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Generate impression based on findings. | Female 35 years old; Reason: rectal IV restage History: none CHEST:LUNGS AND PLEURA: Multiple pulmonary metastasis, with interval resolution of the cavitation. While not significantly changed in size (Reference left lower lobe nodule measures 1.7 x 1.0 cm previously 1.8 x 1 cm (series 4 image 48), the fact that portions of nodules that were cavitated now are solid may mean increased tumor burden without changing measurement. No new nodules detected. MEDIASTINUM AND HILA: Nonspecific hypodense focus in left thyroid lobe, unchanged. No mediastinal or hilar lymphadenopathy.CHEST WALL: Right chest wall port terminates at the cavoatrial junction.ABDOMEN:LIVER, BILIARY TRACT: Interval development of a 2.2 x 2.0-cm hypoattenuating mass in segment IVb of the liver. Suggestion hypoattenuation extending to the liver capsule has progressed when compared to the previous which may represent edema or fatty infiltration adjacent to mass lesion. No other focal lesion detected.. Cholelithiasis without cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Right lower quadrant colostomy with herniation of mesenteric fat at the ostomy site, unchanged.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: Small perirectal nodes measuring 5 mm (series 3 image 167) have also increased in size (previously 4 mm). Non-reference nodes have also increased in size, conspicuity and number.BOWEL, MESENTERY: Circumferential wall thickening of the distal rectosigmoid colon, not significantly changed. No bowel obstruction. Strand of soft tissue extending anteriorly from the colon to the uterus is unchanged. Spiculated soft tissue pelvic mass has increased in size measures 2.2 x 2 .8 cm, previously 1.9 x 3.9 cm, (series 3, image 155). BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. No significant interval change in size of the numerous pulmonary metastasis, however the lesions have become more solid.2. Interval development of a hypoattenuating lesion within the liver, likely metastatic focus.3. Slight interval increased size of spiculated pelvic mass and increase in size and conspicuity of the numerous perirectal nodes.4. Wall thickening of the distal rectosigmoid colon, not significantly changed.4. Cholelithiasis. |
Generate impression based on findings. | 45-year-old female concern for psoas abscess with bacteremia and back pain and leg edema. ABDOMEN: Lack of IV contrast limits evaluation of solid organ pathology and vasculature.LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Status post cholecystectomy. Nodular liver morphology, and recanalized umbilical vein.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Scattered prominent retroperitoneal lymph nodes are noted.BOWEL, MESENTERY: No significant abnormality noted. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate ascites and anasarca. No loculated fluid collections.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: The bowel is normal in caliber. Thickened bowel folds may relate to hypoproteinemia.BONES, SOFT TISSUES: Degenerative changes of the lumbar spine most pronounced at L4 and L5, appearing similar to the prior study.OTHER: Moderate ascites and anasarca. No loculated fluid collections. | 1. No loculated fluid collections. Moderate abdominal and pelvic ascites and anasarca, increased from the prior study.2. Cirrhotic liver morphology. |
Generate impression based on findings. | Chest x-ray concern for dissection. Please evaluate. Short of breath. CHEST:LUNGS AND PLEURA: Large left pleural effusion with overlying atelectasis is new since the prior exam.MEDIASTINUM AND HILA: There is massive mediastinal lymphadenopathy. For reference purposes, a left paratracheal conglomeration of lymph nodes measures 4.5 x 5.6 cm (image 48; series 9). Adenopathy in the left mediastinum compresses the left main pulmonary artery and left lower lobe bronchi. There is no evidence of aortic to section. The ascending aorta measures 4 cm in diameter and the descending thoracic aorta measures 3.6 cm in diameter (image 77; series 9). Mild irregularity of the arch (image 41; series 9) probably represents underlying atherosclerotic disease. Small pericardial effusion.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Hepatic transplant identified in the right quadrant, incompletely evaluated on this early arterial phase only study. Surgical clips adjacent to the transplant.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple bilateral renal cysts. There are additional subcentimeter renal hypodensities which are too small to characterize.RETROPERITONEUM, LYMPH NODES: Status post infrarenal abdominal aneurysm repair. Bypass from the infrarenal aorta to the transplant hepatic artery is widely patent. Mild saccular aneurysmal dilatation proximally is probably postsurgical.BOWEL, MESENTERY: No evidence of bowel obstruction.BONES, SOFT TISSUES: Degenerative disk disease of the lower lumbar spine. Ventral protrusion without evidence of significant hernia bowel herniation.OTHER: No significant abnormality noted. | 1.No evidence of aortic dissection.2.New massive adenopathy in the mediastinum as described above. Differential diagnosis includes small cell carcinoma and lymphoma. Findings were discussed with Dr. Aronson at the time of dictation.3.New large left pleural effusion with overlying atelectasis.4.Small pericardial effusion.5.Status post infrarenal abdominal aortic aneurysm repair |
Generate impression based on findings. | Worsening IPF. Worsening hypoxemia. Question PE. PULMONARY ARTERIES: Adequate infusion quality. Nonopacification of the lateral segmental pulmonary artery to the right middle lobe.. Additional small filling defects noted in the left lower lobe (7/188) and in the medial segment of the right middle lobe may be artifactual, though additional emboli cannot be excluded due to severe motion artifact. Mild air trapping on the expiration sequence.LUNGS AND PLEURA: Subpleural honeycombing and traction bronchiectasis consistent with known UIP/IPF and appears progressed compared to the previous examination, though groundglass opacities may be exaggerated due to underinflation and motion artifact.No evidence of infarct or pulmonary hemorrhage in the right middle lobe lateral segment.MEDIASTINUM AND HILA: Mild to moderate bilateral mediastinal lymphadenopathy with slight progression in some areas. For example, a low right paratracheal lymph node measures 17 mm, previously 10-mm (7/.26). Right greater than left hilar region lymphadenopathy also slightly worse.Upper normal heart size. Patulous thoracic esophagus.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Elevation of left hemidiaphragm. Limited scanning range. Solid organs are unopacified, limiting assessment. No gross abnormality noted. | 1. Segmental level embolus in the right middle lobe compatible with pulmonary embolus. Eric Brandt (2660) verbally notified of the discrepancy between preliminary and final interpretations at 8:35 a.m. on 10/29/13.2. Unable to exclude nonocclusive small subsegmental emboli elsewhere due to motion artifact. No large central embolus in the main pulmonary arteries.3. Interval progression of UIP with diminished lung volumes.4. Slight progression of mediastinal lymphadenopathy. |
Generate impression based on findings. | 27-year-old male with pain and fluctuance, evaluate for perianal abscess. PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Skin thickening and infiltration of the subcutaneous tissues adjacent to the anal canal below the anal sphincter with small region of central hypoattenuation and foci of gas.OTHER: No significant abnormality noted | Phlegmonous collection adjacent to the anal canal below the anal sphincter with possible small fluid collection. |
Generate impression based on findings. | 28-year-old female with right lower quadrant abdominal pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: A small benign cortical subcentimeter cyst in the left kidney. No solid renal masses or perinephric fluid collection seen. No hydronephrosis. No large calcification seen, however, small, punctate calcifications could be obscured due to contrast enhanced only images.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. No evidence of bowel obstruction. No free mesenteric fluid.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No evidence for bowel obstruction. Bowel appears intrinsically normal. Appendix is well-visualized and normal without evidence of inflammation.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Normal CT examination of the abdomen and pelvis without finding seen to account for patient's symptomatology. |
Generate impression based on findings. | Female 45 years old; Reason: please evaluate for recurrence or metastasis. History: history of bladder cancer s/p cystectomy, ileal conduit ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Interval development of a hypoattenuating lesion in the hepatic dome measuring 2.7 x 2.4 cm best seen on series 12 image 1. In retrospect, this lesion was seen in 2012 and has not significantly changed in size. No other focal lesions detected. The gallbladder and biliary systems are unremarkable.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No hydronephrosis or hydroureter. No urolithiasis. No solid renal mass. No lesion in the renal collecting system identified on urographic phase of imaging.Postoperative changes of ileal conduit with ostomy in the right lower quadrant. The visualized right ureter terminates in the ileal conduit. The left ureter is well opacified and no lesion along the expected course of the ureter is identified with no changes of hydronephrosis proximally seen to suggest obstructive changes.RETROPERITONEUM, LYMPH NODES: No enlarged lymph nodesBOWEL, MESENTERY: Postoperative changes of the bowel, with ileal conduit.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Status post cystectomyLYMPH NODES: No enlarged pelvic lymph nodes BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Interval stability of an hypoattenuating lesion in the liver since 2012, however new since 2011. Metastatic disease cannot entirely be ruled out. MRI may be helpful in characterizing lesion. 2. Postoperative changes of cystectomy and ileal conduit without recurrence or obstruction. |
Generate impression based on findings. | 76-year-old female with bladder cancer and recent cystourethrogram -- now with abdominal/right flank pain. Question of Perinephric abscess ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No change in appearance of the kidneys since 10/4/13. No solid mass lesion seen. Renal parenchyma and no evidence of hydronephrosis. No perinephric fluid collections are seen to suggest abscess. Prompt and symmetric excretion is seen bilaterally into normal pyelocalyceal systems. Visualized portions of the ureter show no abnormalities.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Moderately large hiatal hernia, unchanged since 10/4/13. The bowel shows no other abnormalities with no evidence of intrinsic or extrinsic abnormality. No significant peritoneal fluid is seen.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Markedly enlarged uterus, with large dominant 8-cm mass, stable, with prior examinations - this may represent leiomyoma, however, CT cannot characterize uterine masses. No change is seen in the approximately 1.5 cm unilocular right adnexal cystic lesion. Most lesions with this appearance in the size and stability over 12 months are benign.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Unchanged, moderately severe degenerative changes throughout the lumbosacral spine and pelvis. OTHER: No significant abnormality noted | 1. No evidence for perinephric abscess or other upper urinary tract abnormality. 2. No change moderate -sized hiatal hernia. 3 a stability for one year in 1.6-cm unilocular right adnexal cystic lesion -- these characteristics favor benign abnormality.. |
Generate impression based on findings. | Clinical question: Acute onset of headache and right eye pain in setting of metastatic thyroid history. Signs and symptoms: As above Nonenhanced head CT:No acute intracranial process. CT of ovaries insensitive for detection of acute nonhemorrhagic ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation.Unremarkable calvarium, soft tissues of the scalp, orbits and paranasal sinuses. | No acute intracranial process. |
Generate impression based on findings. | 40 year-old female with headache, papilledema, concern for cerebral edema A catheter extends across the cerebellar hemisphere with the tip in the right prepontine cistern, unchanged. The cerebellar pontine angle arachnoid cyst has not significantly changed in size. The CSF spaces are appropriate for the patient's stated age with no midline shift. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma. Empty sella.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1. No acute intracranial abnormalities.2. No significant interval change in catheter position at the right cerebellar pontine angle. |
Generate impression based on findings. | Clinical question: Brain lesion? Signs and symptoms: HIV, limited inflammatory markers and headache. Nonenhanced head CT:No detectable acute intracranial process.Prominence of cortical sulci and ventricular system is us cerebellar/vermian folia the patient stated age of 45 is concerning for underlying parenchymal volume loss. Preserve gray -- white matter differentiation and maintained midline.Unremarkable calvarium, soft tissues of the scalp, visualized orbits and paranasal sinuses are | No acute intracranial process. |
Generate impression based on findings. | Astrocytoma status post VP shunt with new worsening speech, swallowing, and gait difficulty. There is a heterogeneous but predominantly hyperdense mass within the left basal ganglia with corresponding areas of enhancement as well as cystic and hemorrhagic components that overall measures approximately 4.5 cm, which is not significantly changed. Likewise, there is no significant interval change in the associated extensive confluent hypodensity throughout much of the left hemisphere and brainstem, compatible with a vasogenic edema with approximately midline shift with the shift of the third ventricle approximately 12 mm of midline shift to the right, as well as subfalcine and left uncal herniation. There is an unchanged smaller hyperdense mass with course calcifications in the right thalamus with surrounding ill-defined hypoattenuation. There is an unchanged right transfrontal ventricular shunt catheter courses that terminates in the occipital horn of the right lateral ventricle. There has been slight interval decrease in size of the lateral ventricles, while there is persistent effacement of the third ventricle. The imaged portions of the paranasal sinuses and mastoid air cells are clear. The extracranial structures are unremarkable. | 1.No significant interval change in the heterogenous mass with extensive surrounding edema, 12 mm midline shift, as well as subfalcine and uncal herniation, although these findings have gradually progressed over several months.2.No significant change in the partially calcified right thalamic mass.3.Interval decrease in size of the lateral ventricles (compared to with 9/20/13) with a right transfrontal ventricular shunt in position. |
Generate impression based on findings. | 58-year-old female patient with abdominal discomfort and leukocytosis. Evaluate for perinephric or intra-abdominal abscess. ABDOMEN:LUNG BASES: Left basilar scarring versus atelectasis.LIVER, BILIARY TRACT: Heterogeneous liver parenchyma with increased attenuation, consistent with cirrhosis and fatty infiltration. Gallbladder with small gallstones. No biliary dilatation.SPLEEN: Numerous small, subcentimeter hypoattenuating lesions in the splenic parenchyma. In retrospect, it is likely that at least some of these lesions were present on prior noncontrast examination.PANCREAS: Atrophic native pancreas with pancreatic transplant in right lower quadrant.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Hyperdense capsule in right lower quadrant. Otherwise, no significant abnormalities noted.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumber spine. Diffuse soft tissue edema.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Air in the bladder, likely from prior instrumentation.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Contrast rapidly progressed through normal appearing stomach and small bowel. Large bowel is normal in caliber without evidence of obstruction.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumber spine. Diffuse soft tissue edema.OTHER: No significant abnormality noted. | 1.No definitive intra-abdominal abscess.2.Numerous hypoattenuating lesions within the spleen are nonspecific and may represent old granulomatous disease or atypical infection. Given lack of primary neoplasm, they are unlikely to be metastatic. |
Generate impression based on findings. | Reason: r/o PE History: SOB and + dimer PULMONARY ARTERIES: Demonstration of acute pulmonary emboli involving the left lower lobe artery extending into segmental branches of the left lower lobe. In addition there is a filling defect in the right lower lobar artery that is more weblike and may represent chronic embolus.Pulmonary there is not enlarged. There is no evidence of right heart strain.LUNGS AND PLEURA: There is a mild basilar scarring/discoid atelectasis.Scarlike opacities in the left apex (images 26, 29 series 10).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.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Low-density left renal lesion incompletely visualized or characterized most likely represents a cyst. | Demonstration of acute pulmonary emboli within the left lower lobe and probable chronic pulmonary embolus in the right lower lobe. No evidence of pulmonary infarction or hemorrhage. |
Generate impression based on findings. | Worsening IPF. Worsening hypoxemia. Question PE. PULMONARY ARTERIES: Adequate infusion quality. Nonopacification of the lateral segmental pulmonary artery to the right middle lobe.. Additional small filling defects noted in the left lower lobe (7/188) and in the medial segment of the right middle lobe may be artifactual, though additional emboli cannot be excluded due to severe motion artifact. Mild air trapping on the expiration sequence.LUNGS AND PLEURA: Subpleural honeycombing and traction bronchiectasis consistent with known UIP/IPF and appears progressed compared to the previous examination, though groundglass opacities may be exaggerated due to underinflation and motion artifact.No evidence of infarct or pulmonary hemorrhage in the right middle lobe lateral segment.MEDIASTINUM AND HILA: Mild to moderate bilateral mediastinal lymphadenopathy with slight progression in some areas. For example, a low right paratracheal lymph node measures 17 mm, previously 10-mm (7/.26). Right greater than left hilar region lymphadenopathy also slightly worse.Upper normal heart size. Patulous thoracic esophagus.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Elevation of left hemidiaphragm. Limited scanning range. Solid organs are unopacified, limiting assessment. No gross abnormality noted. | 1. Segmental level embolus in the right middle lobe compatible with pulmonary embolus. Eric Brandt (2660) verbally notified of the discrepancy between preliminary and final interpretations at 8:35 a.m. on 10/30/13.2. Unable to exclude nonocclusive small subsegmental emboli elsewhere due to motion artifact. No large central embolus in the main pulmonary arteries.3. Interval progression of UIP with diminished lung volumes.4. Slight progression of mediastinal lymphadenopathy. |
Generate impression based on findings. | Female, 65 years old, status post subdural hemorrhage evacuation. Two right parietal burr holes have been created. A catheter courses through the more anterior of these burr holes to reside within the right subdural space.The large right hemispheric mixed density subdural collection has largely been evacuated. Only a small amount of mixed density fluid and air is seen within the subdural space on the present exam. Hemorrhage continues to layer thinly along the posterior interhemispheric falx and along the tentorium.Substantial generalized mass effect seen on the prior examination has significantly improved. Midline shift to the left has been reduced to approximately 6 mm, previously 16. Transtentorial herniation on the right has resolved. The right lateral ventricle has nearly completely reexpanded, and the basilar cisterns have also reexpanded.No definite evidence of focal parenchymal edema or loss of gray-white distinction is seen. Subtle hypoattenuation is seen in the right corona radiata adjacent to the caudate head which may have been present on prior exam and which is nonspecific. | Interval near complete evacuation of the large right hemispheric subdural hematoma. Minimal residual blood product is seen. Substantial generalized mass effect seen on prior examination has significantly improved. |
Generate impression based on findings. | 67-year-old male with cough and lung cancer. CHEST:LUNGS AND PLEURA: Interval decrease in right upper lobe paramediastinal mass, currently measuring 5.2 x 4 .5 cm, previously measured 6.7 x 5.6 cm (series 5, image 25).Interval decrease in small right pleural effusion and resolution of left pleural effusion. Multiple foci on ground glass opacity in both lower lobes, suspicious for aspiration. Small focus of consolidation in the anterolateral aspect of right lower lobe (series 5, image 97).Linear opacities in right middle lobe most compatible with scarring. No new suspicious nodules.Mild emphysema.MEDIASTINUM AND HILA: Lack of IV contrast limits evaluation of lymphadenopathy. Given limitation, there is mild decrease in mediastinal lymphadenopathy, with reference right paratracheal node measuring 18 mm, previously measured 22 mm (series 3, image 39). Minimal calcifications affect the coronary arteries and aorta. Stable mild cardiomegaly.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: Atrophy of left kidney with no change in large, 15 mm stone in proximal left ureter (series 3, image 118). Smaller stones are seen in left kidney pelvis. Multiple right renal cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant change in mild aneurysmal dilation of the infrarenal area, with diameter measuring approximately 3 cm.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: Partially visualized fluid density structure in midline of upper pelvis may represent bladder. | 1.Interval decrease in right upper lobe mass and right pleural effusion.2.Mildly decreased mediastinal lymphadenopathy.3.Interval improvement in right upper lobe ground glass opacities, however, new bilateral basilar groundglass opacities, most likely due to chronic/recurrent aspiration. |
Generate impression based on findings. | 24-year-old male patient. Stage for testicular neoplasm. ABDOMEN:LUNG BASES: No nodules or abnormalities 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: Left periaortic lymphadenopathy at the level of insertion of the gonadal vein to the left renal vein. Index lymph node measures 2.1 x 1.6 cm (series 3 image 44).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES, TESTICLE: Heterogeneously enhancing left testicle measures 4.7 x 4.6 cm (series 3 image 119).Right testicle within normal limits.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Large, heterogeneously enhancing left testicle. Left periaortic lymphadenopathy at level of left kidney. No evidence of disease in liver, lung bases or bones. |
Generate impression based on findings. | Mesenteric ischemia? Abdominal pain, generalized. Myelodysplastic syndrome. Polymyalgia rheumatica. Pain out of proportion elevated lactate. ABDOMEN:LUNG BASES: 6-mm nonspecific micronodule laterally at the left lung base (image 9; series 9).LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Endplate degenerative changes at the T12 vertebral body.OTHER: The celiac axis, SMA, and IMA are all widely patent. There is no evidence of mesenteric vein thrombosis. Small bowel appears unremarkable. The right colon and transverse colon are unremarkable although left colon is collapsed and is difficult to evaluate. There is no pneumatosis or significant bowel wall thickening.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. No evidence of bowel infarction. Major mesenteric arteries and veins all appear patent. Collapse of the left colon could reflect early or mild ischemia; consider correlation with colonoscopy as clinically indicated.2. 6-mm micronodule at the left lung base. |
Generate impression based on findings. | Male, 34 years old, hemiplegia, intracerebral hemorrhage. Hyperdense blood product within and around the posterior fossa resection cavity as well as along the midbrain has decreased in conspicuity. No evidence of new hemorrhage is seen.Extensive hypoattenuation persists within the right and to a lesser degree the left cerebellar hemispheres as well as the pons and midbrain, not significantly changed. Surgical metallic material is redemonstrated adjacent to the midbrain on the right.A right posterior approach ventricular shunt catheter remains in stable position terminating in the body of the right lateral ventricle. The right lateral ventricle is completely decompressed. The left lateral ventricle remains patent. The third ventricle is unremarkable. Ventricular caliber is unchanged.Supratentorially, no parenchymal edema, mass effect or other specific abnormalities are detected.Redemonstration of suboccipital craniectomy with mesh placement. | 1. Redemonstration of extensive surgical change in the posterior fossa.2. Blood product within and around the resection cavity as well as along the midbrain has decreased in conspicuity. No new hemorrhage is seen. |
Generate impression based on findings. | Male, 57 years old, intracerebral hemorrhage. Right basal ganglia/thalamic hematoma is unchanged in size and extent. The degree of surrounding parenchyma edema has also not substantially changed.Blood seen within the right frontal horn on the prior examination has largely resolved or has redistributed. There remains a small amount of blood at the level of the foramina of Monro and within the third ventricle. Blood layers within the bilateral occipital horns, slightly more so on the left, slightly less on the right, perhaps representing redistribution. Blood product continues to be evident within the cerebral aqueduct and filling the fourth ventricle. Also unchanged is a small amount of subarachnoid blood product in the occipital region. Caliber of the ventricles remains enlarged but not significantly changed from prior. Right frontal approach the shunt catheter remains in stable position just anterior to the level of the foramina of Monro. | 1. Stable right basal ganglia/thalamic parenchymal hemorrhage.2. Persistent intraventricular hemorrhage with some degree of redistribution.3. No definite evidence of new hemorrhage is seen. |
Generate impression based on findings. | Reason: mitral regurgitation History: dyspnea VESSELS:SINUS OF VALSALVA: 3.1 X 3.1X 3.3 cmSINOTUBULAR JUNCTION: 2.6X 2.6 cmASCENDING THORACIC AORTA AT LEVEL OF MAIN PULMONARY ARTERY: 2.7 X 2.9 cmASCENDING THORACIC AORTA IMMEDIATELY PROXIMAL TO THE INNOMINATE ARTERY: 2.7 X 2.7 cmPROXIMAL DESCENDING THORACIC AORTA IMMEDIATELY DISTAL TO THE LEFT SUBCLAVIAN ARTERY: 2.4 X 2.4 cmDESCENDING THORACIC AORTA AT LEVEL OF HIATUS: 2.2 X 2.0 cmSUPRARENAL ABDOMINAL AORTA: 1.7 X 1.7 cmINFRARENAL ABDOMINAL AORTA: 1.5 X 1.5 cmRIGHT COMMON ILIAC ARTERY: 12 X 12 mmRIGHT EXTERNAL ILIAC ARTERY: 10 X 9 mmRIGHT COMMON FEMORAL ARTERY: 7 X 8 mmLEFT COMMON ILIAC ARTERY: 11 X 10 mmLEFT EXTERNAL ILIAC ARTERY: 8 X 7 mmLEFT COMMON FEMORAL ARTERY: 7 X 7 mmCHEST:LUNGS AND PLEURA: Scattered calcified and noncalcified micronodules.Minimal basilar scarring/discoid atelectasis.No suspicious pulmonary nodules or masses.No pleural effusions.MEDIASTINUM AND HILA: Markedly dilated pulmonary artery compatible pulmonary arterial hypertension.No hilar or mediastinal lymphadenopathy.There cardiac enlargement with of right ventricular enlargement.Mild pericardial effusion.CHEST WALL: Degenerative changes in the thoracic spine.ABDOMEN:LIVER, BILIARY TRACT: HepatomegalySPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Nonobstructing left renal calculus.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Marked enlargement of pulmonary artery compatible pulmonary arterial hypertension.2.No significant stenosis or obstruction of the femoral or iliac arteries. Somewhat acute angulation of the left common iliac artery if utilized as an access site. 3.No significant abnormalities within the chest, abdomen, or pelvis. |
Generate impression based on findings. | 54-year-old male with history of bladder cancer status post cystectomy ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Diffuse hepatic steatosis, mildly improved from the prior study. No focal hepatic lesions. No biliary ductal dilatation. The gallbladder appears unremarkable.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Several right renal cysts are unchanged. No filling defects in the collecting system. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Shotty retroperitoneal lymph nodes are again noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Status post cystectomy with neobladder creation.LYMPH NODES: Prominent inguinal and iliac lymph nodes are again noted, appearing similar to the prior study.BOWEL, MESENTERY: Diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Stable exam with no evidence of recurrent or metastatic disease. 2. Diffuse hepatic steatosis, mildly improved from the prior study. |
Generate impression based on findings. | 42 year old female with leukemia, pre-chemotherapy. LUNGS AND PLEURA: No consolidation or pleural effusions. Minimal basilar linear opacities most compatible with mild atelectasis.Several small foci of ground glass opacity, largest in right apex measuring 9 mm; these are of unclear etiology or significance, however, may represent inflammatory changes (series 5, image 23, 35).Several punctate micronodules are also seen bilaterally (series 5, image 85, 41). MEDIASTINUM AND HILA: Heterogeneous thyroid gland. Central venous catheter terminates in upper right atrium. Heart size normal. No mediastinal lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.No specific evidence of active infection.2.Several punctate micronodules all measuring less than 4 mm, and likely benign in nature.3.Several foci of groundglass opacity in the right lung; these are not specific and may be inflammatory in nature. |
Generate impression based on findings. | Clinical question: Concern for hemorrhage. Signs and symptoms: New facial droop. Nonenhanced head CT:There is no detectable acute intracranial hemorrhage. CT however is insensitive for detection of acute non-hemorrhagic ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation. Midline is maintained. Unremarkable images through posterior fossa.Unremarkable calvarium and soft tissues of the scalp. Unremarkable all visualized paranasal sinuses and mastoid air cells. Unremarkable images through the orbits. | No acute intracranial process. Unremarkable exam. |
Generate impression based on findings. | Clinical question: Status post left craniotomy for tumor resection. Signs and symptoms: Basketball. Unenhanced head CT:Examination demonstrates post operative changes of a left lateral suboccipital craniotomy.Expected minimal air and serosanguineous fluid under the craniotomy flap. The craniotomy age is posterior to the mastoid air cells which remain well pneumatized on this exam.There is no convincing evidence of any edema or parenchymal hemorrhage of adjacent left cerebellum. At the site of resected tumor in the left upper cerebellopontine angle region there is a very subtle increased density on axial image 12 which may indicate minimal hemorrhage in the resected surgical cavity.The fourth ventricle remains patent however it appears to slightly smaller and minimally deviated to the right as a result of postop changes. No evidence of crowding of the cerebellar tonsils at the level of foramen magnum. The quadrigeminal plate cistern also remains patent and similar to prior exam.Supratentorial ventricular system remains within normal size and midline is maintained.Several subcortical and periventricular low attenuation of white matter likely representing age indeterminate small muscle ischemic strokes as was noted on prior MRI exam from 8 -- 27 -- 2013. | 1.Expected postoperative changes of left lateral suboccipital craniotomy/craniectomy as detailed.2.Postoperative changes with resultant sulcal mass effect on the fourth ventricle and deviation to the right as detailed.3.Unremarkable images through the supratentorial space other than previously known peri-ventricular and subcortical age indeterminate small vessel ischemic strokes. |
Generate impression based on findings. | 58-year-old male, evaluate abdominal wall and peristomal hernia. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Numerous bilateral renal cysts, largest on the left. No hydronephrosis. Left lower pole 5 mm stone.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Right lower quadrant ileostomy. No parastomal hernia. There is mild dilatation of small bowel loops in the pelvis without evidence of obstruction or active inflammation. Status post colectomy. Multiple surgical clips present in the abdomen.BONES, SOFT TISSUES: Multiple surgical clips are present in the anterior abdominal wall.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Status post total proctocolectomy.BONES, SOFT TISSUES: Small posterior disk bulges along the lower lumbar spine.OTHER: No significant abnormality noted | Status post total proctocolectomy and ileostomy without evidence of parastomal hernia or obstruction. |
Generate impression based on findings. | Female 58 years old; Reason: Pt with h/o relapsed CLL on treatment regimen History: Evaluation of disease status CHEST:LUNGS AND PLEURA: Unchanged scattered micronodules.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion.CHEST WALL: Continued regression of enlarged lymph nodes. Reference left axillary lymph node measures 1.3 x 1.1 cm (image 19; series 3), smaller than previous. Right chest wall port .ABDOMEN:LIVER, BILIARY TRACT: Fatty infiltration of the liver is stable. Ill-defined nonspecific lesion noted in segment 8 is unchanged measuring 6mm (image 71; series 3). Hepatic and portal veins remain patent. Gallstones.SPLEEN: The spleen remains infarcted with multiple cystic areas.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Retroperitoneal adenopathy is stable. Reference left para-aortic lymph node measures 1.5 x 0.8 cm (image 115; series 3).BOWEL, MESENTERY: No significant abnormality noted..BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomyBLADDER: No significant abnormality noted.LYMPH NODES: Multiple small pelvic lymph nodes. Reference right external iliac nodecurrently measures 1.2 x 0.7 cm (image 169; series 3), stable to slightly decreased in size.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Stable to slightly improved adenopathy with measurements provided above. |
Generate impression based on findings. | 64-year-old male status post left knee amputation for sarcoma. Evaluate for metastatic disease. LUNGS AND PLEURA: Interval resolution of previously seen left perihilar nodules, which were likely inflammatory in nature. No new or suspicious nodules. Mild emphysema.MEDIASTINUM AND HILA: No lymphadenopathy. Mild coronary artery calcifications. Heart size normal.CHEST WALL: Loss of height of T9 vertebral body is unchanged. No suspicious osseous lesions identified.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Interval resolution of previously seen left perihilar nodules. No evidence of metastatic disease. |
Generate impression based on findings. | Clinical question: CVA. Signs and symptoms: Compared to prior study. Nonenhanced head CT:Examination demonstrates significant interval decreased in mass-effect from patient's large right hemispheric MCA territory ischemic stroke. There is decreased midline shift from approximately 8.3 mm on prior exam and trace residual leftward shift on current study. There is also slight interval increased size of the supratentorial ventricular system (right greater than left) secondary to decreased mass effect and likely subtle ex vacuo dilatation of right lateral ventricle.There is also significant decreased bulge of right hemispheric through a large right-sided craniectomy defect representing decreased mass effect.There are new linear and punctate increased density involving the cortex of right hemispheric stroke which likely represent mineralization/petechial hemorrhage.Soft tissues of the scalp also demonstrate interval improvement of postop changes. | 1.Significant interval decreased mass effect from patient's right hemispheric large ischemic stroke as detailed above. There is only trace leftward midline shift present.2.Diffuse cortical increased density of the region of the stroke in thin linear and punctate pattern consistent with mineralization/petechial hemorrhage.3.Better visualization of supratentorial ventricular system secondary to decreased mass effect and with suggestion of slight ex vacuo dilatation of right lateral ventricle.4.Improvement in postoperative changes of right scalp since prior exam. |
Generate impression based on findings. | Clinical question: Grade 2 hepatic encephalopathy. Signs and symptoms: Encephalopathy. Nonenhanced head CT:Examination demonstrates bilateral inferior paramedian frontal linear cortical calcification without evidence of any underlying parenchymal edema or parenchymal volume loss/encephalomalacia. The exact etiology of finding is not certain however the finding could possibly represent dystrophic calcification from a prior trauma considering its location and distribution. Correlate with history. There are no prior exams for comparison.The cortical sulci, ventricular system and the CSF spaces remain all widely patent and without convincing areas of intracranial increase pressure. The gray -- white matter differentiation is preserved. CT is insensitive for detection of early subtle cerebral edema. Follow-up with an MRI is recommended for further assessment for cerebral edema as well as above-described foci of cortical calcification. | 1.No convincing evidence of increased intracranial pressure/edema. CT is insensitive for detection of subtle cerebral edema.2.There are symmetrical bilateral paramedian inferior frontal cortical calcification of unknown exact etiology. This finding is not associated with any edema or encephalomalacia of the adjacent parenchyma.3.Recommend follow-up with brain MRI for cerebral edema as well as further evaluation of bilateral frontal cortical calcification. |
Generate impression based on findings. | Reason: Lung cancer s/p chemo and radiation. Please compare to previous. Thanks. History: Lung cancer CHEST:LUNGS AND PLEURA: Centrilobular emphysema of the upper lung zones. Volume loss and architectural distortion in the right lung consistent with evolving radiation reaction . New solid left lower lobe nodule (series 5, image 73) measures 4 mm. New small pulmonary nodule (series 5, image 59) in the left lower lobe measures 5 mm. Calcified micronodules in the and right lung are unchanged.Interval decrease in right pleural effusion. Reference right upper lobe para-mediastinal mass measures 38 x 15 mm (series 5, image 31), previously measuring 38 x 21 mm. Previously described right lower lobe mass and exam dated 6/26/2013 measures 22 x 17 mm (series 3, image 71) previously measuring 40 x 19 mm.MEDIASTINUM AND HILA: Reference inferior right perihilar interlobar lymph node previously measuring 9 mm now measures 6 mm (series 3, image 58). Moderate to severe coronary artery arthrosclerotic calcification. Heart size is normal. No pleural effusion.CHEST WALL: Degenerative changes to the lower thoracic spine unchanged.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Calcified right hepatic lobe granuloma. Interval increase in size of right hepatic lobe metastatic lesion now measuring a 2.0 x 2.8 cm with extension to the capsule, previously measuring 2.7 x 2.6 cm (series 3, image 93).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: Moderate slight calcification of the aorta. No significant lymphadenopathy.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.Right upper lobe paramediastinal mass is slightly decreased in size.2.Interval improvement of acute postradiation changes and interval decrease in right pleural effusion.3.New left-sided micronodules may represent metastatic disease and continued surveillance is recommended.4.Right hepatic lobe metastasis is increased in size compared to exam dated 8/30/2013. Correlation with exam dated 9/7/2013 is difficult due to differences in phase of contrast. Small lesion at the dome of the liver may represent a new site of metastasis. |
Generate impression based on findings. | Female, 25 years old, status post catheter placement. Sequelae of right hemispherectomy are redemonstrated. The previously seen right frontal approach ventricular shunt catheter has been removed. The previously seen small caliber right parietal catheter has also been removed. Two new catheters have been placed, one in the right parietal region extending anteriorly and medially through the hemispherectomy defect to terminate in the vicinity of the left frontal horn. A second catheter approaches from the left parietal region crossing the left hemisphere to terminate in the region of the third ventricle.The amount of fluid within the hemispherectomy defect is probably not significantly changed. The caliber of the left lateral ventricle seems to have improved, at least at the level of the atrium.Scalp swelling and intracranial air are seen consistent with recent surgical intervention. | Interval revision of shunt catheters with removal of the previously seen catheters and placement of two new bilateral parietal approach shunts. The amount of fluid within the right hemispherectomy defect seems to be unchanged. The caliber of the left lateral ventricle has improved. |
Generate impression based on findings. | Male 46 years old; Reason: patient status post cystectomy and ileal conduit for bladder CA in August 2013, with recurrent soft tissue infections at prior SPT site in RLQ History: assess for hernia vs abscess at prior SPT site ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Low attenuating near water density lesion is noted in in what appears to be lateral to pancreatic head and abutting duodenum. This lesion measures 2 x 0.9 cm (series 3 image 70) and is new since 7/13. This could represent a duodenal diverticulum which could explain why it wasn't seen on prior examination if collapsed. Neoplastic process is thought less likely.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Patient is status post left nephrectomy. Patient is status post cystectomy with ileal conduit and neobladder formation. No evident ureteral or renal process detected. Small cyst noted in pole right kidney.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:BLADDER: Patient status post cystoprostatectomy. Neobladder formation noted with postoperative changes in the anterior rectal sheath. No soft tissue thickening or adjacent fluid collections to suggest abscess are noted in the bladder..LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.No evident recurrence or metastatic disease detected. 2. Near water density lesion between duodenum and pancreas of uncertain etiology -- does not appear to be of malignant etiology, but should be followed on subsequent examinations for confirmation. |
Generate impression based on findings. | Male, 66 years old, right hemiparesis, subdural hemorrhage. Redemonstrated is a left holohemispheric mixed density subdural collection which extends around the cerebral hemisphere as well as along the interhemispheric falx and the tentorium. When comparison is made to the prior exam, there has been a mild expansion of the thickness of hypodense fluid most noticeably along the left frontal lobe. On coronal images, this fluid measures 9 mm maximally, previously measuring about 6 mm at this location.Midline structures are shifted very slightly more towards the right at 12 mm on the current exam, previously 10 mm. The left lateral ventricle remains nearly completely effaced, similar to prior. The right lateral ventricle is dilated, also similar to prior. | Mild expansion of the hypodense component of the pre-existing left hemispheric subdural collection. As there does not appear to be any new hyperdense blood, this change may simply represent redistribution or subdural effusion. However, continued follow up is suggested to exclude the possibility of rebleeding. |
Generate impression based on findings. | 69-year-old male with history of bladder cancer status post cystoprostatectomy CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. No focal hepatic lesions. No biliary ductal dilatation. SPLEEN: No significant abnormality noted.PANCREAS: 1.9 x 2.1 cm pancreatic tail cyst is unchanged from the prior study (image 105 series 4).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral nephrostomy tubes are coiled in the renal pelvis. Marked interval decrease in size of right lower pole hyperdense lesion likely representing a hemorrhagic cyst with small adjacent fluid collection. Additional bilateral hypodensities too small to characterize which may represent cysts, are also unchanged.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted..BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine. Unchanged vertebral body lytic lesions. Degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: Status post cystoscopy prostatectomy with neobladder creation. Interval resolution of multiple previously noted abdominal fluid collections.LYMPH NODES: Bilateral lymph node dissection.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Unchanged lytic lesions in the right ilium and vertebral bodies. Anterior abdominal wall defect with infiltration of the subcutaneous tissues, likely postinflammatory, with marked interval improvement in phlegmonous gas containing collection. Degenerative changes of the thoracolumbar spine.OTHER: Small fluid collection in the right inguinal canal. | 1. Resolution of multiple intra-abdominal fluid collections, sinus tracts and near resolution of anterior abdominal wall phlegmonous collection.2. Status post cystoprostatectomy and neobladder formation without new evidence of recurrent or metastatic disease. |
Generate impression based on findings. | Clinical question: Subdural hematoma, chronic evaluate for change. Signs and symptoms: Three months follow-up. Unenhanced head CT:Interval significant decrease in the size of right anterior frontal subdural. The remaining small subdural demonstrates low attenuation and measures maximum of 4 mm in thickness compared to prior study measurements of 11-mm. There is no evidence of an acute new finding since prior exam. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation otherwise. Unremarkable images through the orbits, paranasal sinuses, mastoid air cells and middle air cavities. Calvarium demonstrate changes of bilateral frontal burr holes and unremarkable otherwise. | 1.Interval decreased size of right frontal subdural. Remaining subdural has low attenuation and measures at 4-mm thickness compared to prior study measurements of 11-mm2.unremarkable exam otherwise. |
Generate impression based on findings. | Male 55 years old Reason: eval L periprosthetic fracture Evaluation of the left hip and surrounding soft tissues is limited by metallic streak artifact related to the patient's hip hemiarthroplasty. The stem of the prosthesis traverses an obliquely oriented subtrochanteric fracture. There is approximately 1 cm of lateral displacement as well as slight posterior angulation of the distal fracture fragment. The acetabular component is well situated in the acetabulum. The bones appear slightly demineralized but otherwise within normal limits given the patient's age. No large hematoma is evident. | Left hip arthroplasty prosthesis stem traversing an oblique subtrochanteric fracture as described above. |
Generate impression based on findings. | Clinical question: Patient with history of head and neck cancer, status post CRT; please evaluate and compare to prior studies. Signs and symptoms: As above. Enhanced CT of soft tissues of neck:Images through the skull base including cavernous sinuses, bilateral petrous bones remains within normal limits.Unremarkable images through the nasopharynx and nasal passage. Unremarkable images through masticator spaces and all secondary glands.Unremarkable images through the oropharynx and oral cavity/floor of the mouth. There is no detectable abnormality of the tonsillar regions and stable since prior exam.Stable subtle posttreatment changes of the left neck.There is no detectable cervical adenopathy by CT size criteria.Unremarkable images through the larynx. Unremarkable images through the thyroid gland/cartilage.Unremarkable images through supraclavicular regions.Unremarkable bilateral carotids and jugular vasculature.Revisualization of extensive degenerative disk disease at C4 -- C5 and C6 -- C7 levels adjacent to congenitally fused C5 and C6 vertebral bodies. Mild grade 1 anterolisthesis at C4 on C5 similar to prior exam. | 1.Stable exam and without evidence of local recurrence or cervical adenopathy since prior exam.2.Evidence of congenital fusion of C5 and C6 with resultant significant degenerative disk disease at C6-- C7 and moderate disease at C4 -- C5 and including minimal grade 1 anterolisthesis. |
Generate impression based on findings. | 75-year-old male with lung cancer status post 6 weeks of chemo radiation. CHEST:LUNGS AND PLEURA: Interval decrease in size of right middle lobe mass, currently measuring 4.0 x 2.5 cm, previously measured 4.4 x 3.5 cm (series 4, image 77). Resolution of previously seen cavitation within this mass.Stable subpleural right lower lobe nodule measures 8 mm, previously measured 8 mm (series 6, image 93). No new suspicious nodules identified.No significant change in left base pleural thickening and associated linear opacities, most compatible with scarring (series 6, image 80).MEDIASTINUM AND HILA: Decrease in mediastinal adenopathy. Reference subcarinal node measures 4.0 x 2 .5 cm, previously measured 6.2 x 3.5 cm (series 4, image 57). Right hilar node measures 7 mm, previously measured 11 mm (series 4, image 67). Left hilar node measures 6 mm, previously measured 8 mm (series 4, image 58).Ill-defined soft tissue extending along anterior aspect of trachea is not significantly changed.Heart size normal. No pericardial effusion.CHEST WALL: Postsurgical changes/deformities in the left lateral chest wall and ribs, unchanged.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: Bilateral renal hypodensities are too small to characterize but is 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: Soft tissue nodularity in subcutaneous tissues of right abdominal wall unchanged. However, there is new soft tissue nodule in subcutaneous tissues of the left abdominal wall; this is not specific, however, given the presence of small foci of gas in this location on prior exam, this may represent developing granuloma with possible superimposed infection (series 4, image 140).OTHER: No significant abnormality noted. | Interval decrease in right middle lobe mass and mediastinal lymphadenopathy. Stable right lower lobe nodule. |
Generate impression based on findings. | Head neck neoplasm CHEST:LUNGS AND PLEURA: Persistent scattered nonspecific micronodules without suspicious new findings to suggest metastatic disease. There is a focal area of increased tree and bud abnormality in the right upper lobe (image 32 series 4) suggestive of aspiration. No effusions.MEDIASTINUM AND HILA: Right thyroid nodules unchanged.No lymphadenopathyThe cardiac and pericardium other than mild coronary calcifications are within limitsCHEST 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: Multiple scattered bilateral renal cysts unchangedPANCREAS: 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: Atherosclerotic changes in diffuse scattered moderate to near severe degenerative changes throughout the thoracic and lumbar spine unchanged. No suspicious new lytic or blastic lesionsOTHER: No significant abnormality noted. | No evidence of suggest metastatic disease and new finding suggesting minimal aspiration |
Generate impression based on findings. | Lung cancer, non-small cell CHEST:LUNGS AND PLEURA: Unchanged appearance including a moderate right pleural effusion and associated volume loss and right apical changes suggesting radiation. Similar small right pleural effusion.Numerous small pulmonary and pleural nodules with surrounding ground glass opacities are all unchanged. Mildly greater in number on the left. The reference lesions in both bases remain similar in measurement including 12 mm and 21 x 10 mm on the right and left respectively (image 55 and 69 respectively.MEDIASTINUM AND HILA: The reference high left paratracheal lymph node remains 7 mm (image 12 series 3). No additional new lymphadenopathyModerate persistent pericardial fluid collection unchanged. Cardiac appearance otherwise unremarkable.CHEST WALL: Extensive sclerosis and compression fracture of T5 unchanged. Scattered sclerotic foci in multiple ribs also unchanged.ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No currently appreciated hypodensities throughout the liver although dedicated imaging and with enhancement is recommended if suspicion remains high and follow-up characterization is required. Cholecystectomy clipsSPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Persistent 2.1-cm exophytic lesion arising from the right upper pole is unchanged in appearance. Recurrent stability, however dedicated imaging may be needed to confirm a may represent a complex cystPANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: The reference gastrohepatic ligament lymph node remains 7 mm (image 83 series 3)BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Stable lucent lesion in L3, unchanged and nonspecificOTHER: No significant abnormality noted. | Stable reference measurements as provided without new interval findings to suggest disease progression |
Generate impression based on findings. | Metastatic head and neck CA on therapy. CHEST:LUNGS AND PLEURA: Right upper lobe wedge resection. Soft tissue is seen previously adjacent to the fissure lateral to a subsegmental branch of the posterior right upper lobe has resolved.Interval enlargement and increase in density of a right upper lobe nodule, measuring 6-mm -mm on the current study. On the prior study it measured up to 5-mm but was more angular and nonspecific in appearance. It is now consistent with a neoplastic process.Motion artifact in the left lower lobe causes slice misregistration, limiting assessment. Adjacent to the free wall the left ventricle, there is a nodular opacity which could be artifact of cardiac motion averaging with a cardiac vein (6/60). A cluster of nonspecific peripheral micronodules left lower lobe(6/57) seen in an area of previous atelectasis which has resolved. This should be followed on subsequent exams. Left lower lobe micronodule (6/56) similar in size.Standard subpleural nodular opacities most consistent with intrapulmonary lymph nodes. Other micronodule opacities are too small to characterize. No pleural fluid or pneumothorax.MEDIASTINUM AND HILA: Very small right paratracheal chain lymph nodes have increased in size, some of which are enhancing. These are now consistent with nodal metastases. Bidimensional measurements as requested previously as follows: Right hilar lymphadenopathy with reference level measurement of 19 x 16mm, previously 18 x 13 -mm (4/38). Lymphadenopathy throughout the right hilum and also involving lobar level lymph nodes in the right middle lobe. Subcarinal lymphadenopathy 14 x 17 mm, previously 16 x 21 mm (4/42). Left hilar lymphadenopathy 12 x 19 mm, previously 15 x 20 -mm (4/43). Left lower lobe segmental level peribronchial lymphadenopathy.Enlarged left inferior pulmonary ligament lymph node is smaller (4/54).Left jugular chest port tip in the right atrium. Coronary artery calcifications. No pericardial fluid.CHEST WALL: Mild enlargement of the left internal mammary chain lymph node (4/43) unchanged, these lymph nodes are not normally visible. Small lymph nodes in the right low cervical region, please refer to dedicated neck CT.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: Probable renal cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Interval mixed response with improvement in lower mediastinal and hilar lymphadenopathy but a subtle increase in size and density of nonindex right paratracheal chain lymph nodes. |
Generate impression based on findings. | 36-year-old male with Crohn's disease, ileocecal resection, sigmoid resection, with large intra-abdominal fluid collection. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Subcentimeter right hypodensity, too small to characterize. The gallbladder appears unremarkable. No biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: 5mm left upper pole renal calculus. No hydronephrosis. Symmetric renal cortical enhancementRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Decrease in size of loculated lower abdominal fluid collection, which measures 4.6 x 8.1 cm and previously measured 5.8 x 13.4 cm (image 108, series 3).Status post ileocecal resection and sigmoid resection. There is persistent dilatation of small bowel loops adjacent to a loculated fluid collection with transition point in the right pelvis adjacent to the inferior extension of the fluid collection suggesting partial obstruction.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: Decrease in size of loculated lower abdominal fluid collection, which measures 4.6 x 8.1 cm and previously measured 5.8 x 13.4 cm (image 108, series 3).Status post ileocecal resection and sigmoid resection. There is persistent dilatation of small bowel loops adjacent to a loculated fluid collection with transition point in the right pelvis suggesting partial obstruction.BONES, SOFT TISSUES: Soft tissue tissue infiltration and clips along the left sciatic nerve without loculated fluid collection appears similar to the prior study.OTHER: No significant abnormality noted | Mild interval decrease in size of loculated lower abdominal fluid collection with associated partial small bowel obstruction as detailed above. Although there are overlying bowel loops this may be amenable to percutaneous ultrasound-guided aspiration/drainage. |
Generate impression based on findings. | 49-year-old male patient with malignant neoplasm of ampulla of Vater. Evaluate for progression of metastatic disease. CHEST:LUNGS AND PLEURA: Right posterior pleural based mass with internal calcifications measures 1.2 x 3.7 cm (series 3 image 8), previously 3.0 x 1.5 cm. There is a second right posterior pleural based mass located medially that is stable compared to prior examination.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Right chest wall Port-A-Cath with catheter tip in the right atrium.ABDOMEN:LIVER, BILIARY TRACT: Historically patient had 2 separate inferior right lobe liver index lesions, that subsequently became confluent, but carried separate measurement on 8/28/13 CT. Current examination now measures this lesion as one large confluent lesion, and compares this with a remeasurement of inferior right lobe confluent lesion on 8/28/13 CT as follows below:8/28/13 (image 118, series 3) Index lesion along the inferior right liver measures 7.1 cm x 3.8 cm. 10/30/13 (series 3 image 124 Index lesion measures 8.8 x 4.2 cm. Subjectively, other non index surface lesions are slightly increased in size compared to most recent prior examination.Postsurgical changes are redemonstrated.SPLEEN: No significant abnormality noted. PANCREAS: Prominence of pancreatic duct is unchanged from the prior examination.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild multilevel degenerative changes in the thoracic and lumber spine.OTHER: Redemonstration of peritoneal carcinomatosis. The left upper quadrant mass measures index lesion in the left mid abdomen measures 7.4 x 11.2 cm (series 3 image 108), previously 9.0 x 6.7 cm. Second index lesion in the left mid abdomen measures 11.6 x 7.8 cm (series 3 image 139), previously 11.2 x 8.0 cm.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: Mild multilevel degenerative changes in the thoracic and lumber spine.OTHER: No significant abnormality noted. | Slight interval increase in liver lesions and peritoneal masses. |
Generate impression based on findings. | 77-year-old female patient with history of diffuse large B cell lymphoma status post 6 cycles of chop in 11/09. Restaging scan. Note that the lack of intravenous and oral contrast limits evaluation of lymph nodes, vasculature, hollow and solid viscera.CHEST:LUNGS AND PLEURA: Stable left pleural effusion with adjacent atelectasis versus scarring. Stable small right pleural effusion versus pleural thickening. Scattered pulmonary micronodules are unchanged compared to prior examination. Stable mild centrilobular emphysema.MEDIASTINUM AND HILA: Index high right paratracheal lymph node measures 6 mm (series 3 image 24), stable. Otherwise, no pathologically enlarged mediastinal lymph nodes.CHEST WALL: Interval removal of right chest port. No axillary lymphadenopathy.ABDOMEN:LIVER, BILIARY TRACT: Hypoattenuation of the liver parenchyma is consistent with diffuse fatty infiltration.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Exophytic left renal lesion measures fluid density and is stable compared to prior examination and is consistent with a simple cyst.RETROPERITONEUM, LYMPH NODES: Atherosclerotic changes of the abdominal aorta and iliac arteries.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumbar spine.OTHER: No significant abnormality notedPELVIS: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: Multilevel degenerative changes in the thoracic and lumbar spine.OTHER: No significant abnormality noted. | 1.No enlarged lymph nodes. Prior lymph nodes stable.2.Diffuse fatty infiltration of the liver. |
Generate impression based on findings. | Head and neck cancer CHEST:LUNGS AND PLEURA: The reference right upper lobe anterior nodule is currently not appreciated and suspected to have resolved. No new suspicious nodules or masses. No effusions. Scattered emphysematous changes unchangedMEDIASTINUM AND HILA: No lymphadenopathy.Coronary calcifications without additional cardiac or pericardial abnormalityCHEST WALL: Tracheostomy tube and postsurgical changes in the lower neck unchanged.Interval decreasing right anterior chest wall nodule, currently 1.3 x 1.1 cm (image 10 series 4) from a prior measurement of 1.5 x 1.3 cm. The left breast nodular density is also resolved and currently not appreciated.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholecystectomy without additional hepatic abnormalitySPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Unchanged right renal stone without associated new abnormalities bilaterallyPANCREAS: 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 significant abnormality notedBONES, SOFT TISSUES: Unchanged anterior fat-containing ventral herniasOTHER: No significant abnormality noted. | Interval improving reference measurements and/or complete resolution of previously measured lesions. No new abnormalities. |
Generate impression based on findings. | Acute lymphoid loops seen him. Neutropenic fever. Check for cause LUNGS AND PLEURA: Very minimal atelectasis and/or scarring in the right lung base. Lungs are otherwise clearMEDIASTINUM AND HILA: No lymphadenopathyA cardiac and pericardium are within normal limits. Pulmonary arteries remains borderline in size.Small hiatal herniaCHEST WALL: Interval placement of a right chest portUPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Diffusely fatty liver without focal abnormality. Interval improvement and resolution of the splenomegaly, overall size currently within normal limits | No suspicious abnormalities to account for patient's fever and symptoms |
Generate impression based on findings. | Lung nodules. Right middle lobe adenocarcinoma history in 2011. LUNGS AND PLEURA: Right middle lobe nodule abutting both fissures increased in both size and density. The overall size of the lesion is now 25 x 16 mm (4/211) compared to 15 x 10 mm previously as measured on the high resolution series. There is an additional nodule in the same lobe (series 5 image 81) which is increased in both size and density, 10 x 10 mm compared to 8 x 8 mm previously. This may be a metastasis or a synchronous primary. Though difficult to confirm given the degree of motion artifacts there is a probable new 5-mm nodule also in the right middle lobe (5/80).Subpleural consolidation in the right middle lobe and lingula, the underlying lung parenchyma cannot be assessed.9-mm groundglass density right middle lobe nodule (4/252), previously 6-mm. Questionable 3 to 4-mm groundglass nodule right upper lobe (4/188) too small to characterize and should be followed.Metallic density nodule left lower lobe, likely a retained fragment, correlate for prior gunshot woundAtypically dense subpleural lymph nodes along the medial aspect of the right major fissure are suspicious for nodal metastases, new from previous.Severe emphysema, upper lobe predominant.MEDIASTINUM AND HILA: Atherosclerotic calcification of the thoracic aorta. CABG. Main pulmonary artery may be mildly enlarged. Low paratracheal lymph node 11 mm, unchanged. Patulous thoracic esophagus.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. Numerous hypoattenuating lesions in the visualized portion of the left kidney are incompletely characterized but most likely reflect cysts. Granulomas in the spleen. | 1. Interval increase in size and density of the right middle lobe nodule consistent with known adenocarcinoma2. Interval increase in size and density of a second right middle lobe nodule which may be metastasis or a synchronous primary. There is a probable new 5-mm nodule in the adjacent right middle lobe.3. 9-mm right middle lobe ground glass density nodule increased in size suspicious for synchronous primary MIA or AIS.4. Small but atypically dense and clustered subpleural lymph nodes along the inferomedial aspect of the right major fissure are in close proximity to the second RML nodule and have increased in size since the prior examination, suspicious for subpleural nodal metastases.5. Unchanged low paratracheal lymph node. |
Generate impression based on findings. | Pre-chemo, baseline CT for AML patient. The paranasal sinuses and mastoid air cells are clear. There is pneumatization of the right anterior clinoid process and probable dehiscence of the right optic nerve canal. The carotid grooves are covered by bone. The left fovea ethmoidalis is slightly lower than the right, but are intact. There is mild nasal septal deviation and leftward spur. The imaged intracranial structures are orbits are grossly unremarkable. | No evidence of acute sinusitis. |
Generate impression based on findings. | Lung nodule LUNGS AND PLEURA: Moderate central lobular emphysema with a mixed groundglass and semisolid focal opacity in the right upper lobe peripherally (image 27 series 6). This focus abuts the pleura and measures approximately 3 cm in diameter. Immediately adjacent pleural thickeningMinimal basilar atelectasis or scarring without additional pulmonary abnormality. No effusions. Moderately elevated left hemidiaphragm and associated asymmetric volumes.MEDIASTINUM AND HILA: No discrete lymphadenopathy with a few scattered nodes, specifically a right precarinal lymph node measures 9 mm (image 31 series 4)The cardiac and pericardium are within limits other than moderate coronary and annular calcificationsCHEST WALL: Pronounced focal degenerative changes involving T6-7 and a moderate wedge deformity of T6. More near-severe degenerative changes involving the next 3 levels inferiorly. Mild scoliosis. No superimposed discrete lytic or blastic lesions observedUPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | A large focal right upper lobe abnormality suspicious for leak density and a probable adenocarcinoma given the history and appearance. Correlation with prior outside imaging would be helpful if available to determine chronicity. |
Generate impression based on findings. | Female, 84 years old, delirium, subarachnoid hemorrhage. There has been no significant change in the size of a left temporal lobe parenchymal hematoma. Also unchanged is extensive subarachnoid extension involving the sylvian fissure and the sulci of the left frontal and left occipitotemporal regions. Subarachnoid blood within the right sylvian fissure is also unchanged.No evidence of new intracranial hemorrhage is seen. Edema and mass effect associated with the left temporal lobe parenchymal hematoma has not substantially changed. The ventricular system remains patent and stable in size with only mild effacement of the left ventricular atrium.Bilateral facial/periorbital soft tissue hematomas are redemonstrated. | 1. No significant interval change in the left temporal parenchymal hematoma or of the scattered subarachnoid blood product.2. No evidence of new intracranial hemorrhage is seen. |
Generate impression based on findings. | 63-year-old male with COPD and dyspnea. LUNGS AND PLEURA: Mild centrilobular emphysema, unchanged. Mild increase in bilateral lower lobe paramediastinal linear opacities, compatible with scarring. Stable right upper lobe nodules, largest measuring 5-mm (series 5, image 36). Calcified granuloma in left lower lobe. No new or suspicious nodules.No consolidation or pleural effusions.MEDIASTINUM AND HILA: Again seen multiple calcified mediastinal and left hilar lymph nodes compatible with prior granulomatous infection. The heart is normal in size without pericardial effusion. Mild coronary artery calcifications.CHEST WALL: Subcutaneous soft tissue nodules are unchanged since 2009, likely sebaceous cysts (series 3, image 35, 27).UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Status post left nephrectomy. No other significant abnormality in the partially visualized upper abdomen. | Stable mild emphysema. Mildly increased basilar scarring. No acute intrathoracic abnormality. |
Generate impression based on findings. | Colon cancer restaging CHEST:LUNGS AND PLEURA: Left upper lobe nodule measures 5 mm (image 55; series 6), stable to equivocally larger than previous. Right upper lobe irregular nodule measures 6 mm (image 61; series 6), unchanged.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size is normal without pericardial effusions.CHEST WALL: Right chest port with tip at the cavoatrial junction. ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without evidence of cholecystitis. No focal hepatic lesions. No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Unchanged, punctate nonobstructing calculus in the left upper pole pelvis. Peripheral hypodensity in the right kidney is unchanged. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Multiple mesenteric nodes again are noted. The reference mesenteric node measures 1.7 x 1.2 cm (image 153; series 5), equivocally larger compared to prior.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: PROSTATE, SEMINAL VESICLES: Enlarged prostate.BLADDER: No significant abnormality noted.LYMPH NODES: Scattered prominence bilateral femoral and inguinal lymph nodes are unchanged.BOWEL, MESENTERY: Postsurgical changes in the small bowel and sigmoid colon. Left inguinal hernia no longer contains loops of bowel.BONES, SOFT TISSUES: Degenerate changes at L5-S1.OTHER: No significant abnormality noted. | No substantial interval change. Equivocal lymph node enlargement with measurements given above. |
Generate impression based on findings. | 39 year-old male with Hodgkin's disease, status post 6 cycles of chemotherapy. CHEST:LUNGS AND PLEURA: Right lower lobe pulmonary micronodule (series 5, image 51) is unchanged in size or appearance. No new nodules or effusions are seen.There are multiple new focal areas of groundglass infiltrates, see for example (series 5 image 25) (series 5, image 26), which are nonspecific, but not typical of lymphoma. As patient has symptoms of inflammatory or infectious disease or pulmonary embolic disease, these can be signs associated with that. MEDIASTINUM AND HILA: No adenopathy or change from prior examination.CHEST WALL: No change in small normal sized bilateral axillary lymph nodes. No new lymphadenopathy is seen.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Small, subcentimeter periaortic lymph nodes are again seen and is similar in size and distribution. No enlarged lymph nodes are seen. No new foci of lymph node prominence is seen.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: Reference left inguinal lymph node (series 3, image 199) has not significantly changed and measures 1.5 by 1.0 cm, previously 1.4 x 0.9 cm.. No new foci of enlarged lymph nodes.2BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. No evidence of significant lymph node enlargement, stable appearance to visualize, lymph nodes from prior examination. 2. Scattered no peripheral-based ground glass infiltrates -- nonspecific in appearance -- follow-up may help discern the etiology of these. |
Generate impression based on findings. | Fall. There is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable, without evidence of fracture. | No evidence of intracranial hemorrhage, skull fracture, mass, or cerebral edema. |
Generate impression based on findings. | Lethargy. There is no evidence of intracranial hemorrhage, mass, or cerebral edema. There is mild cerebral white matter hypoattenuation, which likely represent microangiopathy. The ventricles and basal cisterns are normal are mildly prominent diffusely, reflecting cerebral volume loss. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. | No evidence of intracranial hemorrhage, mass, or cerebral edema. However, non-contrast CT is relatively insensitive for detection of brain metastases and a contrast-enhanced CT or MRI is recommended for further evaluation. |
Generate impression based on findings. | ALL, neutropenic fever and concern for right periorbital cellulitis. There is perhaps minimal subcutaneous fat stranding in the region of the right temporal fossa and lateral orbital rim. There is no evidence of postseptal cellulitis. The bilateral globes are intact. The optic nerves and extraocular muscles are unremarkable. There is no evidence of drainable fluid collection. The osseous structures are unremarkable. There is mild scattered opacification in the partially imaged paranasal sinuses. The imaged intracranial structures are unremarkable. | Perhaps minimal subcutaneous fat stranding in the region of the right temporal fossa and lateral orbital rim, which may represent cellulitis, but no evidence of drainable fluid collections or postseptal cellulitis, although the exam is limited by lack of intravenous contrast. |
Generate impression based on findings. | Male 64 years old; Reason: esophagogastric cancer (HER2+) with liver mets, s/p 1.5 months of chemo - evaluate interval change History: none CHEST:LUNGS AND PLEURA: No a new pulmonary lesions. Calcified granulomata in the left lower lobe. No pleural effusions.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. No mediastinal lymphadenopathy. The right chest wall terminates at the cavoatrial junction. Esophageal stent.Left paraesophageal adenopathy measures 2.5 x 1.4 cm (image 74/series 3) equivocally larger.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Innumerable hepatic metastases are demonstrated. There is mild intrahepatic biliary ductal dilatation. Reference lesion measures 4.6 x 5.6 cm (image 84; series 3). Gallstones. Portal vein remains patent.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Atherosclerotic disease of the aorta. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: New ascites. Slight distal abdominal aortic ectasia is noted without evidence of frank aneurysm.PELVIS: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: New ascites | Stable to slight interval progression of disease with reference measurements given above. New abdominal and pelvic ascites. |
Generate impression based on findings. | NSCLC status post RT in 2011. New RML consolidation with focal pleural reaction on last CT, patient is asymptomatic. CHEST:LUNGS AND PLEURA: Metallic artifact from fiducial markers in the right middle lobe. Surrounding the markers, there is an increase in consolidation which is predominantly in the lateral segment of the right lobe which is now collapsed and seen to a lesser extent the medial segment and the adjacent right lower lobe. Previously seen space-occupying air space opacity now appears flat and atelectatic. The distribution of these abnormalities is not consistent with a vascular lesion as previously suggested and now has an appearance of an organizing pneumonia although the time frame is in consistent with remote RT from 2011. Bronchiectasis in the right middle lobe unchanged.Subtle new centrally lucent ground glass nodule in the anterior segment of the left upper lobe measuring 11 x 11 mm (5/34).Numerous foci of endobronchial impaction in the distal airways. No pleural fluid.Right apical micronodule unchanged since 2011 (5/14). Right upper lobe micronodules (5/44, 5/46) and right lower lobe micronodule (5/45) also unchanged since at least 2011, consistent with a benign or treated lesions.10-mm groundglass nodule in the right lower lobe (5/46) increased in size compared to 2011 were measured 7-mm, now suspicious for adenocarcinoma in situ or minimally invasive adenocarcinoma.MEDIASTINUM AND HILA: Mildly enlarged right hilar lymph node 11 mm, previously 12-mm (3/44), not significantly changed. Minimal lymphatic tissue abutting the right middle lobe bronchus (3/50) unchanged..No pericardial fluid or pericardial thickening. No cardiophrenic angle lymphadenopathy.CHEST WALL: Small axillary lymph nodes appear unchanged.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: Atherosclerotic calcification of the aorta and its branches.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. Although the radiographic appearance of masslike lesion in the right middle lobe and adjacent lung have an appearance suggestive of organizing pneumonia related to evolving radiation fibrosis which may sometimes appear without preceding pneumonitis, this pattern is typically seen in the first 12 months post RT. Given in this inconsistency, PET scan is recommended the to exclude recurrent or RT-induced tumor.2. Mildly enlarged right hilar lymph node and right middle lobe peribronchial lymph node, not significantly changed.3. New 11-mm groundglass nodule with central lucency suspicious for neoplastic process in the absence of clinical signs of infection. 4. 1 cm groundglass nodule right lower lobe now consistent with an indolent adenocarcinoma in situ or minimally invasive adenocarcinoma. |
Generate impression based on findings. | Breast cancer follow up CHEST:LUNGS AND PLEURA: Persistent scattered bilateral nonspecific micronodules with calcified granulomas in the mid right lung unchanged. No suspicious new pulmonary nodules or masses. No effusions.Mild left apical and left chest anterior wall post radiation changes.MEDIASTINUM AND HILA: The reference precarinal lymph node is unchanged (image 39 series 3) continuing at 6 mm in short axis. Calcified right hilar lymph nodes compatible with old granulomatous exposure.The cardiac and and pericardium otherwise are within normal limits other than a questionable very small pericardial effusionCHEST WALL: The reference left axillary lymph node is currently not appreciated and presumed resolved.Minimal soft tissue density in the left breast with associated surgical clips (image 34 series 3) requires dedicated imaging and correlation with recent dedicated exams. Focal scarring versus recurrence cannot be entirely excluded.Upper thoracic levoscoliosis unchanged without suspicious lytic or blastic lesions.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: 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. Stable reference measurements without evidence of intra-pulmonary acute malignant abnormality. Post radiation changes observed.2. Presumed postsurgical scarring versus chest wall soft tissue abnormality in the area of recent surgery, consider dedicated imaging and correlation with physical exam. |
Generate impression based on findings. | Male, 61 years old, unresponsive, status post EVD. Right frontal approach ventriculostomy catheter is in stable position, tip at the base of the right lateral ventricle. Caliber of the lateral ventricles remains prominent with no significant interval change. The third ventricle remains similarly dilated. Layering blood products in the occipital horns and within the third ventricle appears similar in extent to the prior study, perhaps slightly less dense consistent with expected evolution.Large right cerebellar hemorrhage is also unchanged in size and extent. This continues to produce substantial mass effect in the posterior fossa shifting the midline structures to the left and causing an upwards transtentorial herniation and a downward mild herniation through the foramen magnum.No new abnormalities are detected. | 1. Stable cerebellar hematoma and associated mass effect.2. Stable degree of intraventricular hemorrhage with stable prominence of the lateral and third ventricles. |
Generate impression based on findings. | Laryngeal cancer CHEST:LUNGS AND PLEURA: Extensive emphysematous changes with left apical fibrosis unchanged. Persistent mild to moderate volume loss with scarring more pronounced in the right extending toward the hilum and apex. Soft tissue thickening and surgical staples remains unchanged in appearance measuring 1.7 cm (image 36 series 6). No suspicious new nodules or masses. Scattered calcified granuloma and micronodules unchanged. No effusions.Persistent yet shifting bilateral bronchial debris, presumed aspiration. MEDIASTINUM AND HILA: No lymphadenopathy. Reference prevascular lymph node remains 6 mm (image 30 series 4) and benign index right paratracheal lymph node is also similar in appearance measuring 1.5 cm (image 30 series 4).Tracheostomy tube unchangedThe cardiac demonstrates coronary calcifications are similar and a small pericardial effusion cannot be excluded and new since prior study.Small hiatal herniaCHEST WALL: Right chest portABDOMEN: 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: Stable large necrotic and/or cystic left adrenal gland mass again inseparable from adjacent structures.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.G-tube unchanged. Multiple fluid-filled small and large bowel segments, uncertain significance without contrast enhancement. A dedicated imaging may be requiredBONES, SOFT TISSUES: Pedicular screws at L4-5 unchanged. Scattered gender changes stable.OTHER: No significant ascites, interval resolution | Stable exam with reference measured provided. |
Generate impression based on findings. | Female 65 years old; Reason: Stage IV endometrial cancer, currently receiving chemotherapy. Restaging. History: n/a CHEST:LUNGS AND PLEURA: Loculated left pleural effusion is essentially unchaged. Percutaneous drainage catheter in the left anterior chest wall is located within the loculated effusion. Compressive left lung atelectasis. Dependent atelectasis at the right lung base. Previously seen right lower subpleural lobe nodules have markedly decreased in size, and currently measure 8 mm, previously 1.8 cm (series 4 image 72)MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Right venous access device is in the expected position.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hypodensity in the caudate lobe is too small to characterize, however stable. Scalloped appearance of the hepatic margin may be due to hypodense metastases that are partly obscured by ascites. This scalloping has decreased since previous examination.Hourglass deformity with the gallbladder likely represents adenomyomatosis. 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: Moderate ascites. PELVIS:UTERUS, ADNEXA: Status post hysterectomy. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Soft tissue thickening along the inferior anterior abdominal wall is the decompressed bladder.OTHER: Moderate ascites | 1. Interval decrease in the hepatic, and pulmonary metastatic disease. Moderate ascites and loculated left pleural effusion stable. Percutaneous drain in left thorax fluid collection. |
Generate impression based on findings. | Male 40 years old; Reason: 40 male with MDS, neutropenic fever. Concern for splenic infarct on prior CT, r/o evolution. Aware that study will be suboptimal without contrast History: Neutropenic fever ABDOMEN: The absence of intravenous contrast limits evaluation of the solid organs and of the bowels. Given these limitations, the following observations were made:LUNG BASES: Bilateral pleural effusions with associated compressive atelectasis and consolidation. Large consolidation in the right lower lobe with extensive edema and compressive atelectasis. This is new since previous exam.LIVER, BILIARY TRACT: Hypodense segment 5 lesion compatible with treated HCC. No new focal hepatic lesion.SPLEEN: Wedge shaped splenic hypodensities and not well visualized on this examination given lack of IV contrast. Infarction cannot be excluded.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Distal esophageal wall thickening and dilated esophagus, raising the possibility of esophagitis. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Trace pelvic fluid. | 1. Distal esophageal wall thickening suggestive of esophagitis, correlation with EGD is suggested if clinically warranted.2. New right lower lobe consolidation which is concerning for pneumonic infiltrate.3. Bilateral pleural effusions with compressive atelectasis and consolidation.4. Unchanged treated HCC lesion. |
Generate impression based on findings. | 25-year-old male with hemoptysis status post lung transplant. LUNGS AND PLEURA: No significant change in small bilateral pleural effusions. On the left the fluid appears to be circumferential and intraparenchymal/subpleural in location. There is diffuse septal thickening, pulmonary venous distention, and axial interstitial thickening, consistent with edema.Centrilobular groundglass and solid branching nodules predominantly seen in the left upper lobe are nonspecific and may represent combination of edema, infection, or diffuse alveolar damage from rejection.Left mainstem bronchus stent is in place; there is new fluid and mucus material in the left mainstem bronchus and within the left bronchial stent. The distal end of the stent may be occluding the lingular bronchus (series 5, image 45). No significant change in near complete consolidation of left lower lobe. Subsegmental areas of consolidation in the lingula appear worse and in the right upper lobe these appear improved.MEDIASTINUM AND HILA: Mild increase in mediastinal lymphadenopathy. Heart size stable, with enlarged right atrium. Left central venous catheter unchanged, with tip in upper right atrium.Surgical clips again noted.CHEST WALL: Status post median sternotomyUPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.New occlusion of the left mainstem bronchus and left bronchial stent with fluid/mucus material, with possible occlusion of lingular bronchus by distal aspect of stent.2.Postobstructive consolidation/pneumonia of the lingula and left lower lobe.3.Persistent severe interstitial edema, left subpleural edema and small pleural effusions.4.Centrilobular nodules in the left upper lobe are nonspecific and may represent combination of edema, infection, or diffuse alveolar damage due to rejection. |
Generate impression based on findings. | Female, 80 years old, altered mental status, history of colon cancer. Patchy periventricular hypoattenuation is a non-specific finding which most commonly represents age-indeterminate small vessel ischemic disease.No intracranial hemorrhage or abnormal extra-axial fluid collection is seen. There is no evidence of mass effect or midline shift. The ventricles and basal cisterns are patent and normal in size. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.The bones of the calvarium and skull base are intact. | Age indeterminate small vessel ischemic disease without evidence of an acute intracranial process. |
Generate impression based on findings. | Reason: h/o recurrent head and neck cancer, compare to previous, measurements pls History: Severe pain LUNGS AND PLEURA: Large benign-appearing calcified nodule in the right upper lobe is unchanged. Calcified right hilar and mediastinal lymph nodes are unchanged. Mild centrilobular emphysema primarily in the apices is unchanged. Mild bronchial wall thickening is unchanged. No pleural effusions.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusions.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Calcified benign-appearing lesion in the spleen is unchanged and likely represents sequela of old granulomatous disease. | No evidence of metastatic disease. |
Generate impression based on findings. | 24 year-old female evaluate for abdominal source of fevers status post colectomy and ileostomy following a sigmoid perforation during colonoscopy. CHEST:LUNGS AND PLEURA: Bilateral pleural effusions, larger on the left with associated compressive atelectasisMEDIASTINUM AND HILA: Multiple large superior mediastinal, thoracic inlet and and supraclavicular lymph nodes. One paratracheal lymph node measures 1.2 x 1.1 cm (image 28, series 3). The heart size is normal.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: Left pelvic kidney, without hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Right lower quadrant ileostomy. Status post total colectomy. Foci of gas in the retroperitoneum identified, possibly postsurgical in etiology. Large amount of abdominal ascites with enhancement of the peritoneum suggesting inflammation/infection. Free fluid tracks into the mesentery. Mild diffuse small bowel dilatation, likely representing postoperative ileus. BONES, SOFT TISSUES: Gas within the anterior abdominal incision is likely postoperative.OTHER: Moderate ascites.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Right lower quadrant ileostomy. Status post total colectomy. Foci of gas in the retroperitoneum identified, possibly postsurgical in etiology. Large amount of abdominal ascites with enhancement of the peritoneum suggesting inflammation/infection. Free fluid tracks into the mesentery. Mild diffuse small bowel dilatation, likely representing postoperative ileus. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Pelvic ascites. | 1. Status post total colectomy and end ileostomy with large amount of abdominal ascites and hyperenhancement of the peritoneum indicating inflammation/infection.2. Bilateral pleural effusions, larger on the left.3. Nonspecific mediastinal and thoracic inlet adenopathy. |
Generate impression based on findings. | Benign Thymoma s/p 6 months. History of thyroid and breast cancer. CHEST:LUNGS AND PLEURA: No new nodules or masses. Scattered micronodules, subpleural/intrapulmonary lymph nodes and in scarlike lesions are unchanged.Chronic atelectasis of the right middle lobe with persistent masslike appearance at the apex of the atelectasis and cut off of the leading airways, suspicious for proximal obstruction of the lateral segmental bronchus. The masslike appearance appears stable to decreased in size currently measuring 12 mm, previously 15 mm. Mild bronchiectasis of the medial and lateral segment airways. Chronic small pleural fluid collection loculated anteriorly abutting the right middle lobe is unchanged.MEDIASTINUM AND HILA: Small left low cervical lymph node unchanged (3/2). Left chest port tip in the superior vena cava. Postsurgical changes anterior mediastinum. Right internal mammary surgical clips. No lymphadenopathy. Mild mediastinal lipomatosis. Thickening of the distal esophageal segment circumferentially is mild, of unclear clinical significance and nonspecific by CT. For reference, the anterior wall of the distal esophagus measures 9-mm (3/50). On the prior scan this measured approximately 5 mm.Large mixed hernia with intrathoracic position of a portion of the stomach. GE junction (3/61) appears thickened however this could be due to artifact underdistention and is nonspecific by CT..CHEST WALL: Bilateral breast prostheses. Soft tissue stranding beneath the medial aspect of the right breast prosthesis present since 2011 favoring benign process such as postsurgical change or scarring, please note that breast abnormalities are nonspecific by CT. If the patient is symptomatic, correlation with chest wall ultrasound would be suggested. Surgical clips right axilla. Healed sternotomy with intact wires. Degenerative change of the spine. Scattered punctate sclerotic foci in the spine are unchanged dating back to 2011.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: Scattered sclerotic foci unchanged dating back to 2011. Degenerative change of the spine.OTHER: No significant abnormality noted. | 1. Mild thickening of the distal esophagus and GE junction, nonspecific by CT. Suggest correlation with endoscopy.2. Chronic obstruction of the right middle lobe segmental bronchus with no significant change in underlying lesion which produces mass effect on adjacent parenchyma. Endobronchial hamartoma is a possibility, indolent neoplasm is considered less likely. Consider PET or bronchoscopy.3. No new or suspicious pulmonary nodules. |
Generate impression based on findings. | 48 year-old female with right tonsillar mass. LUNGS AND PLEURA: No consolidation, pleural effusions, or suspicious nodules.MEDIASTINUM AND HILA: No lymphadenopathy. The heart is normal in size without pericardial effusion.CHEST WALL: Punctate sclerotic focus in T4 vertebral body and left transverse process of T5 most compatible with benign bone island. No suspicious osseous lesions.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Mild prominence of intrahepatic and extrahepatic bile ducts, of questionable clinical significance. Well-defined hypodensities in the liver, incompletely characterized but also could represent benign cysts (series 3, image 97, 99, 106). | No evidence of metastatic disease. |
Generate impression based on findings. | 43 year-old female with active malignancy, tachycardia, and hemoptysis. PULMONARY ARTERIES: Diagnostic quality exam without evidence of pulmonary embolus.LUNGS AND PLEURA: Stable bilateral small pleural effusions, right more than left, with overlying subsegmental consolidation/atelectasis in the bases, likely not significantly changed since most recent radiograph.No new or suspicious nodules or masses.MEDIASTINUM AND HILA: Heart is normal. New small pericardial effusion. No mediastinal lymphadenopathy. Unchanged mildly enlarged left low cervical lymph node (series 7, image 34).Right central venous catheter tip at SVC/RA junction.CHEST WALL: Prominent bilateral axillary lymph nodes unchanged and may be reactive in nature.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Status post cholecystectomy. Gastrostomy tube noted. Right renal cyst. | 1.No pulmonary embolus or other source for patient's hemoptysis.2.Small bilateral pleural effusions with overlying subsegmental consolidation/atelectasis.3.New small pericardial effusion. |
Generate impression based on findings. | 73-year-old male patient with basal cell carcinoma of the skin. Evaluate for progression of metastatic disease. CHEST:LUNGS AND PLEURA: Stable right suprahilar and left infrahilar scar-like opacities and volume loss. Calcified and noncalcified micronodules are unchanged compared to prior examination. No new or suspicious nodules.MEDIASTINUM AND HILA: Infrahilar lymph node measures 1.2 x 1.1 cm (series 3 image 115), unchanged.CHEST WALL: Partially calcified left axillary lymph nodes unchanged.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate with calcifications and seminal vesicles, stable.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: Multilevel degenerative changes and degenerative disk disease in the thoracic and lumbar spine. Spondylolisthesis of L5 on S1. Left inguinal hernia with nonspecific soft tissue attenuation, stable. | Stable examination. No significant interval change in reference left infrahilar lymph node. |
Generate impression based on findings. | Metastatic PTC on clinical trial (IRB 10-182) with cediranib+lenalidomide. Head CT: There is no evidence of intracranial mass, hemorrhage, or infarction. There is no abnormal intracranial enhancement. The ventricles are stable in size and configuration. The right mastoid air cell is under-pneumatized and the left mastoid air cells are partially opacified.Neck CT: There are post-treatment findings related to thyroidectomy and tracheostomy. There has been continued interval decrease in size and cystic transformation of the cervical lymphadenopathy. Reference measurements are as follows:1. Left level IB (image 44, series 6): 8 x 6 mm, previously 11 x 8 mm.2. Left level 4 (image 48, series 63): 12 x 12 mm, previously 19 x 14 mm.3. Midline level 6 (image 53, series 6): 22 x 13 mm, previously 25 x 17 mm.4. Left level 6 (image 57, series 6): 13 x 7 mm, previously 14 x 10 mm.5. Left parastomal (image 57, series 6): 32 x 16 mm, previously 37 x 22 mm.6. Left level 6 (image 60, series 6): 12 x 9 mm, previously 16 x 12 mm.There has also been interval decrease in size of a cystic nodule within the upper right chest wall subcutaneous tissues, now measuring 10 x 8 mm, previously 13 x 10 mm. The left internal jugular vein is mildly compressed by the lymphadenopathy, while the left common carotid artery remains partially surrounded by lymphadenopathy. No lytic or blastic osseous lesions are identified. The major salivary glands are unremarkable. The tracheostomy tube tip lies at the level of the thoracic inlet. The surrounding airway is patent. There are increased air fluid levels within the maxillary sinuses. Refer to the separate chest CT report for additional details. | 1. Continued interval decrease in size of the cystic metastatic cervical lymphadenopathy.2. No evidence of intracranial metastatic disease.3. Increased air fluid levels within the maxillary sinuses, which may reflect acute sinusitis in the appropriate clinical setting. |
Generate impression based on findings. | SCC of the left tonsil s/p cis-RT with lung metastases, followed by chemotherapy with carbo/taxol/cetux. There are post-treatment findings related to radiation therapy and probable left neck dissection with effacement of the fat planes. There is mild asymmetry of the glossotonsillar sulci. However, there is no evidence of mass lesion in the left tonsillar fossa to suggest locoregional tumor recurrence. There has been interval increase in size of right lower paratracheal lymph nodes, including a lymph node that measures 10 x 7 mm (image 61, series 7), previously 6 x 4 mm and a lymph node that measures 9 x 5 mm (image 67, series 7), previously 6 x 4 mm. There is no significant suprahyoid lymphadenopathy. There has been interval decrease in the fluid within the right internal laryngocele that measures up to 5 mm. Otherwise, the larynx appears unremarkable. The submandibular glads are small and hyperemic, most likely secondary to treatment. The thyroid gland is unremarkable. There is a left internal jugular venous catheter. There is unchanged lack of opacification of the left internal jugular vein superior to the catheter with several small caliber collateral veins, suggesting chronic thrombosis of the internal jugular vein. The other major cervical vessels are intact. There is minimal scattered paranasal sinus mucosal thickening. The mastoid air cells are clear. There is multilevel degenerative spondylosis with 4 mm anterolisthesis of C4 upon C5. The orbits and imaged intracranial structures are unremarkable. | Interval increase in size of right lower paratracheal lymphadenopathy suggest progressive disease. Otherwise, no evidence of locoregional tumor recurrence in the left tonsillar region or significant suprahyoid lymphadenopathy. Refer to the separate chest CT report for additional findings. |
Generate impression based on findings. | 65-year-old male with pancreas cancer and history of prior Whipple surgical procedure. Surveillance imaging. CHEST:LUNGS AND PLEURA: No new pulmonary nodules, infiltrates or masses. Prior reported Index lesions as reported below: Right lower lobe (series 5, image 65) 1.1 x 0.9 cm, previously 1.0 x 0.8 cmLeft upper lobe (series 5, image 24) 1.0 x 0 .6 cm, previously 0.8 x 0.6 cm on 8/28/13. MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No new lesions are seen in the liver. Several 3 to 4-mm hypodensities are again seen scattered in the left and right lobes with a similar distribution, unchanged in size. These are too small to characterize, but have not changed since 8/28/13.Portal veins and hepatic veins are patent and normal.Patient is status post cholecystectomy. No intrahepatic or extrahepatic biliary tract abnormality is seen -- the pneumobilia from prior hepaticojejunostomy is unchanged. SPLEEN: No significant abnormality notedPANCREAS: Evidence of prior Whipple surgery with resection of the head and body of the pancreas. No evidence of recurrent tumor in surgical bed is seen and no abnormality seen in residual pancreas.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Stable postsurgical appearance to pancreas with no evidence of recurrent tumor in surgical bed. 2. Minimal increase in size of two lung nodules. No new nodules identified. 3. Scattered, nonspecific liver hypodensities less than 5 mm in diameter, too small to characterize and stable in appearance. |
Generate impression based on findings. | 64-year-old male with history of lung cancer status post chemo radiation. CHEST:LUNGS AND PLEURA: Stable appearing consolidation with cavitation in right upper lobe. No significant change in moderate to large left pleural effusion. Mild right pleural thickening unchanged.Mild left upper lobe paramediastinal scarring appears slightly increased in density (series 4, image 26). No new focal lung opacities.MEDIASTINUM AND HILA: Stable reference right paratracheal node measures 10 mm, previously measured 10 mm (series 3, image 26).Stable enlargement of main pulmonary artery. Stable coronary artery calcifications. Heart size normal. Stable small pericardial effusion.Left brachiocephalic vein stent is in place.CHEST WALL: Again seen extensive chest wall collateral vessels.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: Stable bilateral adrenal masses; right mass measures 2.8 x 4.3 cm and left mass measures 3.1 x 2.3 cm (series 3, image 80 and 88).KIDNEYS, URETERS: Bilateral renal cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Nodular soft tissue attenuation in the anterior abdominal wall fat, nonspecific but most likely benign in nature and may represent injection granulomas.OTHER: No significant abnormality noted. | 1.No significant change in right upper lobe consolidation and pleural effusions.2.Mild interval increase in density of left paramediastinal scarring; continued follow-up recommended. |
Generate impression based on findings. | 4-year-old female with left upper lobe pneumonia, persistent fever. LUNGS AND PLEURA: Left lingular segment upper lobe consolidation is present which appears similar to the chest radiograph from the same day and is compatible with pneumonia. No cavitation or decreased enhancement is present within this consolidation to suggest a necrotizing component.There is mild dependent atelectasis in the left lung. No pleural effusions are present. MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy is present. The left vertebral artery which arises from the aorta, normal variant anatomy. The heart size is within normal limits. No pericardial effusion is present.CHEST WALL: No axillary lymphadenopathy is present. No osseous lesions are identified.UPPER ABDOMEN: The visualized portions of the liver, spleen, adrenal glands, and kidneys appear normal. | Left upper lobe pneumonia. |
Generate impression based on findings. | 51-year-old female patient with recurrent breast cancer (right), evaluate for distant metastases to bone. CHEST:LUNGS AND PLEURA: No lesions or suspicious nodules.MEDIASTINUM AND HILA: No suspicious mediastinal lymphadenopathy.CHEST WALL: Soft tissue density mass in right breast with surgical clips corresponding to area of confirmed recurrent breast cancer. No right sided lymphadenopathy. Normal appearing left-sided lymph nodes.ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No bony lesions identified.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Hardware present from tubal ligation.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No bony lesions identified.OTHER: No significant abnormality noted. | No evidence of metastatic disease. |
Generate impression based on findings. | Male, 6 months old, scalp bump, skull lesion. Evaluate for changes. Adjacent to skin marker placed in the high left parietal region, there is a very subtle, relatively focal convex outward bulging of the calvarium. The bone may be mildly thinned in this location but it is intact, and no osseous lesions are seen. This is similar to findings visualized on the prior MRI. Subjacent to this area, no discrete extra-axial lesions are seen. The underlying brain parenchyma is unremarkable. No enhancing abnormalities are detected.No intracranial hemorrhage or abnormal extra-axial fluid collection is seen. There is no evidence of mass effect or midline shift. The ventricles and basal cisterns are patent and normal in size. | At the area of concern, only a very subtle focal convex outward bulging of the calvarium is seen. The bone is perhaps mildly thinned but intact. No osseous lesions are seen. No lesions are detected in the subjacent extra-axial space or brain parenchyma. |
Generate impression based on findings. | 72-year-old male with malignant neoplasm of the anterior wall of urinary bladder. Status post cystoprostatectomy with neobladder. Please evaluate for metastases with CT urogram. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Kidney shows similar morphology to 11/11/11 examination without evidence of significant abnormality -- prior noted left lower pole exophytic cysts are unchanged. No calcifications. No hydronephrosis. No perinephric fluid collections.Prompt and symmetric excretion of contrast is seen in normal pyelo-calyceal systems bilaterally. Ureters are visualized throughout the majority their course and appear normal.RETROPERITONEUM, LYMPH NODES: No, adenopathy or other abnormality seen..BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prior cystoprostatectomy without evidence of recurrent tumor in surgical bed.BLADDER: Prior cystoprostatectomy without evidence of recurrent tumor in surgical bed.LYMPH NODES: No lymphadenopathy identified.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Prior cystoprostatectomy with continent neobladder without evidence of recurrent tumor. 2. No evidence of metastatic disease identified. 3. Stable examination with no other significant abnormality seen. |
Generate impression based on findings. | 64 year old female with lung cancer. CHEST:LUNGS AND PLEURA: Left upper lobe nodule stable and measures 5 mm (series 4, image 31).No significant change in severe chronic interstitial disease in the lung bases with multiple large cysts and trace pleural effusions/pleural thickening.Reference superior anterior mediastinal mass is slightly increased and measures 30 x 24 mm, previously measured 38 x 22 mm (series 3, image 26).Reference right cardiophrenic angle mass now appears centrally necrotic but slightly smaller in size, measuring 15 x 20 mm, previously measured 22 x 22 mm (series 3, image 65).Anterior subcostal mass is mildly increased and measures 29 x 23 mm, previously measured 30 x 23 mm (series 3, image 71).No significant change in soft tissue nodule adjacent to right atrium, measuring 10 x 19 mm, producing measured 9 x 20 mm (series 3, image 64).No new suspicious nodules or masses.MEDIASTINUM AND HILA: Persistent thrombosis of the right internal jugular vein. Heterogeneous thyroid gland with multiple nodules appears unchanged. No significant change in anterior upper mediastinal lymphadenopathy.Stable moderate cardiomegaly. No pericardial effusion. Stable mildly patulous esophagus.CHEST WALL: Stable reference lesion in anterior left chest wall, measuring 18 mm, previously measured 14 mm (series 3, image 42).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: Bilateral renal cysts.PANCREAS: No significant change in ectatic duct dilation.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Again seen multiple dilated loops of small bowel; there appears to be intramural gas suspicious for pneumatosis intestinalis (series 3, image 137). Gastrostomy tube in place.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Stable to mildly increased reference soft tissue lesions in thorax. No new lesions identified.2.No significant change in basilar lung fibrosis.3.Persistent dilation of multiple small bowel loops, with new intramural foci of gas suspicious for pneumatosis; this is of unclear etiology but may be result of ischemia. Findings communicated to Dr. Desouza at 3:50 p.m. on 10/31/2013. |
Generate impression based on findings. | Cough and S.O.B.. Post inflammatory pulmonary fibrosis. LUNGS AND PLEURA: Mild centrilobular emphysema, predominantly in the left upper lobe and seen to a lesser extent at the right apex. Mild bronchial wall thickening involving the lower lobes, right middle lobe and lingula. Nodularity of the bronchial wall suggestive of lymphatic distention but nonspecific as to etiology. No focal groundglass opacities, honeycombing or bronchiectasis. No pleural fluid.The most recent prior examination is limited by a significant imaging noise and noncontiguous axial images. Groundglass opacities with lobular areas of sparing at the lung bases have resolved. On earlier outside exam of 8/25/13, intralobular septal thickening in a patchy distribution was present and has also resolved.On the expiration sequence there is no significant degree of air trapping, only focally seen in the left lower lobe (coronal series 8080, image 29).MEDIASTINUM AND HILA: Atherosclerotic calcifications of the aorta and its branches. Coronary artery calcifications. Normal heart size. No pericardial fluid. No significant lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. Cholecystectomy clips, incompletely visualized | Interval resolution of the diffuse interstitial abnormality without signs of pulmonary fibrosis or bronchiectasis. Mild centrilobular emphysema and mild bronchial wall thickening. |
Generate impression based on findings. | Syncope, head trauma. There is moderate cerebral white matter hypoattenuation, which is likely related to small vessel ischemic disease. There are also unchanged foci of hypoattenuation within the bilateral thalami and basal ganglia, consistent with chronic lacunar infarctions. There is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are stable in size and configuration. There are atherosclerotic calcifications of bilateral internal carotid arteries are present. The paranasal sinuses and mastoid air cells are clear. The osseous structures and extracranial soft tissues appear unremarkable. | 1. Moderate chronic small vessel ischemic changes and lacunar infarcts. However, CT is insensitive for evaluation of acute infarcts and if this remains a clinical concern, MRI can be considered.2. No evidence of intracranial hemorrhage or mass. |
Generate impression based on findings. | 71-year-old female with history of Crohn's disease that has been inactive, osteoporosis, history of right inguinal hernia repair, now with inguinal and back pain. ABDOMEN: Lack of IV contrast limits evaluation of solid organ pathology and vasculature.LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Cholelithiasis without evidence of cholecystitis. No focal hepatic lesion.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Marked degenerative disk disease at L5/S1 with posterior disk bulge and facet arthropathy. The spinal canal appears narrowed. Absence/atrophy of the left rectus abdominis. Status post left inguinal hernia repair. Several sclerotic lesions in the right ilium, as well as one lucent lesion.OTHER: No significant abnormality noted | 1. No evidence of recurrent hernia. Marked degenerative changes at L5/S1, as detailed above.2. Cholelithiasis without evidence of inflammation. |
Generate impression based on findings. | Reason: 59 yo F w/ bronchiectasis. eval for progression of disease History: SOB LUNGS AND PLEURA: Multiple micronodules and nodules, largest measuring 12 x 9 mm (series 5, image 63). It has increased in size from 2008 examination where it measured 6 mm x 6 mm. In Reference nodule in the left lung remains unchanged in size measuring 9 x 9 mm (series 5, image 49) as do the additional nodules. There is mild bronchiectasis and bronchial wall thickening of the anterior right middle lobe which is slightly decreased from prior exam.MEDIASTINUM AND HILA: Heart size is normal. Minimal coronary calcifications. No pleural effusions.CHEST WALL: Anterior osteophytes in the midthoracic spine. Compression fracture of T12, of indeterminate age, unchanged.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Status-post cholecystectomy. | Interval increase in the right lower lobe nodule suspicious for neoplasm. Recommend PET scan for further evaluation. Remainder of nodules have benign appearance. |
Generate impression based on findings. | ILD, SLE evaluate for interval change. Post inflammatory pulmonary fibrosis. LUNGS AND PLEURA: Suture lines from prior biopsies in the right lung. Trace volume of pleural fluid, right greater than left.Patchy areas of groundglass opacity associated with scattered cysts and minimal honeycombing as well as minimal internal bronchiolectasis are observed with a basal predominance.Mild subpleural honeycombing in the lung apices. Mild scarring left upper lobe.Mild septal thickening and intralobular groundglass opacity at the lung bases.Findings have evolved since the previous examination of with increase in the fibrosis and volume loss and resolution of acute-appearing groundglass opacities.MEDIASTINUM AND HILA: Moderate diffuse lymphadenopathy in the mediastinum and hila bilaterally.Main pulmonary artery is enlarged to 3.3-cm in transverse dimension, consistent with pulmonary arterial hypertension and increased compared to the 4/3/12 exam.Moderate cardiomegaly, unchanged. Trace pericardial thickening or fluid. SVC and azygos arch appear distended. Vascular stents in the left main and LAD coronary arteries.Small hiatal hernia.CHEST WALL: Scattered small axillary and internal mammary lymph nodes appear unchanged. Moderately enlarged subpectoral lymph nodes unchanged. Degenerative changes of the spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Splenomegaly, 14-cm. | 1. Atypical pattern of pulmonary fibrosis consisting of patchy areas of chronic inflammatory change containing scattered cysts and groundglass opacity but only minimal bronchiectasis and honeycombing. Although the appearance is not typical, cystic disease in conjunction with septal thickening and groundglass opacity may be seen in lymphocytic interstitial pneumonia which is the favored radiographic diagnosis. Pulmonary Langerhans cell histiocytosis may also produce cysts but these typically are irregular rather than spherical in appearance and the distribution and is usually upper to mid lung zone rather than basilar. This disease process now appears subacute to chronic with resolution of much of the groundglass opacity that occurred previously.2. Enlargement of the main pulmonary artery consistent with pulmonary arterial hypertension.3. Chronic moderate diffuse lymphadenopathy and splenomegaly nonspecific but remains consistent with lymphoproliferative disease. |
Generate impression based on findings. | Reason: Patient with lung lesions and request by Kyle Hogarth for "superdimension protocol" History: cough with lung mass LUNGS AND PLEURA: Left upper lobe/mediastinal mass (image 31 series 4) now measures 3.2 cm x 7 cm previously measuring 2.7 cm x 6.8 cm.No other suspicious pulmonary nodules.No pleural effusions.MEDIASTINUM AND HILA: Prevascular necrotic appearing lymph node (image 29 series 4) measures 12 mm previously measuring 13 mm. Additional mildly prominent mediastinal and right hilar lymph nodes are unchanged.Cardiac size is normal without evidence of a pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.Left upper lobe mediastinal/paramediastinal mass with apparent extension into the the adjacent lung demonstrates minimal interval increase compared to the prior exam. This mass is suspicious for chronic indolent infection including tuberculosis, however malignancy cannot be excluded.2.Stable mediastinal and hilar lymphadenopathy. However when compared to the remote exam dated 2/4/12 there's been significant decrease in size of the mediastinal lymphadenopathy. |
Generate impression based on findings. | Malignant neoplasm of the supraglottis CHEST:LUNGS AND PLEURA: The index spiculated nodule in the right lower lobe peripherally appears unchanged, again measuring 1.8 cm when measured in a similar fashion (image 58 series 5). The relatively adjacent nodular densities also stable in size measuring 7 mm (image 54 series 5).Moderate to pronounced centrilobular emphysematous changes with additional peripheral subpleural fibrotic changes greater both bases. Scattered small micronodules.. No effusionsScattered debris throughout the bronchi bilaterally and trachea. Of particular note is a somewhat linear density immediately inferior to the tip of the tracheostomy tube, mildly concerning for scarring. Serial imaging would be helpful to confirm.MEDIASTINUM AND HILA: Tracheostomy tube is in place and essentially unchanged. No lymphadenopathy.Coronary calcifications without additional cardiac or pericardial abnormality.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholecystectomy clips without additional hepatic abnormalitySPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The left inferior pole nodular mass is unchanged again measuring 2.6 x 2.2 cm (image 126 series 3). The heterogeneity and appearance again remain suspicious for underlying malignancyPANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Extensive atherosclerotic calcifications of the aorta and branchesBOWEL, 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. Similar scattered intrapulmonary nodules and semisolid nodular opacities.2. Stable left renal mass3. Pulmonary fibrosis and emphysema with scarring. |
Generate impression based on findings. | 67-year-old female reached aging after gastrectomy for gastric cancer. CHEST:LUNGS AND PLEURA: Small left lung base nodule (series 5, image 64) measuring 5 x 3 mm. This was not definitely present on prior examinations and should be followed up. No other nodules, infiltrates, masses, or effusions are seen.MEDIASTINUM AND HILA: New slightly enlarged lymph node seen in the right superior mediastinum (series 3, image 21) measuring 1.5 x 0.9 cm. CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Progression of the parenchymal liver masses are seen with increased number and size of mass lesions representing metastatic disease. The prior reference lesion (series 3, image 94) now measures 1.8 x 3 .3 cm, previously 1.7 x 1.3 cm. Gallbladder and biliary tract appear normal.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Stable right adrenal nodule (series 3, image 90) measuring 2.2 x 2.0 cm, likely benign as, unchanged dating back to 2011 CT. Left adrenal gland appears normal.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Partial gastrectomy again seen without evidence of tumor recurrence in surgical bed. The small bowel shows normal transit of orally administered contrast without intrinsic bowel abnormality. No evidence of bowel obstruction.There is extensive new metastatic deposits seen throughout the mesentery with ascites. These range in size from slightly less than a centimeter (see series 3, image 128 along the lateral peritoneal space) to 4.3 x 3.2 cm lateral to the liver (series 3, image 90). Anterior omental nodules and masses are seen, as well as numerous scalloping in the posterior liver margin.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Uterus appears normal. New complex cystic mass in the right ovary, most likely drop metastasis from gastric cancer. Mass measures 4.1 x 4.0 cm (series 3, image 155). BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Innumerable mesenteric deposits representing metastatic spread are seen ranging in size from several millimeters to the largest in the cul-de-sac (series 3, image 162) measuring 2.7 x 1.4 cm.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Marked increase in metastatic disease to the, mesentery and omentum diffusely. 2. Presumed new metastasis to the right ovary. 3. New small parenchymal lung nodule. 4. New slightly enlarged mediastinal lymph node worrisome for metastasis. 5. Enlarging and new liver metastases. |
Generate impression based on findings. | Dizziness and congestion. The paranasal sinuses and nasal cavity are clear. There is mild nasal septal deviation and leftward spur. The mastoid air cells are clear. The imaged intracranial structures and orbits are grossly unremarkable. | No evidence of sinusitis. |
Generate impression based on findings. | 36 year old female patient with right lower quadrant pain, nausea and anorexia. ABDOMEN:LUNG BASES: Trace 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: Bilateral hypoattenuating renal lesions are stable compared to prior examination are too small to characterize and likely represent cysts.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: Bowel normal in caliber without evidence of obstruction. Appendix is enlarged, measuring 13.8 mm in diameter (series 3 image 110) with thickened wall. Appendix is anterior and inferior to the cecum. Mild adjacent inflammation. No evidence of perforation or abscess formation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace free fluid in the pelvis. | Acute appendicitis without perforation or abscess formation.Findings of acute appendicitis discussed with Dr. Steinman via telephone at 4:30 p.m. on 10/30/2013 by Dr. Blaschke. |
Generate impression based on findings. | Chronic sinusitis, assess extent of nasal polyposis. There is complete opacification of the maxillary, ethmoid, and sphenoid sinuses. The frontal sinuses are not pneumatized. There are hyperdense secretions that measure up to 65 HU within the maxillary sinuses. There are polypoid opacities within the nasal cavity, right greater than left. The mastoid air cells are clear. The imaged intracranial structures are grossly unremarkable. | Pansinus opacification and polypoid opacities in the nasal cavity are compatible with chronic sinusitis and nasal polyposis, perhaps with a component of allergic fungal sinusitis. |
Generate impression based on findings. | Headache on heparin drip. There is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. | No evidence of intracranial hemorrhage, mass, or cerebral edema. |
Generate impression based on findings. | Hemiplegia, unspecified, affecting unspecified side. thalamic hemorrhage There is a 35 x 23 mm axial dimension hyperdense focus in the right thalamus associated with third ventricular blood and lateral ventricular blood and fourth ventricular blood which is unchanged in dimensions when compared to the prior exam.A ventriculostomy tube courses to the right frontal lobe into the right lateral ventricle with tip in the region of foramen of Monro in stable position.The biventricular diameter at the level of the entry point of the ventriculostomy tube is 32 mm on the current exam and 36 mm on the prior examAtherosclerotic calcifications are present along the distal internal carotid arteries.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.Redemonstration and no change of right thalamic hemorrhage associated with intraventricular blood2.the lateral ventricles are slightly smaller on the current exam when compared to the prior |
Generate impression based on findings. | Clinical question: Rule out intracranial hemorrhage. Signs and symptoms: Right-sided headache with off-balance feeling. Nonenhanced head CT:Examination demonstrate no detectable abnormal parenchymal or leptomeningeal enhancement.No detectable acute intracranial process CT however is insensitive for detection of acute non-hemorrhagic ischemic stroke.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation.Unremarkable orbits.Unremarkable paranasal sinuses, bilateral mastoid air cells and middle ear cavities. | Negative unenhanced head CT. |
Generate impression based on findings. | Clinical question: Signs of stroke? Signs and symptoms: AMS. Nonenhanced head CT:No detectable acute intracranial process. CT is insensitive for detection of acute nonhemorrhagic ischemic strokes.Examination redemonstrates an extensive subcortical and periventricular low attenuation white matter remaining grossly similar to prior exam from 10 -- 30 -- 13. Finding consistent with advanced age indeterminate small vessel ischemic strokes.There is mild prominence of cortical sulci and ventricular system which may indicate underlying volume loss. No evidence of mass effect and midline is maintained.Unremarkable calvarium and soft tissues of the scalp.All paranasal sinuses and bilateral mastoid air cells and middle cavities remain well pneumatized.Unremarkable images through the orbits. | Extensive age indeterminate small vessel ischemic strokes grossly similar to prior study. |
Generate impression based on findings. | Clinical question:? Hemorrhage signs and symptoms: AMS. Nonenhanced head CT:There is no detectable acute intracranial process in particular no evidence of hemorrhage. CT ovaries insensitive for the junction of nonhemorrhagic acute ischemic strokes.Examination demonstrates fairly extensive periventricular and subcortical low attenuation of white matter consistent with age indeterminate small vessel ischemic strokes considering patient's stated age of 82. There is mild extra-axial dilatation of the supratentorial ventricular system and cerebral cortical sulci. Unremarkable exam otherwise.Unremarkable calvarium, soft tissues of the scalp, visualized orbits, paranasal sinuses and mastoid air cells. | Extensive age indeterminate small vessel ischemic strokes but |
Generate impression based on findings. | Clinical question: Bleed? Signs and symptoms: Blunt head trauma and syncope. Unenhanced head CT:There is no detectable acute posttraumatic intracranial or calvarial findings.Small focus of subgaleal increased density measuring at 3-mm thickness and with slight subcutaneous fat stranding in right posterior parietal likely as result of recent trauma.Mild to moderate periventricular and subcortical as well as left basal ganglia foci of low-attenuation consistent with age indeterminate small vessel ischemic strokes. Compared to prior head CT exam from 9 -- 3 -- 10 there is no definitive evidence of interval change in the extent of findings.Cortical sulci and ventricular system remain within normal for patient stated age of 65.Visualized paranasal sinuses demonstrate minimal chronic sinusitis of the right maxillary sinus and unremarkable otherwise.Mastoid air cells and bilateral middle ear cavities remain well pneumatized. | Age indeterminate small vessel ischemic strokes. |
Generate impression based on findings. | Reason: Evaluate regions of possible pulmonary infarcts History: SOB LUNGS AND PLEURA: Moderate to large pleural effusions right larger than left, with adjacent atelectasis probably compressive in nature.No specific evidence of pulmonary infarct in the aerated portions of the lungs, as questioned in the clinical history provided.Scattered punctate micronodules appear benign. MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy noted.Heart size normal, with a small pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. At least a small amount of ascites is present. | 1. Moderate to large bilateral pleural effusions with adjacent atelectasis probably from compression. No specific evidence of pulmonary infarct as questioned in the clinical history provided.2. Pericardial effusion and ascites. |
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