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Generate impression based on findings. | 56-year-old male with chest pain and dysphagia. History of lung cancer. Evaluate for esophageal compression. LUNGS AND PLEURA: Interval decrease in the infiltrative, right paramediastinal mass and associated paramediastinal right upper lobe scarring; the soft tissue mass and the scarred lung currently measures 5.9 x 2.7 cm, previously this measured 6.7 x 4.4 cm (series 3, image 41). Interval decrease of previously seen compression of right mainstem bronchus. Again seen is narrowing of the superior vena cava, which remains patent (series 3, image 46). Persistent mild narrowing of the right main pulmonary artery.Mild basilar atelectasis but no consolidation or pleural effusions.Area of lucency in the left lower lobe most compatible with focal perfusion abnormality.MEDIASTINUM AND HILA: Infiltrative right upper mediastinal mass as described above. Infiltrative soft tissue abuts the mid-esophagus, with associated thickening of the esophageal wall and apparent narrowing of the mid-esophageal lumen (series 3, image 51). Small amount of fluid is seen in the upper esophagus, suggestive of resultant stasis.No significant mediastinal adenopathy. Heart size normal. Mild coronary artery calcifications.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.Interval decrease in right mediastinal mass as described above.2.Soft tissue surrounding the esophagus causing narrowing of lumen with resultant air fluid level in or proximal esophagus suggestive of stasis. |
Generate impression based on findings. | 53-year-old male with abdominal pain, history of SBO and gastric cancer, ABDOMEN: The lack of IV contrast limits evaluation of solid organ pathology.LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: The patient's known hepatic metastases are poorly visualized due to the lack of IV contrast, but several hypoattenuating lesions are again noted.SPLEEN: Status post splenectomy with several splenules noted.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Reference gastrohepatic lymph node measures 2.2 x 2.2 cm and previously measured 2.3 x 2.1 cm (image 34, series 3).BOWEL, MESENTERY: The gastric wall remains thickened and the stomach is distended. Postsurgical change of the upper abdomen and GE junction. Mesenteric root mass measures 3.3 x 3.4 cm and previously measured 2.9 x 3.4 cm (image 62, series 3). Adenopathy and wall thickening about the stomach and pancreas near the gastric outlet appears similar to the prior study. The small bowel is normal in caliber.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. Gastric distention with wall thickening/adenopathy at the gastric outlet consistent with partial gastric outlet obstruction.2. Limited exam demonstrating metastatic disease as detailed above. |
Generate impression based on findings. | History of renal cell cancer ABDOMEN:LUNG BASES: Bilateral trace pleural effusions, new from previous study.LIVER, BILIARY TRACT: Hypodense lesion in the left lobe of the liver likely a benign lesion, unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post left nephrectomy. No evidence of recurrence. Benign-appearing right renal cyst in the lower pole is minimal increase in size and now measures 1.5 cm on image number 65 of series number 8 without any evidence of enhancement. Another subcentimeter punctate angiomyolipoma in the lower pole of the right kidney is also unchanged.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes are unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Sclerotic bone lesions involving the pelvic bones are unchanged.OTHER: No significant abnormality noted | No evidence of recurrent or metastatic disease.New, trace, bilateral pleural effusions. |
Generate impression based on findings. | 71-year-old female with history of gastric cancer CHEST:LUNGS AND PLEURA: Scarring in the right lung base.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: 7-mm soft tissue density left renal/perirenal lesion on image number 98 on series number 3. Follow-up imaging is recommended.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes secondary to partial gastrectomy. Fat stranding and soft tissue density in the greater omentum and gastrocolic ligament consistent with peritoneal carcinomatosis. Small amount of ascites is present.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. | Postsurgical changes secondary to gastrectomy. CT findings compatible with peritoneal carcinomatosis.Follow-up imaging is recommended for further evaluation of the subcentimeter left renal/perirenal lesion. |
Generate impression based on findings. | Male, 53 years old, nasal obstruction, polyps on exam. Assess for chronic sinusitis and extent of nasal polyposis. The frontal sinuses are clear. Mucosal thickening is seen at the level of the frontoethmoidal recesses, more so on the left. The sphenoid sinuses are clear. The sphenoethmoidal recesses are obscured by mild mucosal thickening. Mild mucosal thickening is evident within the ethmoid air cells.The maxillary sinuses are free of significant mucosal thickening and debris. Mild mucosal thickening is evident along the bilateral maxillary outflow pathways.Polypoid soft tissue is evident within the medial nasal cavity on the right and very likely on the left as well. Aside from this, the turbinates are unremarkable. The nasal septum is intact and deviates gently towards the left. | Nasal cavity polyps. No other definite evidence of active sinus disease. |
Generate impression based on findings. | Clinical question: Rule out bleed. Signs and symptoms: Pain. Nonenhanced head CT:There is no detectable acute intracranial process. CT however is insensitive for detection of acute nonhemorrhagic ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation for patient's stated age.Calvarium and soft tissues of the scalp are unremarkable.The minimal chronic left maxillary sinusitis is noted.Unremarkable mastoid air cells, middle ear cavities and bilateral orbits. | 1.No active intracranial process.2.Mild chronic left maxillary sinus disease. |
Generate impression based on findings. | Clinical question: Fall, facial laceration. Signs and symptoms: As above. Nonenhanced head CT:No evidence of acute intracranial, calvarial or soft tissues of the scalp findings.There are mild periventricular and subcortical low attenuation a white matter concerning for age indeterminant small vessel ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation.Unremarkable partially visualized maxillofacial region and orbits.Unremarkable bilateral mastoid air cells and middle ear cavities. | 1.No acute post traumatic findings.2.Age indeterminate small vessel ischemic strokes. |
Generate impression based on findings. | Clinical question: Cerebral edema. Signs and symptoms: Hyponatremia. Nonenhanced head CT:There is no detectable acute intracranial process in particular no evidence of cerebral edema.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation.Unremarkable calvarium and soft tissues of the scalp.Unremarkable orbits, paranasal sinuses and mastoid air cells. | No definitive intracranial abnormalities are identified. |
Generate impression based on findings. | Clinical question: Left arm plegia. Signs and symptoms: As above. Unenhanced head CT:No detectable acute intracranial process. CT however is insensitive for detection of acute non-hemorrhagic ischemic strokes.Very subtle subcortical and periventricular low attenuation of white matter is concerning for mild age indeterminate small vessel ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system and CSF spaces. Unremarkable calvarium and soft tissues of the scalp.Unremarkable paranasal sinuses and mastoid air cells. | Mild age indeterminate small vessel ischemic strokes. |
Generate impression based on findings. | 34-year-old male with tachycardia. PULMONARY ARTERIES: Diagnostic quality exam without evidence of pulmonary embolus.LUNGS AND PLEURA: Bilateral basilar ground glass opacities and minimal subsegmental consolidation in the superior segment of the right lower lobe, not entirely specific but likely represent subsegmental atelectasis with probable superimposed aspiration given presence of mucus material in the trachea (series 9, image 34 and image 67). No pleural effusions. No suspicious nodules or masses.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Partially visualized shunt catheter tubing is visualized along the anterior soft tissues of the right chest wall.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.No pulmonary embolus.2.Basilar ground glass opacities and subsegmental consolidation and represent combination of atelectasis and aspiration. |
Generate impression based on findings. | 61-year-old male with chronic driveline leak ABDOMEN: Lack of IV contrast limits evaluation of solid organ pathology and vasculature. Given these limitations the following observations are made.LUNG BASES: Bilateral pleural effusions with consolidation and atelectasis. Cardiac assist device and driveline are noted with no associated fluid collections identified.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Extensive atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Anasarca. Small ventral hernia containing bowel without evidence of obstruction. No bowel fluid collections are identified.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Foley catheter in the bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Nonspecific asymmetric distal thickening of the rectum, possibly inflammatory/infectious. Degenerative changes of the lumbar spine, worst at L4 through S1.OTHER: No significant abnormality noted | 1. No evidence of abdominal or superficial fluid collection/abscess.2. Basilar pleural effusions and consolidation, correlate for pneumonia. |
Generate impression based on findings. | Reason: 40M with MDS recent CAP s/p abx with persistent fever History: fever LUNGS AND PLEURA: New nodular and masslike opacities, involving the right upper lobe and both lower lobes, with surrounding groundglass.Small bilateral pleural effusions are present, left larger than right, left larger than on the prior study. MEDIASTINUM AND HILA: No significantly enlarged mediastinal or hilar lymph nodes.New small pericardial effusion.Diffuse esophageal thickening consistent with esophagitis.Low attenuation of the blood pool is consistent with anemia.CHEST WALL: Minimal degenerative change thoracic region.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Marked splenomegaly is present. | 1. Multifocal pneumonia, likely fungal in etiology with enlarging left pleural effusion.2. Diffuse esophagitis, opportunistic infection a possible etiology. |
Generate impression based on findings. | Drooling, fever, widened retropharyngeal space of the neck on XR. There is no evidence of retropharyngeal abscess or other neck abscess. No mass lesions are identified. There are secretions within the vallecula. Otherwise, there is no significant narrowing of the airway. The epiglottis does not appear thickened. Likewise, the Waldeyer ring structures are not significantly enlarged. The cervical lymph nodes appear diffusely prominent, but this is likely within normal limits for age. The major salivary glands and thyroid gland are unremarkable. The major cervical vessels are patent. There are partially imaged patchy opacities and lucencies in the lungs. There is partial opacification of the left maxillary sinus. The osseous structures are unremarkable. The imaged portions of the orbits and intracranial structures are unremarkable. | 1. No evidence of abscess. Otherwise, non-specific secretions within the vallecula and mildly prominent bilateral level 1 lymph nodes may be reactive.2. Partially imaged patchy opacities and lucencies in the lungs may be related to reactive airway disease or pneumonia. Refer to the recent chest radiograph for additional details. |
Generate impression based on findings. | 55-year-old male vomiting blood on heparin ABDOMEN:LUNG BASES: Consolidation at the both lung bases.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple wedge-shaped hypodensities involving the left kidney suggest infarct.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diffuse dilatation of small and large bowel with air-fluid levels. An enteric tube extends into the stomach. Hiatal hernia with mild distal esophageal thickening. No mesenteric thrombus is identified.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Air in the bladder, presumably from prior instrumentation.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diffuse dilatation of small and large bowel with air-fluid levels. No free or loculated fluid collections. No mesenteric thrombus is identified.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Diffuse bowel dilatation with air-fluid levels consistent with ileus.2. Hiatal hernia and mild distal esophageal wall thickening.3. Basilar consolidation suggesting infection/aspiration. |
Generate impression based on findings. | Male 59 years old; Reason: Pre-Kidney Transplant evaluation, assess aorta and iliacs vessels for kidney transplant History: Lack of Pedal pulses on evaluation ABDOMEN: Reason: Pre-Kidney Transplant evaluation, assess aorta and iliacs vessels for kidney transplant History: Lack of Pedal pulses on evaluationLUNGS 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: The kidneys are atrophic, compatible with chronic renal failure. A small 1.4 cm a cystic lesion measuring 30HU off the inferior pole right kidney. This is incompletely characterized given lack of IV contrast. Few other exophytic, hypoattenuating lesions likely represent cysts although also incompletely characterized given lack of IV contrast.RETROPERITONEUM, LYMPH NODES: Near 360 degree circumferential calcification is seen in the entire abdominal aorta, celiac axis, and superior mesenteric artery.Approximately 180 degree calcification seen in the medial half of the right common iliac artery. Approximately 180 degree calcification along the posterior aspect of the right external iliac artery, and near circumferential calcification of the right internal iliac artery. Approximately 180 degree calcification seen in the medial half of the left common iliac artery. Approximately 180 degree calcification along the posterior aspect of the right external iliac artery, and near circumferential calcification of the right internal iliac artery.BOWEL, MESENTERY: No significant abnormality noted. Retained contrast is noted throughout the colon, and is seen in the appendix.BONES, SOFT TISSUES: Moderate degenerative disease noted throughout the spine.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Moderate degenerative disease noted throughout the spine.OTHER: No significant abnormality noted. | 1.Calcifications of the abdominal aorta and branch vessels as described above.2.Indeterminant small exophytic lesion off of the inferior pole right kidney given lack of IV contrast. RCC cannot entirely be excluded. |
Generate impression based on findings. | 18 year-old female. Clinically worsening pharyngitis. Rule out abscess. CT head: There is no intracranial mass, fluid collection, hemorrhage, hydrocephalus or CT evidence of acute ischemia. Gray-white matter differentiation is normal bilaterally and the midline is intact. The bones, orbits and mastoid air cells are normal. There is mucosal thickening in the sphenoid sinuses bilaterally, more pronounced than on the examination two days prior likely representing sinusitis.CT neck: Palate and tonsils are significantly enlarged bilaterally. There is pharyngeal edema and a trace retropharyngeal effusion which is smaller than on the prior exam without prevertebral soft tissue mass or abscess. The nasopharynx, oropharynx and hypopharynx as well as epiglottis, vocal cords and piriform sinuses are patent. There are scattered prominent lymph nodes, though none are enlarged by size criteria. Vascular structures are patent. There is no perivascular fat stranding. Bones are unremarkable. Limited assessment of the lung apices is unremarkable. | Bilateral enlargement of the palatine tonsils as well as pharyngeal mucosal edema and a small improving retropharyngeal effusion all likely secondary to tonsillitis. No retropharyngeal abscess or vascular abnormality. Sphenoid sinus mucosal thickening likely represents sinusitis. |
Generate impression based on findings. | 74-year-old male with intra-abdominal fluid collections status post drainage, evaluate collections ABDOMEN:LUNG BASES: Bilateral pleural effusions with adjacent atelectasis. Necrotic adenopathy within the mediastinum is partially visualized.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: Bilateral hypodense renal lesions, likely representing cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: G-tube extends into the stomach. The balloon does not appear well opposed to the gastric wall. A fluid collection between the stomach and gastric wall containing air and contrast suggests a G-tube leak. Multiple fluid collections in the abdomen appear smaller than on the prior study. The reference right lower abdominal fluid collection containing a percutaneous drain measures 2.9 x 6.7 cm and previously measured 3.5 x 8.7 cm.BONES, SOFT TISSUES: Lytic lesions involving the vertebral bodies, right ilium, are unchanged. Ventral abdominal wall defect is again identified. OTHER: Interval decrease in abdominal ascites.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Catheter noted in the bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Multiple fluid collections in the abdomen appear smaller than on the prior study. The reference right lower abdominal fluid collection containing a percutaneous drain measures 2.9 x 6.7 cm and previously measured 3.5 x 8.7 cm.BONES, SOFT TISSUES: Lytic lesions involving the vertebral bodies, right ilium, are unchanged. OTHER: Interval decrease in ascites. | Multiple lower abdominal fluid collections are decreased in size. Collection anterior to the stomach containing contrast and gas suggesting a leaking G-tube has increased in size. Findings discussed with clinical service by ROC at the time of the exam as documented in the Stat Consult. |
Generate impression based on findings. | 65 year-old female with leukocytosis status post ex lap ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Status post cholecystectomy. No focal hepatic lesionsSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Multiple prominent retroperitoneal lymph nodes. Index left para-aortic lymph node measures 1.1 x 0.7 cm and previously measured 1.1 x 0.7 cm (image 66, series 3).BOWEL, MESENTERY: Interval increase in size of fluid collection adjacent to terminal ileum, which now measures 6.3 x 2.6 cm (image 96, series 3). Mesenteric adenopathy in the right lower quadrant, possibly reactive in etiology.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Status post hysterectomy and bilateral salpingo-oophorectomy.BLADDER: Catheter is noted within the bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Interval increase in size of fluid collection adjacent to terminal ileum, which now measures 6.3 x 2.6 cm (image 96, series 3). The cecum appears collapsed. Mesenteric adenopathy in the right lower quadrant, possibly reactive in etiology. Post operative changes of sigmoid resection are again identified.BONES, SOFT TISSUES: Degenerative changes of the lumbar spine, worst at L4 through S1.OTHER: No significant abnormality noted | 1. Increase in size of fluid collection containing foci of gas adjacent to the terminal ileum consistent with abscess. This finding was discussed with the referring service (pager 2701) at the time of the preliminary read.2. Borderline enlarged retroperitoneal and mesenteric lymph nodes. |
Generate impression based on findings. | 10-year-old male with abdominal pain, emesis. Evaluate for appendicitis. ABDOMEN:LUNG BASES: No focal air space opacities or pleural effusions.LIVER, BILIARY TRACT: The liver is normal in size and attenuation. There is no extrahepatic or intrahepatic biliary ductal dilatation. The gallbladder is distended without evidence of cholecystitis.SPLEEN: The spleen is normal in size and attenuation.PANCREAS: The pancreas is normal in size and attenuation.ADRENAL GLANDS: The adrenal glands are symmetric in size and attenuation.KIDNEYS, URETERS: The kidneys are symmetric in size and attenuation. No focal renal lesions identified. There is no hydronephrosis.RETROPERITONEUM, LYMPH NODES: There is no retroperitoneal lymphadenopathy.BOWEL, MESENTERY: The appendix is visualized in the right lower quadrant, best seen on coronal series image 55. The appendix appears normal containing fluid and gas and is not distended. There is no periappendiceal inflammation or appendicolith present. Scattered subcentimeter mesenteric lymph nodes are present.No intra-abdominal fluid collections are present. There is no bowel obstruction. BONES, SOFT TISSUES: No focal osseous lesions are identified.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Normal examination. No acute abnormalities to explain the patient's abdominal pain. |
Generate impression based on findings. | 28 year-old male patient with history of renal calculi presents with left flank pain. ABDOMEN:LUNG BASES: Bilateral dependent atelectasis.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mild hydroureter with cluster of obstructing renal calculi in the mid ureter. Cluster of renal calculi measures 6.0 mm in diameter (coronal series 8034 image 49. Proximal to the obstruction, the ureter measures 1.0 cm in diameter (coronal series 8034 image 40). Mild left-sided hydronephrosis, slightly increased compared to prior examination. No perinephric fat stranding. Multiple nonobstructing renal calculi, decreased compared to prior.Right kidney is within normal limits without renal calculi.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No bladder calculi.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Cluster of obstructing renal calculi in the mid left ureter, measuring 6 mm in diameter with associated left mild hydronephrosis. |
Generate impression based on findings. | Neutropenic fever, facial pain, please evaluate for infection. The paranasal sinuses and nasal cavity are clear. There is mild nasal septal deviation and leftward spur. The middle ear and mastoid air cells are clear. The imaged intracranial structures and orbits are grossly unremarkable. There are right palatine tonsilloliths. The facial soft tissues are unremarkable. | No evidence of sinusitis. |
Generate impression based on findings. | Syncope/seizure. There is prominence of sulcal and ventricular spaces which is unchanged from previous and is most likely in keeping with atrophic change. Subtle hypoattenuation within the left basal ganglia and corona radiata likely represents sequela of chronic small vessel ischemic disease. There is no intracranial mass, fluid collection, hemorrhage, hydrocephalus or CT evidence of ischemia. Gray-white matter differentiation is maintained bilaterally and the midline is intact. Bones and the visualized portions of the paranasal air sinuses are unremarkable. Orbits are normal and mastoid cells are aerated. | No acute intracranial abnormality demonstrated. |
Generate impression based on findings. | Subdural hematoma. There is no significant interval change in the predominantly hyperattenuating holohemispheric left subdural hematoma tracking along the falx and tentorium that measures up to 10 mm in width. There is no significant interval change in the approximately 10 mm left to right midline shift and left uncal herniation, and effacement of the left perimesencephalic cistern, although this has increased gradually since 10/20/13. Although there is no significant interval change in the ventricular sizes, including partial effacement of the left lateral and third ventricles are partially effaced mild dilatation of the right lateral ventricle suggestive of trapping, this appears to have progressed slightly since 10/21/13. There is unchanged non-specific mild diffuse cerebral white matter hypoattenuation. The visualized paranasal sinuses and mastoid air cells are clear. The extracranial structures are unchanged. | 1. No significant interval change in the predominantly hyperattenuating holohemispheric left subdural hematoma tracking along the falx and tentorium that measures up to 10 mm in width. 2. No significant interval change in the approximately 10 mm left to right midline shift and left uncal herniation, and effacement of the left perimesencephalic cistern, although this has increased gradually since 10/20/13. 3. Although there is no significant interval change in the ventricular sizes, including partial effacement of the left lateral and third ventricles are partially effaced mild dilatation of the right lateral ventricle suggestive of trapping, this appears to have progressed slightly since 10/21/13. |
Generate impression based on findings. | Reason: h/o tonsil cancer History: r/o lung mets LUNGS AND PLEURA: Punctate benign-appearing micronodules, with no specific evidence of metastases.MEDIASTINUM AND HILA: There is no mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Irregular peripheral enhancing hepatic segment IVb lesion 4.2 x 3.1 centimeters, and 5.4 cm craniocaudal dimension, most likely a cavernous hemangioma. Not significantly changed since 6/18/2013 allowing for the lack of contrast on the prior study. | 1. No sign of metastases.2. Large hepatic cavernous hemangioma, unchanged. |
Generate impression based on findings. | 68 year-old female patient with history of bariatric surgery and diverticulosis presents with acute worsening of chronic epigastric abdominal pain. ABDOMEN:LUNG BASES: Bilateral dependent atelectasis.LIVER, BILIARY TRACT: Gallbladder containing dependent, hyperattenuating material, most likely gallbladder gravel. No ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is redemonstration of postsurgical changes involving the distal esophagus, stomach and small bowel segments. Mild jejunal wall thickening and associated fluid in the mesentery appears less marked compared to prior examination. No focal dilatation of the small bowel. There is no intramural air, free air or areas of nonenhancing bowel.Extensive colonic diverticulosis without evidence of diverticulitis.The superior mesenteric vein, portal vein, celiac trunk and superior mesenteric artery are patent.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small abdominal ascites.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is redemonstration of postsurgical changes involving the distal esophagus, stomach and small bowel segments. Mild small bowel thickening and associated fluid in the mesentery appears less marked compared to prior examination. No focal dilatation of the small bowel. There is no intramural air, free air or areas of nonenhancing bowel.Extensive colonic diverticulosis without evidence of diverticulitis.The superior mesenteric vein, portal vein, celiac trunk and superior mesenteric artery are patent.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of free fluid in the pelvis. | 1.Mild jejunal wall thickening with mesenteric fluid and small amount of ascites. Patent vasculature without intramural air or lack of enhancement makes ischemia less likely. Bowel thickening is nonspecific and may be secondary to infection or inflammation.2.Colonic diverticulosis without evidence of diverticulitis. |
Generate impression based on findings. | Pharyngitis and left lateral neck mass. Rule out abscess. Deep to the left sternocleidomastoid at level III there is a 1.6 (AP) x 2.1 (trans) x 2.7 (CC) mm thinly rim enhancing hypoattenuating lesion which effaces the left internal jugular vein and exerts mass effect on the overlying SCM . There is intramuscular hypoattenuation in the region of the SCM contacting the nearby mass. There is soft tissue density within the carotid sheath, encircling both internal jugular and common carotid artery likely representing edema (series 4 image 111). Tonsils are prominent, however there is no tonsillar or peritonsillar abscess. There are scattered prominent nodes without significant enlargement by size criteria. The nasopharynx, oropharynx, hypopharynx, epiglottis, larynx and piriform sinus are normal. There are no other lymph nodes which are enlarged by size criteria. The spine is normal. The posterior triangles are normal. | Hypoattenuating rim enhancing lesion deep to the SCM at level III which most likely represents a suppuritive lymph node. Given the patient's age and symptoms this most likely represents infectious sequela, however this finding should be followed to ensure resolution to exclude other potential etiologies. |
Generate impression based on findings. | 80 year old female with small cell lung cancer status post 4 cycles of chemotherapy. CHEST:LUNGS AND PLEURA: Right upper lobe paramediastinal mass is decreased in size and measures 7.5 x 6.3 cm in axial dimension, previously measured 9.1 x 6.5 cm (series 80248, image 23); mass currently measures 5.7 cm in craniocaudal dimension, previously measured 6.6 cm (series 80261, image 33). There is persistent mild narrowing and likely invasion by tumor of the anterior aspect of right main pulmonary artery (axial series 80248, image 31). Nodularity of the posterior aspect of the right mainstem bronchus suspicious for invasion by tumor (series 5, image 29).Right upper lobe nodule is slightly increased in size, currently measuring 5 mm, previously measured 3 mm (series 5, image 35). Other scattered micronodules are not significantly changed (series 5, image 40 and 74). No new nodules.Focus of subpleural ground glass opacity and bronchiectasis in right lower lobe appears unchanged.No pleural effusions. MEDIASTINUM AND HILA: No significant change in mediastinal lymphadenopathy. Reference pretracheal node measures 1.7 x 1.8 cm, previously measured 1.7 x 1.7 cm (axial series 80248, image 30). Mild saccular outpouching of aortic arch unchanged (axial series image 26). Stable severe atherosclerotic disease affects the descending aorta.Moderate coronary artery calcifications noted. Heart size normal. No pericardial effusion.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant change in multiple hepatic metastases given the variability in timing of contrast bolus.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is a ill-defined hypodensity in the left kidney which measures 9 x 12 mm; this was not measurable on prior exam (series 80248, image 90). Metastasis is a consideration. Bilateral renal hypodensities, some of which are too small to characterize, are unchanged and likely represent cysts. Bilateral extrarenal pelvises.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No retroperitoneal adenopathy. Aortic stent graft is 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.Interval decrease in size of right apical lung mass.2.Minimal interval increase in size of right upper lobe nodule.3.No significant change in mediastinal lymphadenopathy and liver metastases.4.There is a ill-defined hypodensity in the left kidney which measures 9 x 12 mm; this was not measurable on prior exam (series 80248, image 90). |
Generate impression based on findings. | 85-year-old female patient with history of diverticulosis presents with right-sided abdominal pain. ABDOMEN:LUNG BASES: Bilateral dependent atelectasis.LIVER, BILIARY TRACT: Hypoattenuating, nonenhancing liver lesions in segments 8 and 6 are unchanged compared to prior examination. Hypoattenuating lesion in segment 5b adjacent to the fissure is nonspecific and unchanged.SPLEEN: No significant abnormality noted.PANCREAS: There is redemonstration of pancreatic duct prominence without evidence of obstruction. There is a hypoattenuating lesion in the body of the pancreas (series 3 image 43), which likely represents an intraductal papillary mucinous neoplasm and appears stable compared to prior examination.ADRENAL GLANDS: Redemonstration of stable left adrenal gland nodule, previously characterized as adrenal adenoma.KIDNEYS, URETERS: Numerous well-circumscribed hypoattenuating, nonenhancing lesions in bilateral kidneys are increased in number compared to prior examination and most likely represent cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis. No bowel wall thickening, pericolonic fat stranding or fluid noted. Bowel is normal in caliber without evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Moderate atherosclerotic changes in the abdominal aorta and iliac arteries.PELVIS:UTERUS, ADNEXA: Status-post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis. No bowel wall thickening, pericolonic fat stranding or fluid noted. Bowel is normal in caliber without evidence of obstruction.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumbar spine, slightly increased compared to prior examination. Anterior spondylolisthesis of L5 on S1 with vacuum disk phenomenon, stable.OTHER: No significant abnormality noted. | 1.Colonic diverticulosis without evidence of diverticulitis. Bowel normal in caliber.2.Multiple hypoattenuating liver lesions, stable.3.Stable adrenal adenoma.4.Stable prominence of pancreatic duct and hypoattenuating lesion in the body, consistent with an IPMN.5.Multiple hypoattenuating renal lesions, most likely representing cysts. |
Generate impression based on findings. | Reason: lung cancer s/p 2 cycles of chemo. please evaluate and compare with previous scan History: lung cancer CHEST:LUNGS AND PLEURA: Dense consolidation and atelectasis of the left upper lobe with a large peripheral cavity or loculated pleural air collection with a bronchopleural fistula, consistent with radiation reaction and necrosis is unchanged compared to prior exam. There is a slight interval increase in the subpulmonic left pleural effusion.Interval increase in size of right lung metastases. Reference right upper lobe nodule measures 24 mm, previously measuring 22 mm (series 4, image 46).MEDIASTINUM AND HILA: Multiple small mediastinal lymph nodes, not significantly changed. Moderate coronary artery calcifications. There is narrowing of the brachiocephalic vein as it crosses the aorta anteriorly with a large thrombus in the left subclavian vein.CHEST WALL: T8 compression fracture and left seventh rib old fracture deformity are again seen. Mildly enlarged left jugular lymph node, not significantly change compared prior exam. ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Gallbladder sludge and cholelithiasis without evidence of acute cholecystitis. Possible flash filling hemangioma in the right lobe.SPLEEN: Multiple small hypodense lesions are unchanged in size and number. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Hypodense lesions of water density in bilateral kidneys representing benign renal cyst.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Extensive atherosclerosis of the aorta. Aneurysm at the orifice the superior mesenteric artery is unchanged.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Slight interval progression of right lung metastases.2.New thrombus in the left subclavian vein. |
Generate impression based on findings. | 46-year-old male with diffuse large B-cell lymphoma. Chest radiograph concerning for PCP. LUNGS AND PLEURA: Diffuse bilateral groundglass opacities with sparing of the subpleural lung and relative sparing of the lung bases. No consolidation or pleural effusions.MEDIASTINUM AND HILA: Heart size normal. Mildly enlarged cardiophrenic node but otherwise no mediastinal lymphadenopathy (series 4, image 79). Mild atherosclerotic calcifications of coronary arteries.CHEST WALL: Right chest wall port catheter with tip in SVC/RA junction.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Improved lymphadenopathy in partially visualized upper abdominal retroperitoneum and mesentery, compatible with history of lymphoma. Hypodensities in both kidneys most consistent with benign cysts. | 1.Diffuse bilateral ground glass opacities in the lungs, most suspicious for atypical infection such as PCP given patient's immunosuppressed status. 2.Improved significant lymphadenopathy in upper retroperitoneum and mesentery, consistent with known lymphoma. |
Generate impression based on findings. | 39-year-old female patient with history of gestational trophoblastic disease status post hysterectomy, omentectomy and bilateral salpingo-oophorectomy presents with vomiting. Evaluate for small bowel obstruction. ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Hypoattenuating, well-circumscribed lesion in the inferior pole of the right kidney measures 1.1 x 1.2 cm (coronal series 80264 image 34) and likely represents a cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is small bowel wall thickening and dilatation up to 3.6 cm extending to the terminal ileum. The cecum is not distended. There is surrounding mesenteric fluid and a mesenteric fluid collection in the lower abdomen (coronal series 80264 image 56). No intramural or free air.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy, omentectomy and bilateral salpingo-oophorectomy.BLADDER: No significant abnormality noted.LYMPH NODES: Index left pelvic lymph node measures 1.1 by 1.0 cm (series 3 image 128), previously 0.7 x 1.1 cm. Residual soft tissue density in the left pelvis is stable compared to prior examination (series 3 image 120).BOWEL, MESENTERY: There is small bowel wall thickening and dilatation up to 3.6 cm extending to the terminal ileum. The cecum is not distended. There is surrounding mesenteric fluid and a mesenteric fluid collection in the lower abdomen (coronal series 80264 image 56). No intramural or free air.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Small bowel dilatation extending to the terminal ileum is consistent with a low-grade obstruction. Associated mesenteric fluid. No definitive transition point identified. No intramural air or free air.2.Small index left pelvic lymph node minimally increased in size. |
Generate impression based on findings. | 68-year-old female with history of appendiceal cancer CHEST:LUNGS AND PLEURA: Stable elevation of the right hemidiaphragm with compressive atelectasis. No new nodules or masses.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.CHEST WALL: Marked thoracic dextroscoliosis and spinal rod, again noted.ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. No focal hepatic lesions.SPLEEN: Status post splenectomy.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: Small ventral hernia containing fat. Degenerative changes of the lumbar 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: Degenerative changes of the lumbar spine.OTHER: No significant abnormality noted. | Stable interval exam without evidence of recurrent or metastatic disease. |
Generate impression based on findings. | 66 year old female with thoracic aneurysm, also evaluate iliac vessels CHEST:LUNGS AND PLEURA: Subsegmental atelectasis involving the lingula and lower lobes.MEDIASTINUM AND HILA: There is a partially thrombosed saccular aneurysm arising from the lateral wall of the distal transverse arch, just distal to the origin of the left subclavian artery. The thrombosed wall of the aneurysm initiates approximately 4 mm distal to the left subclavian artery. The aneurysm (including the thrombosed and non-thrombosed components) measures 4.6 x 4.5 cm. The opacified portion of the aneurysm measures 1.9 x 2.2 cm. Saccular outpouchings of the superior and lateral thoracic aortic wall just distal to the aneurysm are identified. The ascending aorta is normal in caliber. Small penetrating ulcerative plaques along the distal thoracic aorta appear similar to the prior study. There is 40% stenosis of the right innominate artery origin by plaque. The origins of the remaining great vessels are not significantly narrowed.Lipomatous hypertrophy of the interatrial septum is noted, of no clinical significance. Heart size is normal. No pericardial effusion is present. No mediastinal or hilar lymphadenopathy.Triple vessel coronary artery disease is identified. Mild aortic valvular calcification. 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: Extensive advanced atherosclerotic calcification and plaque of the abdominal aorta and its branches including the splenic, right hepatic, SMA, and IMA without evidence of dissection or occlusion. Multiple penetrating ulcerative plaques appear similar to the prior study. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: The bilateral common iliac, external iliac and common femoral arteries demonstrate multifocal plaques which contributes to a moderate to severe stenoses. There is moderate tortuosity of the common iliac arteries, right greater than left. The left external iliac artery demonstrates segmental, approximately 70 to 80%, stenosis. The bilateral common femoral arteries demonstrate approximately 50% narrowing from complex plaques.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Catheter occupies the bladder.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace ascites. | 1. Partially thrombosed saccular aneurysm arising from the lateral wall of the distal transverse arch, initiating approximately 4 mm distal to left subclavian artery.2. Extensive atherosclerotic disease of the aorta with ulcerated plaques. Multifocal moderate to severe stenoses involving the common iliac, external iliac, and common femoral arteries, appearing similar to the prior study. |
Generate impression based on findings. | 56-year-old male patient with history of hepatitis C cirrhosis, carcinoid tumor and significant ascites present with left lower quadrant pain. Evaluate for diverticulitis. ABDOMEN:LUNG BASES: Moderate right-sided pleural effusion with overlying atelectasis.LIVER, BILIARY TRACT: Cirrhotic liver morphology without focal mass identified. Calcified gallstone within the gallbladder without biliary dilatation.SPLEEN: Splenomegaly, measuring 17.5 cm in the craniocaudal dimension.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Hypoattenuating lesion in the right intrapolar region and hypoattenuating lesion in the left superior pole are stable compared to prior examination and likely represent cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Esophageal varices. Umbilical hernia containing a loop of opacified bowel without evidence of strangulation.Mild sigmoid diverticulosis without evidence of diverticulitis. No focal bowel wall thickening or pericolonic fat stranding.BONES, SOFT TISSUES: Hardware is redemonstrated in the lumbar and sacral spine.OTHER: There is prominence of the portal vein and splenic vein with partial thrombosis of the portosplenic confluence and superior mesenteric vein, unchanged from prior examination (series 3 image 47, 52).Small amount of abdominal ascites.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mild sigmoid diverticulosis without evidence of diverticulitis. No focal bowel wall thickening or pericolonic fat stranding.BONES, SOFT TISSUES: Hardware is redemonstrated in the lumbar and sacral spine.OTHER: Small amount of abdominal ascites. | 1.Sigmoid diverticulosis without evidence of diverticulitis. 2.Cirrhotic liver with evidence of portal hypertension.3.Partial thrombus in the portosplenic confluence and superior mesenteric vein, stable.4.Small amount of abdominal ascites.5.Moderate right pleural effusion.6.Umbilical hernia. |
Generate impression based on findings. | Subdural hematoma. There is no significant interval change in the predominantly hyperattenuating holohemispheric left subdural hematoma tracking along the falx and tentorium that measures up to 10 mm in width. There is no significant interval change in the approximately 10 mm left to right midline shift and left uncal herniation, and effacement of the left perimesencephalic cistern, although this has increased gradually since 10/20/13. Although there is no significant interval change in the ventricular sizes, including partial effacement of the left lateral and third ventricles are partially effaced mild dilatation of the right lateral ventricle suggestive of trapping, this appears to have progressed slightly since 10/21/13. There is unchanged non-specific mild diffuse cerebral white matter hypoattenuation. The visualized paranasal sinuses and mastoid air cells are clear. The extracranial structures are unchanged. | 1. No significant interval change in the predominantly hyperattenuating holohemispheric left subdural hematoma tracking along the falx and tentorium that measures up to 10 mm in width. 2. No significant interval change in the approximately 10 mm left to right midline shift and left uncal herniation, and effacement of the left perimesencephalic cistern, although this has increased gradually since 10/20/13. 3. Although there is no significant interval change in the ventricular sizes, including partial effacement of the left lateral and third ventricles are partially effaced mild dilatation of the right lateral ventricle suggestive of trapping, this appears to have progressed slightly since 10/21/13. |
Generate impression based on findings. | Persistent fever after treatment for CAP, and nasal/sinus congestion. There is unchanged minimal mucosal thickening and retention cyst formation within the bilateral maxillary sinuses and left frontoethmoid recess. The paranasal sinuses are otherwise clear. The nasal cavity is also clear. There is an unchanged prominent incisive canal, which is a normal variant. The imaged intracranial structures and orbits are grossly unremarkable. | No evidence of acute rhinosinusitis. |
Generate impression based on findings. | 90 year-old male patient with history of renal cell carcinoma. Assess for metastatic disease. Note that lack of intravenous contrast limits evaluation of vasculature, lymph nodes, hollow and solid viscera.CHEST:LUNGS AND PLEURA: Scattered pulmonary nodules are unchanged compared to prior examination.MEDIASTINUM AND HILA: Index right cardiophrenic lymph node measures 1.7 x 1.1 cm (series 3 image 83), previously 1.6 x 0.8 cm.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Index hepatic dome lesion is not well visualized on this noncontrast examination. Calcified hepatic granulomas are redemonstrated. Calcified porta hepatis lymph node is unchanged.SPLEEN: Scattered punctate calcifications, consistent with granulomatous disease.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left kidney without abnormalities. Status post right partial nephrectomy with posterior renal fat stranding and loss of fat plane. Ill-defined soft tissue density in the right renal hilum measures approximately 3.3 by 2.7 cm (series 3 image 101), previously 3.1 x 3.0 cm.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis. Bowel normal in caliber without wall thickening. Hazy mesentery consistent with mild mesenteric panniculitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis. Bowel normal in caliber without wall thickening. Hazy mesentery consistent with mild mesenteric panniculitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted. | 1.Stable examination given limitations of lack of intravenous contrast.2.Mild mesenteric panniculitis. |
Generate impression based on findings. | Reason: follow-up of BOT SCC T1N2B HPV + no measurable disease s/p LND 5/23/11, s/p CRT 10/2011 History: as above CHEST:LUNGS AND PLEURA: Mild apical scarring. Stable left lower lobe calcified granuloma. The right upper lobe ground glass nodule is not significantly changed (series 4, image 26). Streaky right basilar scar like opacity is not significantly changed. No new or suspicious lung nodules or mass. No pleural effusion.MEDIASTINUM AND HILA: Status post thyroidectomy. No significant mediastinal or hilar lymphadenopathy. Heart size is normal. Residual thymic tissue is again noted. CHEST WALL: Sclerotic foci in T7 and T9 vertebral bodies are unchanged. Sclerotic regions in the left lateral ribs and right humerus are not significantly changed and most likely benign.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Numerous scattered hepatic hypodense lesions are unchanged in size are compatible with multiple cysts. Status post cholecystectomy. Status post cholecystectomy.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal hypodensities are unchanged in size and likely represent benign renal cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic calcification of the aorta.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No evidence of metastatic disease. Unchanged ground glass nodule in the right upper lobe likely represents atypical adenomatous hyperplasia. Follow up on this patient's routine surveillance is sufficient. |
Generate impression based on findings. | 19 year-old female with Hodgkin's lymphoma. End of therapy evaluation. LUNGS AND PLEURA: No new suspicious pulmonary nodules are masses. No pleural effusions.MEDIASTINUM AND HILA: The confluent anterior mediastinal and prevascular lymphadenopathy appears similar to the prior exam. The right anterior paramediastinal mass measures 3.6 x 1.5 cm (series 3, image 39), previously 3.7 x 2.0 cm. The round hypoattenuating focus in the floor of the right atrium is unchanged, measuring 1.2 x 1.1 cm (series 3, image 63). This remains separate from the central venous catheter tip.CHEST WALL: Right chest port with catheter tip in the right atrium. The previously seen FDG-avid right subpectoral lymph node is no longer seen. The reference left supraclavicular lymph node measures 0.7 cm in short axis (series 3, image 14), previously 0.5 cm.Slight leftward curvature of the thoracic spine with associated endplate degenerative changes of the lower thoracic spine. UPPER ABDOMEN: Focal fat infiltration along the falciform ligament. Otherwise, normal appearance of the upper abdomen. | 1. Minimal changes in the thoracic lymph nodes, as described above.2. No new sites of disease.3. Stable appearance of the hypoattenuating focus at the floor of the right atrium. |
Generate impression based on findings. | Male 30 years old; Reason: evaluate for intraabdominal process History: sudden onset abdominal pain ABDOMEN:LUNGS BASES: Calcified nodes suggest prior healed granulomatous disease.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. In particular, the appendix is clearly visualized and contains air, normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Calcifications of the ligaments in the pelvis as well as deformity to the pelvic bones suggest prior injury. No acute fractures or dislocation.OTHER: No significant abnormality noted. | 1.No acute intra-abdominal pathology detected. |
Generate impression based on findings. | Female 68 years old; Reason: 68y/oF with a history of multiple myeloma s/p chemo s/p stem cell transplant with diverticulitis. Please reassess for diverticulitis. History: Diverticulitis ABDOMEN:LUNG BASES: Mild dependent atelectasis in bilateral bases.LIVER, BILIARY TRACT: No suspicious focal liver lesions. No intrahepatic or extrahepatic biliary ductal dilatation. Status post cholecystectomy.SPLEEN: Atherosclerotic calcification of the splenic artery.PANCREAS: No significant abnormality notedADRENAL GLANDS: Mild nodularity of the left adrenal gland, stable since 10/1/13.KIDNEYS, URETERS: Punctate calcifications in the right kidney may represent nephrolithiasis or vascular calcifications. Hypodense partially exophytic lesion in the superior pole of the right kidney is of water density and likely represents a benign renal cyst.RETROPERITONEUM, LYMPH NODES: Mild ectasia and aneurysmal dilation of the infrarenal aorta above the iliac bifurcation. Atherosclerotic calcification of the descending aorta and bilateral iliac arteries. This is stable since previous exam.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Loss of height of T12, stable and compatible with previously known diagnosis of multiple myeloma.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Decrease in size of the previously mentioned diverticulitis with intramural abscess and walled off perforation. The approximate measurements of the abscess measuring 6.1 x 2.5cm (series 3 image 102) previously 6.9 x 3.4 cm.BONES, SOFT TISSUES: Calcified focus in the soft tissue of the right hip. OTHER: Moderate amount of pelvic fluid. | 1.Decrease in size of the diverticulitis with intramural abscess and walled off perforation.2.Stable mild ectasia and aneurysmal dilatation of the infrarenal aorta prior to the iliac bifurcation.3.Stable nodular left adrenal gland with slight interval increase in size compared to 2012 CT study. |
Generate impression based on findings. | 72-year-old male with history of urothelial cancer CHEST:LUNGS AND PLEURA: Scattered micronodules are unchanged. Mild subpleural apical scarring.MEDIASTINUM AND HILA: Scattered mediastinal lymph nodes are unchanged. Moderate athero-sclerotic calcification of the coronary arteries and thoracic aorta.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without evidence of cholecystitis. No focal hepatic lesions. Hepatic steatosis.SPLEEN: Splenule in calcified splenic lesion are unchanged.PANCREAS: Atrophic pancreas.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post right nephrectomy. Hypoattenuating left renal lesions are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Left lower quadrant ileostomy.BONES, SOFT TISSUES: Nonspecific soft tissue thickening of the left lateral subcutaneous soft tissue is unchanged.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy.BLADDER: Status post cystectomy.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: A fluid collection arising from the bed of the prostate and extending into the base of the penis measures 5.8 x 2.5 cm and previously measured 5.0 x 1 .7 cm, mildly increased in size. Left pelvic sidewall soft tissue lesion is not significantly changed and measures 2.2 x 1.3 cm and previously measured 2.1 x 1.0 cm (image 194, series 5).OTHER: No significant abnormality noted | Unchanged reference left pelvic sidewall mass. Moderate fluid collection extending to the base of the penis. |
Generate impression based on findings. | Reason: testicular cancer surveillance History: testicular cancer CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Postsurgical clips secondary to lymph node dissection.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No interval change. No evidence of metastatic disease. |
Generate impression based on findings. | 48-year-old male with history of appendiceal cancer, evaluate for recurrent disease. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Calcified granulomata.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical change in the right lower quadrant is again identified.BONES, SOFT TISSUES: Right flank lipoma is unchanged. Degenerative changes of the lumbar spine are again identified.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Postsurgical change in the right lower quadrant is again identified.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Stable exam without evidence of metastatic disease. |
Generate impression based on findings. | Hodgkin lymphoma. There is no residual significant lymphadenopathy in the neck. A reference left level IV node now measures 4 x 4 mm (series 6, image 50), previously 4 x 4 mm. There are partially imaged enlarged superior mediastinal lymph nodes. The oral cavity, oropharynx, nasopharynx, hypopharynx, larynx and subglottic airways are unremarkable. The major salivary glands are unremarkable. There are unchanged 2 to 3 mm hypoattenuating thyroid nodules. There is a right subclavian venous catheter. The carotid arteries and jugular veins are otherwise patent. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. The imaged intracranial structures and orbits are unremarkable. The imaged portions of the lungs are clear. | No residual significant lymphadenopathy in the neck, but there are partially imaged enlarged superior mediastinal lymph nodes. Please refer to the separate chest CT dictation for additional details. |
Generate impression based on findings. | 60 year-old male with metastatic melanoma, evaluate for progression. CHEST:LUNGS AND PLEURA: Scattered micronodules are unchanged.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No axillary lymphadenopathy. Reference left axillary lymph node is unchanged and measures 1.3 x 0.6 cm and previously measured 1.5 x 0.8 cm (image 32 series 3).ABDOMEN:LIVER, BILIARY TRACT: Reference right hepatic lesion measures 2.1 x 1.8 cm and previously measured 2.1 x 1 .8 cm, unchanged (image 104, series 3). Several additional small hypoattenuating lesions in the posterior right hepatic lobe are better visualized now than on the prior study. The gallbladder is unremarkable. No new focal 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: 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: Sclerotic foci in the iliac bone are unchanged.OTHER: No significant abnormality noted. | Stable reference lesions as detailed above without new evidence of metastatic disease. |
Generate impression based on findings. | BOT SCC T1N2B HPV + no measurable disease s/p LND 5/23/1. s/p CRT 10/2011 and thyroid cancer status post CRT. Head: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. There is no evidence of abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The osseous structures are unremarkable. Neck: There are stable post-treatment findings related to thyroidectomy without discrete focal mass to suggest recurrent disease. Likewise, there is no discernable mass lesion at the base of the tongue. There is no evidence of significant cervical lymphadenopathy. Portions of the left internal jugular vein do not opacify, which is unchanged and likely treatment related. There is minimal residual supraglottic mucosal edema. The salivary glands are unchanged. The osseous structures are unremarkable. There is unchanged scarring in the lung apices and ground-glass nodule on the right. Refer to the separately dictated chest CT report for additional details. | 1.Stable post-treatment findings in the neck with no evidence of locoregional tumor recurrence in the thyroidectomy bed or tongue base and no significant lymphadenopathy.2.No evidence of intracranial metastatic disease. |
Generate impression based on findings. | Male 32 years old; Reason: H/O Recurrent Hodgkin Lymphoma in need of restaging imaging. History: H/O Recurrent Hodgkin Lymphoma CHEST:LUNGS AND PLEURA: Trace left pleural effusion. Small to moderate right pleural effusion occupies at least 25% of the right hemithorax.Multiple bilateral pleural-based nodules. New left upper lobe lung nodule measures 0.6 x 0.6 cm (image 23/series 6). MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion.Peripherally calcified right pericardial mass measures 6.2 x 5.3 cm (image 54/series 40) previously, 6.2 x 5.6 cm.Segmental and subsegmental left lower lobe and right emboli.CHEST WALL: Large right subpectoral lesions. The right axillary lesion measures 1.7 x 1.3 cm (image 26/series 4 a one) previously, 1.4 x 1.3 cm. OTHER: ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple nonobstructive right renal calculi. No hydronephrosis in either kidney.RETROPERITONEUM, LYMPH NODES: Small left para-aortic lymph node measures 0.8 x 0.5 cm (image 111/series 401) previously, 0.6 x 0.6 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Left inguinal lymph node measures 2.8 x 1.8 cm (image 196/series 401) previously, 1.9 x 1.3 cm.BOWEL, MESENTERY: Suboptimal evaluation of the rectum although there appears be mild wall thickening. There is trace mesenteric and pelvic ascites.BONES, SOFT TISSUES: Right iliac fossa soft tissue mass.OTHER: No significant abnormality noted | 1.Increase in the size of the lymph nodes.2.New left upper lobe pulmonary lesion.3.New left lower lobe emboli4.Findings discussed with Dr. Smith by telephone by Dr. Thomas |
Generate impression based on findings. | Nasal inverted papilloma excised 6/5/12. There are postoperative findings related to left maxillary antrostomy and uncinectomy, partial resection of the left anterior ethmoid air cells and left middle turbinate, and absence of a part of the posterior left frontal process of the maxilla and lamina papyracea. There has been interval increase in size of a mass in the region of the left medial canthus, now extending through the bony defect into the nasal cavity at the level of the operated anterior middle meatus. The tumor also extends inferiorly trough a partially dehiscent and mildly widened left nasolacrimal duct into the inferior meatus. There is slightly increase opacification of the left frontoethmoid recess and frontal sinus, which appears separate from the mass. There is mild mucosal thickening within the bilateral maxillary sinuses. The imaged intracranial structures are grossly unremarkable. | Interval increase in size of a mass within the region of the left medial canthus, middle meatus, and nasolacrimal duct with extension into the inferior meatus, compatible with recurrent inverted papilloma. The precise margins of the mass are difficult to delineate on this non-contrast CT and MRI may be useful for further characterization. |
Generate impression based on findings. | Clinical question: Evaluate for intracranial injury. Signs and symptoms: Head trauma status post seizure. Nonenhanced head CT:There is no detectable acute posttraumatic intracranial, calvarial or soft tissues of the scalp findings.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation.There is a slight prominence of cerebellar and vermian folia for patient stated age. This may be treatment related.Unremarkable orbits, calvarium, soft tissues of the scalp, all visualized paranasal sinuses, are visualized mastoid air cells and bilateral middle ear cavities. | No acute posttraumatic findings. |
Generate impression based on findings. | Chronic myeloid leukemia. There is a new air-fluid level within the left maxillary sinus. The infundibula are patent. There is also opacification of a right ethmoid air cell and a small retention cyst within the right frontoethmoid recess. The remaining paranasal sinuses are otherwise clear. The nasal cavity and mastoid air cells are clear. The imaged intracranial structures and orbits are grossly unremarkable. There is an unchanged nonspecific 5 mm diameter lucency in the left sphenoid triangle. | New air-fluid level within the left maxillary sinus may indicate acute sinusitis in the appropriate clinical setting. |
Generate impression based on findings. | Reason: evaluate ILD History: sob cough fibrosis LUNGS AND PLEURA: Mild subpleural reticulation with septal thickening noted throughout both lungs in a uniform distribution. There is no evidence of groundglass opacities or significant architectural distortion. There is the suggestion of minimal basilar honeycombing. Scattered apical bullae.No air trapping on expiratory imaging.No suspicious pulmonary nodules or masses.No pleural effusions.MEDIASTINUM AND HILA: Enlargedaa pre-carinal and subcarinal lymph nodes.Cardiac size is normal without evidence of a pericardial effusion.Mild coronary artery calcification.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Partially visualized hypoattenuating right renal mass most likely representing a cyst. | Mild pulmonary fibrosis in a nonspecific pattern. Scattered areas of very minimal honeycombing may represent early UIP. |
Generate impression based on findings. | Reason: Evaluate for infection. Pt s/p SCT with history of ggo on CT History: Fever LUNGS AND PLEURA: Upper lobe scattered bilateral groundglass opacities have not significantly changed when compared to the prior study. Resolution of the left lower lobe groundglass, consistent with slowlyresolving infection. Bilateral pleural effusions have decreased in size, small right and trace on the left, with associated atelectasis. No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Minimal thymic tissue is detected which may represent rebound hyperplasia. No mediastinal or hilar lymphadenopathy. The heart size remains normal. No interval pericardial effusion. The blood pool is of low density, consistent with anemia.CHEST WALL: Left PICC stable. Diffuse osseous changes affecting the bone marrow are stable. Mild anasarca.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Upper lobe scattered bilateral groundglass opacities have not significantly changed when compared to the prior study. Resolution of the left lower lobe groundglass, consistent with slowlyresolving infection. |
Generate impression based on findings. | Neck pain. There is straightening of the physiologic lordosis and subtle kyphosis at the most superior aspect of the cervical spine. There is multilevel spondylosis including posterior osteophytes at C4-5, C5-6, C6-7 and T1-2. Anterior osteophytes are most prominent at C5-6 and to a lesser extent C4-5, C7-T1, and T1-2. There is moderate intervertebral disk height loss at C4-5, C5-6 and C6-7. There is diffuse osteopenia. There is overall preserved vertebral body heights, with the exception of some very slight loss at C5. There are multiple thyroid nodules.C2-3: There are small uncovertebral osteophytes without significant neuroforaminal or spinal canal stenosis.C3-4: There are bilateral uncovertebral osteophytes resulting in moderate neural foraminal stenosis. A central protrusion results in a moderate degree of canal stenosis.C4-5: There are is a prominent posterior disc-osteophyte complex that results in complete effacement CSF space and effacement of the cord at this level. There are bilateral uncovertebral joint complex hypertrophy, worse on the right than left, resulting in severe right and moderate-severe left neural foraminal stenosis.C5-6: There is mild posterior osteophytes and disk protrusion with bilateral small intravertebral osteophytes which result in mild-moderate bilateral neural foraminal stenosis and mild canal stenosis.C6-7: There are significant posterior osteophytes in addition to a disc protrusion as well as significant bilateral uncovertebral joint osteophytes which result in mild spinal canal and bilateral neural foraminal stenosis. C7-T1: There are mild bilateral uncovertebral joint osteophytes without significant canal or neural foraminal stenosis. | Multilevel degenerative spondylosis most prominent at C3-4 and C4-5, where there is up to moderate to severe spinal canal and bilateral neural foraminal stenosis. There are milder degenerative changes at C5-6 and C6-7. These findings are better delineated on the prior MRI.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Female, 2 months old, mandibular hypoplasia status post mandibular distraction. Evidence of bilateral mandibular osteotomy is seen with advancement of the anterior mandible by several millimeters. Bilateral distraction hardware is in place. The degree of mandibular hypoplasia is mildly improved relative to the prior exam. The hard palate is short more downwardly angled than usual. The sella sits at an unusual posteriorly directed angle within the sphenoid bone. Intracranial contents are unremarkable. | Evidence of interval mandibular distraction as above. |
Generate impression based on findings. | Reason: 75 yo F with T4N0 NSCLC on 4.5 year post adjuvant therapy surveillance History: none CHEST:LUNGS AND PLEURA: Postsurgical findings consistent with left lower lobectomy.Bilateral pulmonary micronodules are stable. Calcified nodules within the peripheral right middle lobe again identified. Subpleural scar like opacity posterior basal segment left lower lobe unchanged.MEDIASTINUM AND HILA: Severe atherosclerotic calcification in the coronary arteries andaorta. Calcified right hilar lymph nodes, compatible with prior granulomas infection.Reference precarinal lymph node measures 9 mm (series 3 image 32), unchanged. Hypodense nodule inferior pole of the left thyroid lobe, stable. Small hiatal hernia. CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of IV and 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 exophytic cyst is unchanged.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No evidence of metastatic disease. |
Generate impression based on findings. | Female 68 years old; Reason: pancreatic cancer restaging History: pancreatic cancer restaging CHEST:LUNGS AND PLEURA: Scattered micronodules. The right lower lobe pulmonary nodule measures 0.6 x 0.3 cm (image 61/series 5) and is unchanged.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion.Right chest wall port terminates at the cavoatrial junction.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Intrahepatic pneumobilia. Hepatic and portal veins are patent. There are subtle hypodense foci in the liver remain too small to characterize. No dominant lesion. Biliary stent with mild intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic head mass that extends to the uncinate process measures 3.5 x 2.8 cm (image 102/series 3) previously, 3.5 x 2.6 cm.Progressive atrophy of the pancreatic body and tail with ductal dilatation. Mild inflammation surrounding the pancreas. The lesion extends to the superior mesenteric vein with lymph nodes in the gastrohepatic ligament.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: IVC filter. Peripancreatic lymph node measures 1.7 x 0.6 cm (image 83/series 3) previously, 1.7 x 0.7 cm.BOWEL, MESENTERY: Subtle omental nodularity. Thickening of the transverse colon is new.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Near stable size measurements of the primary pancreatic lesion and lymph nodes.2.Transverse colonic wall thickening of unclear etiology.3.No definite evidence of hepatic metastases. |
Generate impression based on findings. | Reason: eval for metastatic disease History: none LUNGS AND PLEURA: No pulmonary or pleural metastases noted.Minimal scarring right middle lobe.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.Aberrant origin of the left vertebral artery directly from the arch, a normal variant.CHEST WALL: Mild degenerative abnormalities with a focus of sclerosis in the lower thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Multiple hepatic cystlike hypodensities, grossly unchanged since a PET/CT 8/15/2012. | No sign of metastases, or other significant abnormality. |
Generate impression based on findings. | Male 71 years old; Reason: assess for metastatic extent of prostate cancer History: assess for metastatic extent of prostate cancer CHEST:LUNGS AND PLEURA: Scattered pulmonary granulomata. No dominant lung lesion. The pleural spaces are clear.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. Extensive coronary calcifications.Calcified left hilar lymph nodes.CHEST WALL: Small left axillary lymph nodes.OTHER: ABDOMEN:LIVER, BILIARY TRACT: Liver has a smooth contour. No suspicious hepatic lesions. Few scattered hepatic granulomata.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Fat-containing right adrenal mass measures 5.3 x 2.9-cm (image 93/series 3) with imaging features compatible with a myelolipoma.KIDNEYS, URETERS: Complex cystic mass with enhancing nodular components at the upper pole of the right kidney measures 3.0 x 3.2 cm on image 104/series 3 and is suspicious for a cystic renal cell carcinoma (Bosniak 4).Other hypodense lesions in both kidneys do not meet the criteria for simple cyst and may also represent small renal neoplasms.RETROPERITONEUM, LYMPH NODES: Calcific arterial sclerotic disease of the aorta. No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic metastatic disease in the thoracolumbar spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Sclerotic osseous metastatic disease in the pelvis.OTHER: No significant abnormality noted | 1.Osseous metastatic disease.2.Findings highly suspicious for a right renal cystic renal cell carcinoma the imaging features of a Bosniak 4 lesion.3.Right adrenal myelolipoma. |
Generate impression based on findings. | Clinical question: Suspected small nasal septal perforation. Signs and symptoms: Sinus pressure. Maxillofacial CT:Frontal sinuses are well pneumatized and without evidence of disease.Ethmoid sinuses are well pneumatized and without evidence of disease.Sphenoid sinus demonstrate a small focus of frothy contents in its anterior and right chamber suggestive of acute sinusitis. Occluded bilateral sphenoethmoidal recess secondary to mucosal thickening in the nasal cavity and along the anterior wall of sphenoid sinus.Maxillary sinuses are well pneumatized bilaterally and with patent ostiomeatal units.Nasal cavity demonstrate mild nasoseptal deviation to the right and a small bony septal spur projecting to the right measuring at 3 mm size. The bony spurring is in contact with the right inferior turbinate. There is also a large anterior nasal septum defect measuring at 19-mm in AP axis an 18-mm in cranial cephalad axis. Anatomical variation of concha bullosa of bilateral middle turbinate (left greater than right) are noted.Bilateral mastoid air cells and middle ear cavities are well pneumatized and unremarkable.Unremarkable images through the orbits. | 1.Small focus of frothy material in the anterior right chamber of sphenoid sinus may represent minimal acute sinusitis. Occluded bilateral sphenoethmoidal recess secondary to mucosal thickening in the superior nasal cavity and along the anterior sphenoid wall.2.Unremarkable paranasal sinuses otherwise.3.Anterior nasal septum defect measuring at 19 x 18-mm in AP and cranial cephalad axis. Mild rightward deviation of nasal septum and a 3 mm nasal bony spur projecting o the right. |
Generate impression based on findings. | Prenatal ultrasound showing CPAM LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedUPPER ABDOMEN: No significant abnormality noted. | Normal examination. |
Generate impression based on findings. | Female 48 years old; Reason: evaluate tumor burden History: s/p laryngectomy, head/neck ca CHEST:LUNGS AND PLEURA: Right lower lobe subsegmental atelectasis. Complete atelectasis of the left lung. Large left effusion occupying most of the left hemithorax. Trace right effusion.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. Bulky mediastinal lymphadenopathy near the thoracic inlet. Bulky mediastinal adenopathy posterior to the trachea.Tracheostomy terminates superior to the carina.CHEST WALL: Bilateral enlarged axillary lymphadenopathy. Reference left axillary node measures 2.9 x 2.8 cm (image 28/series 3) extensive soft tissue thickening and masses involving the lower neck.ABDOMEN:LIVER, BILIARY TRACT: Liver has a smooth contour. Nonspecific hypodense lesion in segment IVb of the liver.Cholelithiasis without biliary ductal dilatation or gallbladder distention.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: Lymph node adjacent to the gastrohepatic ligament measures 1.8 x 1.7 cm (image 79/series 3). BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Enlarged uterus. Likely due to multiple leiomyomata.BLADDER: Bladder decompressed by Foley catheter.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Left femoral vascular access catheter.OTHER: No significant abnormality noted. | 1.Enlarged upper mediastinal lymphadenopathy and bilateral axillary lymphadenopathy.2.Enlarged gastrohepatic lymph node.3.Complete collapse of the left lung with a large effusion.4.Cholelithiasis. |
Generate impression based on findings. | 54-year-old male with Crohn's disease and abdominal pain, rule out extramural abscess or tumor. ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: The spleen is somewhat small for age.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: Long segment of descending colon extending to the proximal sigmoid, measuring 14.4 cm with submucosal fat deposition and hyperenhancement of the mucosa. There is infiltration of the surrounding fat and fascia. A 2.3 x 0.6 cm fluid collection is noted within the transversalis fascia (image 49, series 3). The small bowel is normal in caliber. Extensive fibrofatty proliferation about the descending and sigmoid colon is noted. The TI is unremarkable. No evidence of fistula or intra-abdominal abscess.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Long segment of descending colon extending to the proximal sigmoid, measuring 14.4 cm with submucosal fat deposition and hyperenhancement of the mucosa. There is infiltration of the surrounding fat and fascia. A 2.3 x 0.6 cm fluid collection is noted within the transversalis fascia (image 49, series 3). The small bowel is normal in caliber. Extensive fibrofatty proliferation about the descending and sigmoid colon is noted. The TI is unremarkable. No evidence of fistula or intra-abdominal abscess.BONES, SOFT TISSUES:. Mild retrolisthesis of L5 on S1. Findings suggestive of bilateral sacroiliac disease.OTHER: No significant abnormality noted. | Findings suggesting acute on chronic disease involvement of the descending colon with small fluid collection noted within the transversalis fascia. |
Generate impression based on findings. | Reason: follow-up RUL nodule History: none LUNGS AND PLEURA: Solid nodule with spiculated margins measures 5 mm and is unchanged in size. Ground glass micronodule in the left upper lobe is unchanged (series 5, image 8). Left medial lower lobe scar-like opacity in measures 9 x 5 mm and is not significantly changed in size (series 5, image 281). Bronchial wall thickening. Minimal central lobular emphysema is unchanged. No pleural effusion.MEDIASTINUM AND HILA: No significant hilar or mediastinal lymphadenopathy. Small nonspecific mediastinal lymph nodes are again noted. Significant atherosclerotic calcification of the LAD and left main coronary artery ostium. There is low density focus in the apical septum raising question of prior myocardial infarct in the LAD territory. Calcifications along the right and inferior border of the pericardium are again noted.CHEST WALL: Moderate degenerative changes to the thoracic spine are again seen.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Stable solid nodule in the right upper lobe. If the patient is low risk, no further follow-up is recommended. If the patient is high risk, such as smoking or malignancy history, follow up is recommended another 6 to 12 months. |
Generate impression based on findings. | Female 85 years old Reason: preop evaluation TSA . Please include entire scapula There are multiple subchondral cysts in the glenoid and superior femoral head as well is associated subchondral sclerosis, osteophytosis and severe glenohumeral joint space narrowing compatible with severe osteoarthritis. No definite fatty atrophy of the muscles of the rotator cuff. | Severe glenohumeral osteoarthritis as described above. |
Generate impression based on findings. | 72 year-old male with mesothelioma. CHEST:LUNGS AND PLEURA: Again seen is diffuse pleural thickening in the right hemithorax with associated volume loss.Reference pleural measurements appear similar to prior study:1.Adjacent to T4 vertebral body at the 4 clock position measures 17 mm, previously measured 18 mm (series 3, image 27).2.Pleural nodule at the level of right main pulmonary artery at 7 o'clock position measures 7 mm, previously measured 7 mm (series 3, image 45).3.The para-aortic thickening at 4 clock position measures 6 mm, previously measured 4 mm (series 3, image 60). Loculated fluid collections along the right mediastinum have mildly decreased inferiorly along the azygoesophageal groove (series 3, image 39).Pleural thickening along the right major fissure does not appear significantly changed. Ill-defined opacity left lower lobe opacity located along the left major fissure also appears unchanged (series 4, image 62). Scattered lung nodules are unchanged. No new nodules.Postsurgical changes in the right base.MEDIASTINUM AND HILA: No change in upper normal size mediastinal lymph nodes. Heart is normal in size without pericardial effusion. Moderate coronary artery calcifications. CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Multiple subcentimeter hypodensities are incompletely characterized but unchanged and most consistent with benign cysts.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Stable thickening of both adrenal glands.KIDNEYS, URETERS: Hypoattenuating foci in both kidneys, many of which are too small to characterize, but unchanged and most likely benign cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.No significant change in right thoracic mesothelioma. 2.Irregularly marginated nodular opacity in left lower lobe is unchanged since CT from 9/2013; however, while not specific, the morphology is compatible with primary lung carcinoma and continued follow-up is recommended. |
Generate impression based on findings. | Status post tonsillectomy, neck dissection followed by radiation for a T2N1 cancer of the right tonsil. There are postoperative findings related to right tonsillectomy and neck dissection. There has been interval decrease in the degree of supraglottic edema related to radiation therapy as well as decreased effacement of the right glossotonsillar sulcus. There is no evidence of mass lesions. There is no evidence of significant lymphadenopathy by CT size criteria. The remaining major salivary glands appear unchanged. The thyroid gland is unremarkable. The major cervical vessels are patent. There are no lytic lesions within the cervical vertebral bodies. There is unchanged loss of cervical lordosis, right greater than left foraminal stenosis, and mild C3 on C4 anterolisthesis. The imaged paranasal sinuses and mastoid air cells are clear. The imaged portions of the lungs are clear. | 1.Interval evolution of post-treatment findings for right tonsillar squamous cell carcinoma without evidence of locoregional tumor recurrence.2.No evidence of significant cervical lymphadenopathy. |
Generate impression based on findings. | Reason: assess for causes of worsening shortness of breath, recent h/o pulmonary hemorrhage at OSH History: worsening SOB since 8/13 LUNGS AND PLEURA: Scattered groundglass opacities are similar to the prior exam and are suggestive of edema. Increased interlobular septal thickening compare to the prior exam compatible with interstitial edema.Subpleural 5 mm nodules identified at the left lung base may be inflammatory in origin.There is dependent basilar atelectasis. No pleural effusions.MEDIASTINUM AND HILA: Redemonstration of severe enlargement of pulmonary artery compatible with pulmonary to hypertension. This measures approximate 5.5 cm in diameter.Prominent mediastinal lymph nodes unchanged.There is cardiac enlargement.Previously noted pericardial effusion has increased in size.Right central venous catheter with its tip in the SVC.CHEST WALL: Mild degenerative changes in the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.Marked enlargement of pulmonary artery compatible with pulmonary hypertension.2.Scattered groundglass opacities with interval increase in interlobular septal thickening compatible with pulmonary edema. No evidence of pleural effusions.3.Pericardial effusion is increased in size since the prior exam.4.Subpleural nodules at the left lung base are nonspecific however may be inflammatory in origin. |
Generate impression based on findings. | Left upper quadrant abdominal pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: 1.2 by 0.9-cm left adrenal nodular focus best seen on image 49 of series 4KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Extensive vascular calcificationPELVIS: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: Extensive vascular calcification | Left adrenal nodular focus incompletely characterized on this portal venous study. Dedicated adrenal CT or MR would be helpful for further characterization. Otherwise, no acute, inflammatory, or neoplastic process. Extensive vascular calcification. |
Generate impression based on findings. | Reason: PE History: SOB PULMONARY ARTERIES: Technically adequate study. There is a small filling defect in the left lower lobe segmental artery consistent with pulmonary embolus.LUNGS AND PLEURA: Marked improvement of left upper lobe consolidation with residual groundglass opacities. Residual fine groundglass opacities in the lingula and bilateral lower lobes may represent recurrent infection. There is mild bronchial wall thickening. Right small pleural effusion with overlying atelectasis.MEDIASTINUM AND HILA: Heart size is normal. Small to moderate circumferential pericardial effusion. No significant mediastinal or hilar lymphadenopathy. The main pulmonary artery appears enlarged measuring 33 mm in transverse dimension, which appears slightly improved from prior exam.CHEST WALL: Subpectoral lymphadenopathy, left greater than right. Mild right axillary lymphadenopathy.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Status post cholecystectomy. Spleen is absent. Peritoneal calcifications in the left upper quadrant are again seen. Mild degenerative changes in the lumbar spine. | 1.Small left lower lobe segmental artery pulmonary embolus.2.Marked improvement of left upper lobe consolidation with residual groundglass opacities that may represent recurrent infection.3.Small to moderate circumferential pericardial effusion.4.Right small pleural effusion.Findings discussed with ER physician over the phone at 1530 on 10/29/13 by Dr. Alexander. |
Generate impression based on findings. | 69-year-old female with history of bladder cancer ABDOMEN:LUNG BASES: Calcified left lower lobe granuloma.LIVER, BILIARY TRACT: Stable left hepatic cyst and subcentimeter hypodensities.SPLEEN: Splenic granulomas.PANCREAS: No significant abnormality notedADRENAL GLANDS: Unchanged left adrenal adenoma.KIDNEYS, URETERS: Right renal AML is again noted. Right renal calcifications also identified. Soft tissue mass along the right ureter measures 1.5 x 1.0 cm and previously measured 1.2 x 0.6 cm (image 92, series 9). Hypodense left renal lesions are unchanged.RETROPERITONEUM, LYMPH NODES: New complex enhancing collection posterior to the right kidney extending along the psoas muscle measures 5.9 x 5.8 cm (image 58, series 7).Index left para-aortic lymph node measures 1.1 x 0.9 cm (image 52, series 7) and previously measured 1.2 x 0.9 cm. Atherosclerotic calcification and plaque of the abdominal aorta and its branches, with multiple ulcerated plaques. Additional retroperitoneal lymph nodes are unchanged.BOWEL, MESENTERY: Left lower quadrant ostomy.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Surgically absent.BLADDER: Status post cystectomy.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Left sided lymphocele is again noted. Anterior bowel wall laxity containing bowel loops without evidence of obstruction. | 1. New large complex enhancing lesion posterior right kidney most suspicious for tumor recurrence unless there are clinical signs of infection. Additional reference lesions are unchanged.2. Extensive atherosclerotic calcification and plaque of the abdominal aorta and its branches, with multiple ulcerated plaques, appearing similar to the prior study. |
Generate impression based on findings. | 36-year-old female patient with history of abdominal desmoid tumor status post chemotherapy, surgery and radiation therapy. Finished therapy one month ago. Evaluate for recurrence. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Right chest wall port with catheter tip terminating at the right atrium.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: Heterogeneously enhancing mass in the greater omentum in the left quadrant appears to be surgically removed and previously measured 3.9 x 4.9 cm. No evidence of new sites of disease. Surgical clips and mild fat stranding is consistent with interval surgery.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Heterogeneously enhancing uterus is compatible with noncalcified fibroids.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. | Interval surgery with removal of greater omental mass. No evidence of new disease. |
Generate impression based on findings. | SCC of the head and neck with recurrent fevers and hypotension despite broad antibiotic coverage and no clear source. CT head: There is a newly apparent focus of hypoattenuation in the left basal ganglia. Hyperattenuation within the globus pallidi bilaterally most likely represents mineralization. Otherwise, no intracranial mass or extra-axial fluid collection is identified. There is no evidence of acute hydrocephalus. There is sinus mucosal thickening within the sphenoid, ethmoids and maxillary is bilaterally. There is fluid within mastoid air cells bilaterally. There are no visualized bony lesions. The orbits are unremarkable.CT neck: There are postoperative findings related to laryngectomy, tracheostomy, and neck dissection. There are extensive heterogeneous masses throughout the neck, which are compatible with necrotic lymph nodes. Some of the necrotic areas now appear smaller, while some of the more solid components appear larger. There is a communication between the fluid within the oropharynx and the left carotid sheath at the site of the carotid/jugular ligation, implying fistulous connection. There has been interval stenting of the right common carotid artery, which traverses necrotic masses. The bilateral vertebral arteries appear to be encroached upon at some sites by tumor, although the exact relationship is difficult to delineate due to suboptimal contrast opacification. There is diffuse skin thickening and subcutaneous fat stranding as well as markedly increased tongue swelling. There is increased opacification of the paranasal sinuses. There is anterior mandibular subluxation with mandibular condyles overlying the articular eminences bilaterally. There is multilevel degenerative spondylosis. However, there are no aggressive appearing bony lesions. There is partially imaged left lung atelectasis and a large pleural effusion. | 1.Extensive confluent necrotic nodal masses throughout the neck related to metastatic squamous cell carcinoma of the tongue virtually throughout all nodal levels of the neck with evidence of extracapsular spread. Some of the necrotic areas now appear smaller, while some of the more solid components appear larger.2.Fluid collection within the ulcerated neopharynx that extends to the left carotid.3. A new hypodensity within the left basal ganglia may represent a subacute infarct. 4. Interval stenting of the encased of the right carotid artery, which courses through necrotic tumor. 5. Soft tissue stranding most likely related to post-therapeutic and obstructive lymphedema with interval increase diffuse tongue swelling.6. Increased opacification of the paranasal sinuses, likely replated to intubation, although sinusitis cannot be excluded. 7. Partially imaged left lung atelectasis and a large pleural effusion. Refer to the separate chest CT report for additional details.Discussed with DR. Howell at 4 PM on 10/29/13. |
Generate impression based on findings. | 52-year-old male status post thigh sarcoma resection. Evaluate for metastatic disease LUNGS AND PLEURA: New punctate nodule in left lower lobe measuring 3 mm (series 10355, image 86). Punctate calcified granuloma again noted in right apex. No other nodules identified. No consolidation or pleural effusions. MEDIASTINUM AND HILA: No mediastinal lymphadenopathy. The heart is normal in size without pericardial effusion. Right pericardial cyst again noted. Minimal coronary artery calcifications.CHEST WALL: Unchanged punctate sclerotic focus in T2 vertebral body. No new or suspicious osseous lesions.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | New micronodule in left lower lobe measures 3 mm; although this may be due to infection rather than metastatic disease, continued follow-up is recommended. No other findings of metastatic disease. |
Generate impression based on findings. | 36-year-old male with mild chronic nonproductive cough, history of lymphoma. Evaluate for radiation fibrosis or postchemotherapy effect. LUNGS AND PLEURA: Mild left lung volume loss with linear left apex opacities most consistent with scarring, possibly due to prior infection or radiation. Minimal left basilar ground-glass opacities, not specific but likely chronic. Several punctate micronodules bilaterally, all measuring less than 4 mm and likely benign in nature. Otherwise, the lungs appear unremarkable without consolidation or pleural effusions. MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.Mild left lung volume loss with mild scarring in left apex and mild ground glass opacities in left base; findings not specific but likely chronic and could be related to prior radiation and/or infection. 2.Several punctate micronodules all measuring less than 4 mm, likely benign in nature. |
Generate impression based on findings. | 16 year old female with history of leukemia, intubated. Evaluate lung fields, specifically pulmonary nodules and pleural effusions. LUNGS AND PLEURA: Bibasilar areas of consolidation are noted with surrounding nodular airspace and ground glass opacities compatible with atelectasis and likely superimposed pneumonia. There has been interval resolution of the bilateral pleural effusions seen on the prior study from October 21, 2013. Previously seen left apex groundglass opacity (series 5, image 18) is decreased in size compared to the prior study. Likewise other smaller nodular ground glass opacities appear overall decreased in size compared to prior examinations.MEDIASTINUM AND HILA: An endotracheal tube is noted with its tip below the thoracic inlet and above the carina. An enteric tube is noted coursing into the stomach with its tip inferior to the field of view.The previously noted enlarged right paratracheal lymph node is decreased in size since the prior study, currently measuring 6 mm in short axis (series 4, image 21). No new mediastinal or hilar lymphadenopathy is present.Cardiac size is within normal limits. The pericardial effusion seen on the previous exam has resolved. CHEST WALL: No significant abnormality notedUPPER ABDOMEN: There has been interval development of high attenuation abdominal ascites which measures approximately 60 Hounsfield units. Differential considerations include excreted contrast from prior IV contrast administration, proteinaceous fluid, or less likely hemorrhage. The intra-abdominal extent of this ascites is not visualized on this examination.The gallbladder is not visualized on this exam. | 1. Bibasilar airspace opacities/consolidation compatible with atelectasis and likely superimposed pneumonia. Interval decrease in size of scattered nodular and groundglass opacities suggests overall improvement compared to the prior study from October 21, 2013.2. Interval resolution of small bilateral pleural effusions and moderate pericardial effusion since the prior study. Interval decrease in size of enlarged mediastinal lymph node.3. Interval development of high attenuation abdominal ascites partially visualized for which differential considerations include excreted contrast from prior IV contrast administration, proteinaceous fluid, or less likely hemorrhage. |
Generate impression based on findings. | Reason: evidence of PE? History: SOB, tachypnea, tachycardia PULMONARY ARTERIES: No evidence of pulmonary embolus.LUNGS AND PLEURA: Previous basilar groundglass opacities near completely resolved. Bronchial wall thickening in several areas of mucoid impaction remain. There are groundglass opacities with areas of septal thickening within the bilateral upper lobes and right middle lobe but in the distribution different from the prior exam. Bronchial wall thickening persists in these locations, raising a question of recurrent aspiration and infection. This is slightly atypical for hypersensitivity pneumonitis.No pleural effusion or pneumothorax.MEDIASTINUM AND HILA: Reduction in size of mediastinal lymph nodes. No hilar lymphadenopathy. Small amount of mucus is noted within the trachea.The heart size is normal. No pericardial effusion.CHEST WALL: Low-density lesion within the lateral superior lateral right breast (series 7 image 105) unchanged from prior study. This may represent a cyst. Correlation to mammography and physical examination is recommended.Stable, mildly enlarged left axillary lymph nodes.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Multifocal areas of groundglass opacity with diffuse bronchial wall thickening suspicious for recurrent aspiration and infection. Consider underlying asthma or reactive airway disease. |
Generate impression based on findings. | 68-year-old female patient with cholangiocarcinoma. Please assess response to therapy and provide index lesion measurements. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Right cardiophrenic lymph node is stable compared to prior examination.CHEST WALL: Right Port-A-Cath with catheter tip terminating at the cavoatrial junction.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedgallbladder filled with small gallstones with thickening of the gallbladder wall and solid mass encircling and involving most of the gallbladder. Mass extends to segments 4 and 6. Maximal cross-sectional diameter of involvement measures 8.6 X 5.8 cm (series 4 image 111), previously 8.8 x 6.8 cm. Redemonstration of extension to the common hepatic duct and encasement of vascular structures in the porta hepatis.Large-bore bile duct stent is in position extending to the ampulla. Air in the intrahepatic biliary system is consistent with patent stent.Segment 7 mass lesion with peripheral enhancement measures 1.7 x 1.3 cm (series 4 image 88), previously 1.6 x 1.2 cm. A second peripherally enhancing lesion in the inferior right lobe measures 1.6 x 2.1 cm (series 4 image 124), previously 1.6 x 2.2 cm. There is an enhancing lesion in segment 3 and measures 1.9 x 1.3 cm (series 4 image 102), seen on prior examination and stable.There is redemonstration of a hemangioma in segment 8.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: There are two fat-containing ventral hernias (series 4 images 131 and 141).BONES, SOFT TISSUES: No significant abnormality notedOTHER: Soft tissue density in the subcutaneous right lateral abdominal wall may be secondary to injection versus mass.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Numerous liver lesions, grossly stable in size. No evidence of new sites of disease. Recommend continued follow up with arterial and portal venous phase CT scans.2.Soft tissue density in subcutaneous fat in right lateral abdominal wall is new compared to prior examination and may represent injection site versus new soft tissue density mass. |
Generate impression based on findings. | 81 year old patient with advanced dementia and hallucinations. There is unchanged diffuse mild prominence of CSF spaces in keeping with atrophic change most prominent over the frontal lobes bilaterally. There is no evidence of intracranial mass, hemorrhage, hydrocephalus or cerebral edema. There is mild nonspecific cerebral white matter hypoattenuation. There is also a more focal hypoattenuating area in the let basal ganglia that corresponds to a chronic lacunar infarct. There is partial opacification of the right mastoid air cells. The imaged paranasal sinuses are clear. | 1. Mild cerebral volume loss, but no evidence of acute intracranial hemorrhage, mass, or cerebral edema.2. Partial opacification of the right mastoid air cells, which may represent mastoiditis in the appropriate clinical setting. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Clinical question: Evaluate for chronic sinusitis. Signs and symptoms: History of previous sinus surgery now having frequent sinusitis treated medically without resolution. Medtronic fusion sinus CT:Frontal sinuses are well pneumatized and without evidence of disease. Improvement since prior exam.Ethmoid sinuses. There is evidence of bilateral ethmoidectomy without evidence of disease. There is interval improvement since prior exam.Sphenoid sinus is well pneumatized and without evidence of disease. There are patent bilateral sphenoethmoidal recess. There is interval improvement since prior exam.Maxillary sinuses demonstrate expected postoperative changes of bilateral endoscopic functional sinus surgery with widely patent bilateral sinonasal windows. No evidence of disease. A tiny retention cyst or small focus of mucosal thickening noted along the medial wall of the left maxillary sinus since prior exam has resolved.Nasal cavity demonstrate expected postop changes. The mucosal lining of the nasal passage appear very thin compared to prior exam which may be treatment related. Unremarkable otherwise.Bilateral mastoid air cells and middle ear cavities remain well pneumatized.Images through the orbits demonstrate a tiny focus of bony dehiscence along the right lamina papyracea with minute bulging of the retropatellar fat through the defect (coronal reformatted series 80575 image 22). The findings likely result of a congenital variation or less likely of a post traumatic finding. This remain stable since prior exam. | 1.No detectable acute or chronic sinusitis. Interval complete resolution of previously noted sinusitis.2.Expected postoperative changes of endoscopic functional sinus surgery as detailed above. |
Generate impression based on findings. | Male 25 years old; Reason: kidney stone History: low back pain with groin pain, history of 5 stones in the past 5 years 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: Small nonobstructing calcification noted in the midpole left kidney. There is no hydronephrosis or hydroureter. No perinephric inflammation.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diverticulosis without diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Small nonobstructing nephrolith in the mid pole left kidney. Otherwise, no acute intra-abdominal pathology detected. |
Generate impression based on findings. | Male 65 years old; Reason: mets lung cancer, s/p chemo and RT, pls c/w previous study and evaluate dz status and tx response. History: lung ca CHEST:LUNGS AND PLEURA: Unchanged moderate sized right pleural effusion and right basilar atelectasis obscuring right lower lobe nodule . Volume loss in the right middle lobe with right middle lobe nodule contiguous with the right pericardium similar in appearance to the prior exam. Subpleural right middle lobe nodule (image 57 series 6) re-demonstrated. Scattered calcified and noncalcified micro-nodules.MEDIASTINUM AND HILA: Mediastinal lymphadenopathy with reference precarinal lymph node (image 39 series 4) now measuring 1.7 Cm x 2.4 cm previously measuring 2.4 cm x 3.3 cm. Epicardial lymph nodes stable. Cardiac size is normal with small pericardial effusion unchanged.CHEST WALL: Dextroscoliosis of the thoracic spine with accompanying degenerative changes.Stable rib metastases with right 10th rib associated soft tissue mass effacing the right liver capsule and extending into the right lateral chest wall.Partially visualized right supraclavicular lymphadenopathy.ABDOMEN:LIVER, BILIARY TRACT: No focal lesion detected. Gallstones are noted in the gallbladder without evidence of cholecystitis. No intra-or extrahepatic biliary ductal dilationSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: A few too small to characterize lesions in the kidneys bilaterally. Hyperdense foci noted in the kidneys bilaterally, which could be compatible with nonobstructing nephroliths. There is no hydronephrosis or hydroureter. No perinephric stranding or fluid collections.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is a large mass indenting into the liver arising from the soft tissues of the rib metastases on the right which appears similar. OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Overall stable to slightly improved metastatic disease. |
Generate impression based on findings. | 69-year-old female status post fall, evaluate for bleed. CT brain:Soft tissue injury to the left posterior parietal scalp.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.CT cervical spine:The vertebral body heights are relatively maintained without evidence of fracture or malalignment. Reversal of normal cervical lordosis which may be secondary to positioning.Multilevel degenerative changes of the cervical spine including anterior osteophyte formation, loss of disk height, posterior disk protrusions and uncovertebral hypertrophy. Degenerative changes result in multilevel central canal compromise and neuroforaminal narrowing most pronounced at C5-C6 and less severe at other levels.The visualized intracranial and paraspinal contents are unremarkable. | 1. No acute intracranial abnormalities.2. Multilevel degenerative changes of the cervical spine without evidence of fracture or malalignment.If clinical desire to further evaluate degenerative changes exists, MRI of the cervical spine may be obtained. |
Generate impression based on findings. | Male 72 years old; Reason: history of progressive prostate cancer History: prostate cancer ABDOMEN:LUNGS BASES: Bibasilar atelectasis noted. No nodule or mass detected.LIVER, BILIARY TRACT: Subcentimeter hypoattenuating lesion in segment V too small to reliably characterize, however stable. Liver morphology is normal. The gallbladder and biliary system is normal.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Again noted significant bilateral hydronephrosis and bilateral renalcysts. The hydronephrosis has improved since previous examination. Bilateral ureters are diffuse the dilated all the way to the level of the bladder also mildly improved since previous examination..KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small duodenal diverticulum noted, unchanged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE: Prostate is significantly enlarged causing infravesical obstruction and extending to the bladder.BLADDER: Bladder is completely decompressed by a suprapubic catheter. Multiple calcifications around the balloon of the catheter likely represent bladder stones.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Bilateral fat-containing hernias. These are also unchanged. | Interval decrease in the significant bilateral hydronephrosis and hydroureter with mild to moderate residual. Multiple bladder stones with a significantly enlarged prostate is also stable. |
Generate impression based on findings. | 74 year-old male with laryngeal cancer and emphysema. CT chest on 8/8/2013 showed new nodular opacity. LUNGS AND PLEURA: Severe centrilobular emphysema. Interval decrease in previously seen posterior right lung opacities and right lower lobe nodularity, which may have been due to aspiration, especially given patient's tracheostomy and presence of mucous material in the trachea on prior exam. However, there are persistent small opacities seen in the superior segment of the right lower lobe and inferior aspect of right upper lobe, which may represent scarring although continued follow up is recommended.Several other punctate micronodules are unchanged. No new suspicious nodules.MEDIASTINUM AND HILA: No mediastinal adenopathy. Severe coronary artery calcifications. The heart is normal in size without pericardial effusion.Cystic structure in anterior mediastinum unchanged, likely thymic or pericardial in origin and of doubtful clinical significance.Small hiatal hernia.CHEST WALL: Postsurgical changes in the lower neck again noted. Small cystic lesion in subcutaneous tissues of anterior chest wall unchanged, likely sebaceous cyst (series 3, image 67).UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Status post cholecystectomy. Multiple hepatic and renal hypodensities are again noted, some of which are too small to accurately characterize but most likely benign cysts. | 1.Interval decrease in right lung opacities, which may have been due to aspiration. Persistent small opacities seen in the superior segment of the right lower lobe and inferior aspect of right upper lobe may post-inflammatory although continued follow up is recommended.2.No convincing evidence of metastatic disease. |
Generate impression based on findings. | 59-year-old male patient with pre-kidney transplant assessment of vasculature. History of advanced peripheral vascular disease. Note that the lack of intravenous and oral contrast limits evaluation of the vasculature, lymph nodes, hollow and solid viscera.ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral atrophic kidneys with multiple hypoattenuating lesions. Larger lesions measure fluid density and are consistent with cysts.RETROPERITONEUM, LYMPH NODES: Significant atherosclerotic changes in the abdominal aorta.BOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Significant atherosclerotic changes in the common and internal iliac arteries. Scattered calcifications consistent with atherosclerotic changes in the external iliac arteries. Numerous collaterals are noted in the subcutaneous tissues of the anterior pelvic wall and upper thighs.Left femoral graft is noted. Correlate clinically. | Significant calcifications in the common and internal iliac arteries with scattered calcifications in the external iliac arteries. |
Generate impression based on findings. | 62 year-old female with shortness of breath and increased work of breathing. Evaluate pleural effusion and mass. LUNGS AND PLEURA: Significant interval increase in previously seen centrally necrotic left lung mass; the mass is difficult to measure due to lack of IV contrast and difficulty differentiating from underlying collapsed lung.Large, loculated left pleural effusion and diffuse pleural thickening. The underlying left lung is completely collapsed/consolidated due to complete obliteration of the left mainstem bronchus. A percutaneous pleural catheter is present in the left base.Small right pleural effusion and right basilar consolidation/atelectasis. Multiple nodules are present in the right lung, which are likely not significantly changed, however somewhat difficult to evaluate given shift in length position due to left basilar consolidation; the reference right lower lobe nodule measures 20 x 18 mm, previously measured 20 x 19 mm (series 4, image 68).MEDIASTINUM AND HILA: The large left lung mass invades the left hilum and encases the left main pulmonary artery.Multiple enlarged mediastinal lymph nodes, difficult to evaluate with lack of IV contrast; the reference precarinal node is likely not significantly changed, measuring 25 mm, previously measured 26 mm (series 3, image 34).Heart size normal without significant pericardial effusion. Coronary artery calcifications again noted.CHEST WALL: Increased anasarca in the subcutaneous soft tissues.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Liver hypodensities unchanged likely represent benign cysts. Increased soft tissue nodularity in the retroperitoneum, consistent with worsening lymphadenopathy. | 1.Interval increase in large left lung mass which now causes complete obstruction of left mainstem bronchus and resultant complete collapse of left lung. There is associated large, loculated left pleural effusion. 2.Interval development of small right pleural effusion and right basilar consolidation/atelectasis.3.Multiple right lung nodules, and mediastinal lymphadenopathy likely not significantly changed. |
Generate impression based on findings. | Reason: Patient with a h/o swcca pyriform sinus s/p CRT at OSH. Please evaluate. History: SCCA pyriform sinus LUNGS AND PLEURA: Motion limits sensitivity. Mild apical and basilar scarring.Bronchial wall thickening. No suspicious pulmonary nodules or masses.No pleural effusions.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.Cardiac size is normal without evidence of a pericardial effusion.Mild coronary calcification.Left-sided ICDCHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Multiple splenic calcifications compatible with prior granulomatous disease. Pancreatic atrophy. | No evidence of metastatic disease. |
Generate impression based on findings. | Clinical question: Gait disorder. Signs and symptoms: Gait disorder. Unenhanced head CT:There is no detectable acute intracranial process CT however is insensitive for detection of acute nonhemorrhagic ischemic strokes. There is mild to moderate primarily periventricular foci of low-attenuation a white matter consistent with previously known (seen on prior MRI ) small vessel ischemic strokes of indeterminate age. There is resultant mild ex vacuo validation of supratentorial ventricular system which remain grossly similar to prior exam. No detectable cerebral cortical abnormalities. Mild prominence of cortical sulci is noted. No detectable abnormality of the cerebellar hemispheres, vermis, pons or medulla is detected.Minimally calcified tortuous tumor abuts our system is identified. Minimal bilateral cavernous carotid vascular calcification is noted.Unremarkable images through the orbits or the external postoperative changes of cataract.All the paranasal sinuses and bilateral mastoid air cells and middle ear cavities remain well pneumatized. | 1.No acute intracranial process.2.Age indeterminate small vessel ischemic strokes with resultant ex vacuo dilatation of supratentorial ventricular system.3.No convincing evidence of any abnormality in the posterior fossa. |
Generate impression based on findings. | Male, 74 years old, larynx cancer who failed radiation therapy, status post total laryngectomy. Since the prior examination, the patient has undergone total laryngectomy and tracheostomy. There is a voice prosthesis in place. Within the surgical bed, no definite evidence of recurrent disease is seen. There is smooth soft tissue thickening along the pharynx posteriorly at the level of the resected glottis which most likely represents pharyngeal reconstruction.No pathologic adenopathy is detected by size criteria. The salivary glands are free of focal lesions. Most of the thyroid has been resected but there is a small amount of residual thyroid tissue along the right laryngectomy bed.An ICA stent is in place on the right spanning from the C2 down to the C4 levels. The stent is irregularly narrowed but seems to show contrast opacification throughout. The remaining cervical vessels are unremarkable. Severe emphysema is present in the lung apices.No concerning osseous lesions are demonstrated. Extensive degenerative disk disease is again seen in cervical spine similar to prior. | 1. Expected changes status post laryngectomy and tracheostomy. No evidence of recurrent disease in the resection bed.2. No pathologic adenopathy in the neck. |
Generate impression based on findings. | Recurrent sinusitis, 3 prior sinus surgeries. There are postoperative findings related to bilateral uncinectomy, partial middle turbinectomy ,and partial ethmoidectomy. There is near complete opacification of the right maxillary sinus with hyperdense secretions (~90 HU) and diffuse mucosal thickening. There is an air-fluid level within the left maxillary sinus in addition to moderate mucosal thickening. There is complete opacification of the ethmoid. sphenoid, and frontal sinuses, which also contain hyperdense components. There is neo-osteogenesis within the remaining ethmoid air cells. There is diffuse thickening and sclerosis of the paranasal sinus walls. The ethmoid roofs are intact and symmetric. The optic canals and carotid grooves are covered by bone. There is opacification of the bilateral olfactory recesses. There is no significant nasal septal deviation. The mastoid air cells are clear. The imaged intracranial structures are grossly unremarkable. | Diffuse paranasal sinus opacification with evidence of acute upon chronic sinusitis, perhaps with a component of allergic fungal sinusitis. |
Generate impression based on findings. | 41-year-old male with head and neck cancer. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted. Interval removal of central venous catheter. CHEST WALL: Right clavicular fixation device.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. | No evidence of metastases. |
Generate impression based on findings. | 76-year-old male patient with history of resection of sigmoid, rectum and anus and exlap for obstruction presents with prolonged ileus. Assess for bowel obstruction/fluid collection. ABDOMEN:LUNG BASES: Interval increase in bilateral pleural effusions with associated atelectasis, right greater than left.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: Persistently dilated loops of bowel with air fluid levels and transition point in pelvis. Left lower quadrant ostomy.BONES, SOFT TISSUES: No significant abnormality notedOTHER: There is a large loculated fluid collection that extends from the left pericolic gutter to the pelvis. Collection measures 5.6 x 6.7 cm (series 3 image 130) and contains air. Perihepatic fluid loculated fluid collection measures 8.8 x 2.6 cm (series 3 image 73), new compared to prior examination. There is a right pericolic loculated fluid collection that measures 4.0 by 2.6 cm (series 3 image 117).PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Persistently dilated loops of bowel with air fluid levels and transition point in pelvis. Left lower quadrant ostomy.BONES, SOFT TISSUES: Multilevel degenerative changes of the thoracic and lumber spine. Diffuse subcutaneous edema.OTHER: Presacral drain in place with presacral collection measuring 5.6 x 6.0 cm (series 3 image 144), previously 6.5 x 7.1 cm. | 1.Loculated fluid collections in the abdomen and pelvis. Largest fluid collection extending from the left pericolic gutter into the pelvis contains air, which may or present infection versus communication with loop of bowel.2.Slight interval decrease in presacral collection with drain in place.3.Persistently dilated loops of bowel with transition point in pelvis.4.Interval increase in bilateral pleural effusions. |
Generate impression based on findings. | Male 34 years old; Reason: perforation? History: pneumoperitoneum ABDOMEN:Extensive free intraperitoneal air is noted.LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a G-tube projecting into the stomach lumen. No extravasation of enteric contrast is noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: Foley catheter is noted decompressing the bladder.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: The rectum is markedly distended with stool, and there is asymmetric rectal wall thickening. There is fat stranding and presacral space.OTHER: No significant abnormality noted. | 1.Extensive free intraperitoneal air, likely from prior G-tube placement. No extravasation of enteric contrast.2.Rectal wall thickening with presacral space inflammation, correlate for stercoral colitis |
Generate impression based on findings. | 41-year-old male with right lower lobe lung nodule. LUNGS AND PLEURA: Moderate emphysema predominantly affecting the lung apices. Scattered punctate micronodules all measuring approximately 1 to 2 mm, likely benign in nature. No suspicious nodules identified.Mild basilar scarring/atelectasis.MEDIASTINUM AND HILA: Heart size normal. No pericardial effusion. No significant mediastinal adenopathy. Mild coronary artery and aortic calcifications.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Status post cholecystectomy. | No suspicious nodules identified, specifically no nodules in right lower lobe. |
Generate impression based on findings. | Male, 41 years old, squamous cell cancer of the tongue status post CRT. Surgical deformity of the tongue is again seen with volume loss on the right appearing similar to the prior exam. Additional radiation related changes are also seen including mild infiltration and blurring of the fascial planes. This has improved from the prior examination as has mucosal hyperemia.No masses or pathologically enhancing lesions are demonstrated. A left vallecular cystic structure is more difficult to visualize on today's study but probably not changed.No pathologic adenopathy is detected in the neck by size criteria. The previously referenced right level 2 lymph node is difficult to identify within the background treatment related change and some motion artifact, however it may measure approximately 0.9 x 0.8 cm (image 39 series 1202), previously 1.2 x 1.1 cm.Parotid and submandibular glands are unremarkable. The thyroid is free of focal lesions. Cervical vessels are patent. Lung apices are clear. No concerning osseous lesions are demonstrated. Plate fixation of the right clavicle is again seen. | Redemonstration of postsurgical and treatment related change in the neck. No evidence of recurrent tumor or pathologic adenopathy. |
Generate impression based on findings. | Female 45 years old Reason: concern for abscess or tracking of infection History: leg pain, edema, induration, persistent bacteremia The study is limited by the lack of IV contrast.RIGHT THIGH: There is a large wound with complete loss of the subcutaneous fat along the anteromedial aspect of the right thigh musculature. The underlying gracilis and sartorius muscles are enlarged reflecting edema. The fat planes of the adductor muscles are indistinct likely due to underlying edema. The remaining thigh musculature also appears edematous compared to that of the left and there is diffuse intramuscular edema, which is nonspecific. There is extensive reticulation of the subcutaneous fat as well as skin thickening indicating additional edema. Given the limitations of this noncontrast examination, no discrete drainable abscess is evident. Severe osteoarthritis affects the right knee and there is a moderate joint effusion extending posteriorly to a Baker's cyst, which contains loose bodies. Mild osteoarthritis of affects the right hip. There is no imaging evidence of osteomyelitis and no gas density is seen within the soft tissues.LEFT THIGH: There is diffuse reticulation of the subcutaneous fat and skin thickening. There is perhaps mild intramuscular edema but no discrete fluid collection to suggest abscess. Severe osteoarthritis affects the left knee and there is a joint effusion extending posteriorly into a Baker's cyst, which contains loose bodies, similar to the right. There is mild osteoarthritis of the right hip.Please refer to the abdominal and pelvic CT examination report from the same day for pelvic findings. | 1.Large right thigh wound with intra- and intermuscular edema as well as surrounding subcutaneous edema and skin thickening. We see no discrete abscess although we cannot exclude necrotizing fasciitis on the basis of this examination.2.Diffuse subcutaneous edema and skin thickening of the left thigh.3.Degenerative changes as described above.These findings were relayed to Dr. Sofia at 17:41 on 10/29/2013 |
Generate impression based on findings. | Fall on coumadin. There is no evidence of acute intracranial hemorrhage, mass, or edema. There is unchanged patchy hypoattenuation in the cerebral white matter, which likely represents small vessel ischemic disease. The ventricles and basal cisterns are stable in size and configuration. There is an unchanged 5 mm diameter sclerotic focus within the right clivus that likely represents an enostosis. There is an unchanged punctate well-defined ossific body in the left temporomandibular joint, which may represent an synovial osteochondromatosis. The calvaria and skull base are otherwise intact without evidence of fracture. There is mild scattered paranasal sinus mucosal thickening without evidence of air-fluid levels. The mastoid air cells are clear. The extracranial structures are unremarkable. | 1. No evidence of acute intracranial hemorrhage, fracture, mass, or edema. 2. Unchanged moderate patchy periventricular white matter hypoattenuation likely represents small vessel ischemic disease. |
Generate impression based on findings. | Head trauma. There is a right parieto-occipital subgaleal hematoma that measures up to 6 mm in width. There is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull appears unremarkable without evidence of depressed fractures. | Small right parieto-occipital subgaleal hematoma. No evidence of intracranial hemorrhage, depressed skull fracture, mass, or cerebral edema. |
Generate impression based on findings. | Reason: 77F w/ end stage COPD w/ subacute worsening shortness of breath and dyspnea on exertion, evaluate for PE History: Shortness of breath, dyspnea on exertion PULMONARY ARTERIES: Technically adequate study. Very small nonocclusive linear filling defect in the proximal left apicoposterior segmental pulmonary artery. Motion causes additional areas of artifactual non-opacification. Main pulmonary artery appears upper normal in size. Lobar level branches appear prominent.LUNGS AND PLEURA: New small left pleural effusion. Interval worsening of centrilobular and paraseptal emphysema. Scarring in the right apex has worsened and large bulla has also increased in size. Multiple calcified nodules, left greater than right, unchanged from prior exam. Nodule in the left lower lobe measuring 6 mm, new from prior exam (series 7, image 145).MEDIASTINUM AND HILA: Multiple calcified mediastinal lymph nodes. Small pericardial effusion. Moderate coronary artery and aortic calcifications. No signs of right heart strain.CHEST WALL: Punctate calcification in the right lobe of the thyroid unchanged.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Significant motion artifact limits evaluation.Mild nodularity to the right adrenal gland. Interval enlargement of exophytic hypodense lesion of water density in the upper pole of the left kidney likely represents a benign renal cyst. Small hypodense lesions in the right kidney are too small to further characterize. | 1.Filling defect in the left upper segmental pulmonary artery consistent with acute pulmonary embolus.2.New small left pleural effusion and pericardial effusion.3.New 6mm left lower lobe nodule. Follow-up is recommended in 6 months if the patient is a smoker or otherwise at high risk for malignancy. 12 months CT follow up recommended if patient has no risk factors.4.Interval worsening of centrilobular and paraseptal emphysema.5.Motion artifact limits the assessment of solid organs.Findings and recommendations discussed with and acknowledged by medicine service pg 3420 over the phone at 9:20a.m. by Dr. Alexander. |
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