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Generate impression based on findings. | History of T4N2c SCC of the head and neck (base of tongue), HBV positive who completed TFHX on in 9/16/11. CHEST:LUNGS AND PLEURA: Scattered areas of microatelectasis and groundglass opacity in the right lower lobe most likely reflect sequelae of aspiration. No pleural fluid or pneumothorax. 10 x 13 x 7 mm groundglass nodule right upper lobe abutting the fissure is unlikely to be metastatic, new from previous. This could represent an area of focal pneumonitis secondary to aspiration however should be followed to exclude atypical adenomatous hyperplasia or possibly AAH or a low grade primary lesion such MAI/ AIS. Recommend follow-up CT in 3 months to assess for resolution.Probable subsegmental atelectasis left lower lobe (5/72).7 x 4 mm nodule right lower lobe (4/225) unchanged compared to the most recent previous study and present dating back to 5/2011 there was minimally smaller. The configuration is suspicious for a small AVM.MEDIASTINUM AND HILA: Index high right paratracheal lymph node unchanged at 5 millimeter (3/15). Aortic valve calcifications. Normal heart size. Hiatal hernia containing fat. No lymphadenopathy.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. No specific evidence of pulmonary metastases.2. Index high right paratracheal lymph node is unchanged in size.3. Right upper lobe ground glass nodule most likely post inflammatory. Three-month CT follow-up recommended to assess for resolution. If the lesion persists on subsequent scan, yearly CTs for a total of 3 years would be recommended to exclude indolent low-grade primary neoplasm such as adenocarcinoma in situ.4. Subtle distal bronchial wall thickening with associated ground glass opacities in the right lower lobe atypical in appearance for acute aspiration by may reflect a a subacute event, correlate with history and for signs of infection.5. Possible 7 x 4 mm AVM right lower lobe. |
Generate impression based on findings. | Reason: Pt with hx of HNC; please re-eval and compare to prior sscans History: as above CHEST:LUNGS AND PLEURA: Right upper lobe subsegmental bronchial obstruction mild bronchial wall thickening, and probable mucoid impaction unchanged over several years. Adjacent nodular opacity also unchanged over multiple exams. Scattered nodular opacities throughout the right lung and left basilar atelectasis/consolidation similar in appearance to multiple prior exams.No new suspicious pulmonary nodules or masses.No pleural effusions.MEDIASTINUM AND HILA: Stable large low-density nodule right lobe of thyroid gland.No hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of a pericardial effusion..CHEST WALL: Old fracture deformity involving the left eighth rib with nonosseous union.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Stable pulmonary abnormalities compatible with aspiration and post radiation changes. No evidence of metastatic disease. |
Generate impression based on findings. | 54 year old female with chest pain. Rule out CAD. Height: 61 in Weight: 104 lbs BSA: 1.43 m^2BMI: 19.7 kg/m^2Calcium Score:LM: 0LAD: 335LCx: 0RCA: 32Total: 366.6, This represents the 99% for this patient's age and gender.(Based on MESA - Multi-Ethnic Study of Atherosclerosis, http://www.mesa-nhlbi.org/Calcium/input.aspx)Cardiac Morphology:Left Ventricle:EDV: 85 ml The left ventricle is normal in size, shape, wall thickness, and volume. Right Ventricle:EDV: 90 ml The right ventricle is normal in size, shape, wall thickness, and volume. Left Atrium: The left atrial volume minus the pulmonary veins is 101ml, within normal limits. There are four distinct pulmonary veins which drain normally into the left atrium.Right Atrium: The right atrial volume is within normal limits. The right atrium is structurally normal. Cardiac Veins: The coronary sinus is normal.Cardiac Valves: There are no aortic calcifications. There is no mitral annular calcification.Great Vessels: Aorta: The aortic arch is left sided. The brachiocephalic vessels branch normally from the arch. Visualized portions of the aorta demonstrate no evidence of dissection or aneurysm. Largest dimensions of the thoracic aorta are as follows:Sinuses of Valsalva: 33 mm Ascending: 24 mm Sinotubular Junction: 22 mm Descending: 18 mmPulmonary Artery: Main PA: 22 mmRight PA: 19 mmLeft PA: [not included in the field of view] Vena Cavae: The SVC is normal in size and without structural abnormality. The IVC is normal in size and without structural abnormality.Pericardium: The pericardium is normal in thickness. There is no pericardial effusion.Coronary Artery Anatomy:LM: The left main coronary artery arises normally from the left sinus of valsalva and bifurcates into the left anterior descending and left circumflex coronary arteries. There is no significant plaque in the left main.LAD: The LAD gives rise to the diagonal and septal branches. There is dense calcification in the proximal LAD which is associated with approximately 25% stenosis. There are additional foci of calcification in the LAD and its branches. LCx: The left circumflex artery gives rise to the obtuse marginal branches. There is no calcification in the LCx.RCA: The RCA arises normally from the right sinus of valsalva. It is the dominant coronary artery giving rise to the posterior descending artery and a posterolateral branch. There are diffuse focal calcifications in the RCA without associated significant stenoses. EXTRACARDIAC CHEST | 1. Multifocal calcification in the LAD and RCA, most prominent at the LAD origin associated with 25% stenosis.2. Coronary artery score is 366.6, This represents the 99%ile for this patient's age and gender.3. Normal ventricular size and shape. |
Generate impression based on findings. | Male 61 years old Reason: Pt with h/o of relapsed CLL on treatment regimen History: Evaluation of disease status. CHEST:LUNGS AND PLEURA: Pleural-based soft tissue density series 5 image 68 1.4 x 1.4 cm. Previously 1.8 x 1.7 cm. No new nodules. No effusions.MEDIASTINUM AND HILA: Small non-pathologic sized mediastinal nodes roughly stable. Index nodes measured as follows: AP window node series 2 image 38, 0.9 x 0.6 cm. Previously 1.2 x .8 cm.Index right paratracheal node series 2 image 40, 1.1 x 0.8 cm. Previously 1 x 0.7 cm.CHEST WALL: Index right axillary node series 2 image 29, 1.1 x 0.6 cm. Previously 1.1 x 0.6 cm.ABDOMEN: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: Multifocal roughly stable retroperitoneal nodes. Partially calcified index left para-aortic node, series image 123, 1.4 x 0.8 cm. Previously 1.4 x 1 cm.No new nodes. Atherosclerotic changes, no aneurysm.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: Scattered pelvic lymph nodes stable with calcified left obturator node series 2 image 179, 1.7 x 1 cm. Previously 2 x 1.3 cm. No new nodes. Postsurgical changes left inguinal area.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Decrease in size of index lesions. No new sites of disease. |
Generate impression based on findings. | Clinical question: Rule out intracranial hemorrhage. Signs and symptoms: Headache and weakness. Nonenhanced head CT:There is no evidence of an acute intracranial process CT however is insensitive for detection of acute nonhemorrhagic ischemic stroke.There are patchy foci of cortical and periventricular low-attenuation white matter consistent with age indeterminate small muscle ischemic stroke.There is a focus of low attenuation with surrounding very subtle high-density (likely minimal calcification) in the left posterior basal ganglia/left thalamus corresponding to previously known extensive chronic blood product seen on prior MRI exam. Stable normal size of the lateral ventricles and maintained midline.Unremarkable calvarium, paranasal sinuses, mastoid air cells, middle ear cavities and bilateral orbits. | 1.No acute intracranial process. Please see above comments.2.Age indeterminate small vessel ischemic strokes as detailed. |
Generate impression based on findings. | Grade III follicular NHL status post chemotherapy. Assessment is limited without intravenous contrast administration. Nevertheless, there is no significant interval change in an enlarged left supraclavicular lymph node that demonstrated hypermetabolism on the prior PET, which currently measures 10 x 11 mm, previously also 10 x 11 mm. No other significantly enlarged cervical lymph nodes are identified by size criteria. The Waldeyer ring structures are unremarkable. The aerodigestive track is patent. There is diffuse enlargement of the left thyroid lobe, which also appears heterogeneous, but not significantly changed and without hypermetabolism on the prior PET. The major salivary glands are unremarkable. The imaged intracranial structures and orbits are grossly unremarkable. The imaged portions of the lungs are clear. There are postoperative findings related to right axillary lymph node dissection. Refer to the separate chest CT report for additional details. | 1. No significant interval change in an enlarged left supraclavicular lymph node that demonstrated hypermetabolism on the prior PET, which currently measures 10 x 11 mm. No additional significant cervical lymphadenopathy is identified.2. Diffuse enlargement of the left thyroid lobe, which appears heterogeneous, but not significantly changed and without hypermetabolism on the prior PET. |
Generate impression based on findings. | Squamous cell cancer of esophagus and head and neck cancer of the larynx status post chemo and radiation. CHEST:LUNGS AND PLEURA: Moderate centrilobular emphysema. No pleural fluid or pneumothorax. Unchanged scattered nodular densities, but no suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Mild circumferential wall thickening of the mid thoracic esophagus appears slightly improved compared to the most recent previous study, and has significantly decreased compared to the prior study of 6/10/13 when focal posterior wall thickening was present. Mild diffuse wall thickening of the distal thoracic esophagus is more prominent however this may be the result of radiation esophagitis. No significant lymphadenopathy.The right chest port tip at the SVC/RA junction. Normal heart size. No pericardial fluid. Severe coronary artery calcifications.CHEST WALL: Postsurgical changes consistent with laryngectomy and neck dissection. Focal prosthesis.A small low cervical lymph node (3/16) measures millimeter minimally larger, previously 3-mm., Within the limits of scan of variability however please refer to dedicated neck CT for significance.Degenerative change of the spine. Right chest port. Posterior rib sclerosis may be the result of radiation.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: Renal vascular calcifications.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Reference lymph node in the gastrohepatic ligament decreased in size, now two smaller separate lesions measuring 4 and 4mm (3/95), previously 11-mm.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Retained oral contrast material within colonic diverticuli, presumably from recent upper GI study. Gastrostomy tube retention device in the stomach.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Continued improvement in the appearance of the esophagus with probable radiation esophagitis in the distal segment. Gastrohepatic ligament lymphadenopathy has also improved. No pulmonary metastases. |
Generate impression based on findings. | 77-year-old male with history of fall and confusion. Head: There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration. The calvaria and skull base are intact. The visualized paranasal sinuses and mastoid air cells are clear. There is a sclerotic focus within the left maxillary alveolus, which likely represents an enostosis. There is patient motion artifact through the mandibular condyles, which results in an aberrant appearance.Cervical Spine: There is mild multilevel degenerative spondylosis of the cervical spine without significant stenosis of the spinal canal. There is no evidence of cervical vertebral fracture or dislocation. The soft tissues of the neck are grossly unremarkable. The imaged portions of the lung apices are unremarkable. | 1. No evidence of intracranial hemorrhage, mass, or cerebral edema.2. No evidence of cervical spine fracture or spondylolisthesis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 62-year-old female patient with history of abdominal mesh and previous bowel resection present with weight loss, night sweats and left-sided abdominal pain. Evaluate for mass or internal hernia. ABDOMEN:LUNG BASES: Dependent atelectasis in the right lung base.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. No internal hernias or masses identified.BONES, SOFT TISSUES: Minimal multilevel degenerative changes in the thoracic and lumbar spine. OTHER: Status post mesh ventral hernia repair without hernia recurrence.PELVIS:UTERUS, ADNEXA: Surgically absent.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Sigmoid diverticulosis without evidence of diverticulitis. No internal hernias or masses identified.BONES, SOFT TISSUES: Sclerotic lesion in left femoral head stable examinations dating back to 2008. Status post right hip arthroplasty with streak artifact. Minimal multilevel degenerative changes in the thoracic and lumbar spine. Vacuum disk phenomenon between L5 and S1 consistent with degenerative disk disease.OTHER: Status post mesh ventral hernia repair without hernia recurrence. | 1.No internal hernias or mass identified.2.Sigmoid diverticulosis without diverticulitis.3.Stable hernia repair.4.No significant lymphadenopathy. |
Generate impression based on findings. | Invasive squamous cell carcinoma of the left superior buccal and alveolus status post composite resection of a supraclavicular island flap reconstruction and local flap advancement. There are postoperative findings related to left marginal mandibulectomy, bilateral neck dissection, and flap reconstruction. There is a small amount of gas and fluid in the flap. There is no definite evidence of residual or recurrent oral cavity mass amidst post-treatment inflammatory changes. There is no evidence of significant cervical lymphadenopathy. The airways are patent. The major cervical vessels are intact. The thyroid gland is unremarkable. The remaining major salivary glands are unremarkable. The imaged intracranial structures and orbits are grossly unremarkable. There is mild partial opacification of the left mastoid air cells. There is multilevel ossification of the posterior longitudinal ligament and evidence of diffuse idiopathic skeletal hyperostosis at C5-6. | 1. Interval resection of a left oral cavity mass without definite evidence of residual or recurrent locoregional tumor, although assessment is limited by dental amalgam artifact. No evidence of significant cervical lymphadenopathy.2. A small amount of gas and fluid in the flap may represent an infected collection, although there is no evidence of abscess. 3. Ossification of the posterior longitudinal ligament associated with diffuse idiopathic skeletal hyperostosis. |
Generate impression based on findings. | Male, 64 years old, history of esophageal cancer and had a neck cancer, status post chemo and radiation. Extensive postsurgical changes are demonstrated including total laryngectomy, tracheostomy and perhaps myocutaneous flap placement. A voice prosthesis is in place. Extensive additional treatment related findings include skin thickening and infiltration of the fascial planes.Within this abnormal background, no evidence of recurrent tumor is seen. No pathologic adenopathy is detected. A reference level Ia lymph node has not significantly changed in size, measuring 13 x 6 mm (image 37 series 6).The salivary glands are free of focal lesions. Accessory parotid tissue is seen bilaterally with prominent parotid ducts, stable. The right lobe of the thyroid has been resected, and the left lobe is unremarkable. The cervical vessels remain patent. Again seen is atherosclerotic calcification at the carotid bifurcations. Lung apices are unremarkable.No concerning osseous lesions are seen. Degenerative disk disease is again identified in the cervical spine. | No evidence of recurrent disease in the neck. |
Generate impression based on findings. | 44-year-old who has undergone multiple neck surgeries following esophageal perforation by a foreign body. Status post pectoral flap with fevers. Assess for fluid collection, abscess. Sequelae of multiple previous surgeries are demonstrated -- there is a tracheostomy, a right-sided PICC line with its tip inferior to the field of view. There is soft tissue stranding and surgical clips associated with the left pectoralis muscle which has been transposed. No subcutaneous air or rim enhancing fluid collections are identified.The mucosal surfaces of the nasopharynx, oropharynx, hypopharynx and larynx are unremarkable. There is a density within the left paraglottic soft tissues at the site of previous perforation without focal air or fluid collection. Prevertebral and retropharyngeal soft tissues are normal. The tongue is unremarkable. There are diffuse periapical lucencies representing dental disease involving several maxillary and mandibular teeth bilaterally, with overall thinning of the alveolar processes. There are borderline right and left-sided level Ib submandibular nodes measuring 1.3 and 1.1 cm respectively, which are most likely reactive.Remaining visualized nodes are within normal limits for size. The parotid and submandibular glands are normal. Vessels are unchanged - there is normal opacification of arterial structures with nonvisualization of the left jugular vein. Bones are unremarkable with the exception of mild cervical spine degenerative change. There is patchy ground glass airspace opacity within the right apex. | Expected postoperative changes in this patient who recently underwent left pectoral flap and multiple prior surgical procedures following esophageal perforation. No CT evidence of free air or fluid collection/abscess. |
Generate impression based on findings. | 41-year-old female patient with right flank pain and difficulty voiding. Evaluate for right-sided kidney stone. Note that the lack of intravenous contrast limits evaluation of vasculature, lymph nodes, solid and hollow viscera.ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Fatty infiltration, most prominent in the right hepatic lobe, with focal areas of sparing. No cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No renal calculi within the kidney. No hydronephrosis, hydroureter or perinephric fat stranding. Near the right ureterovesical junction there is a punctate calcification that measures 4mm (series 3 image 126) without associated hydroureter. This calcification may represent phleboliths versus renal calculus. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. Appendix normal in appearance.BONES, SOFT TISSUES: Multilevel degenerative changes of the thoracic and lumbar spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Prominent uterus, suggestive of uterine fibroids. Punctate bilateral hyperdense clips in the area of the adnexa most likely represent tubal ligation clips.BLADDER: No bladder calculi.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. Appendix normal in appearance.BONES, SOFT TISSUES: Multilevel degenerative changes of the thoracic and lumbar spine.OTHER: No significant abnormality noted. | 1.Punctate calcification near the right ureterovesical junction may represent a phlebolith versus renal calculus. However, given lack of hydronephrosis, hydroureter and perinephric fat stranding, this is unlikely to be the cause of patient's symptomatology.2.Fatty liver. Consider correlation with LFTs.3.Prominent uterus consistent with fibroids. |
Generate impression based on findings. | Female 62 years old Reason: eval for internal hemorrhage, RP bleed, organ laceration History: LVAD s/p fall with SAH, Ascites, s/p paracentesis with 4.8L bright red blood Exam is not sensitive for detecting lesions in the bowel, solid organs of vasculature due to lack of oral or intravenous contrast. Given those limitations, the following observations are madeABDOMEN:LUNG BASES: Cardiomegaly. Postsurgical changes. LVAD device.LIVER, BILIARY TRACT: Cholelithiasis. No obvious biliary dilatation. No evidence of fatty liver.SPLEEN: Stable size splenic artery aneurysm proximally 1.2 cm in diameter as measured on series 3 image 50.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: New marked generalized ascites. There is no evidence of hematocrit effect within the ascites to suggest hemoperitoneum. Component of blood cannot be excluded by fluid density. Given limitation of the exam no definite bowel wall thickening or dilatation.BONES, SOFT TISSUES: Anasarca.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: Atrophic or surgically absent.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Large amount generalized free intraperitoneal fluid without obvious hematocrit effect to specifically suggest blood.BONES, SOFT TISSUES: Anasarca.OTHER: No significant abnormality noted | New, large amount of free intraperitoneal fluid. Stable splenic artery aneurysm. Cholelithiasis. |
Generate impression based on findings. | Female, 97 years old, status post mechanical fall with headache. There is a right parietal subgaleal hematoma with swelling of the overlying scalp. No skull fractures are seen.No acute intracranial hemorrhage, abnormal extra-axial fluid collections, or other posttraumatic abnormalities are detected.Extensive white matter hypoattenuation is redemonstrated compatible with age indeterminate small vessel ischemic disease. In some areas, this hypoattenuation extends to involve the overlying cortex including within the orbital gyrus of the right frontal lobe and to some degree within the bilateral postcentral gyri. Findings have not significantly changed.No mass effect is detected. The ventricular system and cerebral sulci remain prominent compatible with parenchymal volume loss. | 1. Right parietal scalp injury. No acute intracranial findings.2. Extensive, largely small vessel ischemic disease is redemonstrated. |
Generate impression based on findings. | Female 46 years old Reason: Pre-transplant evaluation. Evaluate vessels for transplant. History: Poor palpation of left femoral pulse on exam. Exam is not sensitive for detecting lesions in the bowel, solid organs or blood vessels due to lack of oral or intravenous contrast. Given those limitations, the following observations are made:ABDOMEN:LUNG BASES: In addition to prominent subpleural flap there might be some mild pleural thickening or minimal fluid in the posterior costophrenic angles.Extensive vascular structures presumably venous collaterals in the subcutaneous tissues of the lower chest and throughout the abdominal wall.LIVER, BILIARY TRACT: Cholelithiasis. No obvious biliary dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Near complete replacement the renal parenchyma with varying size typical and atypical cysts. Many high density with punctate and round calcifications seen in the cysts and the renal parenchyma. This is consistent with chronic medical renal disease.RETROPERITONEUM, LYMPH NODES: Mild to moderate calcification of the aorta and iliac arteries evidence of aneurysm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Diffusely high density osseous structures consistent with renal osteodystrophy.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: 5.2-cm diameter mass left adnexa with rim-like calcification and heterogeneous high and low density components. This may represent an infarcted renal allograft correlate clinically. Ultimately could represent an adnexal mass although I do not identify uterus or ovaries.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Peritoneal dialysis catheter. The bowel wall thickening or dilatation. Prominent submucosal fat throughout the right colon. Correlate clinically for history of colitis.BONES, SOFT TISSUES: Extensive diffuse subcutaneous collateral vessels seen in the anterior abdominal wall. Mild anasarca anterior abdominal wall.OTHER: There is heavy calcification of the internal iliac artery system and its branches. There is only minimal calcification of the common and external iliac arteries. | Left lower quadrant mass correlate with surgical history and GYN history. Differential diagnosis includes ovarian neoplasm. Discussed by telephone with Dr. Josephson. Renal osteodystrophy. Chronic medical renal multicystic kidneys.Extensive subcutaneous collaterals anterior chest abdominal and pelvic wall. Correlate for SVC syndrome. Cholelithiasis. |
Generate impression based on findings. | 68-year-old male with increasing bladder pressure and necrotic ostomy, evaluate for progression of bowel infarction and ascites. Additional history of invasive colonic adenocarcinoma obtained from chart. ABDOMEN:LUNG BASES: Pleural effusions and basilar consolidation and atelectasis. Right pleural catheter is noted with gas extending along the chest wall tract. A central venous catheter tip is at the cavoatrial junction.LIVER, BILIARY TRACT: Extensive, infiltrating hepatic mass with poorly defined margins, compressing and distorting the hepatic vasculature. No central thrombosis is noted. Gallstones and pericholecystic fluid.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: Enteric tube tip in the gastric antrum. Diffuse small bowel wall thickening.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Marked abdominal and pelvic ascites.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diverting colostomy with focal necrotic appearing wall just proximal to the afferent loop (image 120, series 4) with several foci of adjacent gas and surgical clips. No free air is noted. Diffuse small bowel wall thickening.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Marked abdominal and pelvic ascites. | 1. Short segment of necrotic appearing colon, just proximal to the diverting colostomy. No free air.2. Extensive hepatic metastases as detailed above.3. Marked abdominal and pelvic ascites.4. Pleural effusions and basilar consolidation and atelectasis. |
Generate impression based on findings. | Female, 60 years old, vertigo. Evaluate for stroke. A smoothly marginated, mildly and homogeneously hyperdense extra-axial mass is present along the right frontal lobe measuring 2.4 x 1.5 cm transaxial. This mass mildly displaces the adjacent middle frontal gyri.Elsewhere in the brain, vague subcortical and periventricular hypodensities are seen, more so on the left than on the right, which is nonspecific but most likely represents age indeterminate small vessel ischemic disease.No definite focal parenchymal edema, loss of the gray-white differentiation or other CT findings of acute territorial ischemia are seen. No generalized mass-effect is demonstrated. No intracranial hemorrhage or abnormal extra-axial fluid is demonstrated. The ventricular system is patent and within normal limits for size.The bones of the calvarium are intact. The paranasal sinuses as visualized are clear. | 1. Extra-axial mass along the right frontal lobe probably represents a meningioma. A more confident diagnosis could be made on MRI. This finding is likely incidental and of doubtful relevance to the patient's present complaint of vertigo. 2. Moderately extensive age indeterminate small vessel ischemic disease is suspected. No definite evidence of acute territorial ischemia is seen on this exam. |
Generate impression based on findings. | Headache and dizziness. There is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. Thre is prominent dural calcification along the falx cerebri for age, which is of uncertain significance. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. | No evidence of intracranial hemorrhage, mass, or cerebral edema. |
Generate impression based on findings. | Head and neck cancer, follow-up CHEST:LUNGS AND PLEURA: Scattered stable micronodules which at least one is large and solid with punctate calcifications compatible granulomata. The less specific subcentimeter nodule in the probe posterior right lower lobe (image 74 series 5) is also unchanged containing to measure 6 mm. No effusions.MEDIASTINUM AND HILA: No lymphadenopathy. Old calcified lymph nodes compatible with old healed granulomatous disease exposureThe cardiac and pericardium demonstrate moderate coronary calcifications, unchangedSmall hiatal herniaCHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cystsPANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Mild stable degenerative changes scattered throughout the lower thoracic and lumbar spineOTHER: No significant abnormality noted. | Old granulomatous disease exposure without evidence of metastatic disease |
Generate impression based on findings. | Alzheimer disease, admitted for sepsis and AMS. There is unchanged moderate cerebral white matter hypoattenuation that likely represents microangiopathy. There is also a chronic small left PICA territory infarct. There is no evidence of acute intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are stable in size and configuration. There is no midline shift or herniation. There is partial opacification of the left mastoid air cells. The imaged paranasal sinuses are clear. There are partially imaged endotracheal and enteric tubes that are surrounded by fluid in the upper aerodigestive track. | No evidence of acute intracranial hemorrhage, mass, or cerebral edema. |
Generate impression based on findings. | 47-year-old female patient with acute urinary retention, constipation, abdominal and thigh numbness. ABDOMEN:LUNG BASES: Status post right middle lobe wedge resection. Bilateral lower lobe volume loss with ground-glass opacities, honeycombing and mild fibrosis in the lung bases.LIVER, BILIARY TRACT: Mild hepatomegaly.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 bowel dilatation or evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Mildly enlarged heart. Inferior vena cava filter in place below the level of the renal vein. At this level of the IVC there is severe narrowing and likely thrombosis.Varices throughout the abdomen and pelvis, stable.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Urinary bladder with thickened, hyperenhancing wall with Foley catheter in place.LYMPH NODES: Inguinal lymphadenopathy stable compared to 11/22/2012.BOWEL, MESENTERY: No bowel dilatation or evidence of obstruction. Minimal stool burden.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumbar spine.OTHER: Varices throughout the abdomen and pelvis, stable. | 1.Inflammatory changes in the urinary bladder wall consistent with cystitis.2.No evidence of bowel obstruction or fecal impaction.3.Chronic lung changes.4.Severe narrowing of the inferior vena cava at the level of the IVC filter. |
Generate impression based on findings. | Male 78 years old Reason: Assess for IBD History: Pt. with multiple interloop abscesses ABDOMEN:LUNG BASES: Previously seen bilateral pleural effusions are resolved. Minimal bibasilar atelectasis. Minimal calcification at the root of the aorta. Presumed central line tip at the junction of the SVC RA.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Malrotation left kidney. Small presumptive cyst left kidney.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification aorta and branch vessels. No evidence of aneurysm.BOWEL, MESENTERY: There is excellent dilatation of the jejunum with a transition zone in the jejuno-ileal area in the right lower quadrant. Please see pelvic report for details. The dilated loops of jejunum have no evidence of abnormal wall thickening. No free or loculated intraperitoneal fluid.Probable diverticulum off the third portion of the duodenum.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: Matted loops of small bowel are seen throughout the pelvis particularly clustered in the midline probably causing a partial small bowel obstruction. These loops are thickened and prominently enhancing suggesting active inflammatory bowel disease. The obstruction is partial and fluid is seen entering normal caliber loops of distal ileum and terminal ileum in the right lower quadrant. These loops are prominent enhancing walls some of the diffuse thickening suggesting active inflammatory bowel disease. There is prominent enhancement of the wall of the ascending colon as well in the 3.3 x 1.7 cm lipoma in the ascending colon coronal image 71.The previously seen focal air fluid collection to the left of the midline in the pelvis as well as other interloop fluid collections are not this completely measurable at that might still be present. There be difficult to discern separate from the abnormal matted loops of bowel. I suspect at least one loculated fluid collection is present on coronal image 70/137 measuring 3.1 x 1.2 cm.There is stranding of the mesenteric fat around the matted loops of bowel. Stranding extends to the adjacent sigmoid colon and urinary bladder without discrete fistulization. No fistulas are seen to the skin.No evidence of mesenteric venous thrombus.Colonic diverticulosis particularly sigmoid colon.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Previously seen abscess cavities are difficult to identify in the matted loops of diseased bowel in the pelvis. If present, they are certainly smaller or resolved. Given the caliber discrepancy there is probably a low-grade mechanical obstruction.There also diseased loops of distal ileum and the ascending colon with thickened wall and enhancing mucosa relative to normal bowel.Other findings include colonic diverticulosis and in the ascending colon lipoma. Malrotation left kidney.Discussed with Dr. Tony Rodriguez, covering intern, pager 2701 4:45pm. |
Generate impression based on findings. | Secondary neuroendocrine tumor of the liver. Malignant carcinoid. Follow-up. CHEST:LUNGS AND PLEURA: No focal consolidation or pleural effusion. Multiple right sided nodules are unchanged. A right middle lobe reference nodule is not significantly changed measuring 6 mm (image 37 clinical series 9), compared to 6 mm previously. No new nodules are evident.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Normal heart size without pericardial effusion.CHEST WALL: No significant abnormality notedABDOMEN: LIVER, BILIARY TRACT: Innumerable hepatic metastatic lesions are redemonstrated:*The reference segment IVb lesion is widely larger measuring 5.6 x 5.7 cm (image 85; series 7) *The reference segment 7 lesion is clinically larger measuring 5.8 x 5.2 cm (image 66; series 7) SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Stable pericaval node in the upper retroperitoneum.BOWEL, MESENTERY: The cecal mass appears unchanged measuring 3.4 x 3.4cm (image 118; series 7). Ileal inflammation also appear stable.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: UTERUS, ADNEXA: Bilateral adnexal cysts are likely physiologic.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.Stable pulmonary nodules.2.Multiple hepatic metastases slightly larger. 3.Unchanged cecal mass and adjacent mesenteric soft tissue attenuation. |
Generate impression based on findings. | Female, 64 years old, weakness. Extensive patchy hypoattenuation is demonstrated on both sides of the brain but more extensively and more conspicuously on the right. This hypoattenuation extends to involve the cortex within the superior and middle frontal gyri. The post central gyrus is also extensively affected. The above mentioned patchy cortical and subcortical hypoattenuation blends with areas of periventricular hypoattenuation. Periventricular changes are more pronounced along the left frontal horn. The corpus callosum is thin through this region. The left frontal horn seems to demonstrate some degree of ex vacuo dilatation but this could also be normal variation. There is also a focal hypodensity within the left caudate head suggestive of age indeterminate lacunar infarction.No evidence of acute intracranial hemorrhage or abnormal extra-axial fluid collections. No significant generalized mass-effect is seen. Except as discussed above, the ventricular system is unremarkable.The bones of the calvarium are intact. The paranasal sinuses and mastoid air cells are clear. Note is made of hyperdense material within the left globe which likely represents ophthalmologic intervention. Correlation with history is suggested. | Findings concerning for acute to subacute cortical ischemia involving largely the right frontal lobe and the right post central gyrus but to a lesser degree the left frontal lobe as well. Underlying white matter hypoattenuation is compatible with small vessel ischemic disease of indeterminate age. Further evaluation with MRI is suggested. |
Generate impression based on findings. | 67-year-old female with chest pain and shortness of breath. PULMONARY ARTERIES: Diagnostic quality exam with no evidence of pulmonary embolus.LUNGS AND PLEURA: Innumerable lung nodules throughout both lungs most compatible with metastases. Moderate to large bilateral pleural effusions, right more than left, with associated atelectasis/consolidation.MEDIASTINUM AND HILA: Mediastinal and hilar lymphadenopathy; for reference right hilar node measures 2.5 x 2.8 cm (series 9, image 153). Multiple prominent retrocrural lymph nodes are present.Heart size normal. Moderate pericardial effusion.CHEST WALL: Multiple lytic lesions throughout the osseous structures, including humeral heads, vertebral bodies, scapula, manubrium, and ribs, consistent with metastases. Destructive soft tissue mass arising from right fifth rib measures 3.9 x 6.4 cm (series 9, image 108). There is mild compression deformity of the superior endplate of T10 vertebral body.Asymmetric soft tissue in the right breast is nonspecific but raises possibility of primary breast neoplasm (series 9, image 153).UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Partially visualized heterogeneous, exophytic mass arising from left kidney, highly suspicious for primary renal neoplasm. Multiple subtle hypodensities in the liver, many of which are too small to characterize, but suspicious for metastases. Bilateral adrenal nodules. Small amount of ascites. | 1.Findings consistent with diffuse metastatic disease, including innumerable lung nodules, hypoattenuating liver lesions, bilateral adrenal nodules, and destructive osseous lesions; given large exophytic mass arising from the left kidney, suspect primary renal neoplasm. Dedicated abdominal and pelvic CT should be considered for further evaluation.2.No pulmonary embolus. |
Generate impression based on findings. | 30 year-old female with chest pain. PULMONARY ARTERIES: Diagnostic quality exam with no evidence of pulmonary embolus.LUNGS AND PLEURA: No consolidation or pleural effusions. Mild scarring/atelectasis in left lung base.MEDIASTINUM AND HILA: No adenopathy. Heart size normal. Pulmonary artery size is normal. No evidence of right ventricular dilation.CHEST WALL: Mild thoracic dextroscoliosis.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Partially visualized gallbladder reveals gallstone (series 6, image 279). There is reflux of contrast into the hepatic veins, which is most likely due to rapid injection of contrast although this also raises possibility of increased right heart pressures. | 1.No pulmonary embolus or other acute abnormality to account for symptoms.2.Cholelithiasis. |
Generate impression based on findings. | 25-year-old female patient with history of Crohn's disease, off Remicade for one year presents with abdominal pain and bloody diarrhea. Please evaluate for active inflammatory changes and obstruction. ABDOMEN:LUNG BASES: Subcentimeter pleural scarring in the posterior right lower lobe. Otherwise, no significant abnormalities.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: Oral contrast rapidly progressed through normal appearing stomach, small bowel and proximal colon. Normal-appearing appendix.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: Stable pelvic and inguinal lymphadenopathy.BOWEL, MESENTERY: Circumferential rectal wall thickening. At the distal rectum there are increased perirectal inflammatory changes and fat stranding between the lavator ani muscle and wall of the rectum. There are numerous circular hyperattenuating foci with hypoattenuating centers measuring between 1 cm to 1.5 cm in the perirectal region, best seen on coronal images (series 80256 image 36). These foci most likely represent perirectal phlegmon versus early abscesses. There is a dominant right perirectal focus that measures 1.7 x 2.0 cm (series 3 image 120). There are areas of hyperattenuation in the perianal fat that are likely consistent with scars or fistulas.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Rectal wall thickening and inflammation of perirectal tissue with numerous phlegmon. No drainable fluid collection.2.Perianal fat hyperattenuating foci may be chronic changes from previous fistulas versus active fistulas. |
Generate impression based on findings. | 66-year-old male with squamous cell lung carcinoma with dyspnea of increased frequency. PULMONARY ARTERIES: Mild motion artifact mildly limits evaluation of lung bases. Given this limitation, no evidence of pulmonary embolus.LUNGS AND PLEURA: Interval increase in large right parahilar mass which encases the right lower and middle lobe pulmonary artery branches, invades and obliterates the superior and inferior right pulmonary veins, compresses the right middle and lower lobe bronchi, invades the mediastinum and is contiguous with multiple enlarged mediastinal lymph nodes; the mass is difficult to accurately measure however measures approximately 7.8 x 9.5 cm, previously measured 4.2 x 6.7 cm (series 7, image 176). There is postobstructive consolidation of the right middle lobe and new complete consolidation of right lower lobe. Moderate, partially loculated right pleural effusion.Right pleural catheter is present.MEDIASTINUM AND HILA: Multiple enlarged mediastinal and supraclavicular lymph nodes; for reference precarinal lymph node measures 1.1 x 2.0 cm, increased since prior exam (series 7, image 126).CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Left renal cysts. | 1.Interval increase in size of large right parahilar lung mass causing postobstructive consolidation of the right lower and middle lobes, as described above.2.Mediastinal and supraclavicular adenopathy, consistent with involvement by tumor.3.No pulmonary embolus. |
Generate impression based on findings. | Clinical question: Hemorrhage or mass. Signs and symptoms: Headache and papilledema. Nonenhanced head CT:There is no detectable acute intracranial process CT however is insensitive for detection of acute non-hemorrhagic ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray to white matter differentiation.All paranasal sinuses and bilateral mastoid air cells are visualized and remain well pneumatized.Calvarium and soft tissues of the scalp are unremarkable.Unremarkable images through the orbits. | Unremarkable nonenhanced head CT. |
Generate impression based on findings. | Clinical question: Rule out mass. Signs and symptoms: Seizure. Nonenhanced head CT:There is no detectable acute intracranial process.Usual cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation is within normal.Calvarium and soft tissues of the scalp, paranasal sinuses, mastoid air cells, middle air cavities and images through the orbits are unremarkable. | Unremarkable head CT. |
Generate impression based on findings. | Clinical question: CVA. Signs and symptoms: CVA. Unenhanced head CT:No detectable acute intracranial process. CT however is insensitive to detection of acute on hemorrhagic ischemia strokes.Mild prominence of the cortical sulci and ventricular system remain similar to prior exam from 2012.Present gray -- white differentiation.Unremarkable calvarium and soft tissues of the scalp.Images through the orbits are unremarkable.Mild chronic sinusitis is noted. | No acute intracranial process. |
Generate impression based on findings. | Altered mental status. There is no evidence of intracranial hemorrhage, mass, or cerebral edema. There is a punctate focus of hypoattenuation in the right basal ganglia which may represent a lacunar infarct of indeterminate age. There is also moderate diffuse cerebral white mater hypoattenuation, which is likely related to microangiopathy. There are intradural vertebral and carotid siphon vascular calcifications. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. | A punctate focus of hypoattenuation in the right basal ganglia which may represent a lacunar infarct of indeterminate age. There is also moderate diffuse cerebral white mater hypoattenuation, which is likely related to microangiopathy. No evidence of intracranial hemorrhage, mass, or cerebral edema. However, non-contrast CT is insensitive for early infarcts. |
Generate impression based on findings. | 29-year-old female with hematuria and dysuria -- rule-out urinary tract stone. Within the limits of a non-IV contrast enhanced examination which limits ability to evaluate solid parenchymal organs and vascular structures, following observations can be made:ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Both kidneys are of normal size, shape, and morphology without abnormal calcifications. No hydronephrosis. No perinephric fluid collections. Lack of IV contrast limits ability to evaluate renal parenchyma for infection or masses. Ureters are not distended -- no calculus in the expected course of the ureters are seen.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Normal examination of the abdomen and pelvis -- no findings seen to account for patient's symptomatology. |
Generate impression based on findings. | 50 year-old male with tonsillar cancer and known metastases -- please evaluate for new metastases, infection source. CHEST:LUNGS AND PLEURA: There is been increased in size and number of pulmonary parenchymal metastases. The reference left anterior upper lobe mass (series 5, image 40) has only minimally increased in size to 4.9-cm (previously 4.6 cm), and the left lower lobe pleural-based nodule referenced previously, now measures 1.4-cm (series 5, image 69) compared with 1.2 cm, previously. Other nodules have increased in size proportionately in new nodules are identified.Increasing size of right pleural effusion.MEDIASTINUM AND HILA: Increasing size of diffuse mediastinal adenopathy is seen. The referenced, AP window node, now measures 4.0-cm (series 4, image 37) compared with 3.0 cm previously. The right hilar. Reference lymph node (series 4, image 41) is unchanged, measuring 2.2-cm.The reference right paratracheal node (series 4 x 16) is unchanged and measures 1.4-cm.While the referenced lymph nodes in past have only minimally changed, other mediastinal lymph nodes, have increased in size, particularly the left cardiophrenic angle, lymph nodes (series 4, image 60).CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Increase in size of prior noted. Reference liver, mass lesion (series 4, image 89) which now measures 3.2 x 3.1 cm compared with 2.9 x 2 .5 cm, previously numerous other solid lesions have now appeared, consistent with diffuse metastases.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: New large right upper pole renal mass (series 4, image 105) measuring 2.6 x 2.4 cm -- while this is nonspecific and could represent a second primary or most likely represents a metastatic focus. Other than benign cortical renal cyst -- no other renal abnormalities seen.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Stomach, small bowel, and colon appear normal. There has been interval development of clusters of sizable enlarged mesenteric lymph nodes, largest of which measures 2.5 x 2.2 cm (series 4, image 125) indicative of new metastatic disease..BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Benign prostatic calcification seen. 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. Worsening pulmonary, parenchymal metastases. 2. Worsening mediastinal lymphadenopathy. 3. Increasing size and number of liver metastases. 4. Increasing size of left pleural effusion. 5. New mesenteric lymphadenopathy. |
Generate impression based on findings. | Right maxillary swelling and right orbital abrasion after fall. There is subcutaneous stranding overlying the right zygoma. There is no evidence of maxillofacial fracture. The paranasal sinuses and mastoid air cells are clear. There is a right lens implant. The orbits are otherwise unremarkable without evidence of retrobulbar hemorrhage. The imaged intracranial structures are grossly unremarkable. There is torus maxillaris internus. | Subcutaneous hematoma overlying the right zygoma, but no evidence of maxillofacial fracture. |
Generate impression based on findings. | 29-year-old female with history of right lower back pain and positive blood on urinalysis. ABDOMEN:LUNG BASES: Mild basilar atelectasis.LIVER, BILIARY TRACT: Status post cholecystectomy. No focal hepatic lesions. Diffusely increased liver density may relate to iron overload.SPLEEN: Small, autoinfarcted spleen.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No nephrolithiasis or ureteral calculus visualized. No hydronephrosis. Minimal right perinephric stranding is nonspecific -- evaluation for pyelonephritis or infarction is limited on this noncontrast exam.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Osseous changes of sickle cell disease.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: Osseous changes of sickle cell disease.OTHER: No significant abnormality noted. | 1. No nephrolithiasis, ureteral calculus or hydronephrosis. 2. Diffusely increased hepatic density indicating hemosiderosis. |
Generate impression based on findings. | 39-year-old female with history of pancreatitis, complicated by pseudocyst, status post necrosectomy and multiple drain placements with worsening fever. ABDOMEN:LUNG BASES: Moderate left pleural effusion with adjacent consolidation and atelectasis.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No pancreatic ductal dilatation. The parenchyma is mildly distorted by adjacent fluid collections but enhances normally.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Interval decrease in size of fluid collections containing gas and thick debris throughout the abdomen and pelvis. A percutaneous drain extends into a left abdominal fluid collection which communicates with the peripancreatic collection. Three cystgastrostomy tubes extends into the peripancreatic fluid collection. Multiple additional small fingerlike loculated fluid collections extend inferiorly and posteriorly within the mesentery, also decreased in size, although we cannot determine whether they communicate simply abut one another. Free fluid is tracking within the mesentery.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Abdominal ascites.PELVIS:UTERUS, ADNEXA: An IUD is noted.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: A catheter is noted in the right hemicolon. Multiple enhancing fluid collections extending inferiorly within the mesentery and anterior to the uterus are decreased in size but still persist. Free fluid tracks within the mesentery as well layering in dependent pelvis without loculation.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Pelvic ascites. | 1. Marked interval decrease in size of peripancreatic and multiple additional abdominal and pelvic loculated fluid collections as detailed above. Although all the fluid collections are decreased in size we cannot determine whether some communicate or simply abut one another. 2. Left pleural effusion with adjacent atelectasis. |
Generate impression based on findings. | 27-year-old male patient with left costovertebral angle tenderness, left groin pain and left lower quadrant pain. Evaluate for renal stone. Note that lack of intravenous contrast limits evaluation of vasculature, lymph nodes and solid organs.ABDOMEN:LUNG BASES: Trace bibasilar dependent atelectasis. Otherwise, no significant abnormalities.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis. No perinephric fat stranding. There is prominence of the left ureter noted proximally. No obstructing renal calculi.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Minimal multilevel degenerative changes through out the thoracic and lumbar spine.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: 3-mm calcification within the urinary bladder near the left ureterovesical junction.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Minimal multilevel degenerative changes throughout the thoracic and lumbar spine.OTHER: No significant abnormality noted. | 1.Prominence of the left ureter with 3mm punctate calcification in the urinary bladder. Findings are consistent with a passed renal calculus. |
Generate impression based on findings. | Reason: eval for PE History: l sided chest pain PULMONARY ARTERIES: No evidence of a pulmonary embolus.LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of a pericardial effusion.CHEST WALL: Large axillary and subpectoral lymph nodes.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Dilated air-filled bowel in the upper abdomen. | 1.No evidence of a pulmonary embolus.2.Axillary and subpectoral lymphadenopathy similar in appearance to the prior exam. |
Generate impression based on findings. | Fall. There is no evidence of fracture or significant spondylolisthesis. The vertebral body heights are preserved. There are several subcentimeter lucent foci with prominent trabecula that likely represent intraosseous hemangiomas. There is multilevel degenerative spondylosis with several areas of intravertebral gas, moderate to severe neural foramen stenosis, and prominent disc-osteophyte complexes. Thre are small erosions of the dens, which otherwise appears intact. There are bilateral carotid stents, in which the left stent is mildly deformed by atherosclerotic plaque. The imaged paranasal sinuses and mastoid air cells are clear. The imaged portions of the intracranial structures are grossly unremarkable. There is biapical scarring. | 1. No evidence of cervical spine fracture or spondylolisthesis.2. Multilevel degenerative spondylosis with several areas of intravertebral gas, moderate to severe neural foramen stenosis, and prominent disc-osteophyte complexes. This can be further evaluated via MRI if clinically warranted. |
Generate impression based on findings. | Reason: Pt with ss disease, 2 PEs in past, off coumadin for last 1 year. Now with SOB, tachycardia History: SOB PULMONARY ARTERIES: No evidence of pulmonary embolus.LUNGS AND PLEURA: Mild basilar scarring/atelectasis. Stable probable intrapulmonary lymph node lung the minor fissure.Chronic elevation of the left hemidiaphragm.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy. There is cardiac enlargement without evidence of a pericardial effusion.CHEST WALL: Osseous changes compatible with sickle cell disease similar in appearance to the prior exams.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Unchanged small atrophic spleen. | No evidence of a pulmonary embolus. No acute abnormalities identified. |
Generate impression based on findings. | 70 year-old male with abdominal pain, postop day 6 for right nephrectomy. Lack of IV contrast limits ability to evaluate solid parenchymal organs and vascular structures -- within these limitations, the following observations can be made:ABDOMEN:LUNG BASES: Right pleural effusion and atelectasis. Innumerable lung nodules are seen in both lung bases, new since outside CT examination of 7/22/13. These are most likely diffuse metastatic lesions.LIVER, BILIARY TRACT: No significant abnormality noted in non-IV contrast enhanced liver parenchyma. Gallstones without complication seen in the, gallbladder, unchanged since 7/22/13.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post right nephrectomy with fluid density in the surgical bed without visible loculated wall seen. Small amounts of air are seen rising freely to the nondependent anterior location. These are expected findings in a recent postop nephrectomy patient, however, CT cannot characterize fluid collections for infection.Left kidney shows left lower pole nonobstructive calyceal calculus. No other abnormalities are seen.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Orally administered contrast rapidly progresses from stomach through normal small bowel to the right lower quadrant without evidence of obstruction or intrinsic abnormality. No free mesenteric fluid is identified, however, there is extensive pneumoperitoneum and subcutaneous emphysema, consistent with recent laparoscopic nephrectomy procedure. No signs of any inflammatory changes or fluid collections adjacent to bowel are seen to suggest bowel injury as source of gas and, therefore pneumoperitoneum, most likely is residual air from procedure.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Orally administered contrast rapidly progresses from stomach through normal small bowel to the right lower quadrant without evidence of obstruction or intrinsic abnormality. No free mesenteric fluid is identified, however, there is extensive pneumoperitoneum and subcutaneous emphysema, consistent with recent laparoscopic nephrectomy procedure. No signs of any inflammatory changes or fluid collections adjacent to bowel are seen to suggest bowel injury as source of gas and, therefore pneumoperitoneum, most likely is residual air from procedure.BONES, SOFT TISSUES: Degenerative changes throughout lumbar spine and pelvis are seen without focal lytic lesion to suggest bony metastasis. Scattered subcentimeter, round, well-defined, sclerotic lesions are seen -- in light of usual lytic appearance to renal neoplasm, metastases, these are most likely benign bone islands. OTHER: No significant abnormality notedd | 1. Expected changes of postoperative right nephrectomy with predominantly fluid and small amount of air in surgical bed. 2. Pneumoperitoneum seen in subcutaneous emphysema, most likely relating to recent laparoscopic procedure. 3. Innumerable parenchymal lung nodules or post lung bases, most likely, metastatic disease, new since 7/22/13. 4. Small right pleural effusion. 5. Gallstones without other biliary tract complication. |
Generate impression based on findings. | Left tonsillar pain and swelling. There is enlargement of the left palatine tonsil with extensive surrounding areas of ill-defined hypoattenuation that extend into the soft palate, parapharyngeal space, submandibular space, epiglottis, and arytenoid on the left side. There is associated moderate narrowing of the nasopharyngeal and oropharyngeal airway, as well as effacement of the left piriform sinus. There is no significant cervical lymphadenopathy. The imaged paranasal sinuses and mastoid air cells are clear. The imaged portions of the intracranial structures are orbits are unremarkable. There is loss of the normal cervical lordosis. The osseous structures are otherwise unremarkable. The imaged portions of the lungs are clear. | Findings indicative of left palatine tonsillitis associated with extensive peritonsillar edema and areas that may represent phlegmon or very early abscess formation, but no evidence of a drainable abscess. |
Generate impression based on findings. | 66-year-old male with diabetic ketoacidosis. Extracardiac mass seen on echocardiography. LUNGS AND PLEURA: Small left pleural effusion with associated segmental atelectasis/consolidation in the left base. Minimal dependent atelectasis in the right lung. No right pleural effusion. No suspicious nodules.MEDIASTINUM AND HILA: No lymphadenopathy. Heart size normal. Severe atherosclerotic calcifications affect coronary arteries, and to a lesser degree, the aorta. The esophagus is moderately patulous. No evidence of mediastinal or extracardiac mass. Hypoattenuating blood pool compatible with anemia.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. The partially visualized kidneys are atrophic. Large amount of food material is present in a distended stomach. | 1.Evaluation of mediastinum is suboptimal given lack of IV contrast, however, no mediastinal or extracardiac mass is identified.2.Small left pleural effusion with associated atelectasis/consolidation and left base.3.Severe atherosclerotic disease. |
Generate impression based on findings. | Clinical question: Tonsillar cancer, rule out metastases. Signs and symptoms: As above. Nonenhanced head CT:Examination demonstrates 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.Lack of intravenous contrast significantly reduces the sensitivity of the exam for detection of smaller metastatic lesions or leptomeningeal metastatic process. This nonenhanced exam however demonstrate no gross evidence of metastatic disease of brain or the calvarium.Unremarkable calvarium and soft tissues of the scalp.Unremarkable alternatives of sinuses, mastoid air cells and bilateral middle ear cavities.Unremarkable images through the orbits. | Unremarkable nonenhanced head CT. |
Generate impression based on findings. | 73-year-old male patient status post gastric pull up for cancer and diaphragmatic hernia repair presented with shortness of breath. Postop day 5 from hernia repair. Evaluate for reherniation. Note that the lack of oral and intravenous contrast limits evaluation of vasculature, lymph nodes, solid organs and bowel.CHEST:LUNGS AND PLEURA: Large bilateral pleural effusions with associated atelectasis and volume loss of the lower lung lobes.Status post gastric pull-up.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postoperative changes from gastric pull up. Nasogastric tube coiled within the intrathoracic portion of the stomach. No oral contrast in the small bowel no evidence of contrast leak. Sigmoid diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Multilevel degenerative changes of the thoracic and lumbar spine.OTHER: Extensive intraperitoneal free air, slightly greater in expected 5 days postop. There is mottled air infiltrating fat underneath the left diaphragm. There is no evidence of oral contrast leak in this area. Moderate free fluid within the abdomen and pelvis.Atherosclerotic changes of the abdominal aorta and iliac arteries.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: Multilevel degenerative changes of the thoracic and lumbar spine.OTHER: Extensive intraperitoneal free air, slightly greater in expected 5 days postop. Moderate free fluid within the abdomen and pelvis.Atherosclerotic changes of the abdominal aorta and iliac arteries. | 1.No diaphragmatic hernia.2.Extensive amount of intraperitoneal free air and mottled, infiltrating air underneath the left diaphragm. No evidence of oral contrast leak.3.Stable large bilateral pleural effusions with atelectasis. 4.Enteric tube coiled in intrathoracic portion of gastric pull up.5.Extravasation of 30 cc of intravenous contrast in left wrist. Study performed without intravenous contrast. |
Generate impression based on findings. | ams s/p multiple falls. pt has a hx of MS. There is no evidence of intracranial hemorrhage, mass, or cerebral edema. There are extensive patchy areas of supratentorial and infratentorial white matter hypoattenuation that likely correspond to the reported history of multiple sclerosis. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is extensive frontal, ethmoid, and right sphenoid sinus opacification with some polypoid features and sclerosis of the sinus walls as well as milder bilateral maxillary sinus mucosal thickening amidst evidence of prior bilateral uncinectomy and partial ethmoidectomy. The mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. | 1. No evidence of acute intracranial hemorrhage, mass, or cerebral edema.2. Extensive patchy areas of supratentorial and infratentorial white matter hypoattenuation likely correspond to the reported history of multiple sclerosis. A brain MRI would be useful for further delineation, if clinically warranted.3. Pansinus opacification with polypoid components suggestive of sinonasal polyposis and diffuse sclerosis of the sinus walls suggestive of a chronic process. |
Generate impression based on findings. | 52-year-old male with tachycardia and history of metastatic colorectal carcinoma. PULMONARY ARTERIES: Diagnostic quality exam with no evidence of pulmonary embolus.LUNGS AND PLEURA: Multiple bilateral pulmonary nodules are again noted, some of which appear slightly increased; reference right lower lobe nodule currently measures 9 x 11 mm, previously measured 7 x 10 mm (series 9, image 66).Reference pleural-based anterior right middle lobe nodule measures 16 x 12 mm, previously measured 14 x 12 mm (series 8, image 28). No definite new nodules are identified. Small right and trace left pleural effusions. No consolidation.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. Diffuse hepatic metastases are again identified. Partially visualized biliary stent is noted, with expected pneumobilia. Large amount of ascites.Although this is not a dedicated abdominal CT with different timing of contrast bolus compared to prior exam, the reference hepatic segment 8 lesion appears increased in size, currently measuring 5.8 x 4.9 cm, previously measured at 5.0 x 4.5 cm (series 8, image 220). | 1.No pulmonary embolus.2.Minimal increase in size of bilateral lung metastases. No definite new nodules.3.Although there are technical differences compared to prior exam from 10/2013, the reference right hepatic lobe lesion appears increased in size.4.Large amount of ascites fluid. |
Generate impression based on findings. | 57 year-old male with nausea and vomiting, evaluate for bowel obstruction or worsening fluid collections. ABDOMEN:LUNG BASES: No focal hepatic lesions. Pneumobilia is again noted. A biliary stent is unchanged in position, extending to the duodenum. Air is again noted within the gallbladder.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: A loculated fluid collection containing gas abuts the head and uncinate process of the pancreas, similar to the prior study.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left simple cyst is again noted. Moderate right hydronephrosis similar to the prior study likely related to partial ureteral obstruction from adjacent inflammatory fluid collection. Extensive perinephric fluid collections as described below. Symmetric renal cortical enhancement.RETROPERITONEUM, LYMPH NODES: A loculated fluid collection containing gas extends within the right retroperitoneum along the right paracolic gutter and into the right lower quadrant. The inferior-most component measures 2.0 x 2.5 cm (image 75, series 3) and previously measured 1.8 x 3.9 cm. The superior component of the fluid collection adjacent to the uncinate process and kidney measures 3.9 x 9.0 cm (image 46, series 3) and previously measured 5.0 x 10.8 cm, mildly decreased in size. A right percutaneous catheter extends into the perinephric fluid collection.BOWEL, MESENTERY: Dilated fluid-filled stomach suggesting delayed emptying, possibly due to inflammatory collection adjacent to the pancreas, and duodenum. An enteric tube extends into the jejunum.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. Mild interval decrease in size of right perinephric/peripancreatic and retroperitoneal fluid collections. No new fluid collections. 2. Persistent moderate right hydronephrosis. |
Generate impression based on findings. | 21-year-old female with abdominal pain, generalized, but greater in the lower quadrant. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality noted -- benign. Left cortical cyst seen unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted in stomach, small or large bowel. Appendix is well visualized and normal in appearance. 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 noted in stomach, small or large bowel. Appendix is well visualized and normal in appearance. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Normal CT scan of the abdomen and pelvis without findings seen to account for patient's symptomatology. No change since 7/2/13. |
Generate impression based on findings. | Male 58 years old Reason: assess for infection History: pain, immunocompromise BONES, SOFT TISSUES: There is a prominent erosion of the superior lateral femoral head with associated fluid within the joint space. Patchy sclerosis is seen along the margin of the femoral head suggestive of avascular necrosis. There is a sclerotic band which traverses the mid femoral neck compatible with a fracture of indeterminate age.OTHER: No significant abnormality noted. | 1. Erosion of the femoral head, which may represent atypical infection, pigmented villonodular synovitis or synovial osteochondromatosis. 2. Findings suggestive of avascular necrosis.3. Possible femoral neck fracture of indeterminate age. |
Generate impression based on findings. | 79-year-old male with question of possible stroke. There is no evidence of intracranial hemorrhage, mass or edema. There is no CT evidence of stroke, however CT is suboptimal for evaluation of acute ischemic stroke.There are prominent sulci and mildly enlarged ventricles which are appropriate for the patient's age.The calvaria and skull base are radiographically normal. There is a moderate amount of fluid and mucosal thickening in the left maxillary and ethmoid sinuses and opacification of the mastoid sinuses. | No evidence of intracranial hemorrhage, mass, or stroke, however CT is suboptimal for evaluation of acute ischemic stroke. |
Generate impression based on findings. | 54-year-old male patient with distention, lack of ostomy output and feculent material around tracheostomy. Evaluate for obstruction versus ileus. CHEST:LUNGS AND PLEURA: Bilateral pleural effusions and dependent atelectasis. Atelectasis stable compared to prior examination. Tracheostomy tube in place. Bronchiectasis and scarring bilaterally in the lung bases, right greater than left.MEDIASTINUM AND HILA: Interval decrease in hemopericardium, measuring up to thickness of 2.0 cm around the left ventricle, previously 4.2 cm. Interval placement of drain over the left ventricle.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Stable diffuse calcifications within the pancreatic parenchyma, consistent with chronic pancreatic.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral atrophic native kidneys. Redemonstration of hyperattenuating cyst in the upper pole of the left kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Debris noted in the esophagus to the thoracic inlet. G-tube in place with thick debris within the stomach. Mildly dilated loops of small bowel with desiccated debris extending to the ileocecal valve. Divergent loop sigmoid colostomy in the left lower quadrant. No definite transition point. Oral contrast extending into ostomy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Large amount of abdominal ascites with dependent debris in the pelvis. Significant atherosclerotic changes.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Mildly dilated loops of small bowel with desiccated debris extending to the ileocecal valve. Divergent loop sigmoid colostomy in the left lower quadrant. No definite transition point. Oral contrast extending into ostomy.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Large amount of abdominal ascites with dependent debris in the pelvis. Significant atherosclerotic changes.Transplanted kidney in right iliac fossa with nephroureteral stent.Subcutaneous necrotizing focus in the left inguinal region measures 2.2 x 4.5 cm (series 3 image 205), new from prior examination.Redemonstration of right inguinal necrotic area with drain, stable. | 1.Debris within the esophagus and stomach with mildly dilated loops of small bowel. No evidence of obstruction. Findings most consistent with ileus.2.Interval decrease in hemoperitoneum with drain in place.3.New subcutaneous necrosis in the left inguinal region. |
Generate impression based on findings. | Clinical question: 28 year old male with T11, new severe headache. Rule out hemorrhage. Signs and symptoms: Headache. Nonenhanced head CT:No detectable acute intracranial process.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation. No evidence of edema, hemorrhage, mass effect or midline shift.Unremarkable calvarium, soft tissues of the scalp, orbits, paranasal sinuses or mastoid air cells. | Unremarkable nonenhanced head CT. |
Generate impression based on findings. | 49-year-old female with tuberous sclerosis, and generalized epilepsy, follow-up renal angiomyolipoma. ABDOMEN:LUNG BASES: Mild basilar atelectasis and small cysts.LIVER, BILIARY TRACT: Small punctate foci of fat likely representing AML are unchanged.SPLEEN: Unchanged small splenic AML.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple bilateral renal angiomyolipomas. The largest left inferior pole AML measures 4.5 x 3.1 cm and previously measured 4.7 x 3.4 cm (image 80, series 10). High density in the left lower pole lesion suggests prior hemorrhage. Bilateral simple cysts are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No significant interval change in bilateral renal angiomyolipomas with the largest left lower pole lesion measuring 4.5 cm. |
Generate impression based on findings. | 55-year-old male status post tumor resection. There has been interval left occipital craniotomy with resection of the left cerebellar mass. There is significant edema with a small amount of pneumocephalus and acute blood surrounding the surgical cavity, expected postsurgical findings. The fourth ventricle and basal cisterns are more patent on today's examination although they remain near completely effaced. There is unchanged crowding of the cerebellar tonsils and supratentorial herniation.There is decreased size of the lateral ventricles with persistent periventricular edema. There is calcification of the falx which is unchanged.The calvaria and skull base are radiographically normal with expected findings of left occipital craniotomy. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. | 1. Expected postsurgical findings status post resection of left cerebellar mass.2. Improvement in effacement of fourth ventricle with slight decrease in hydrocephalus. |
Generate impression based on findings. | Reason: thymoma History: myasthenia LUNGS AND PLEURA: Scarlike abnormality right middle lobe image 49 series 5, the lungs otherwise unremarkable.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.There is no evidence of thymoma or thymic hyperplasia.Severe coronary artery calcifications are present primarily involving the LAD but also be RCA. The esophagus is air filled and slightly distended throughout its entire intrathoracic course suggestive of an esophageal dysmotility.CHEST WALL: Degenerative abnormalities affect the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Bilateral renal cystlike hypodensities appear benign. Both adrenal glands appear prominent, probably benign hyperplasia. | 1. No evidence of thymic tissue.2. Severe coronary artery calcification.3. Possible esophageal dysmotility. |
Generate impression based on findings. | HA, found to have papilledema. There is a partially empty sella. There is minimal flattening of the optic discs bilaterally. There is no evidence of acute intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. | A partially empty sella and minimal flattening of the optic discs bilaterally may indicate intracranial hypertension. No evidence of intracranial hemorrhage, mass, or cerebral edema. |
Generate impression based on findings. | Female 62 years old; Reason: MESENTERIC MASS, POSITIVE ON PET BUT STABLE OVER TIME. EVALUATE FOR INTERVAL GROWTH History: COLON CANCER CHEST:LUNGS AND PLEURA: 4-mm right lower lobe peripheral nodule is stable compared to prior exams (series 5 image 56). No additional new pulmonary nodules.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. The heart is normal in size. No pericardial effusion.CHEST WALL: Numerous prominent supraclavicular lymph nodes with subtle increase in size of the reference right axillary lymph node measuring 1.7 x 1.1 (series 3 image 23) previously 1.3 x 0.9 cm. Right humeral prosthesis.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: Multiple bilateral subcentimeter renal hypodensities are too small to characterize but are unchanged from prior and likely represent benign renal cysts. Single nonobstructing calculi in the left upper pole collecting system.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Multiple enlarged mesenteric lymph nodes are unchanged to slightly smaller compared to the previous. The reference lymph node measures 1.0 x 0.8 cm (series 3 image 130) previously 1.3 x 1.0 cm .The small bowel is normal in caliber and wall thickness.BONES, SOFT TISSUES: Moderate degenerative changes of the thoracolumbar spine. No focal osseous lesion.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: Uncomplicated diverticulosis in the sigmoid colon. No clear focus of wall thickening to correspond with the patient's primary malignancy.BONES, SOFT TISSUES: No focal osseous lesion.OTHER: No significant abnormality noted. | No significant interval change in with stable reference lesions as described above. |
Generate impression based on findings. | Left sided facial swelling from temple to submandibular area. There is mild diffuse enlargement and heterogeneous hyperattenuation of the let parotid gland. There is no evidence of radio-opaque calculi. The right parotid gland and bilateral submandibular gland are unremarkable. There is diffuse stranding of the overlying subcutaneous fat. There is a hyperattenuating lesion in the left temporal subcutaneous tissues that measures 7 AP x 10 RL x 8 SI mm, which may represent a prominent lymph node. There are also several other prominent left suprahyoid lymph nodes. The upper aerodigestive track is patent. The paranasal sinuses and mastoid air cells are clear. The imaged portions of the cervical vessels are unremarkable. The osseous structures are unremarkable. The imaged intracranial structures and orbits are unremarkable. | Diffuse left facial cellulitis with mild swelling of the left parotid gland, which may represent parotitis, and reactive regional lymphadenopathy, but no evidence of abscess. |
Generate impression based on findings. | 33-year-old male with nausea, abdominal pain and vomiting with eating, evaluate for pathology. ABDOMEN: Contrast phase is late arterial rather than portal venous, limiting evaluation of solid organ pathology, likely due to heart dysfunction.LUNG BASES: Right cardiac lead is partially visualized. Cardiomegaly and dilated right atrium, IVC, and hepatic veins, suggesting right heart dysfunction. The lung bases are clear.LIVER, BILIARY TRACT: Dilated IVC, and hepatic veins, suggesting right heart dysfunction. SPLEEN: No significant abnormality notedPANCREAS: The pancreas demonstrates normal enhancement and morphology.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. No specific findings to account for the patient's abdominal pain.2. Cardiomegaly with dilated right atrium, IVC, and hepatic veins, suggesting right heart dysfunction. |
Generate impression based on findings. | S/P hemorrhagic stroke. There is right anterior frontal subarachnoid hemorrhage. The right temporal region subarachnoid hemorrhage is no longer conspicuous. There are unchanged scattered areas of cerebral white matter hypoattenuation, which is most pronounced in the bilateral frontal lobes and right cerebellar hemisphere. There is diffuse cerebral volume loss with mildly enlarged ventricles. There is persistent right frontotemporal scalp hematoma. There is no evidence of calvarial fracture. The imaged paranasal sinuses and mastoid air cells are clear. There are bilateral lens implants. | 1. Unchanged right frontal subarachnoid hemorrhage.2. Unchanged scattered areas of cerebral white matter hypoattenuation, which is most pronounced in the bilateral frontal lobes and right cerebellar hemisphere. |
Generate impression based on findings. | 52-year-old female with history of left breast cancer and multiple axillary lymph nodes. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.CHEST WALL: Several large left breast masses are identified. Left axillary adenopathy with the largest lymph node measuring 1.5 x 1.2 cm (image 24, series 3). Scattered right axillary lymph nodes, with normal fatty hila. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Left breast masses and left axillary lymphadenopathy without additional evidence of metastatic disease. |
Generate impression based on findings. | 29-year-old female with fevers and history of metastatic breast cancer. LUNGS AND PLEURA: Mild interval increase in multiple pulmonary metastases. Reference right lower lobe nodule measures 2.6 x 2 .4 cm, previously measured 2.2 x 2.1 cm (series 4, image 57). Reference left upper lobe nodule measures 2.0 x 2.1 cm, previously measured 1.8 x 1.7 cm (series 4, image 31).No consolidation, pleural effusions or specific findings to suggest superimposed infection.MEDIASTINUM AND HILA: Interval increase in bulky mediastinal and hilar lymphadenopathy, with persistent encasement of right lower lobe pulmonary artery. Pulmonary arteries remain patent. Reference left hilar node measures 4.7 x 3.2 cm, previously measured 4.2 x 2.5 cm (series 3, image 37). Reference subcarinal node measures 2.6 x 2.1 cm, previously measured 2.2 x 1.6 cm (series 3, image 48).No new nodules.Heart size normal. No pericardial effusionCHEST WALL: Bilateral breast implants. Lytic T5 lesion with associated mild central compression deformity appears similar. Round lucency in T10 also appears similar. No axillary lymphadenopathy.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Punctate subcentimeter hypodensity in segment 4 is stable, likely cyst. Previously seen segment 6 lesion is not included in field of view. | Mild but definite increase in size of multiple pulmonary metastases and mediastinal lymphadenopathy, without evidence of superimposed infectious process. |
Generate impression based on findings. | Female 38 years old; Reason: evaluate pelvic abscess fluid collection History: known abscess This study is limited due to lack of IV contrastABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Previously described hypodense lesions in the liver are not seen. Lack of IV contrast limits optimal evaluation of the liver.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes are unchanged since previous.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Patient status post hysterectomy.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER:Residual phlegmonous inflammation with no discernable fluid collection. Stable position of the pelvic drain. | Limited study due to lack of intravenous contrast.1. Residual phlegmonous inflammation with no discernable fluid collection. Stable position of the pelvic drain.2. Patient's known liver lesions cannot be evaluated due to lack of IV contrast. |
Generate impression based on findings. | 69-year-old male with history of ischemic stroke. There is continued evolution of the previously seen right parietal lobe stroke which now appears less dense. There is no evidence of increased size or hemorrhagic conversion. There is persistent local mass effect with effacement of the sulci without any midline shift or effacement of the lateral ventricle.The left parietal area of infarction is now better visualized, but appears unchanged from MR on 10/20.Extensive periventricular and subcortical low attenuation lesions are again seen which are consistent with age indeterminate small vessel ischemic disease. A chronic appearing right cerebellar infarct is again noted.The fourth ventricle is somewhat prominent, otherwise the ventricles and basal cisterns are normal in size and configuration.There is a chronic healed fracture of the left lamina papricia. There is a moderate amount of fluid in the sphenoid sinus and mucosal thickening in bilateral maxillary sinuses which has not significantly changed. | 1.Continued evolution of right parietal lobe stroke without evidence of increase in size or hemorrhagic conversion. 2.Scattered age indeterminate small vessel ischemic disease. |
Generate impression based on findings. | Reason: baseline exam prior to starting systemic oral TKI therapy History: hx of metastatic renal cell cancer LUNGS AND PLEURA: 4-mm nodule in the right middle lobe (series 4 image 67), increased from 2 mm on the previous scan.The differential diagnosis includes metastasis and intrapulmonary lymph node.Other micronodules are unchanged.MEDIASTINUM AND HILA: Severe coronary artery calcification.No significant lymphadenopathy.CHEST WALL: Degenerative abnormalities and possible hemangiomas in the spine, unchanged.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Large mass in the area of the left adrenal gland measuring 13.0 by 10.2 cm, slightly increased from 12.8 x 9.7 cm previously.An adjacent pancreatic mass has not appreciably changed. Additional soft tissue nodules adjacent to the spleen, without appreciable change. | 4 mm nodule in the right middle lobe increased from 2 mm previously, which remains indeterminate for metastasis versus an intrapulmonary lymph node. Further follow up is recommended. |
Generate impression based on findings. | New onset seizure activity. There is extensive periventricular and subcortical low attenuation of white matter remains without evidence of mass effect. There is unchanged moderate diffuse cerebral and cerebellar volume loss. There is no mass-effect or midline shift. There is no acute intracranial hemorrhage. Stable fluid is again noted in the right maxillary sinus. The remaining sinuses and mastoid air cells are clear.Unremarkable images through the orbits. There has been interval increase in size of a skin excrescence along the midline apex of the scalp, now measuring up to 8 mm, previously 5 mm. | 1. Extensive cerebral white matter volume loss and hypoattenuation is not significantly changed. However, noncontrast CT is insensitive for early infarct and detection of seizure foci. Brain MRI with contrast may be useful for further investigation.2. No evidence of acute intracranial hemorrhage.3. Interval increase in size of a skin excrescence along the midline apex of the scalp, now measuring up to 8 mm, previously 5 mm, which may represent a neoplasm.Discussed with Dr. Warnecke at10:20 AM on 10/24/13. |
Generate impression based on findings. | 57 year-old female with CHF, dizziness, and critical aortic stenosis. Evaluate the aortic size in patient being evaluated for aortic valve replacement. LUNGS AND PLEURA: No consolidation or pleural effusions. Scattered calcified and noncalcified bilateral punctate micronodules, likely benign in etiology. No suspicious nodules. Mild atelectasis in left base. Focal linear opacity along lateral aspect of left upper lobe, consistent with scarring.MEDIASTINUM AND HILA: Heart mildly enlarged. Extensive calcifications affect the aortic and mitral valves. Minimal atherosclerotic calcifications are seen in the aortic arch. No pericardial effusion. Pulmonary artery is upper normal in size, measuring 3.0 cm in diameter.Multiple moderately enlarged mediastinal lymph nodes, which are nonspecific, possibly due to sarcoid.Aortic measurements as follows (accuracy of measurements may be suboptimal given lack of IV contrast):ANNULUS: Not accurately measurable.SINUS OF VALSALVA: 2.9 X 3.1 cmSINOTUBULAR JUNCTION: 2.9 X 2.7 cmASCENDING THORACIC AORTA AT LEVEL OF MAIN PULMONARY ARTERY: 4.0 X 3.9 cmASCENDING THORACIC AORTA IMMEDIATELY PROXIMAL TO THE INNOMINATE ARTERY: 3.8 X 3.6 cmPROXIMAL DESCENDING THORACIC AORTA IMMEDIATELY DISTAL TO THE LEFT SUBCLAVIAN ARTERY: 2.9 X 2.8 cmDESCENDING THORACIC AORTA AT LEVEL OF HIATUS: 2.4 X 2.3 cmCHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.Upper normal ascending aortic diameter as detailed above. 2.Nonspecific moderately enlarged mediastinal lymph nodes. |
Generate impression based on findings. | Reason: ?evidence of active/progressive sarcoid History: shortness of breath, cough LUNGS AND PLEURA: Stable upper lobe predominant perihilar bronchovascular areas of fibrosis, architectural distortion, traction bronchiectasis.Apical predominant bullae unchanged.No new suspicious pulmonary nodules or masses.Pleural thickening without evidence of effusions.MEDIASTINUM AND HILA: Stable subcarinal lymphadenopathy.Cardiac size is normal without evidence of a pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Unchanged extensive upper lobe predominant perihilar fibrosis, architectural distortion, and traction bronchiectasis in a bronchovascular distribution compatible with known history of sarcoidosis. There is accompanying paraseptal emphysema large apical bullae. No suspicious pulmonary nodules or masses. |
Generate impression based on findings. | 62-year-old male with history of bilateral infarct. The wedge-shaped area of hypodensity in the posterior right medial temporal, right occipital, and left paramedian occipital lobe appears to have lower density. There is no evidence of increase in size or hemorrhagic conversion. There is regional mass effect with persistent effacement of the occipital horn on the right lateral ventricle, no midline shift.The areas of low density in the anterior right parietal lobe and left supramarginal gyrus are unchanged.The calvaria and skull base are normal. There is unchanged mucosal thickening of the right maxillary sinus and fluid in the mastoid air cells bilaterally. | Evolution of PCA-territory stroke involving the right medial temporal, right occipital, and left paramedian occipital lobes without significant increase in size or hemorrhagic conversion. |
Generate impression based on findings. | Reason: ant chest ache, cough on persistent smoker History: as above LUNGS AND PLEURA: A diffuse bilateral groundglass opacity is present with strong and basilar predominance.Multiple small areas of air trapping are present at the lung bases suggestive of small airways disease. These findings are somewhat accentuated by partial expiration. Moderate bronchial thickening is present.Previous diffuse bilateral nodular air space opacities, compatible with infection, have cleared.MEDIASTINUM AND HILA: No significant lymphadenopathy.Calcification or possibly a stent in the left anterior descending coronary artery.CHEST WALL: Mildly enlarged axillary lymph nodes, unchanged.Degenerative disease in the spine with end plate depression of two midthoracic vertebrae.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Status post cholecystectomy. | Diffuse interstitial lung disease with basilar predominant ground glass opacity and moderate underlying emphysema with areas of focal air trapping.In view of the history of persistent smoking the differential diagnosis includes respiratory bronchiolitis interstitial lung disease (RBILD) and desquamative interstitial pneumonitis (DIP). The findings are also compatible with NSIP, and a similar appearance can be seen in drug reactions. Hypersensitivity pneumonitis seems unlikely in the context of cigarette smoking. |
Generate impression based on findings. | 72-year-old male with history of base of tongue cancer, with productive cough for two months. Evaluate for worsening aspiration. LUNGS AND PLEURA: Stable right apical scarring and small loculated pleural effusion. Scarlike opacity in the anterior aspect of the left upper lobe is unchanged (series 5, image 62).Persistent ill-defined opacities and tree in bud nodularity in the lung bases, right more than left, with slight improvement in the left base; compatible with aspiration especially given presence of mucous material in the bronchus intermedius, mucus plugging of the right upper lobe bronchi, and basilar bronchial wall thickening/bronchiectasis. New ill-defined opacities in the anterior aspect of right middle lobe, also most likely due to aspiration and resultant postinflammatory scarring (series 5, image 89).No new or suspicious nodules.Severe emphysema. MEDIASTINUM AND HILA: Reference AP window node is stable, measuring 8 mm. Heart size normal. No pericardial effusion. Moderate atherosclerotic calcifications in the aortic arch and coronary arteries. Enlarged main pulmonary artery, suggestive of pulmonary arterial hypertension.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. G-tube in place. | Chronic aspiration without evidence of superimposed infection or metastatic disease. |
Generate impression based on findings. | Critical question: Altered mental status rule out hemorrhage. Signs and symptoms: As above. Unenhanced head CT:There is no detectable acute intracranial process CT however is insensitive for detection of acute nonhemorrhagic ischemic strokes. There are diffuse subcortical and periventricular confluence of low attenuation of white matter consistent with advanced age indeterminate small less ischemic strokes. Similar changes are also present bilateral basal ganglia and left thalamus.No detectable cerebral cortical abnormalities. Unremarkable cortical sulci. Mildly dilated lateral ventricles secondary to advanced small vessel ischemic strokes. Midline is maintained. Unremarkable images through posterior fossa.Unremarkable calvarium, all paranasal sinuses and mastoid air cells and partially visualized orbits. | Extensive age indeterminate small vessel ischemic strokes. |
Generate impression based on findings. | Reason: h/o larynx cancer History: r/o lung mets LUNGS AND PLEURA: No significant abnormality noted. No evidence of pulmonary or pleural metastases.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.Status post tracheostomy and neck dissection with a phonation device in place.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Scattered stable hepatic cystlike hypodensities. | No change, and no evidence of metastases. |
Generate impression based on findings. | Clinical portion coiled in without hemorrhage. Signs and symptoms: Alteration of mental status and right facial droop. Unenhanced head CT:No evidence of acute intracranial process. CT ovaries insensitive for detection of acute nonhemorrhagic ischemic strokes.There are several patchy foci of periventricular and subcortical low attenuation white matter which considering patient's stated age of 87 likely representing age indeterminate small vessel ischemic strokes. Minimal similar findings in bilateral basal ganglia and left thalamus is also noted.Unremarkable signal cortex, cortical sulci, ventricular system and gray -- white matter to initiation otherwise.Unremarkable calvarium and soft tissues of the scalp.Unremarkable visualized paranasal sinuses, mastoid air cells and orbits. | Age indeterminate small vessel ischemic strokes and unremarkable exam otherwise. |
Generate impression based on findings. | Reason: r/o mass History: cough LUNGS AND PLEURA: Right apical scarring is present, possibly radiation reaction as the patient has had a prior right mastectomy and axillary dissection.Otherwise, the lungs are normal in appearance.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy present.A very small amount of pericardial fluid is stable since 2007, probably physiologic.CHEST WALL: Right mastectomy and axillary dissection.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Very small subcentimeter right hepatic lobe cyst-like hypodensity image 92 series 3 is not well seen on the prior study although there are differences in the phase of contrast, and it appears benign. | No significant abnormality. Mild evolution of right apical radiation reaction. |
Generate impression based on findings. | Reason: s/p 3mo after left VATS LUL lobectomy, mediastinal LN dissection for adenocarcinoma (pT1aN0), mediastinal LN dissection (0 nodes postive).Stage 1a NSLC History: 3 mo f/u LUNGS AND PLEURA: Postsurgical changes related to interval left upper lobectomy for lung cancer.Mild focal pleural thickening and left upper mediastinal postsurgical fibrotic changes .No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of pericardial effusion.Moderate aortic and mitral valve calcification.Small hiatal hernia.CHEST WALL: Degenerative changes in the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Status post cholecystectomy. Evidence of previous pancreatic surgery. | No evidence of recurrent or metastatic disease. |
Generate impression based on findings. | 51-year-old female with gallbladder cancer, restaging CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Right central venous catheter tip at the cavoatrial junction.CHEST WALL: Prominent bilateral axillary lymph nodes are again noted with the reference right node measuring 2.0 x 1.1 cm (image 48, series 5) and previously measuring 2.5 x 2.1 cm, moderately decreased in size. Right chest wall collection is markedly decreased in size and now measures 3.7 x 1.8 cm (image 77, series 5) and previously measured 3.5 x 9.5 cm.ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. No focal hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Moderate degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small nonobstructive umbilical hernia containing fat, and small bowel.OTHER: No significant abnormality noted. | 1. Status post cholecystectomy without evidence of metastatic disease.2. Right chest wall soft tissue collection markedly decreased in size with improvement in axillary adenopathy. |
Generate impression based on findings. | 67-year-old male with history of right upper lobe lung cancer. LUNGS AND PLEURA: Status post right upper lobectomy, with stable linear scarlike opacity in the right apex and in right lower lobe adjacent to right hilum (series 5, image 49). No new or suspicious pulmonary nodules.Stable mild narrowing of the right middle lobe bronchus. Mild emphysema. No specific evidence of edema or infection.MEDIASTINUM AND HILA: Moderate atherosclerotic calcifications of the coronary arteries and aorta. No mediastinal lymphadenopathy. Reference right hilar node measures 9 mm, unchanged (series 4, image 55). Heart size stable. No pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Postsurgical changes in the right lung without evidence of recurrence or metastatic disease. |
Generate impression based on findings. | 68 year-old male with pleural mesothelioma status post resection and chemotherapy. LUNGS AND PLEURA: Status post left pneumonectomy with large collection of fluid in the pneumonectomy cavity. Left diaphragmatic, pleural, and pericardial graft material are again noted. No new areas of pleural thickening are appreciated on the left.There is new scattered tree in bud opacities throughout the right lung with associated bronchial wall thickening suggestive of bronchiolitis from possible microaspiration. No evidence of pleural thickening. MEDIASTINUM AND HILA: There is mild decrease in previously noted mediastinal fat stranding at the level of the great vessels (series 4, image 24). Multiple surgical clips in the aortopulmonary window region. No evidence of pericardial effusion. Moderately severe coronary artery calcifications.Right paraesophageal lymph node (series 4, image 85) measuring 11 mm is unchanged in size. An adjacent lymph node appears larger in size compared to prior exam, likely reactive. Right subcentimeter, likely reactive paratracheal lymph nodes. CHEST WALL: Subcentimeter left posterior soft tissue enhancing nodule is no longer seen. Stable left lateral chest wall soft tissue asymmetry near the level of the medial diaphragm.Sclerosis of the posterior processes of the upper thoracic spine, unchanged and likely benign.UPPER ABDOMEN: Elevation of the left hemidiaphragm. No significant abnormality noted. | 1.Status post left pneumonectomy with no signs of recurrence. 2.New diffuse bronchiolitis pattern in the right lung suggestive of recurrent microaspiration and/or infection. |
Generate impression based on findings. | Reason: history of R lung cancer s/p palliative RT in 2/2013, History: sob CHEST:LUNGS AND PLEURA: Right middle lobe nodular density (image 123 series 5) is unchanged measuring 7 mm.Right lower lobe nodular and scarlike opacities stable.Postsurgical changes in the right lower lobe redemonstrated.Severe emphysema and bronchial wall thickening similar in appearance the prior exam.No new suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Hypodensities in the left thyroid lobe unchanged.No hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of a pericardial effusion.Severe coronary artery and aortic calcification with ectasia of the ascending and descending aorta with mural thrombus redemonstrated in the lower descending aorta.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Mild dilatation of the intra-and extra hepatic biliary system unchanged.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Renal cysts unchanged.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Extensive atherosclerotic changes of the abdominal aorta with aneurysmal dilatation of the infrarenal abdominal aorta and prominent mural thrombus. Aortic femoral bypass graft redemonstrated.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Anterior abdominal wall hernia unchanged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Stable right middle lobe nodule No evidence of metastatic disease. |
Generate impression based on findings. | Male 68 years old; Reason: pt with mesothelioma recurrent as of 10/2/13. No therapy yet History: now needs disease evaluation compare to previous scans and comment ABDOMEN:LUNGS BASES: Please refer to CT chest done same day for full evaluationElevation of the left hemidiaphragm, unchanged.LIVER, BILIARY TRACT: No significant abnormality detected.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Nonspecific lesion in the interpolar left kidney anteriorly measures 10 x 10 mm, unchanged in size (7/42). This remains indeterminate given its density. PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: IVC filter.BOWEL, MESENTERY: No significant abnormality detected.BONES, SOFT TISSUES: Surgical sutures are noted in the left flank, with interval resolution of the previously seen enhancing mass.OTHER: Elevation of the left diaphragm.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 new or evident recurrence detected. 2.Please refer to CT chest performed same day for full characterization. |
Generate impression based on findings. | 42 year old female, history of autosomal dominant polycystic kidney disease and nephrolithiasis, evaluate for nephrolithiasis. Examination is limited by the lack of IV and oral contrast in the evaluation of solid organ pathology, vasculature, and bowel. Given these limitations, the following observations are made.ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Marked hepatomegaly with innumerable cysts present throughout the liver. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple bilateral, hypodense renal lesions of various densities are again noted, unchanged. Punctate hyperdensities in bilateral kidneys consistent with small stones appear similar to the prior study. The right kidney is displaced inferiorly by the large liver.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No bowel wall thickening, dilatation, free or loculated fluid.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Fibroid uterus with note made of several exophytic fibroids.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No bowel wall thickening, dilatation, free or loculated fluid.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Punctate nonobstructive renal calculi appearing similar to the prior study. No hydronephrosis or hydroureter.2. Innumerable renal and hepatic cysts compatible with the history of autosomal dominant polycystic kidney disease as detailed above.3. Fibroid uterus. |
Generate impression based on findings. | 38 -year-old male with Hodgkin lymphoma -- restaging. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Scattered subcentimeter lymph nodes seen in mediastinum unchanged from 2013 and 2010 examinations without evidence of enlarged lymph nodes.CHEST WALL: Scattered normal sized axillary lymph nodes bilaterally seen, unchanged -- no enlarged lymph nodes identified.ABDOMEN: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 enlarged retroperitoneal lymph node seen with no change since 2013, January examination. No other abnormalities.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 change in the intrapelvic appearance to the, lymph nodes without significant lymph node enlargement -- the largest lymph node seen in the left external iliac chain measures 9 mm in short axis dimension and is unchanged dating back to 2010.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Slightly prominent inguinal lymph nodes are seen, left greater than right in a pattern unchanged. The prior reference measured lymph node now measures 1.1 x 1.6 cm (series 3, image 200) compared with 1.9 x 1.1 cm previously.OTHER: No significant abnormality noted | No significant lymphadenopathy seen in the chest, abdomen or pelvis, and without other significant abnormality. The previous referenced left inguinal lymph node remains unchanged in size. |
Generate impression based on findings. | 75-year-old female. Lung cancer screening. LUNGS AND PLEURA: Mild to moderate upper lobe predominant emphysema. Few calcified micronodules are unchanged. No new or suspicious nodules or masses. Mild basilar atelectasis.MEDIASTINUM AND HILA: Moderate atherosclerotic calcifications in aorta and coronary arteries. Heart size normal. No pericardial effusion. No mediastinal lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Hypodense lesions in both kidneys, some of which are only partially visualized, but most likely represent benign cysts. Hepatic hypodensities, some of which are too small to characterize, also most likely represent cysts. | Emphysema without suspicious lung nodules. |
Generate impression based on findings. | 61-year-old female with left upper quadrant pain -- history of ovarian cancer. CHEST:LUNGS AND PLEURA: New left lower lobe supradiaphragmatic nodule seen measuring 1.3 cm -- in retrospect a small nodule was present measuring 6 mm on 1/17/13. No other infiltrates, nodules, masses or effusions seen.MEDIASTINUM AND HILA: No adenopathy or other significant abnormality noted.CHEST WALL: Right anterior chest wall Port-A-Cath with tip catheter in the distal superior vena cava without change.ABDOMEN:LIVER, BILIARY TRACT: Liver parenchyma appears homogeneous with normal portal and hepatic venous enhancement. The prior noted abnormality anterior to segment 4 along surface of the liver is seen. Smaller in size (series 3, image 114) at 2.2 x 0.9 cm.. This was in an area where abnormal loculated fluid collection outside the liver was seen previously and this has been assumed radiologically to represent postsurgical changes -- continued follow-up is recommended to ensure this is not peritoneal seeding of disease.Post cholecystectomy without other biliary tract abnormality.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Normal right gland -- slight nodularity to the left gland is stable in appearance over past several examinations.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted -- no enlarged lymph nodes identified.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy with no evidence of recurrent or residual mass..BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted -- no enlarged lymph nodes identified.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. New left lower lobe 1.2-cm nodule, most consistent with metastatic focus. 2. Slight decrease in size and residual low attenuation involving the anterior aspect of left lobe of liver -- this has appearance consistent with postoperative change, but should be followed to ensure this is not peritoneal seeding of tumor. |
Generate impression based on findings. | Female 49 years old; Reason: severe pain History: dIFFUSE PAIN Limited evaluation due to the lack of IV and oral contrast in the evaluation of solid organ pathology, lymphadenopathy and vasculature.ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Minimal symmetric bilateral perinephric stranding and small kidneys for the patient's age. Moderate calcification is present at the origin of both renal arteries.RETROPERITONEUM, LYMPH NODES: Moderate calcification at the origin of bilateral renal arteries.BOWEL, MESENTERY: No bowel wall dilatation, wall thickening, free or loculated fluid.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 bowel wall dilatation, wall thickening, free or loculated fluid.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.No specific findings to account for the patient's pain. |
Generate impression based on findings. | 63-year-old female patient with history of 1.7-cm right renal mass, urothelial versus renal. 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 renal calculi on noncontrast images. Within the left kidney there are 3 subcentimeter hypoattenuating foci, the largest of which measures 0.6 x 0.8 cm (series 80445 image 34 and 30). These foci do not demonstrate enhancement and are too small to characterize.No masses or suspicious lesions in the right kidney. Delayed images do not demonstrate any filling defects in the collecting system.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: End-to-side anastomosis in the jejunum.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumber spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: End-to-side anastomosis in the jejunum.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumber spine.OTHER: No significant abnormality noted. | 1.No suspicious renal masses or filling defects in the collecting system.2.Three hypoattenuating foci within the left renal cortex are too small to characterize and most likely represent cysts.3.No renal calculi. |
Generate impression based on findings. | Female 80 years old; Reason: Evaluation of left lower quadrant nodularity (?mass) of the abdominal wall and for intraabdominal adenopathy. Ovaries absent on recent pelvic ultrasound. History: Weight loss and night sweats. Palpable abdominal wall mass left lower quadrant mass. ABDOMEN:LUNGS BASES: No nodule or mass detected. Simple appearing lipoma incompletely visualized on this examination measuring approximate 4 cm in diameter.LIVER, BILIARY TRACT: The liver is normal in morphology. No suspicious mass detected. The gallbladder is markedly distended with stones. No evidence of cholecystitis.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: Moderate to severe atheromatous calcifications of the abdominal aorta and branch vessels.BOWEL, MESENTERY: Significant stool burden noted throughout the colon. Diverticulosis without evidence of diverticulitis.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: Bowel appears normal. Focal Mesenteric nodularity and fat stranding noted in the left lower quadrant, nonspecific. This may be scarring from prior inflammation (such as diverticulitis), but mesenteric metastatic disease could look similar if patient has a history of appropriate primary cancer.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace free fluid noted in the pelvic cul-de-sac. | 1.Focal mesenteric nodule/Infiltrative changes in the left lower quadrant anterior mesentery, nonspecific. This can be seen in scarring, however metastatic neoplasm cannot be excluded given lack of prior imaging.2. Cholelithiasis without cholecystitis |
Generate impression based on findings. | 55-year-old male with history of bladder cancer. Status post cystectomy with neobladder reconstruction. Rule out stricture. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Normal appearing left renal contrast excretion filling the ureter to the level of the anastomosis. No hydronephrosis Atrophic right kidney, without evidence of contrast excretion.RETROPERITONEUM, LYMPH NODES: Shotty mesenteric and retroperitoneal adenopathy is unchanged.BOWEL, MESENTERY: Shotty mesenteric and retroperitoneal adenopathy is unchanged.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Status post neobladder creation. Soft tissue prominence is noted at the ureteral anastomosis without evidence of ureteral dilatation.LYMPH NODES: Prominent bilateral external iliac lymph nodes are unchanged with the largest left external iliac lymph node measuring 2.1 x 1.4 cm (image 124, series 6) and previously measuring 2.3 x 1.4 cm (series 12, image 111).BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Cystic collections in bilateral inguinal canals along the spermatic cord possibly representing seromas or cysts are unchanged. Fat extends into a right inguinal hernia. | Status cystectomy with neobladder creation without significant interval change or new evidence of metastatic disease. |
Generate impression based on findings. | Reason: COPD, heavy smoking, asbestos exposure History: cough LUNGS AND PLEURA: Multiple micronodules, most compatible with previous infection and intrapulmonary lymph nodes.No suspicious nodules.Mild upper zone centrilobular emphysema and moderate diffuse bronchial thickening compatible with bronchitis.Secretions are present in the central airways.No pleural effusions or calcification.MEDIASTINUM AND HILA: No significant lymphadenopathy.Moderately severe coronary artery calcification.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Emphysema and bronchitis, with several nonspecific micronodules which are most likely benign.In view of the patient's high risk status follow-up with annual low-dose CT scans would be appropriate. |
Generate impression based on findings. | Reason: 34 male with AML, r/o baseline infiltrate History: AML LUNGS AND PLEURA: Focal air space opacity deep in the left costophrenic sulcus is consistent with localized infection.Several small ground glass nodules are present in the right lung base.MEDIASTINUM AND HILA: Numerous mediastinal lymph nodes are present, but are small, less than 1 cm in diameter.Low attenuation of the circulating blood pool is consistent with anemia.The right PICC terminates low in the SVC.CHEST WALL: Numerous axillary lymph nodes are present.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. The spleen is markedly enlarged, with at least one accessory splenule. | 1. Left lung base focal opacity, consistent with infection although a leukemic infiltrate is in the differential diagnosis.2. Marked splenomegaly. |
Generate impression based on findings. | Reason: eval known bilateral lung transplant History: see above LUNGS AND PLEURA: Scarring/discoid atelectasis in the left lower lobe.No suspicious pulmonary nodules or masses.No pleural effusions.MEDIASTINUM AND HILA: Left central venous catheter with its tip in the SVC.No hilar or mediastinal lymphadenopathy.Surgical clips in the hilar regions compatible with a bilateral lung transplant.CHEST WALL: Median sternotomy .UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. Perfusion abnormality involving the caudate lobe of the liver. Postsurgical changes within the stomach. | Status post bilateral lung transplant without evidence of acute abnormalities or complications. |
Generate impression based on findings. | Status post sigmoid resection. Presenting with increased leukocytosis ABDOMEN:LUNG BASES: There is a subcentimeter nodule, best seen on image number two, series number 3. Further evaluation with chest CT may be helpful.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: There are multiple borderline enlarged retroperitoneal lymph nodes. An index left para-aortic lymph node measures 1.1 x 0.7 cm on image number 71, series number 3.BOWEL, MESENTERY: There small amount of free air and free fluid in the abdomen.In addition there is increased fat stranding in the pelvis, predominantly in the right lower quadrant.There is a small air-containing fluid collection in the pelvis on the right side near the anastomosis measuring 1.6-cm in diameter image number 118, series number 3.In addition there is significant wall thickening involving the cecum basin a long segment of distal ileum including the terminal ileum. Between the small bowel loops there is a small collection measuring 2.1-cm in diameter image number 95, series number 3.Postsurgical changes involving the sigmoid colon.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Please see discussion above.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Postsurgical changes in the pelvis. There are two small collections, one neared anastomosis and a second one near the terminal ileum.Significant wall thickening involving the cecal base and distal ileal loops. Etiology is unknown but may be secondary to infection and less likely ischemia.Small amount of free air and fluid in the abdomen are likely due to recent surgery.Chest CT is recommended for further evaluation of the chest for nodules. Subcentimeter left lower lobe lung nodule.Borderline enlarged retroperitoneal lymph nodes of uncertain significance and etiology. |
Generate impression based on findings. | 82-year-old female with abdominal pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: G-tube is in place. No evidence of collections.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No specific CT findings to explain patient's acute abdominal pain. No significant change from previous study. |
Generate impression based on findings. | Male 61 years old Reason: abd pain, s/p radical cystectomy and ileal conduit urinary diversion 10/16/13 History: abd pain ABDOMEN:LUNG BASES: Basilar atelectasis.LIVER, BILIARY TRACT: Diffuse fatty liver. No focal lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Small fatty mass in the left adrenal gland consistent with a benign myelolipoma measuring 1.5 x 1.1 cm, series 4 image 37.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Post cystectomy. Loop ileostomy. JP drain in place.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Minimal free fluid in the surgical bed. No loculated fluid to suggest abscess. Sigmoid diverticulosis. No bowel dilatation.BONES, SOFT TISSUES: Moderate amount of fluid in the surgical wound without enhancing rim. Continued follow-up and clinical correlation advised. Loop ileostomy. Right lower quadrant.OTHER: No significant abnormality noted | Expected postsurgical changes with small amount of fluid in the pelvis and in the surgical scar. No loculation to suggest abscess, however.Fatty liver. Left adrenal myelolipoma. |
Generate impression based on findings. | History of intranasal polyps and sinusitis. Evaluate for sinus disease after treatment with intranasal steroids. There is an opacified left superior anterior ethmoid air cell adjacent to the basal lamina. The paranasal sinuses and mastoid air cells are otherwise clear. There is mild nasal septal deviation and 4 mm rightward spur. There is a pneumatized crista galli. The left ethmoid roof is 2 mm higher than the right, but these appear to be intact. The optic canals and carotid grooves are covered by bone. The imaged intracranial structures and orbits are grossly unremarkable. | Opacified left ethmoid air cell, but otherwise clear paranasal sinuses and nasal cavity. |
Generate impression based on findings. | Postop menopausal bleeding. Increased abdominal distention.. ABDOMEN:LUNG BASES: Small pleural effusions.LIVER, BILIARY TRACT: There are multiple hypodense lesions in the liver suspicious for metastatic disease. Index lesion in the right lobe measures 1.1-cm image number 32, series number 3.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right sided moderate hydronephrosis with delayed nephrogram secondary to invasion of the right ureter by the pelvic mass. Left kidney is unremarkable.RETROPERITONEUM, LYMPH NODES: Borderline enlarged retroperitoneal lymph nodes. An index aortocaval node measures 1 x 0.6 cm image number 84, series number 3.BOWEL, MESENTERY: Extensive peritoneal carcinomatosis with omental caking and large amount of ascites.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Leiomyomatous uterus. Ill-defined soft tissue in bilateral adnexa which cannot be differentiated from the enlarged uterus. There is a fat containing mass in the left adnexa.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Small amount of ascites.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Extensive peritoneal carcinomatosis and metastatic liver disease.Right-sided hydronephrosis caused by decompression of the pelvic mass.Ill-defined soft tissue mass in the pelvis, which cannot be differentiated from the leiomyomatous uterus. Bilateral adnexal masses cannot be excluded. |
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