left pleural fluid collection with associated compressive atelectasis. No septal thickening, pulmonary fibrosis or emphysema.7 x 6 mm solid nodule in the left lower lobe hazy appearance to the adjacent medial pleural surface which is tented. This lesion contains internal lipid (-76HU) and solid components which may indicate a hamartoma however adherence to the pleural surface would be atypical. Also, there is no visible calcification within the lesion.Mild mosaic attenuation of the lung parenchyma is appreciated on the high resolution sequence. Very faint and subtle groundglass opacity surrounds the peripheral vascular branches. In addition, several punctate peripheral. Vascular nodular opacities are noted especially in the right upper lobe and tortuosity of the peripheral vessel of the subpleural lung are appreciated. 14 x 9 x 8 mm ground glass nodule in the anterior segment right upper lobe (5/88). MEDIASTINUM AND HILA: Right PICC tip in the superior vena cava.The main pulmonary artery enlarged, measuring 38-mm in transverse dimension (3/29). Peripheral calcification and involving the main pulmonary arteries can be seen in long-standing pulmonary hypertension. Scattered small calcified mediastinal and peribronchial lymph nodes bilaterally. No significant lymphadenopathy.Small pericardial fluid collection. Severe cardiomegaly with enlargement of the right atrium and ventricle. The left atrium and ventricle appear small. Severe coronary artery calcifications. CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. Small volume of perihepatic and perisplenic ascites. Granulomas in the spleen. Vascular calcifications. High density sludge or stones in the gallbladder. The liver appears enlarged, but is incompletely included within the scanning range. | 1. Indeterminate 7mm left lower lobe nodule. If the referring clinical service is able to obtain and submit remote outside CT scans to prove stability of this lesion, an addendum to this report can be provided. Otherwise, a 3-month CT follow-up is recommended if the patient is a smoker or otherwise at high risk for malignancy. If the patient is a nonsmoker, the initial follow-up can be performed in 6 months. 2. 14-mm groundglass nodule in the anterior segment of the right upper lobe may represent a benign lesion such as atypical adenomatous hyperplasia or an indolent a low-grade malignancy such as adenocarcinoma in situ or minimally invasive adenocarcinoma. Recommend follow-up CT in 3 months to assess for resolution. If this lesion persists, then annual scanner for total of 3 years would be recommended.3. Enlargement of the central pulmonary vasculature compatible with diagnosis of pulmonary hypertension. Although the right atrium and ventricle are enlarged, there is no septal thickening in the lung parenchyma to suggest pulmonary venoocclusive disease at this time. Subpleural nodular opacities and slight tortuosity of peripheral subpleural vessels may be an early indicator of shunting, beyond the resolution of CT.4. Ascites and probable hepatomegaly. Unable to assess for hepatic shunting on unenhanced exam.5. No specific evidence of interstitial lung disease. |
Generate impression based on findings. | 58-year-old male with esophageal cancer status post resection one year ago, concern for recurrence and new adenopathy. CHEST:LUNGS AND PLEURA: Moderate right pleural effusion with right lower lobe pleural thickening.MEDIASTINUM AND HILA: Postsurgical change consistent with a esophagectomy and gastric pull up. Right central venous catheter tip in the SVC. Severe atherosclerotic calcification of the coronary arteries.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Small splenule.PANCREAS: Cystic collection in the pancreas with surgical clips adjacent to the mobilized stomach may be postoperative in etiology, possibly a pseudocyst or seroma.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Atherosclerotic changes of the abdominal aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative disk disease, worst at L5/S1. Sclerotic lesions adjacent to the right SI joint are nonspecific.OTHER: No significant abnormality noted | 1. Status post esophagectomy and gastric pull-up without lymphadenopathy. Two nonspecific sclerotic osseous lesions adjacent to the right SI joint are noted.2. Moderate right pleural effusion.3. Pancreatic cystic collection with adjacent surgical clips may be postoperative in etiology, possibly a pseudocyst or seroma. |
Generate impression based on findings. | Male 69 years old Reason: prostate cancer, baseline scan for initiation of investigational therapy. History: prostate cancer, CHEST:LUNGS AND PLEURA: Apical scarring and right lower lobe postsurgical scarring redemonstrated. No effusions. Pleural based micronodule right lower lobe mid image 35, unchanged.MEDIASTINUM AND HILA: 0.9-cm nodule posterior aspect right thyroid lobe no pathologic size nodes. Minimal calcification left coronary artery and aortic root.CHEST WALL: Minimal gynecomastia only on the right side.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right renal atrophy redemonstrated.RETROPERITONEUM, LYMPH NODES: Small shotty nodes unchanged. Scattered atherosclerotic changes, no evidence of aneurysm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Surgically absent.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No evidence of recurrent disease. |
Generate impression based on findings. | Female 54 years old Reason: history of ovarian cancer, currenlty receiving treatment. eval for progression response using measurements if applicable. pls compare with previous History: see above CHEST:LUNGS AND PLEURA: Index right lower lobe mass series 5 image 72 lung windows, 2.9 x 2 cm. Previously 3.2 x 2.2 cm.No new nodules.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Postsurgical changes. No pathologic size lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Surgically absent. Previously measured possible soft tissue abutting the left aspect of the vaginal cuff, series 2 image 173, 1 x 0.5 cm. Previously 1.4 x 0.7 cm.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. | Decrease in size of index lesions. No new sites of disease. |
Generate impression based on findings. | Alcoholic cirrhotic liver. Please check right basilar lung nodule LUNGS AND PLEURA: Stable appearing discrete peripheral right lower lobe nodule (image 44 series 4) still measuring 8 x 8 mm. Surrounding lung and remaining lungs other than diffuse mild emphysematous changes are otherwise unremarkable. No distinct additional large nodules other than scattered non-specific micronodules. No effusions.MEDIASTINUM AND HILA: No lymphadenopathy.The cardiac and pericardium are within limitsCHEST WALL: No significant abnormality noted. No osseous abnormality.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Extensive ascites partially visualized. The remaining portions of the upper abdomen incompletely visualized are unremarkable. Please correlate with recent dedicated CT exam | A solitary right lower lobe pulmonary nodule which is uncertain significance. Its size allows imaging is suspicious high for malignancy otherwise serial CT imaging can be performed at 3, 9 and 24 months from discovery if the patient is at high risk for pulmonary malignancy. |
Generate impression based on findings. | Male 71 years old Reason: patient with a history of prostate cancer, most recently treated with xtandi. please assess for disease progression History: prostate cancer CHEST:LUNGS AND PLEURA: Micronodules unchanged.MEDIASTINUM AND HILA: Index AP window node series 2 image 33 measures 1.5 x 1.1 cm. Previously 1.1 by 0.9-CM. other nodes are stable. No new nodes.CHEST WALL: Small benign appearing axillary nodes are unchanged. Diffuse sclerotic metastases redemonstrated.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left upper pole simple cyst unchanged. No other renal lesions.RETROPERITONEUM, LYMPH NODES: Atherosclerotic changes diffusely without evidence of aneurysm. Small shotty retroperitoneal nodes, not pathologic by size criteria, unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Diffuse sclerotic metastases redemonstrated.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Surgically absent.BLADDER: No significant abnormality notedLYMPH NODES: Small nonpathologic in size, unchanged.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Two sclerotic metastases, unchanged.OTHER: Atherosclerotic disease. No evidence of aneurysm. | Stable. |
Generate impression based on findings. | Female, 83 years old, contusion of the face and neck, fell and hit head this weekend, INR 8.4, evaluate for bleed. CT head:Left parietal scalp swelling/hematoma is demonstrated. No skull fracture is demonstrated.A small area of encephalomalacia within the right post central gyrus is compatible with chronic stroke. Periventricular hypoattenuation is demonstrated, a nonspecific finding which likely indicates age indeterminate small vessel ischemic disease. No intracranial hemorrhage or abnormal extra-axial fluid collection is demonstrated. No focal parenchymal edema or mass effect is seen. Ventricular system is patent and within normal limits for size.The left maxillary sinus is small and demonstrates mucosal thickening and secretions. This appearance may reflect the sequelae of long-standing mucosal inflammation and sinus obstruction.CTA neck:Conventional aortic branching noted. Mild atherosclerotic calcification at the origins of the great vessels. Atherosclerotic calcification at the right carotid bifurcation with 20 to 30% stenosis by NASCET criteria at the right ICA origin. Atherosclerotic calcification is also seen at the left carotid bifurcation with a similar degree of stenosis. Remainder of the carotid circulation is unremarkable.Atherosclerotic calcification likely causing some degree of stenosis at the origin of the left vertebral artery. Vertebral arteries are otherwise patent.No evidence of large or space occupying hematoma or contrast extravasation is seen in the neck.Intracranial views show mild atherosclerotic calcification of the cavernous ICAs, but no other specific abnormalities. Fenestration of the left A1 segment is noted incidentally.Cutaneous thickening and subcutaneous infiltration is evident within the left neck extending from the retroauricular region down nearly to the supraclavicular fossa. These findings are nonspecific and could represent a variety of processes from skin abrasion, superficial bruising, as well as cellulitis and other inflammatory processes.The soft tissues of the neck are otherwise unremarkable. No masses or adenopathy seen. No concerning osseous lesions are demonstrated. Moderately advanced degenerative disk disease is seen in the cervical spine. This is most notable at C5-6 where there is likely a spinal canal stenosis. Grade 1 anterolisthesis of C6 relative to C7 is noted. Loss of vertebral body height at T4 is stable compared to prior exams. | 1. No acute intracranial abnormality, and in particular, no intracranial hemorrhage. There is evidence of chronic territorial ischemia and age indeterminate small vessel ischemia.2. No large or space occupying hematoma is demonstrated in the neck. No evidence of vascular disruption is seen. Note is made of cutaneous thickening and subcutaneous infiltration through the left neck which could represent skin abrasion, superficial bruising/hematoma, cellulitis or other inflammatory processes.3. Atherosclerotic narrowing at the origins of the bilateral ICAs is demonstrated, not considered to be significant by NASCET criteria. No other specific vascular abnormalities are demonstrated in the neck. |
Generate impression based on findings. | Right tonsil SCC T2N2b (HPV+) s/p C5/5 TFHX 7/22/123 per IRB 10-069. Head: There is no evidence of intracranial hemorrhage, mass, or cerebral edema. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. Neck: There is no significant lymphadenopathy by CT size criteria. Reference lymph nodes include the following:1. A right level 2A lymph node measures 6 x 2 mm, previously 8 x 5 mm. 2. Another right level 2A lymph node measures 3 x 3 mm, previously 3 x 3 mm.3. A right level 4B lymph node measures 3 x 2 mm, previously 3 x 2 mm. 4. A left level 3 lymph node measures 5 x 3 mm, previously 5 x 3 mm.The aerodigestive tract is patent. The thyroid gland and major salivary glands are unchanged. The imaged intracranial contents and orbits are unremarkable. The paranasal sinuses and mastoid air cells are clear. No lytic lesions are identified. The imaged lung apices are clear. Please refer to the separately dictated CT chest for further details. | 1. No evidence of locoregional tumor recurrence of significant cervical lymphadenopathy.2. No evidence of intracranial metastases. |
Generate impression based on findings. | Male 84 years old; Reason: hematuria History: hematuria ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver contour is smooth. No suspicious hepatic lesions. The hepatic and portal veins are patent.SPLEEN: There are multiple subcentimeter hypodense splenic lesions including a subtle ring enhancing splenic lesion. Spleen is normal in size.PANCREAS: Fatty atrophy of the pancreas. Subtle soft tissue enhancement in the pancreatic tail (image 44/series 6) may represent atrophic pancreatic tissue or a small intrapancreatic accessory spleen or small focal pancreatic lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Kidneys are normal in morphology. No nephrolithiasis or hydronephrosis in either kidney.Subcentimeter cysts in the right kidney. Left kidney has 2 interpolar cysts. No solid lesion is evident.RETROPERITONEUM, LYMPH NODES: Calcific arteriosclerotic disease affects the aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: Prostate is enlarged.BLADDER: No distal ureteral or bladder calculi.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.No nephrolithiasis or solid renal mass.2.Renal cysts3.Enlarged prostate4.Focal enhancement in the tail of the pancreas may represent focal non atrophic pancreas, intra-pancreatic accessory spleen or a small pancreatic mass. Follow up suggested.5.Nonspecific splenic lesions. |
Generate impression based on findings. | Failed newborn hearing screen and recurrent otitis media status post bilateral myringotomy and tympanostomy tube placement. On the right, the modiolus and interscalar septum are deficient with fewer than 2 cochlear turns. There is also a markedly enlarged and dysplastic vestibule and an enlarged vestibular aqueduct. In addition, the lateral semicircular canal is markedly enlarged and there is severe stenosis of the oval window. The internal auditory canal is patent and the cochlear fossette measures up to 2 mm in diameter. There is partial right middle ear opacification and a tympanostomy tube tube is in position. There is also complete opacification of the incompletely pneumatized mastoid air cells. The facial nerve describes a normal course.On the left, there is severe narrowing of the internal auditory canal, measuring approximately up to 2 mm in diameter. Likewise, the cochlear fossette is markedly stenotic. The singular canal and labyrinthine facial nerve canal are intact. There is deficiency of the modiolus and cochlear turns as well as a dysplastic vestibule and enlargement of the vestibular aqueduct. In addition, the lateral semicircular canal is mildly enlarged and there is severe stenosis of the oval window. The short process of the incus appears to contact the lateral wall of the middle ear cavity and fixation cannot be excluded. The ossicular chain is otherwise intact. The mastoid air cells are marked underpneumatized and opacified. The round window niche is also opacified. There is mild middle ear opacification and/or tympanic membrane thickening adjacent to the tympanostomy tube. The facial nerve describes a nearly normal course, but appears dehiscent along the tympanic segment.There is a dysmorphic, hypoplastic right cerebellar hemisphere. | 1. Bilateral congenital inner ear malformations suggestive of incomplete partition type 2 with associated lateral semicircular canal-vestibule dysplasia, more severe on the right, as well as severe left internal auditory canal stenosis.2. Bilateral partial tympanomastoid opacification with tympanostomy tubes in position.3.Dysmorphic, hypoplastic right cerebellar hemisphere. Refer to the separate concurrent temporal bone MRI for additional findings. |
Generate impression based on findings. | Male, 61 years old, right-sided weakness. Very subtle scattered areas of white matter hypoattenuation is compatible with age indeterminate small vessel ischemic disease, not substantially changed. No CT evidence of acute territorial ischemia is demonstrated. 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. Mucosal thickening is demonstrated in the right maxillary sinus. The bones of the calvarium and skull base are intact. | No acute intracranial abnormality. |
Generate impression based on findings. | 52-year-old female patient with right lower back pain, hematuria and history of renal stones. Evaluate for renal stone. Exam is not sensitive for detecting lesions in the bowel and solid organs due to the lack of oral intravenous contrast. Given those limitations, the following observations are made:ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: There is redemonstration of 3 punctate calcifications in the left kidney, unchanged from prior and may be vascular. Renal contour is stable compared to prior examination. No nephrolithiasis within the ureters. No hydronephrosis or perinephric fat stranding.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications in the abdominal aorta and iliac arteries.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No bladder calculi.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.No hydronephrosis or evidence of obstructing renal calculi.2.Stable punctate calcifications within the left kidney. 3.Stable renal contour. Note evaluation for renal masses is limited secondary to lack of intravenous contrast. |
Generate impression based on findings. | 69-year-old female with lupus and aortic root dilation. LUNGS AND PLEURA: No consolidation or pleural effusions. Linear opacities in right apex is new, however, most compatible post inflammatory scar (series 6, image 53). No evidence of fibrosis or interstitial lung disease.Several bilateral lung nodules; largest of these located in the left lower lobe measures 6 mm, unchanged since 2006 and benign in nature (series 5, image 43).MEDIASTINUM AND HILA: Heterogeneous thyroid gland.Stable moderate dilation of the ascending aorta, with maximal diameter at level of main pulmonary artery measuring 4.2 cm, previously measured 4.2 cm (series 4, image 46). Heart size normal. No pericardial effusion. No mediastinal adenopathy. Moderate atherosclerotic calcifications in coronary arteries and aorta.CHEST WALL: Thoracic dextroscoliosis unchanged.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Stable hypodensity in hepatic dome compatible with cyst. | Stable moderate dilation of the ascending aorta. |
Generate impression based on findings. | Female 58 years old Reason: H/O DLBC Lymphoma s/p 3 cycles of DA EPOCH R in need of restaging scans. Please compare to prior History: DLBCL CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Central venous access device tip in the region of the SVC right atrial junction.CHEST WALL: Bilateral breast implants, intact. Surgical clips both axillae. Small nonpathologic sized axillary nodes.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Upper normal 12.1 cm cephalocaudad coronal image 57/83PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Retroperitoneal nodes essentially resolved. Minuscule fibrotic residual is seen at the index lesion unsafe image 134 measuring 0.5 x 0.4 mm. Previously 2.8 x 2.5 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Subcutaneous injection sites anterior abdominal wall.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Previously seen a large mass inseparable from the left psoas muscle in the left common iliac distribution is markedly decreased in size. The residual is low attenuation relative to the muscle and measured on series 3 image 148, 3.3 x 3.2 cm. Previously 9 x 7.4 cm.Other mass is also similarly decreased in size.The left external iliac lymph nodes a small fibrotic residual on series 3 image 184 measuring 1 x 0.6 cm. Previously 2.2 x 1.4 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Subcutaneous injection sites.OTHER: No significant abnormality noted. | Dramatic decrease in all sites of disease. |
Generate impression based on findings. | 61-year-old male with history of relapsed CLL and treatment regimen, reevaluate Limited intracranial views are grossly unremarkable. The mastoid air cells are clear. Polypoid mucosal thickening of the maxillary sinuses, similar to prior.The aerodigestive tract and mucosal spaces are without focal lesions. The salivary glands and thyroid gland are within normal limits. No cervical lymphadenopathy by CT size criteria. Reference small left supraclavicular lymph node measures 5 mm (series 6 image 44), previously measured 5 mm. Reference left submental lymph node measures 4 x 10 mm (series 6 image 39), previously measured 4 x 10 mm.The cervical vasculature remains patent. Mild atherosclerotic calcification at the left carotid bifurcation.The lung apices are clear. No suspicious osseous lesions are identified. Redemonstration of moderate degenerative disk disease primarily at C3-C4 through C6-C7 appearing similar to the prior study. | No evidence of a cervical mass or lymphadenopathy by CT size criteria. |
Generate impression based on findings. | 55-year-old male with pancreatic neuroendocrine tumor, evaluate for interval change. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Diffuse hepatic steatosis with peripheral sparing. No focal abnormality suspicious for metastasis. Cholelithiasis without evidence of cholecystitis.SPLEEN: Status post splenectomy, the splenic vein is not visualized.PANCREAS: Arterially enhancing mass at the junction of the pancreatic neck and body with small regions of internal hypodensity suggestive of cystic degeneration measures 6.6 x 5.2 cm (image 54, series 8) and previously measured 6.8 x 4.9 cm. The mass encases and compresses the proximal celiac axis and common hepatic artery, which is reconstituted distally. The SMA and SMV are patent.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Dilated of fluid-filled loops of small bowel are again noted.BONES, SOFT TISSUES: Large ventral abdominal hernia which contains loops of large and small bowel with regions of submucosal fat deposition without evidence of obstruction.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Unchanged prominent right obturator lymph node.BOWEL, MESENTERY: Colonic diverticulosis without evidence of complication.BONES, SOFT TISSUES: Unchanged round hypoattenuating lesion in the left gluteal muscles.OTHER: No significant abnormality noted | No significant interval change in pancreatic mass involving the celiac axis and hepatic artery. |
Generate impression based on findings. | 72-year-old male with head and neck cancer. CHEST:LUNGS AND PLEURA: Interval improvement in previously seen basilar consolidation and tree in bud opacities. Mild basilar centrilobular and tree in opacities as well as new ground glass opacity in anterior left upper lobe. Findings are most consistent with recurrent aspiration. Resolution of previously seen right basilar nodular opacity. New ill-defined opacity in the posterior aspect of right lower lobe measures 1.5 cm, and is mos likely post aspiration in etiology(series 6, image 46). No suspicious nodules.No consolidation or pleural effusions.MEDIASTINUM AND HILA: Stable mediastinal and hilar lymph nodes; reference paratracheal node measures 1.1 cm, previously measured 1.3 cm (series 4, image 45). Calcified mediastinal nodes consistent with prior granulomatous infection.Heart size normal. No pericardial effusion. Small amount of mucus material is present in the trachea.CHEST WALL: Stable sclerotic lesion in C7 vertebral body. Healing left rib fractures again noted. Interval removal of right port catheter.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Stable subcentimeter hypodense foci, most compatible with cysts.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable bilateral renal cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Gastrojejunostomy tube is in place, with partially visualized intussusception along the distal aspect of tube (series 4, image 143); no evidence of small bowel dilation to suggest obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Improved basilar consolidation with residual basilar clusters of centrilobular nodules and tree and opacities. New ground glass opacities in left upper lobe and ill-defined opacity in right lower lobe are most compatible with recurrent aspiration, however, continued follow-up is recommended. 2.Partially visualized intussusception associated with GJ tube, which is most likely incidental finding given lack of more proximal bowel dilation. |
Generate impression based on findings. | Reason: mets lung cancer, s/p chemo, pls c/w previous study and evaluate tx response. History: lung ca CHEST:LUNGS AND PLEURA: Mild centrilobular emphysema.Sharply defined the 11-mm nodule in the superior segment of the left lower lobe, increased from 7 mm on the previous scan. Tubular opacity and distal to the nodule is compatible with an obstructed bronchus with a bronchocele formation.Marked bronchial thickening in the basilar segments of the lower lobes with scarlike opacities and tree in bud opacity consistent with recurrent aspiration.MEDIASTINUM AND HILA: Subcarinal lymphadenopathy now 17 mm in short axis diameter, increased from previous.Severe coronary artery calcification.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Moderately enlarged periportal lymph nodes (series 3 image 120) not significantly changed.A previously measured periportal lymph node is not clearly identified on the current scan.A small retrocaval node measuring about 7 mm in short axis is unchanged.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cyst and bilateral vascular calcifications.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Descending aortic and bilateral iliac stent graft within a thrombosed lower aortic aneurysm, unchanged.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Enlarging nodule in the superior segment of the left lower lobe with associated bronchial obstruction, suspicious for metastatic disease. |
Generate impression based on findings. | Clinical question:H/O sdh s/p bilateral burr holes. Signs and symptoms: Surveillance: Nonenhanced head CT:There is interval complete resolution of previously noted large amount of subdural air since prior exam.There is evidence of residual low attenuation bilateral frontal subdurals (left greater than right). The remaining left frontal subdural measures a maximum of 14.2-mm size in thickness. The remaining right frontal subdural measures at 11.4 mm in its thickest segment. There is underlying slight flattening and pressure in all anterior frontal lobes. No appreciable mass effect on the lateral ventricles and no midline shift. There are two foci of cortical and subcortical low attenuation in the left anterior and left posterior frontal lobe consistent with chronic ischemic strokes. This findings were present before however they are better appreciated on current exam likely due to interval decreased mass effect.There is no detectable new foci of parenchymal abnormal density or hemorrhage. The ventricular system remain within normal size and maintained midline.Heavy vertebra vascular and bilateral cavernous carotid vascular calcification in | 1.No evidence of new hemorrhage since prior consent.2.Residual bilateral frontal (left greater than right) low attenuation subdurals measuring at 14.2 Mm at this on the left and 11.4 mm on the right.3.Interval complete resolution of previously noted postoperative subdural air.4.Stable normal size of ventricular system and with maintained midline.5.Foci of cortical and subcortical low attenuation in the left anterior and posterior frontal lobe consistent with chronic left MCA territory strokes. Findings were present on prior study however there are better visualized due to decreased mass effect. |
Generate impression based on findings. | 8-year-old female with history of intubation, blood per endotracheal tube. Evaluate for recurrent pulmonary hemorrhage. LUNGS AND PLEURA: There is bibasilar consolidation/atelectasis and small bilateral pleural effusions with fluid tracking along the fissures.Patchy areas of groundglass opacity are noted within the aerated portions of both lungs which are nonspecific but most suggestive of areas of multifocal pulmonary hemorrhage given the clinical history of blood per endotracheal tube. Other differential considerations for this appearance include atypical edema, drug reaction, and infection which are considered less likely.MEDIASTINUM AND HILA: An endotracheal tube is in place with its tip 1-2 cm above the carina. A left central venous catheter is noted with its tip at the SVC/RA junction.The heart size is within normal limits. No pericardial effusion is present.CHEST WALL: No significant abnormality notedUPPER ABDOMEN: No significant abnormality noted. | 1. Multifocal bilateral ground glass opacities which are nonspecific but suggestive of pulmonary hemorrhage in the clinical setting of blood per endotracheal tube. Other differential considerations for this appearance include atypical edema, drug reaction, and infection which are considered less likely.2. Bibasilar atelectasis and small bilateral pleural effusions. |
Generate impression based on findings. | History of hemorrhagic telangiectasia, lung AVMs. Follow up LUNGS AND PLEURA: Numerous pulmonary AVMs are identified without interval change in number or size. Two reference lesions in the superior segment of the left lower lobe and right middle lobe respectively have been embolized with coils. No superimposed additional airspace abnormality. No effusions.MEDIASTINUM AND HILA: No lymphadenopathy.The cardiac and pericardium are well within limits.Small hiatal herniaCHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Multiple stable appearing pulmonary AVMs without interval new superimposed abnormality. Appearance remains consistent with patient's history of Osler Webber Rendu/HHT |
Generate impression based on findings. | Reason: lung CA s/p XRT History: as above CHEST:LUNGS AND PLEURA: Status post left upper lobectomy with postsurgical changes and volume loss similar appearance to prior exam.Redemonstration of paramediastinal fibrosis compatible with radiation reaction.Interval clearing of the airspace consolidation in the superior segment of the right lower lobe.Increasing tree in bud opacities at the left lung base compatible with aspiration/bronchiolitis.Interval improvement in the left lower lobe groundglass opacities.No new suspicious pulmonary nodules or masses.No pleural effusion.MEDIASTINUM AND HILA: Reference right hilar lymph node (image 49 series 3) decreased in size now measuring 10 mm previously measuring 14 mm.Reference right paratracheal lymph node (image 29 series 3) unchanged measuring 8 mm.Enlarged pulmonary artery measuring 3.4 cm.Cardiac size is normal.Stable small pericardial effusion.Moderate coronary artery calcifications.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Stable 14-mm right adrenal nodule most likely benign.KIDNEYS, URETERS: Small renal hypodensities compatible with cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic changes of the aorta.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Interval clearing of the right lower lobe airspace consolidation and improvement in left lower lobe groundglass opacities. Tree in bud opacities at the left lung base compatible aspiration bronchiolitis.2.Interval decrease in the reference right hilar lymph node.3.Stable small pericardial effusion.4.No evidence of recurrent or metastatic disease. |
Generate impression based on findings. | History of pulmonary MAI for follow-up. Cough and weight loss. LUNGS AND PLEURA: Groundglass and solid opacities in the inferior lingula along with tree in bud appearance. Within the right middle lobe chronic appearing bronchiectasis and volume loss is noted in the medial segment while in the lateral segment, tree in bud opacities are identified. Mild diffuse bronchiolitis right lower lobe. Bronchocele right lower lobe is larger but contains less fluid and internal debris compared to the previous examination. Scattered pulmonary micronodules elsewhere are nonspecific in appearance.MEDIASTINUM AND HILA: Faint calcifications and areas of hypoattenuation in the thyroid gland nonspecific by CT. Atherosclerotic calcification of the aorta and its branches, including the coronary arteries. Normal heart size. No significant pericardial fluid or mediastinal lymphadenopathy. Hilar lymph nodes are mildly enlarged, right greater than left.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Subcentimeter hypoattenuating lesions in the liver are too small to characterize. Cholecystectomy clips. Vascular calcifications. | New areas of groundglass opacity, consolidation and bronchiolitis consistent with active infection such as MAI or other mycobacterial infection, progressed since the previous examination. |
Generate impression based on findings. | 63 yo male with history of T4N2c SCC of the base of tongue), HPV+, completed TFHX on 9/16/11. Extensive streak artifact related to dental amalgam obscures much of the oral cavity. Nevertheless, there is mild asymmetry of the tongue base without evidence of discrete mass lesions. There is overall deceased mucosal edema in the oropharynx, hypopharynx, and larynx with residual asymmetric swelling of the right inferior aryepiglottic fold. There is no significant cervical lymphadenopathy by size criteria. The major salivary glands and thyroid gland are unremarkable. There is mild scattered paranasal sinus mucosal thickening. The mastoid air cells are clear. The carotid arteries and jugular veins are patent. Multiple teeth have been extracted. The osseous structures are unremarkable. The imaged portions of the intracranial structures and orbits are unremarkable. The imaged lung apices are clear. | Interval evolution of post-treatment findings without evidence of locoregional tumor recurrence or significant cervical lymphadenopathy. |
Generate impression based on findings. | Breast cancer with rising tumor markers. CHEST:LUNGS AND PLEURA: Bilateral scattered micronodules without new suspicious intrapulmonary abnormalities. No effusions.MEDIASTINUM AND HILA: A large mass along the anterior aspect of the chest wall superiorly is unchanged again measuring 9.8 x 4.4 cm (image 10 series 3). The mass continues to extend and invade the right pectoralis major muscle in the head of the right clavicle. Associated clavicular fracture and or partial repair/deformity unchanged.The pre-aortic reference lymph node (image 25 series 3) when measured in similar fashion remains 1.0 cm. No additional lymphadenopathy. The cardiac and pericardium are otherwise remain unremarkableCHEST WALL: A smaller reference nodule in the right breast with the associated large calcifications also unchanged measuring 1.8 x 1.0 cm (image 27 series 3). Right mastectomy and associated axillary clips.A small focal sclerotic well-defined lesion in the L2 vertebral body is unchanged (image 35 series 80273). Remainder of the osseous skeleton is otherwise unremarkableABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Scattered hypodensities demonstrate interval change with enlargement, a reference lesion in the inferior right lobe currently measures 1.9 x 1.7 cm (image 105 series 3) from a prior measurement of approximately 0.0 x 1.1 cm. measurement is mildly limited secondary to non enhanced scans. Consider dedicated imagingSPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Interval enlarging hepatic lesions suspected represent metastatic disease. No new pulmonary involvement and stable reference lymph nodes. Measurements provided |
Generate impression based on findings. | 72-year-old female with cough and hemoptysis. History of COPD. LUNGS AND PLEURA: Severe emphysema. New solid nodule with spiculated margins is located in the superior segment of right lower lobe and is adjacent to bronchus; this nodule measures 16 mm in greatest dimension (series 5, image 46). Linear opacities are present in both apices and in the mid left lung, most compatible with scarring (series 5, image 52). The previously measured right upper lobe lesion appears stable to slightly decreased, measuring approximately 7 x 11 mm, previously measured 7 x 12 mm (series 6, image 78).MEDIASTINUM AND HILA: Moderate atherosclerotic calcifications in the aorta and coronary arteries. Heart size normal. No pericardial effusion. No enlarged mediastinal lymph nodes. Several calcified lymph nodes are compatible with prior granulomatous infection.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Several hypoattenuating lesions in partially visualized liver are unchanged prior exam and most likely benign in nature. Left renal hypoattenuating lesion is also not significantly changed, compatible with cyst. | 1.New solid nodule measuring 16 mm nodular opacity in superior segment of right lower lobe; morphology is compatible with but not specific for neoplasm. 2.Linear, scar-like opacities in both apices and left mid lung. 3.Severe emphysema. |
Generate impression based on findings. | Clinical question: Rule out mass or lesion. Signs and symptoms: New onset of right-sided headache, not responding to medical management. Nonenhanced head CT:There is no evidence of an 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 images through the orbits.All paranasal sinuses are visualized and are pneumatized.Bilateral mastoid air cells and middle ear cavities also remain pneumatized and unremarkable. | 1.Negative nonenhanced head CT.2.All paranasal sinuses and mastoid air cells/middle ear cavities remain well pneumatized |
Generate impression based on findings. | 69-year-old male with malignant neoplasm of the thyroid gland, neck mass, pain. Limited intracranial views are grossly unremarkable.Extensive conglomerate right neck mass, invading and expanding the right sternocleidomastoid muscle, with hypoattenuating central portions measuring approximately 7.1 x 8.4 by 10.1 cm (series 80440 image 39 and series 4 image 148). The lesion extends from the thoracic inlet caudally to the level of the right submandibular gland cranially. There is leftward deviation of the patent airway secondary to mass effect. The lesion abuts the right lobe of the thyroid gland which is enlarged and contains multiple hypodensities with calcification. The right internal jugular vein is nearly completely effaced at the level of the hyoid bone but is likely patent throughout its course. The right common carotid artery abuts the lesion but is not encased.There are multiple pathologically enlarged right-sided neck lymph nodes including levels 2a, 2b, and 5a. Reference level 2b lymph node measures 1.0 x 1.2 cm (series 6 image 30). No contralateral pathologically enlarged by CT criteria cervical lymph nodes are identified.Bilateral atherosclerotic vascular calcifications at the carotid bifurcations. The salivary glands are free of focal lesions. No focal lesions efface the aerodigestive tract or mucosal spaces.The lung apices are within normal limits. Multilevel degenerative changes of the visualized spine without suspicious osseous lesions. | 1. Extensive right neck mass as detailed above which extends from the thoracic inlet to the level of the submandibular gland.2. Cervical lymphadenopathy of the right neck. |
Generate impression based on findings. | 83-year-old male with history of non-Hodgkin's lymphoma, restaging. CHEST:LUNGS AND PLEURA: 5-mm left lower lobe micronodule.MEDIASTINUM AND HILA: Nonspecific left thyroid mass measures 3.6 x 2.2 cm and previously measured 3.9 x 2.3 cm (image 15, series 3). Mediastinal adenopathy with one retroesophageal lymph node measuring 1.4 x 1.4 cm (image 43 series 3) and previously measuring 1.2 x 1.3 cm.CHEST WALL: Right axillary lymph node dissection. Marked bilateral gynecomastia.ABDOMEN:LIVER, BILIARY TRACT: Status-post cholecystectomy. No focal hepatic lesions.SPLEEN: . The spleen measures 14 cm, mildly enlarged.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Extensive retroperitoneal and mesenteric adenopathy with the largest para-aortic lymph node measuring 2.6 x 4.0 cm (image 121, series 3) and previously measuring 2.2 x 2.0 cm.BOWEL, MESENTERY: Extensive mesenteric adenopathy with hazy soft tissue infiltration at the mesenteric root.BONES, SOFT TISSUES: Severe degenerative changes of the thoracolumbar spine.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: Severe degenerative changes of the thoracolumbar spine. Nonspecific stranding in the left anterior pubic soft tissues.OTHER: No significant abnormality noted | Thoracic and extensive abdominal lymphadenopathy with reference measurements as detailed above, consistent with the history of lymphoma. |
Generate impression based on findings. | Male 66 years old Reason: Metastatic prostate cancer on abiraterone with rising PSA, assess for disease burden History: chronic leg weakness. Additional history of the pathology report indicates history of rectal cancer and colocolic anastomosis. ABDOMEN:LUNG BASES: Redemonstration of calcified pleural plaques and post surgical changes left lower lobe. No effusions. No discrete nodules visualized.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: Postsurgical changes of subtotal colectomy with right lower quadrant ileostomy. No evidence of ascites or carcinomatosis.BONES, SOFT TISSUES: Diffuse sclerotic metastases snf loss of height of some vertebral bodies redemonstrated. No change.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Colectomy. Soft tissue density around the Hartmann's pouch is somewhat increased compared to the prior exam. No loculated extraluminal fluid collections. All fluid and gas appear to connect to the Hartmann's pouch. See sagittal image 61 - 64.BONES, SOFT TISSUES: Focal sclerotic metastases unchanged.OTHER: No significant abnormality noted | Increasing soft tissue density around the Hartmann's pouch but without discrete abscess. Correlate clinically. Stable osseous metastases. |
Generate impression based on findings. | 70 year-old male with history of follicular lymphoma in need of restaging The exam is limited by lack of IV contrast in the evaluation of solid organ pathology.CHEST: LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Reference mediastinal lymph node measures 7 mm (image 20, series 6 to 9) and previously measured 7 mm. No new mediastinal lymphadenopathy. Moderate atherosclerotic calcification of the coronary arteries.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: Bilateral nephroureterostomy stents extend to the bladder. There is increased bilateral hydronephrosis. Atrophic native kidneys and perinephric fat stranding are unchanged.RETROPERITONEUM, LYMPH NODES: Extensive shotty retroperitoneal adenopathy and haziness of the retroperitoneal fat and mesenteric root are redemonstrated without significant interval change..BOWEL, MESENTERY: Extensive hazy infiltration of the mesenteric root is unchanged.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Nephroureterostomy tips in bladder.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 or new lymphadenopathy. Interval increase in bilateral hydronephrosis, this finding was discussed with doctor Thirman (pager 3753) at the time of dictation. |
Generate impression based on findings. | 17 month female with history of abdominal mass. Evaluate for metastatic lesions. LUNGS AND PLEURA: No pulmonary nodules or masses are present to suggest metastatic disease. There are no focal air space opacities or pleural effusions.MEDIASTINUM AND HILA: An enlarged lymph node is noted in the right hilum which measures 9 mm in short axis (series 4, image 18). The thymus appears within normal limits for the patient's age. The heart size is normal. No pericardial effusion is present.CHEST WALL: No focal osseous lesions are identified.UPPER ABDOMEN: A large heterogeneous mass is noted arising from the left kidney which measures up to 7.5 x 7.2 cm in axial dimension (series 4, image 43). The inferior extent of the mass is not entirely visualized on this study. The mass replaces most of the left kidney and exhibits mass effect on adjacent structures within the abdomen.A round homogeneous simple fluid attenuation lesion is noted arising from the right kidney which measures up to 2.9 x 3.0 cm in axial dimension (series 4, image 51), which is likely a cyst. The inferior extent of this cystic lesion is not entirely visualized on this study. | 1.Enlarged right hilar lymph node which is nonspecific. Follow up is recommended to confirm stability. 2.No evidence of pulmonary metastatic disease. 3.Redemonstration of large left renal mass for which differential considerations include Wilms tumor, clear cell sarcoma, or less likely rhabdoid tumor. |
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