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Generate impression based on findings. | Pt with encephalopathy, poss cerebritis;Signs and Symptoms: Intraprocedural stroke; giving tPA There is redemonstration of encephalomalacia involving the right middle cerebral artery territory which is stable compared to prior examThere is intravascular contrast presentThe 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 evidence for acute intracranial hemorrhage mass effect or edema.2.CT is insensitive for the early detection of nonhemorrhagic CVA.3.Findings are compatible with encephalomalacia related to an old infarction in the right middle cerebral artery territory.4.MRI findings of PRES are not readily identified on the current CT exam |
Generate impression based on findings. | 24-year-old male with idiopathic pulmonary fibrosis on steroids and tacrolimus. Concern for pneumonia. LUNGS AND PLEURA: Combined emphysematous and fibrotic changes with architectural distortion and honeycombing, left worse than right; no significant change since prior exam. No superimposed areas of consolidation. The previously seen small left pleural effusion has resolved.MEDIASTINUM AND HILA: Multiple mildly enlarged mediastinal lymph nodes are not significantly changed, may be reactive in nature. No significant change in mildly enlarged main pulmonary artery, suggestive of pulmonary arterial hypertension. Heart size within normal limits, without pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Punctate nonobstructive left renal stones. | Stable findings compatible with a combined pulmonary fibrosis and emphysema, without superimposed consolidation to suggest pneumonia. Interval resolution of small left pleural effusion. |
Generate impression based on findings. | Reason: evaluate for PE History: pleuritic chest pain PULMONARY ARTERIES: Technically adequate study. No pulmonary embolism.LUNGS AND PLEURA: Bibasilar dependent atelectasis. There is mild paraseptal emphysema. Mild bronchial thickening compatible with bronchitis. Small area of tree-in-bud opacity in the right middle lobe, unchanged and most likely represents residual infection.MEDIASTINUM AND HILA: Mild atherosclerotic calcification of the aorta. Severe coronary artery calcifications. Heart size is normal. No pericardial effusion.Scattered mild mediastinal lymphadenopathy unchanged from prior exam.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Status post cholecystectomy. Mild thickening of the left adrenal gland remains unchanged compared to prior exam. | No evidence of pulmonary embolus. No other acute abnormalities. |
Generate impression based on findings. | Male 59 years old Reason: Pt is a 59 y/o male with prostate cancer, rising PSA, evaluate for recurrence History: prostate cancer ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a trans-omental hernia with nearly the entire small intestine located within the hernia sac. Images and annotated. The hernia ring is wide and nonobstructive. There is no bowel wall thickening or dilatation. No free or loculated intraperitoneal fluid.Small sliding hiatal hernia. Periampullary duodenal diverticulum. No free or loculated intraperitoneal fluid.BONES, SOFT TISSUES: No lytic or blastic disease.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: The transverse colon is located dorsal to the small bowel, and deviated deep into the pelvis, secondary to the trans-omental hernia. The course of the inferior mesenteric vein is likewise of normal. There is no evidence of obstruction. No free or loculated intraperitoneal fluid.Scattered colonic diverticulosis.BONES, SOFT TISSUES: No lytic or blastic disease.OTHER: No significant abnormality noted | Nonobstructive trans-omental hernia containing nearly the entire small intestine.Incidental findings of the small ileal diverticulum, periampullary diverticulum and sliding hiatal hernia.No evidence of metastatic disease. |
Generate impression based on findings. | 57-year-old male kidney donor. 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: The right kidney measures 11.8 x 6.6 cm. The left kidney measures 12.8 x 6.5 cm. No renal lesions/masses identified. Punctate vascular calcifications in the distal right renal vasculature. Normal right renal vascular anatomy with a single right renal artery and vein. The main left renal artery as well as a single accessory left renal artery are identified. Normal anatomy left preaortic vein. Normal bilateral collecting systems/ureters without duplication. No hydronephrosis or hydroureter.RETROPERITONEUM, LYMPH NODES: Scattered mild atherosclerotic calcification of the abdominal aorta and its branches sparing the distal common and external iliac arteries. Moderate noncalcified plaque involves the distal abdominal aorta and proximal bifurcation. There is calcification at the origin of the celiac artery with mild narrowing.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: Prominent bilateral inguinal lymph nodes.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Single accessory left renal artery with otherwise normal vascular anatomy. Punctate distal vascular calcifications in the right kidney.2. Normal renal size and parenchyma without lesion/mass identified as described above.3. Normal collecting system anatomy without evidence of duplication.4. Scattered atherosclerotic calcifications and moderate noncalcified plaque of the distal abdominal aorta and proximal bifurcation. Mild narrowing of the celiac artery origin. |
Generate impression based on findings. | 24 year-old female with leukocytosis, assess for abscess/infection. CHEST:LUNGS AND PLEURA: Patchy basilar atelectasis/consolidation and bilateral pleural effusions, which appear loculated, mildly improved from the prior study.MEDIASTINUM AND HILA: Left central venous catheter tip extends to the cavoatrial junction. Several enlarged mediastinal lymph nodes may be reactive in etiology.CHEST WALL: Multiple prominent axillary lymph nodes may be reactive in etiology.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: Medullary calcinosis and renal stones without hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Loculated fluid collections in the left upper quadrant, measuring 4.4 x 1.2 cm and 4.7 x 1.7 cm have decreased in size as has a loculated fluid collection in the left lower quadrant, which measures 2.4 cm x 9.1 cm and previously measured 3.5 cm x 11.9 cm (image 62, series 80276). Post operative changes of the stomach are again identified andBONES, SOFT TISSUES: A fluid collection extending along the soft tissues dorsal to the thoracic and lumbar spine with percutaneous drain is again noted.OTHER: Anasarca.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Fecal distention of the colon. No evidence of obstruction.BONES, SOFT TISSUES: Sacral ulcer with small fluid collection within the ischiorectal fossa also appear improved. A fluid collection extending along the soft tissues dorsal to the thoracic and lumbar spine with percutaneous drain is again noted.OTHER: Anasarca. | 1. Interval improvement in multiple intra-abdominal loculated fluid collections, as well as sacral ulcer. Fluid collection in the soft tissues dorsal to the spine with percutaneous drain appears unchanged.2. Bilateral loculated pleural effusions with adjacent atelectasis/consolidation, mildly improved from the prior study. |
Generate impression based on findings. | Reason: evaluate ILD History: sob LUNGS AND PLEURA: Severe basilar predominant interstitial lung disease characterized by reticular opacities, traction bronchiectasis, some honeycombing are also groundglass opacities.Although there are a few hyperlucent lobules, there is no significant air trapping on the expiration series.Calcified punctate granulomata are present versus dendritic ossification in the lung periphery.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy is present.Coronary artery calcifications are severe, and there is at least mild cardiomegaly.Small hiatal hernia. CHEST WALL: Moderate degenerative abnormalities affect the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. A left renal hypodense region is slightly higher attenuation than water, and could be a renal cyst although confirmation is recommended by dedicated renal protocol abdominal CT or ultrasound. | 1. Severe interstitial lung disease with a possible UIP pattern, although the differential diagnosis includes an NSIP and chronic hypersensitivity pneumonitis.2. Left renal lesion likely a cyst but confirmation by a dedicated renal protocol abdomen CT or renal ultrasound is recommended. |
Generate impression based on findings. | Headache. Rule out cellulitis. Orbits: The exam is limited by lack of intravenous contrast. Nevertheless, there appears to be minimal preseptal fat stranding of the right upper eyelid. There is no postseptal involvement. There is no evidence of drainable fluid collections. The globe, lacrimal gland, and extraocular muscles are unremarkable. The osseous structures are intact. Head: 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. There is a partially imaged air-fluid level within the right maxillary sinus. The mastoid air cells are clear. The osseous structures are unremarkable. | 1. Apparent minimal preseptal stranding of the right upper eyelid. There is no postseptal involvement, which may represent an infectious or inflammatory cellulitis or in the appropriate clinical setting, which can be further evaluated via ophthalmological examination. 2. An air-fluid level within the right maxillary sinus may indicate acute sinusitis in the appropriate clinical setting. 3. No evidence of intracranial hemorrhage, mass, or cerebral edema.Discussed with Dr. Blumen at 8:30 AM on 10/31/13. |
Generate impression based on findings. | Female 40 years old; Reason: Pt with mets TNBC on PD-1 inhibitor (immune therapy). Now with progression of skin mets concerning for tumor flare vs POD. Evaluate new diffuse lung infiltrates--?pneumonitis vs lymphangitic spread vs edema? History: Pt reports mild orthopnea, no DOE. CXR with diffuse infiltrates of unclear etiology--please assess further and compare to previous CHEST:LUNGS AND PLEURA: There is a new right-sided pleural effusion. New Extensive ground glass nodularity noted throughout the lungs bilaterally. Scattered nonspecific pulmonary nodules are reidentified with increasing number and size, most consistent with progressive metastatic disease. Reference left lower lobe pleural-based nodule measuring 5 mm (series 4 image 72), previously 3 mm. Another nodule measures 0.8 x 0.5 cm which is new since prior exam (series 4 image 64)MEDIASTINUM AND HILA: Chronic nonspecific prominent AP window lymph nodes. Bilateral hilar lymphadenopathy has increased in size and conspicuity. Bidimensional measurements for the reference lymphadenopathy are as follows: Left hilar lymph node measures 1.3 X 2.4 cm, previously 1.0 x 1.7 cm (series 3 image 46). Right hilar nodal mass measures 1.9 x 2.4 cm, previously 1.5 x 2.6 cm (series 3 image 47).The heart is normal in size. No pericardial effusion.CHEST WALL: Status post bilateral mastectomy with soft tissue expanders and implants in place. Soft tissue thickening in the right axilla is stable measuring 1.3 x 1.7 cm (series 3 image 35). This is may be postsurgical in etiology, but underlying tumor cannot be entirely excluded. Fluid attenuation is noted adjacent to the left implant is new since previous exam and could be related to a small rupture.Interval placement of a left-sided Port-A-Cath with its tip in the right atrium.ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesion. No intra-extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Prominence of the proximal right ureter likely reflects an extrarenal pelvis as the calyces are not dilated. The left kidney is unremarkable.RETROPERITONEUM, LYMPH NODES: No intraperitoneal or retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No focal osseous lesion.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No focal osseous lesionsOTHER: No significant abnormality noted | 1. Increase in size of the reference and non-reference hilar and mediastinal lymphadenopathy. Increase in size and number of the numerous pulmonary nodules - these findings are most consistent with progressive metastatic disease.2. New right pleural effusion with diffuse bilateral ground glass nodularity in the lungs - these are nonspecific findings and can be seen with lymphangitic obstruction from central lymphadenopathy, versus drug reaction versus infectious etiology. Lymphangitic carcinomatosis is felt less likely. 3. Stable right axillary soft tissue thickening which may be postsurgical in etiology, but underlying tumor cannot be entirely excluded. Stable bilateral hilar lymphadenopathy. 4. No evidence of metastatic disease in the abdomen and pelvis. |
Generate impression based on findings. | Posterior cervical pain r/o fracture The cervical vertebral bodies are appropriate in overall height. No fractures are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is right-sided facet hypertrophy present at this level with narrowing at the facet joint space.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is bilateral facet hypertrophy present at this level associated with some posterior ligamentous hypertrophyAt C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is some endplate and uncovertebral osteophytes present at this level associated with loss of disk space height and some endplate reactive changesAt C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a disk bulge present at this level associated with minor endplate osteophytes and mild anterior subluxation of C6 on C7At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The thyroid gland is large in appearance but probably at the upper limits of normal in size. A mildly hypodense focus is present in the right thyroid gland lobe | 1.There is no evidence for cervical spine fracture.2.There are multilevel degenerative changes present in the cervical spine which appear to be worse along the posterior elements C3-4 and the disk of C6-7. There is mild anterior subluxation of C6 on C73.mild hypodense focus in the right thyroid gland lobe is nonspecific |
Generate impression based on findings. | 51-year-old male patient with abdominal pain. Evaluate for appendicitis. ABDOMEN:LUNG BASES: Diffuse nodular pleural thickening in the right lung base with loculated fluid collections, pleural calcifications and intralobular septal thickening are stable compared to prior examination.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: The spleen is absent.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Area of decreased enhancement and cortical thinning of the medial left kidney most likely represents chronic scarring.RETROPERITONEUM, LYMPH NODES: Atherosclerotic changes in the abdominal aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Markedly dilated, fluid-filled loops of small bowel with passage of oral contrast limited to the proximal jejunum. Dilated loops measure 4.4 cm in largest diameter. Transition point in right mid abdomen at the distal ileum (coronal series 80252 image 48 and series 3 image 73) with desiccation of stool proximally. No mass or fluid collection identified at this transition point. There is collapsed small bowel distal to the transition point. Right colon surgically removed with numerous surgical clips. Collapsed distal colon without diverticulosis.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumbar spine.OTHER: Atherosclerotic changes in the abdominal aorta and iliac arteries. Small amount of free fluid in the pelvis may be a sign of bowel vasculature compromise if patient does not have another source of ascites. | 1.Dilated loops of small bowel with transition point in the distal ileum, consistent with small bowel obstruction. 2.Small amount of abdominal ascites. |
Generate impression based on findings. | 69 year old female with dull right-sided lower pain ABDOMEN: Lack of IV contrast limits evaluation of solid organ pathology and vasculature.LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Small left hepatic cysts are unchanged. No biliary ductal dilatation. The gallbladder appears unremarkable.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Nonobstructing 1.5-cm right renal stone is unchanged. Adjacent cluster of cysts versus dilated calix again noted. Additional punctate right stones are present. No hydronephrosis, perinephric stranding, hydroureter or ureteral stones.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Nonobstructive right nephrolithiasis with the largest stone measuring 1.5 cm, unchanged. No hydronephrosis, hydroureter or ureteral stones. |
Generate impression based on findings. | assessment of shift from left hemisphere The patient is status post left-sided MA craniectomy. There is a left parafalcine hyperdense subdural collection measuring approximately 9 mm in thickness on the current exam and similar dimension on the prior exam. It extends along the left tentorial lesion.There is redemonstration of mild midline shift towards the right with shift of the septum pellucidum approximately 8 mm to the right of midline on the current exam which is unchanged when compared to the prior exam.There is redemonstration of enlargement of the temporal horn of the right lateral ventricle and compression of the left lateral ventricle. This is also stableThe 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.The exam is mildly compromised by patient motion | 1.A left-sided subdural hematoma is stable when compared to prior exam.2.Status post left craniectomy3.Midline shift and dilation of the right lateral ventricle associated with subfalcine herniation and mild uncal herniation are stable when compared to the prior exam. |
Generate impression based on findings. | 65-year-old male with decreasing hemoglobin -- rule-out bleed. Within the limits of a non-IV contrast enhanced examination which limits the ability to evaluate solid parenchymal organs and vascular structures, the following observations can be made:ABDOMEN:LUNG BASES: Left pleural effusion and bibasilar atelectasis -- basilar parenchymal edema is again seen as demonstrated on prior chest radiographs. No evidence of source of bleeding.LIVER, BILIARY TRACT: Liver parenchyma is homogeneous without evidence of abnormal fluid collection. Lack of contrast limits ability to detect parenchymal masses. Gallbladder and biliary tract show no diagnostic abnormalities.SPLEEN: No significant abnormality noted without evidence of parenchymal bleed or other abnormality.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality noted -- bilateral near water density lesion seen that most likely represent benign cysts,,however, without IV contrast these lesions cannot definitively be characterize.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications throughout. The aorta, and other vascular structures. No evidence of significant adenopathy or mass. No evidence of retroperitoneal bleed.BOWEL, MESENTERY: No significant abnormality noted in the stomach, small bowel or colon with rapid progression of orally administered contrast through the intestines to the colon without evidence of obstruction. Small amounts of scattered free mesenteric fluid are seen. No evidence of hemorrhage..BONES, SOFT TISSUES: Diffuse degenerative changes about the lumbar spine -- No other 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 noted in the small bowel or colon with rapid progression of orally administered contrast through the intestines to the colon without evidence of obstruction. Small amounts of scattered free mesenteric fluid are seen. No evidence of hemorrhage.BONES, SOFT TISSUES: Degenerative changes seen about the lumbar spine, pelvis, bony structures, without focal abnormality.OTHER: No evidence of hemorrhage seen in the pelvis. | No significant abnormality seen in the abdomen and pelvis -- specifically no source of hemorrhage identified. |
Generate impression based on findings. | Intracerebral hemorrhageUnspecified essential hypertension The patient has undergone left-sided MA craniectomy since the prior exam. There is associated postsurgical changeA left-sided subdural hematoma adjacent to the left hemisphere has been evacuated since the prior exam.There is a left parafalcine hyperdense subdural collection measuring approximately 9 mm in thickness on the current exam and similar dimension on the prior exam. It extends along the left tentorial lesion.There is interval decrease in mild midline shift towards the right with shift of the septum pellucidum approximately 8 mm to the right of midline on the current exam and 13 mm on the prior exam. There is a redemonstration of a focal herniation which has decreased since the prior exam with less effacement of the left parimesencephalic cistern.There is redemonstration of enlargement of the temporal horn of the right lateral ventricle and compression of the left lateral ventricle. This is stableThe 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.Since the prior exam the patient has undergone left-sided craniectomy and partial evacuation of a left-sided subdural hematoma. There is less midline shift on the current exam when compared to the prior exam |
Generate impression based on findings. | Altered mental status. There is no evidence of acute intracranial hemorrhage, mass, or cerebral edema. There is unchanged extensive cerebral white matter hypoattenuation that likely represents microangiopathy and unchanged encephalomalacia in the left MCA-PCA borderzone, consistent with a chronic watershed infarct. The ventricles and basal cisterns are stable in size and configuration. There is no midline shift or herniation. There is mild mucosal thickening within the sphenoid sinuses with suggestion of an air-fluid level in the left sphenoid sinus. There is also partial opacification of the left middle ear and mastoid air cells. Thre is fluid within the posterior nasopharynx. There is unchanged deformity of the left lamina papyracea, compatible with a remote medial orbital wall fracture. There is mild anterior subluxation of the right mandibular condyle. The patient is intubated. | 1. No evidence of acute intracranial hemorrhage, mass, or cerebral edema. Otherwise, unchanged extensive cerebral white matter hypoattenuation that likely represents microangiopathy and unchanged encephalomalacia in the left MCA-PCA borderzone, consistent with a chronic watershed infarct. 2. Suggestion of an air-fluid level in the left sphenoid sinus, which may indicate sinusitis in the appropriate clinical setting or perhaps related to recent intubation. Likewise, partial tympanomastoid of opacification may indicate mastoiditis or may be related to intubation, along with the presence of fluid in the nasopharynx. Nevertheless, direct inspection is recommended to rule out an underlying obstructive left nasopharyngeal mass.3. Mild anterior subluxation of the right mandibular condyle may be related to recent intubation. |
Generate impression based on findings. | Diagnosis: Unspecified sinusitis (chronic)Other polyp of sinusPolypoid sinus degenerationClinical question: chronic polypoid sinusitisSigns and Symptoms: chronic polypoid sinusi9tis Postsurgical changes are present including ethmoidectomy and uncinate process resection. There continues to be residual mucosal thickening throughout the sinuses has regressed in the region of the maxillary sinuses but progressed in the region of the ethmoid air cells and the sphenoid sinuses with higher density in the ethmoid air cells, right frontal ethmoid recess and sphenoid sinuses which may indicate recurrent fungal sinusitis.The nasal septum is shifted toward the right side and is stable.There is redemonstration of dehiscence of the left lamina papyracea which is relatively stable. There is also some distortion of the right medial orbital wall which is a stable. There is some subtle displacement of the right medial rectus muscle laterallyVisualized portions of the mastoid air cells and middle ears are clear. the visualized intracranial structures are within normal limits. | 1.Since the previous exam there has been progression of a opacification and hyperdensity within the ethmoid air cells, sphenoid sinuses and right sphenoethmoid recess This is concerning for polyposis and/or recurrent fungal sinusitis. Please correlate with clinical findings2.there is dehiscence and distortion of the medial walls of the orbits with some subtle but stable displacement of the right medial rectus muscle and a mild but stable herniation of the left orbital fat into the left ethmoid. There does not appear to be any extension of disease into the orbits3.the patient is status post paranasal sinus surgery |
Generate impression based on findings. | 86-year-old female with non-small cell lung cancer history of radiation. Pulmonary edema seen on chest radiograph. CHEST:LUNGS AND PLEURA: New moderate right pleural effusion with overlying consolidation/atelectasis in the right lower lobe and inferior aspect of the right upper lobe; given right basilar consolidation and lack of IV contrast, evaluation for underlying progression of neoplastic disease is difficult however suspected given new pleural effusion. There is increased right hilar soft tissue/consolidation, which is difficult to accurately evaluate without IV contrast; this may represent progression of radiation change.Left lung is unremarkable. Mild centrilobular emphysema.MEDIASTINUM AND HILA: Heterogeneous thyroid gland with large nodule in the left lobe.Multiple enlarged mediastinal lymph nodes are not significantly changed. Reference right hilar lymphadenopathy is not accurately measurable given lack of IV contrast.Coronary artery calcifications. Heart size normal without pericardial effusion.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: Splenic hypodense lesion is difficult to accurately measure given lack of contrast, however, not significantly changed and measuring approximately 20 x 17 mm, previously measured 21 x 17 mm (series 3, image 84).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple hypodense and hyperdense lesions in both kidneys cannot be completely characterized on this study, however, are likely not significantly changed.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: Multiple compression fractures including T10, T11, and L2 appear similar. No suspicious osseous lesions. Sclerotic focus in right fifth, left third, and left sixth ribs unchanged.OTHER: No significant abnormality noted. | 1.New moderate right pleural effusion and overlying right base consolidation/atelectasis; given right basilar consolidation and lack of IV contrast, evaluation for underlying progression of neoplastic disease is difficult however suspected given new pleural effusion. . 2.Increasing right perihilar consolidation, likely representing post radiation changes. Evaluation for underlying mass is difficult and continued follow-up is recommended.3.Given limitation of lack of IV contrast, mediastinal lymphadenopathy and left splenic lesion are likely not significantly changed. |
Generate impression based on findings. | pre-op planning for VPS placementSigns and Symptoms: vps placement There is redemonstration of the hyperdense focus along the right deep gray nuclei associated with surrounding hypodensity related to a recently documented large right basal ganglia hematoma.A small amount of intraventricular blood is redemonstrated. Midline shift is stable and compared with the prior exam. There is mild dilation of the left lateral ventricle which is also stableThe visualized portions of the paranasal sinuses demonstrate partial opacification of the left sphenoid sinus. The visualized portions of the mastoid air cells demonstrate minor opacities. The visualized portions of the orbits are intact.There are periapical lucencies present along visualized dentition. | 1.Examination is essentially stable when compared to prior exam. There is redemonstration of a sequela of right hemispheric hematoma with associated midline shift and mild ventriculomegaly2.the exam is performed for the purpose of stereotactic guidance for ventricular drain placement3.There are extensive periapical lucencies along visualized dentition is present. The possibility of a periapical abscesses cannot be excluded |
Generate impression based on findings. | Clinical motion: Evaluate atrophy. Signs and symptoms: Memory impairment. Nonenhanced head CT:Examination demonstrates no evidence of acute intracranial process CT however is insensitive for detection of acute nonhemorrhagic ischemic strokes.There is diffuse subcortical and periventricular low-attenuation all bilateral hemispheric white matter with resultant mild ex vacuo dilatation of the supratentorial ventricular system. Findings are consistent with age indeterminate small vessel ischemic strokes. There are very minimal similar changes in the right basal ganglia and right thalamus.There is no detectable surgical cortical abnormalities. Images through posterior fossa demonstrate a very small subtle focus of low-attenuation in the left cerebellum which could represent a tiny age indeterminate cerebellar stroke. Unremarkable images through posterior fossa otherwise. No significant vascular calcification of the cavernous carotids or the intracranial vertebral /basilar arteries.Images through the orbits demonstrate uniformly increased density of the posterior chamber of the left globe suggestive of prior hemorrhage. Correlate with history. There is no visualization of the lenses which may be result of prior cataract surgery.Paranasal sinuses demonstrate minimal sinusitis of right posterior ethmoids and unremarkable otherwise.Bilateral mastoid air cells and middle ear cavities remain well pneumatized there | 1.No acute intracranial process.2.Extensive and primarily subcortical/periventricular low-attenuation old white matter consistent with age indeterminate small vessel ischemic strokes. Findings results in very subtle enlargement of supratentorial ventricular system. Minimal similar findings are also noted in the right basal ganglia, and right thalamus and left cerebellar hemispheres.3.Diffuse increased density in the posterior chamber of the left globe suspected for hemorrhage. Absence of bilateral lenses likely postsurgical. |
Generate impression based on findings. | 57 year-old female with breast cancer on chemotherapy. CHEST:LUNGS AND PLEURA: Stable 9-mm nodule in right upper lobe (series 6, image 37). Several ill-defined linear and nodular opacities in the left base are unchanged and may be related to aspiration and/or scarring. Several other punctate micronodules are unchanged. No new nodules.No pleural effusions.MEDIASTINUM AND HILA: Enlarged, heterogeneous thyroid gland with substernal extension, unchanged. Multiple enlarged mediastinal and hilar lymph nodes are not significantly changed. The reference left paratracheal node at measures 2.9 x 1.9 cm, previously measured 2.9 x 1.9 cm (series 4, image 30).Heart size normal. No pericardial effusion. Coronary artery calcifications noted. Interval placement of right port catheter with tip terminating in right atrium. CHEST WALL: Interval decrease in left breast mass, which currently measures 1.7 x 1.4 cm, previously measured 2.7 x 2.6 cm (series 4, image 30). Significant interval decrease in axillary lymphadenopathy, left more than right; reference left axillary node currently measures 6 mm in short axis, previously measured 12 mm in short axis (series 4, image 21).ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Previously seen subcentimeter hypodensity in the left lobe is not well seen on current study. No new or suspicious liver lesions. Cholelithiasis without evidence of cholecystitis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Nonspecific 11-mm left adrenal nodule is unchanged (series 4, image 80).KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications affect the aorta and its branches. No retroperitoneal 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.Significant interval decrease in left breast lesion and left axillary lymphadenopathy.2.No significant change in mediastinal lymphadenopathy.3.Stable lung nodules; largest nodule located in right upper lobe has benign morphology. No new suspicious nodules.4.Stable nonspecific left adrenal nodule. |
Generate impression based on findings. | 54-year-old male patient with history of metastatic renal cancer, on pazopanib. Evaluate for progression. CHEST:LUNGS AND PLEURA: Redemonstration of multiple bilateral pulmonary lesions. Reference left upper lobe pulmonary lesion measures 1.6 x 1.1 cm (series 6 image 34), previously 1.2 x 1.0 cm. The remaining numerous pulmonary lesions are not significantly changed.MEDIASTINUM AND HILA: Necrotic mediastinal lymphadenopathy. Reference prevascular lymph node measures 2.0 x 1.5 cm (series 4 image 27), previously 1.5 x 1.2 cm.Other lymph nodes, including the subcarinal lymph node, are relatively stable.CHEST WALL: Interval removal of right chest wall port.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Bilateral adrenal metastases are redemonstrated. Left adrenal gland mass measures 3.0 x 2.0 cm (series 4 image 105), previously 2.4 x 1.7 cm. Right adrenal gland stable in appearance.KIDNEYS, URETERS: Large right renal mass measures 10.9 x 9.6 centimeters (series 4 image 112), previously 11.0 x 8.9 cm.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Slight interval increase in some reference lesions. See index measurements. |
Generate impression based on findings. | 61-year-old male with metastatic renal cell cancer -- evaluate for progression of disease CHEST:LUNGS AND PLEURA: Multiple bilateral pulmonary nodules continued to enlarge. The. Reference left lower lobe nodule (series 4, image 84) now measures 1.4 x 1 .0 cm, previously 1.2 x 0.7. Similarly, the nodularity along the left major fissure has increased with increased soft tissue components, most consistent with progressive tumor.MEDIASTINUM AND HILA: Mediastinal and hilar lymphadenopathy has continued to increase in size with reference measurements as noted below:Subcarinal lymph node (series 3, image 52): 5.7 x 4 .5 cm, compared with 5.3 x 3 .5 cm, previously.Right hilar lymph node (series 3, image 48): 3.3 x 3.2 cm, previously 3.2 x 2.9 cm.Left hilar lymph node (series 3, image 63) 4.6 x 3 .6 cm, previously 3.9 x 3.2 cm.CHEST WALL: Right limb lytic osseous lesion with soft tissue mass appears unchanged. No new bony lesions are seen.Left anterior chest wall Port-A-Cath is unchanged with tip of the catheter in the superior vena cava.ABDOMEN: Within the limits of a non-IV contrast enhanced examination which limits ability to visualize solid organ parenchyma and vascular structures, the following observations can be made:LIVER, BILIARY TRACT: Lack of IV contrast makes it difficult to accurately delineate the margins of space occupying lesions in the liver. The prior noted reference lesion (series 3, image 105) measures 5.9 x 4 .2 cm, previously 5.4 x 4.0-cm.. This degree of change does not reflect the overall degree of change subjectively seen throughout the liver. There is a large right lobe aggregate confluent mass lesion (series 3, image 100) that measures approximately 10.2 by 8.9-cm that was substantially smaller on 8/8/13 (9.0 x 6.4 cm) and barely visible on the noncontrast enhanced 5/2/13 examination.Gallbladder and biliary tree appear normal.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Right adrenal mass measures 4.0 x 2.7 cm (series 3, image 119, not significantly changed from previous measurement of 3.8 x 2.9 cm.KIDNEYS, URETERS: Left nephrectomy with multiple soft tissue masses in the left nephrectomy bed. The index lesion in the left nephrectomy bed (series 3, image 115) has increased in size, measuring 4.5 x 3.5 cm compared with previous 3.5 x 2.5-cm. Right kidney appears normal, however, lack of IV contrast limits ability to evaluate solid parenchyma.RETROPERITONEUM, LYMPH NODES: Retroperitoneal adenopathy is again seen throughout the left periaortic region and has subjectively increased. Reference conglomerate of retroperitoneal nodes (series 3, image 1.5) now measures 4.9 x 3.8 cm compare with previous 4.0 x 3.4 cm.BOWEL, MESENTERY: Left lateral abdominal wall hernia. Again seen containing small bowel, and colon without evidence of complication unchanged.BONES, SOFT TISSUES: Lytic lesions involving the lumbar spine are unchanged.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Lytic lesions involving the lumbar spine and right iliac bone are unchanged.OTHER: No significant abnormality noted | 1. Continued enlargement of multiple pulmonary nodules. 2. Increasing size of mediastinal lymphadenopathy. 3. Stable appearance to musculoskeletal metastases in the chest, abdomen, and pelvis. 4. Increasing retroperitoneal lymphadenopathy and mass in left nephrectomy bed. |
Generate impression based on findings. | Resolution of IVH Since the prior exam the intraventricular blood and periventricular blood is no longer visible.The visualized portions of the paranasal sinuses demonstrates some opacification at the right maxillary sinus and ethmoid air cells which is stable. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.No evidence for acute intracranial hemorrhage mass effect or edema.2.Since the prior exam intraventricular blood is no longer visible. |
Generate impression based on findings. | 63-year-old male with abdominal pain and tachycardia ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Evaluation of the hepatic parenchyma is limited due to the contrast phase. Multiple foci of arterial enhancement are nonspecific. No biliary ductal dilatation. The gallbladder is unremarkable.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal hypodensities, some too small to characterize, as well as cortical scarring. RETROPERITONEUM, LYMPH NODES: Scattered atherosclerotic and moderate noncalcified plaque involves the abdominal aorta and its branches. The, celiac, SMA, and IMA are patent. No evidence of dissection or aneurysm.BOWEL, MESENTERY: The small bowel is normal in diameter. Diffuse colonic dilatation extending to the sigmoid colon mass, as detailed below.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostate calcifications.BLADDER: No significant abnormality notedLYMPH NODES: Scattered borderline enlarged periaortic and pelvic lymph nodes. One 9 x 8 mm left iliac lymph node and 1.2 x 0.9 cm left periaortic lymph node are provided for reference. Multiple large inguinal lymph nodes are present.BOWEL, MESENTERY: Diffuse stool filled colonic dilatation extending to the mid sigmoid colon where there is focal circumferential wall thickening indicating an underlying mass. The distal sigmoid and rectum are collapsed. The small bowel is normal in diameter.BONES, SOFT TISSUES: Possible L3 vertebral body hemangioma.OTHER: No significant abnormality noted | 1. Focal circumferential sigmoid colon wall thickening/mass with associated colonic obstruction. Multiple prominent pelvic and abdominal lymph nodes.2. No evidence of abdominal aortic aneurysm or dissection or bowel ischemia. |
Generate impression based on findings. | Male 64 years old; Reason: anal cancer restaging History: anal cancer restaging CHEST:LUNGS AND PLEURA: 10 x 7 millimeter nodule in the right middle lobe (image 56; series 6) should be followed.MEDIASTINUM AND HILA: Subcentimeter lymph nodes in the mediastinum are stable. Coronary artery calcifications are noted.CHEST WALL: Subcentimeter axillary lymph nodes are not enlarged by CT size criteria.ABDOMEN:LIVER, BILIARY TRACT: No focal lesion detected. There is no evidence of intrahepatic biliary ductal dilatation. Hepatic vasculature appears patent.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Thoracic vertebral body hemangioma.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: 0.7 x 0.7cm right common femoral lymph node is smaller in size, previously 1.1 x 1.0 cm (series4 image 196). Scattered subcentimeter nodes are also noted in the pelvis.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Small right middle lobe pulmonary nodule which is unchanged in size. Scattered small lymph nodes in the pelvis, smaller since previous exam. |
Generate impression based on findings. | Clinical question: Progression of pituitary adenoma. Signs and symptoms: Evaluate change and growth of mass from prior scan/surgery planned. Medtronic fusion sinus CT:All paranasal sinuses are well pneumatized and without evidence of acute sinusitis.The right maxillary sinus is slightly hypoplastic and unremarkable otherwise. Small retention cyst in the dependent portion of the left maxillary sinus measures up to 14 x11-mm measured on coronal images.Sphenoid sinus is well pneumatized and without evidence of disease. There is a thin midline septation of the sphenoid sinus. The sphenoethmoidal recesses are patent bilaterally. There is enlarged sella turcica secondary to patient's known pituitary adenoma. The sella demonstrates a small bony defect along its anterior -- inferior aspect on the right likely as result of bony thinning secondary to the large pituitary. This finding is best appreciated on axial series 3 image 140 and sagittal reformatted series 80322 images 119 through 124.Enlarged sella measures at 22.6 x 23 mm in transaxial dimensions and 17.5-mm in cc axis.Images through nasal cavity demonstrate midline position of nasal septum and without deviation. There is a small bilateral middle turbinate concha bullosa and unremarkable otherwise.Images through the orbits demonstrate no abnormalities.Bilateral mastoid air cells and middle ear cavities are well pneumatized and unremarkable. | 1.No evidence of acute sinusitis.2.Small retention cyst in the left maxillary sinus and unremarkable paranasal sinuses for disease otherwise.3.Sphenoid sinus is well pneumatized and demonstrate a midline thin vertically oriented bony septation.4.Images through nasal passage are unremarkable and with midline position of the nasal septum and small bilateral middle turbinate concha bullosa.5.Enlarged sella measuring 22.6 x 23 mm sized in transverse axis. It demonstrate a small bony defect along its anterior and inferior aspect on the right as detailed. Finding likely due to bony thinning secondary to enlarged pituitary adenoma. |
Generate impression based on findings. | 24-year-old male patient with suspected carcinoid tumor. Evaluate for carcinoid tumor and cholelithiasis. ABDOMEN:LUNG BASES: Stable left lower lobe pleural-based micronodule.LIVER, BILIARY TRACT: No significant abnormality noted. No hyperattenuating gallstones identified.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: Stable sclerotic foci involving the right ilium. Degenerative changes involving the L2, L3 and L4 vertebral bodies.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable sclerotic foci involving the right ilium. Degenerative changes involving the L2, L3 and L4 vertebral bodies.OTHER: No significant abnormality noted. | 1.No acute abdominal abnormalities. No liver lesions or hyperdense gallstones identified.2.Stable left lower lobe pleural-based micronodule. |
Generate impression based on findings. | 18 year-old female patient with thigh abscess. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Right inguinal lymphadenopathy, likely reactive.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: 2.1 x 2.9 cm mass with rim enhancement and central hypoattenuation in the superficial subcutaneous tissue of the right inguinal crease (series 80280 image 86). Overlying skin thickening is consistent with cellulitis. There is adjacent subcutaneous inflammatory edema. No involvement of deep soft tissues or muscle.OTHER: No significant abnormality noted. | Findings consistent with right inguinal crease severe phlegmon versus early necrosis/liquefaction with associated cellulitis and edema. No involvement of deep soft tissue. |
Generate impression based on findings. | Reason: rule out CAD History: SOB, previously reported history of cirrhosis and portal hypertension Coronary arteries: LM: The left main coronary artery arises normally from the left sinus of Valsalva and bifurcates into the left anterior descending and left circumflex coronary arteries. Approximately 1.3 cm from the ostium of the left main, mixed plaque is present. The noncalcified component contributes to approximately 30% stenosis.LAD: The left anterior descending coronary artery courses along the anterior interventricular groove, with superficial bridging of the mid LAD over a length of approximately 2.4 cm. The LAD supplies 3 diagonal and several septal branches. The plaque from the distal left main coronary artery extends into the proximal LAD. This is comprised mainly of calcification, spanning the length of the entire proximal LAD, to the ostia of D1 and D2, which are immediately adjacent to each other. The calcification with blooming precludes quantification of stenosis in this segment.At the initiation of the mid LAD, at the ostium of D2, there is a segmental caliber change over a length of approximately 2 cm, appearing moderate to severely stenotic. The caliber of the vessel beyond this becomes larger and the distal LAD is visualized to the apex.The first diagonal branch is diminutive. No obstructive lesion is identified. The second diagonal branch demonstrates severe stenosis initiating at the ostium and extending over approximately 2 cm. The third diagonal branch is also diminutive without a severe obstructive lesion.LCx: The left circumflex coronary artery is non-dominant. It courses normally in the left atrioventricular groove. It gives rise to 3 obtuse marginal branches. The first obtuse marginal branch is diminutive and free of significant stenosis. The second obtuse marginal branch is dominant, also free of obstructive lesion. The third obtuse marginal branch is diminutive and unremarkable. The ostium of the circumflex coronary artery is unremarkable. Approximately 1.4 cm from the ostium, there is a focal calcified plaque. The blooming artifact from the calcification precludes quantification of potential stenosis in this location.RCA: The right coronary artery is large and arises normally from the right sinus of Valsalva. There is significant motion artifact on all reconstructed phases, which limits evaluation for potential stenosis. However, multi-focal calcified plaques are identified from the proximal to the distal segments. It is the dominant coronary artery supplying a posterior descending artery and a posterolateral branch. The posterior descending artery is visualized to the inferoapex and is free of obstructive lesions. Left Ventricle: The left ventricular late diastolic volume is normal. There is low density at the left ventricular apex which may represent a perfusion defect or prior subendocardial infarct (series 7 images 28 through 33). No left ventricular apical thrombus is identified.Right Ventricle: Visually the right ventricular late diastolic volume is within normal limits.Left Atrium: Visually, the left atrial volume is normal in size. There are 3 pulmonary veins on the right that drain into the left atrium with a separate middle lobe branch. Two left pulmonary veins drain into the left atrium. No early branching is identified. There is no evidence of left atrial appendage thrombus.Right atrium, vena cavae, and coronary sinus: The right atrial volume is normal in size. The superior and inferior vena cavae are unremarkable. The coronary sinus is normal in size. Valves: There is no calcification on the aortic or mitral valves.Great vessels: The visualized portions of the thoracic aorta demonstrate no evidence of dissection or aneurysm. The aortic arch is not visualized. The main pulmonary artery is normal in size.Pericardium: The pericardium is normal in thickness. There is no pericardial effusion.Lungs: Visualization of the lung parenchyma is limited by the field of view and length of scan which excludes a substantial amount of the lungs. Scattered calcified granulomas are identified. Subsegmental atelectasis involves the left lower lobe.Mediastinum: No mediastinal lymphadenopathy. Overall heart size is normal. Several right cardiophrenic lymph nodes are present. The largest is located lateral to the suprahepatic IVC and is approximately 11 mm in short axis (series 7 image 28). Multiple paraesophageal varices are identified to the level of the right atrium.Abdomen: Cirrhotic morphology of the visualized hepatic parenchyma. | One whole Diffuse coronary artery disease which is most severe at the LAD and diagonal branches, as above. |
Generate impression based on findings. | Reason: Attention to right medial clavicle to evaluate for growth. Also has periodic dyspnea. History: right clavicle end enlarging and periodic dyspnea. LUNGS AND PLEURA: Large left pleural effusion with underlying compressive atelectasis.Diffuse nodular pleural thickening in the apical area of the left hemithorax, and to a lesser extent at the left base.An enhancing pleural nodule measuring 13 mm in maximum diameter is present posterior laterally at the left base (series 4/image 75).Moderate upper zone emphysema.Calcified micronodule right lower lobe compatible with previous infection.MEDIASTINUM AND HILA: Moderately enlarged lymph node measuring 11 mm in short axis in the AP window.Moderate coronary artery calcification and extensive aortic calcification.CHEST WALL: Degenerative disease in the medial clavicles, greater on the right, but no sign of a destructive lesion.Degenerative disease in the spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Multiple small hypodensities in the liver, most compatible with cysts. Focal fatty infiltration adjacent to the falciform ligament.Mild enlarged medial limb of the left adrenal gland which is nonspecific but more likely benign than malignant. | Large left pleural effusion with diffuse nodular pleural thickening highly suspicious for metastatic neoplasm or primary mesothelioma.The findings were discussed with Dr. Blackman at the time of reporting. |
Generate impression based on findings. | blunt head trauma CT head:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a hypodense focus present at the right centrum semiovale extending towards the right internal capsule associated with adjacent ex vacuo effect on the right lateral ventricle.There is a hypodense focus present at the left caudate nucleus measuring 8 mm in diameter.There is a left-sided subgaleal thickening present without underlying skull fracture .No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Facial bonesThe 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, however, there is left periorbital soft tissue swelling present.There is a right-sided from the fibroosseous lesion present the right zygomaCT cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. No fractures are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is a disk bulge present associated with some uncovertebral osteophytes. There is suspicion for spinal stenosis due to disk bulge this level. There is bilateral neural foramen encroachment due to osteophytes.At C4-5 there is no significant compromise to the spinal canal . There are bilateral uncovertebral osteophytes present at this level resulting in narrowing of the neural foramina .At C5-6 there is no significant compromise to the spinal canal . There are bilateral uncovertebral osteophytes present at this level resulting in narrowing of the neural foramina .At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina. | 1.No evidence for cervical spine fracture2.No evidence for acute intracranial hemorrhage mass effect or edema.3.A small lesion in the right centrum semiovale is suspicious for old lacunar infarct. 4.A left caudate nucleus lesion most likely represents lacunar infarct age indeterminant. This can be confirmed with MRI.5.There is left periorbital soft tissue swelling present and left scalp soft tissue swelling present most likely related to the patient's reported injury. Please correlate with clinical findings. No underlying fractures are detected.6.There are multilevel degenerative changes present in the cervical spine worst at C3-4 where there are findings suspicious for mild to moderate spinal stenosis and bilateral neural foramen encroachment. |
Generate impression based on findings. | Reason: DILD RLD DERMATOMYOSITIS History: SWEAT COUGH SOB LUNGS AND PLEURA: Nonspecific basilar coarse reticular opacities and some ground glass disease left greater than right common slightly progressed since the prior study, consistent with the patient's known interstitial lung disease.Benign-appearing micronodules are unchanged. No specific evidence of infection or failure.MEDIASTINUM AND HILA: Numerous small mediastinal lymph nodes may have slightly enlarged, but are likely related to the patient's known rheumatoid and dermatomyositis associated interstitial lung disease.Mild pericardial thickening and or pericardial fluid slightly progressed.There are severe coronary artery calcifications.CHEST WALL: Mild degenerative abnormalities affect the thoracic spineUPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Slight progression of basilar interstitial lung disease consistent with the provided history of rheumatoid and dermatomyositis related interstitial lung disease. |
Generate impression based on findings. | Reason: LUL nodule, please compare to previous outside CT scan History: none LUNGS AND PLEURA: Focal irregularly marginated subpleural nodular opacity in the posterior segment of the left upper lobe, with internal bronchiectasis and architectural distortion, measuring approximately 17 x 11 mm in axial dimensions, unchanged from previous allowing for differences in technique.Sharply marginated elliptical solid nodule measuring 7 mm in diameter in a subpleural location in the right lower lobe (series 4 image 67), also unchanged allowing for differences in technique. This is suggestive of an intrapulmonary lymph node.Volume loss and scarring in the left lower hemithorax with abrupt cut off of the left lower lobe bronchus suggestive of a previous lobectomy.MEDIASTINUM AND HILA: No significant lymphadenopathy.Extensive calcification in the mitral annulus.CHEST WALL: Previous surgical resection of the left fifth rib with partial regeneration.Marked elevation of the left hemidiaphragmUPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Nodular opacity in the posterior left upper lobe with morphological features that favor post infectious scarring, without appreciable change. However because of the lower quality of the outside scans I cannot exclude some degree of interval change and therefore an additional follow-up scan in approximately 8 months is recommended to confirm stability. |
Generate impression based on findings. | Reason: evaluate for eventration of left hemi-diaphragm, vs hiatal hernia, deviation of mediastinum History: sob, abdominal pain CHEST:LUNGS AND PLEURA: Few nonspecific micronodules in the left lung. There is pleural thickening at the left lung base. Bibasilar dependent atelectasis. Bilateral parenchymal bands suggesting scarring/discoid atelectasis. MEDIASTINUM AND HILA: Large left hemidiaphragm elevation causing mediastinal shift to the right. Heart size is normal. No pleural effusions. CHEST WALL: Hypodense nodule in the left lobe of the thyroid.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Multiple large hypodense lesions in the liver not significantly change compared prior exam.SPLEEN: Large left hemidiaphragmatic eventration is with the spleen within the thoracic cavity. Small hypodense lesion in the spleen.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple hypodense lesions in bilateral kidneys.PANCREAS: Hypodense cysts within the body and tail of the pancreas unchanged. Mild pancreatic duct dilation unchanged from prior exam.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Almost the entire stomach is within the thoracic cavity. Portions of bowel are within the thoracic cavity. No evidence of strangulation or incarceration.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Marked elevation of the left hemidiaphragm causing rightward mediastinal shift without evidence of herniation possibly representing phrenic nerve paralysis.2.Multiple renal, hepatic, and the pancreatic cysts compatible with patient's history of polycystic kidney disease.3.Left thyroid lobe nodule. |
Generate impression based on findings. | 42 year-old female with dyspnea. Evaluate right upper lobe lesion. LUNGS AND PLEURA: Severe, upper lobe predominant emphysema. Bilateral upper lobe linear opacities most compatible with scarring. In the right upper lobe there is a solid, nodular component which is continuous with scarring; this measures 12 mm, previously measured 12 mm (series 6, image 25). Additional nodular foci associated with scarring are also not significantly changed (series 6, image 31, 35, 36).Pleural based left lower lobe nodule measures 8 mm, previously measured 8 mm (series 6, image 66). Nonspecific groundglass opacity noted in left upper lobe, which may represent early scarring (series 6, image 25).No pleural effusions or consolidation.MEDIASTINUM AND HILA: Multiple mildly enlarged mediastinal lymph nodes are not significant changed, nonspecific and may be reactive in nature. Heart normal in size without pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Subcentimeter hypodensity in the left lobe of liver, too small to characterize but likely benign cyst and unchanged. | 1.Bilateral upper lobe scarring, right more than left, with associated nodular components, largest located in right upper lobe and measuring 12 mm. These may represent confluent fibrosis, however, primary lung neoplasm is also a consideration and continued follow-up is recommended.2.Severe upper lobe predominant emphysema. |
Generate impression based on findings. | 76-year-old male with history of renal cell carcinoma -- please assess for disease progression. CHEST:LUNGS AND PLEURA: No significant nodules, masses, infiltrates or effusions.MEDIASTINUM AND HILA: No lymphadenopathy. Coronary artery calcification again seen. No change in the prior noted pericardial cyst in right cardiophrenic angle.CHEST WALL: No significant abnormality notedABDOMEN: Lack of IV contrast limits ability to evaluate solid parenchymal organs and vascular structures. Within these limitations, the following observations can be made:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left nephrectomy without evidence of recurrent or residual tumor. Right kidney shows no change in morphology with several low attenuation near water density lesions most likely benign cyst, but without IV contrast these cannot be definitively characterized.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Inguinal hernias containing only mesenteric fat. Low density near water well circumscribed abnormality in the right psoas muscle insertion anterior to the right hip (series 3, image 200) which has been present since 7/24/12, but gradually increasing in size from 1.1-cm in 2012 to 2.5 cm currently. This is of uncertain significance and does not an appearance for metastases and may represent a synovial cyst or other inflammatory condition. -- No other significant abnormalities with only unchanged degenerative changes seen diffusely throughout the bony skeleton.OTHER: No significant abnormality noted | 1. Status post left nephrectomy without evidence of recurrent, residual or metastatic disease. 2. Near water density well circumscribed lesion in the distal insertion of the right psoas muscle anterior to right hip of uncertain significance -- most likely inflammatory. See above discussion. |
Generate impression based on findings. | 23 year-old female with Crohn's disease and abdominal pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post appendectomy, and possibly cecectomy as the ileocecal valive is not visualized. No evidence of bowel wall thickening or inflammation. No fibrofatty proliferation of the mesentery or lymphadenopathy. No free or loculated fluid collections. The bowel is normal in caliber.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: Status post appendectomy, and possibly cecectomy as the ileocecal valve is not visualized. No evidence of bowel wall thickening or inflammation. No fibrofatty proliferation of the mesentery or lymphadenopathy. No free or loculated fluid collections. The bowel is normal in caliber.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No specific findings to account for the patient's abdominal pain. No evidence of inflammatory bowel disease. |
Generate impression based on findings. | 87-year-old male patient with history of hypertension, gout, acute kidney injury and prostate cancer presented with abdominal pain. Note that the of intravenous and oral contrast limits evaluation of vasculature, lymph nodes, hollow and solid viscera.CHEST:LUNGS AND PLEURA: Bilateral moderate pleural effusions with associated atelectasis versus consolidation, stable. Stable mild centrilobular emphysematous changes, predominantly in the upper lobes.MEDIASTINUM AND HILA: Coronary artery calcifications. Small pericardial effusion, unchanged. Moderate cardiomegaly. Calcified mediastinal lymph nodes consistent with granulomatous disease.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Mildly Hyperattenuating liver parenchyma without focal abnormality. No other significant abnormality.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: Enteric tube with tip in the distal stomach. Normal-appearing bowel with moderate amount of feces in the colon. Diffuse haziness of the mesentery consistent with diffuse edema and limits differentiation of mesenteric fat versus fluid. Evaluation of possible rectal wall thickening is limited secondary to lack of contrast and may be adherent feces versus focal inflammation. BONES, SOFT TISSUES: Diffuse subcutaneous edema. Severe degenerative changes in the thoracic and lumbar spine. Continued L1 vertebral body height loss.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Normal-appearing bowel with moderate amount of feces in the colon. Diffuse haziness of the mesentery consistent with diffuse edema and limits differentiation of mesenteric fat versus fluid. Evaluation of possible rectal wall thickening is limited secondary to lack of contrast and may be adherent feces versus focal inflammation. BONES, SOFT TISSUES: Diffuse subcutaneous edema. Severe degenerative changes in the thoracic and lumbar spine. Continued L1 vertebral body height loss. Stable heterogeneous bone marrow within the right iliac bone.OTHER: No significant abnormality noted. | 1.No evidence of acute intra-abdominal process.2.Stable bilateral pleural effusions. |
Generate impression based on findings. | 65-year-old female with history of RCC, assess for progression of disease. CHEST:LUNGS AND PLEURA: Left upper lobe metastatic lesion measures 1.3 x 1.1 cm (image 19, series 6) and previously measured 1.5 x 1.1 cm. Reference right lower lobe pulmonary nodule measures 5 x 4 mm and previously measured 6 x 5 mm (image 60 series 6). Clustered micronodule opacities in the right upper lobe (image 27) at the right lung base (image 84) are unchanged. No new lung nodules or masses.Left apical and left lower lobe subpleural arteriovenous malformations are unchanged.MEDIASTINUM AND HILA: Unchanged subcentimeter lymph nodes. The heart size is normal.CHEST WALL: No significant abnormality noted.ABDOMEN: Evaluation of solid organ pathology and vasculature is limited by lack of IV contrast.LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy. No evidence of recurrence in the nephrectomy bed. The left kidney appears unremarkable although evaluation for parenchymal lesions is limited on this noncontrast exam.RETROPERITONEUM, LYMPH NODES: Enlarged gastrohepatic lymph nodes are not significantly changed with the reference lymph node measuring 2.8 x 1.5 cm and previously measuring 2.6 x 1.6 cm (image 93, series 4).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Right abdominal wall incisional hernia containing multiple loops of small bowel without evidence of obstruction or fluid within the sac is unchanged.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Bilateral subcentimeter obturator and internal iliac lymph nodes are unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Multiple unchanged metastatic pulmonary nodules.2. Stable gastrohepatic lymphadenopathy.3. Unchanged clusters of nodular opacities in the right lung which may be inflammatory or possibly represent low-grade adenocarcinoma.4. Stable left pulmonary AVMs. |
Generate impression based on findings. | Reason: 50yo female with incidental lung nodule on CXR History: cough LUNGS AND PLEURA: Multiple he clustered groundglass nodular opacities in both upper lobes with associated bronchial bronchiolar wall thickening with centrilobular nodules, suggesting tree in bud opacities suggestive of bronchiolitis.No suspicious pulmonary nodules or masses.No pleural effusions.MEDIASTINUM AND HILA: Mildly prominent mediastinal lymph nodes unchanged from the prior exam. No evidence of lymphadenopathy.Cardiac size is normal without evidence of a pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Bronchial/bronchiolar wall thickening with bilateral upper lobe clustered groundglass nodular opacities compatible with infectious bronchiolitis. |
Generate impression based on findings. | 67-year-old male with a history of metastatic renal cancer -- assess disease status on treatment. CHEST:LUNGS AND PLEURA: Again seen are innumerable bilateral pulmonary nodules and masses consistent with metastatic disease. No new nodules are seen and the prior referenced left upper lobe nodule (series 6, image 36) is slightly smaller, measuring 0.6 x 0 .8 cm, slightly decreased from previous 1.0 x 0.8 cm. Subjectively, the remaining other nodules may be similarly very slightly smaller. No pleural abnormalities are seen. MEDIASTINUM AND HILA: Slightly enlarged scattered mediastinal and hilar lymph nodes are again seen. The referenced anterior prevascular lymph node (series 4, image 36) has minimally changed in size, measuring 2.0 x 0.7 cm, previously 2.0 x 0.8 cm.. No new areas of lymphadenopathy are seen.CHEST WALL: The lytic/sclerotic metastasis in the T8 vertebral body is unchanged. The left anterior chest wall/rib mass has decreased. The soft tissue visible component now measures 4.4 x 2.0 cm (series 4, image 78) compared with 6.7 x 2 .2 cm, previously. No new skeletal abnormalities are seen.ABDOMEN:LIVER, BILIARY TRACT: Multiple, hypodense hepatic lesions throughout the liver. Again seen with less well visualized. Peripheral margins and, perhaps slightly smaller. No new lesions are identified. The prior noted. Reference right hepatic lobe lesion (series 4, image 86) measures 1.5 x 1 .0 cm, previously 1.5 x 1.4 cm.Cholelithiasis again seen without complication. No other biliary tract abnormalities are seen.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Large, heterogeneous left renal mass is again seen with maximal tumor dimensions (series 4, image 124) of 7.3 x 5 .7 cm, previously 8.4 x 5.4 cm. left renal vein thrombus, unchanged. Left perinephric soft tissue stranding is unchanged.Right kidney. Morphology is unchanged with benign cortical cyst and no neoplastic masses suspected.RETROPERITONEUM, LYMPH NODES: No enlarged, lymph nodes or other masses identified. 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. Left renal cell carcinoma, minimally decreased in size with left renal vein. Thrombus, unchanged. 2. Slight decrease in referenced, pulmonary nodule with subjectively, similar slight decrease in other parenchymal lung metastases. 3. Multiple hepatic metastases with slight decrease in reference lesion. 4. No change appearance of the T8 vertebral body metastasis -- decrease in size of soft tissue component associated with left anterior rib metastasis. |
Generate impression based on findings. | 14-year-old male with history of pain. Evaluate for fracture nonunion.EXAMINATION: CT left femur without IV contrast 10/31/13 at 944. A side plate and screw device is partially visualized affixing the left femur with associated streak artifact. An osteotomy site is noted in the left proximal femur as was seen on prior radiographs. The cortex along both sides of the osteotomy site margins remain distinct with areas of sclerosis. Callus formation is noted peripherally along the osteotomy site but no areas of bony bridging are identified. The visualized adjacent soft tissues appear within normal limits. No abnormal fluid collections are present. | Nonunion of proximal left femoral osteotomy as described above. |
Generate impression based on findings. | Clinical impression: Evaluate for fracture or entrapment. Signs and symptoms: Left facial pain after fall. Maxillofacial CT:Examination demonstrates no detectable osseous fracture of the maxillofacial region as is questioned clinically. Images through the orbits are within normal limits and without evidence of fracture or entrapment as clinically suppression.All paranasal sinuses remain well pneumatized and unremarkable.Images through the nasal passage demonstrate mild nasal septum deviation to the left and mid evidence of a left port projecting bony septal spur measuring approximately 7 mm in transverse axis. This finding is in contact with the left inferior turbinate mucosal.No detectable abnormality of mandible.Well pneumatized bilateral mastoid air cells and middle ear cavities.There is a very subtle focus of subcutaneous fat stranding/edema of the left cheek likely as result of recent trauma. | 1.No evidence of osseous fractures of the maxillofacial region.2.Minimal soft tissue thickening/subcutaneous fat stranding of the left cheek as detailed.3.Unremarkable orbits, paranasal sinuses, mastoid air cells and middle ear cavities.4.Mild nasal septum deviation to the left and a bony septal spur measuring 7-mm in length as detailed above. |
Generate impression based on findings. | Cervical lymphadenopathy. There is considerable motion artifact at the level of the oropharynx, which may be responsible for the prominent appearance of the Waldeyer ring structures. The cervical lymph nodes are not enlarged by size criteria. For example, a level 1A lymph node measures 6 x 9 mm (image 102, series 7), a right level 2A lymph node measures 7 x 13 mm (image 74, series 7), and a left level 2A lymph node measures 7 x 14 mm (image 78, series 7). The thyroid and major salivary glands are unremarkable. The osseous structures are unremarkable, The imaged portions of the intracranial structures are orbits are unremarkable. The major cervical vessels appear to be patent. The imaged paranasal sinuses and mastoid air cells are clear. The imaged portions of the lungs are clear. | 1. No significant cervical lymphadenopathy by size criteria and this may represent a resolving reactive process, given the reported prior cervical lymphadenopathy. 2. Considerable motion artifact at the level of the oropharynx, which may be responsible for the prominent appearance of the Waldeyer ring structures. Nevertheless, direct inspection is recommended to exclude tonsillar enlargement. |
Generate impression based on findings. | 82 year-old female with lower abdominal pain and blood in stool. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Large hiatal hernia. The bowel is normal in caliber.BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Several short segments of transverse colon which are narrowed with mild apparent wall thickening, likely representing peristalsis/spasm, although underlying lesion cannot be excluded.BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine. Three left trochanteric pins extend into the femoral head.OTHER: No significant abnormality noted | 1. No specific findings to account for patient's abdominal pain. 2. Hiatal hernia. |
Generate impression based on findings. | Neurofibromatosis, unspecified(237.70)Atherosclerosis of renal arteryUnspecified essential hypertension Brain CTA: There is opacification of the distal internal carotid arteries, the distal vertebral arteries and the proximal anterior middle and posterior cerebral arteries. No aneurysms or intracranial stenosis is appreciated.The anterior communicating artery is intact an medium size. There is a fetal origin of the left posterior cerebral artery. The right posterior communicating artery is tinyThere is extracranial origin of the left posterior-inferior cerebellar artery.The left transverse sinus is tiny. the left sigmoid sinus groove and jugular fossa is small.CT head:The CSF spaces are appropriate for the patient's stated age with no midline shift. The left cerebellar tonsil extends well below the level of the foramen magnum by approximately 10 mm and the right cerebellar tonsil extends approximately 5 mm below the level of foramen magnumNo abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.No evidence for aneurysm.2.No evidence for cerebral vascular occlusive disease.3.Chiari one malformation with asymmetric tonsil ectopia left more than right. |
Generate impression based on findings. | 74-year-old male patient with renal mass. ABDOMEN:LUNG BASES: Bilateral pleural effusions, left greater than right. Interval decrease compared to prior examination.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Diffuse fatty replacement.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Solid, heterogeneously enhancing nodule in the upper pole of the right kidney measures 3.3 x 2.8 cm (series 7 image 57), previously 3.3 x 2.1 cm. On coronal images, lesion appears stable compared to prior.RETROPERITONEUM, LYMPH NODES: Moderate atherosclerotic changes in the abdominal aorta and iliac arteries. Generalized dilatation of the common iliac arteries. Left iliac artery measures 2.2 cm in diameter and right iliac artery measures 2.0 cm in diameter (series 8 image 93).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Multilevel degenerative changes in the thoracic and lumbar spine. | 1.Stable right renal mass without new sites of disease.2.Interval decrease in bilateral pleural effusions. |
Generate impression based on findings. | Arachnoid cyst, preoperative planning. There is a stereotactic frame in position, which produces extensive streak artifact that obscures surrounding structures. Within this limitation, there is a small amount of subcutaneous emphysema in the left frontal scalp adjacent to the device screw. there is a right posterior fossa shunt catheter that terminates in the right cerebellomedullary cistern arachnoid cyst. The remainder of the intracranial structures are grossly unremarkable. | 1. Stereotactic frame in position, which produces extensive streak artifact that obscures surrounding structures. Within this limitation, there is a small amount of subcutaneous emphysema in the left frontal scalp adjacent to the device screw. 2. A right posterior fossa shunt catheter that terminates in the right cerebellomedullary cistern arachnoid cyst. |
Generate impression based on findings. | 68-year-old male with history of tongue cancer, evaluate for right mandibular infection Limited intracranial views demonstrate no gross abnormalities. The visualized paranasal sinuses and mastoid air cells are clear. Visualized orbits are unremarkable.Chronic appearing fracture at the right mandibular body with mixed foci of lucency and sclerosis. Probable slight interval increase in anterior cortical based lucency along the right mandibular body. No drainable fluid collections are identified in the neck.Postsurgical changes of a radical right neck dissection and chemoradiation are identified in neck including effacement and loss of fascial planes with reticulation of subcutaneous fat. Fatty atrophy of the right half of the tongue and right floor of the mouth. The right internal jugular vein is not identified similar to prior. The remainder of the cervical vasculature is patent. Bilateral atherosclerotic calcifications at the carotid bifurcations.No lymphadenopathy by CT size criteria. No soft tissue masses are identified in the neck. There are no mucosal masses or effacement of the aerodigestive tract. The right piriform sinus is not well aerated. Both submandibular glands are not identified. The parotids are atrophic. The thyroid gland is small with hypodense nodules.Multilevel degenerative changes of the visualized cervicothoracic spine most pronounced at C4-C5 and C5-C6 including loss of disk height, sclerotic endplate changes and grade 1 anterolisthesis of C3 on C4. Additionally, there is grade 1 anterolisthesis of C4 on C5 and grade 1 retrolisthesis of C5 on C6.Biapical paramediastinal fibrosis/scarring which is likely secondary to radiation therapy. Tracheal debris. | 1. Slight interval increase in cortical bone loss suggested along the anterior aspect of the chronic appearing right mandibular fracture which in the appropriate clinical setting may represent changes relating to osteomyelitis. No associated soft tissue abnormality. 2. No soft tissue masses or cervical lymphadenopathy of the neck. |
Generate impression based on findings. | New lung mass concerning for malignancy. There is no evidence of intracranial hemorrhage, mass, or cerebral edema. There is mild scattered cerebral white matter hypoattenuation that likely represents microangiopathy. The ventricles are normal in size and configuration. There is a prominent retrocerebellar cistern, which can be a normal variant. There is no midline shift or herniation. There is opacification of the right sphenoid sinus with sclerotic walls. There is partial opacification of the left mastoid air cells. The skull appears unremarkable. There are bilateral lens implants. | 1. No evidence of acute intracranial hemorrhage, mass, or cerebral edema. However, non-contrast CT is insensitive for detection of metastases and if there is persistent clinical concern for this, MRI is recommended, assuming there are no contraindications for this modality. 2. Opacification of the right sphenoid sinus with sclerotic walls is indicative of chronic sinuses. |
Generate impression based on findings. | Female 31 years old; Reason: mets lung cancer, s/p chemo, pls c/w previous study and evaluate tx response . History: lung ca CHEST:LUNGS AND PLEURA: Right upper lobe apical nodule (series 5, image 15) measures 1.0 x 0.5 cm, unchanged from previous.Second right upper lobe nodule (series 5 come image 23) measures 1.3 x 1 .0 cm, continuing to decrease from prior report of 1.4 x 1.1 cm..No new nodules identified.Anterior subpleural interstitial and nodular opacities have decreased with better aeration in right middle lobe.Slightly smaller right pleural effusion -- stable left pleural effusion.MEDIASTINUM AND HILA: Again seen are numerous small subcentimeter scattered lymph nodes. The reference anterior mediastinal prevascular lymph node (series 3, image 33) has continued to slightly decreased in size at 0.4-cm compared with 0.5 cm short axis measurement previously. No change in the slightly thickened anterior pericardium.CHEST WALL: Spinal stabilization hardware again seen with underlying bony destruction difficult to evaluate due to streak artifact from hardware.ABDOMEN:LIVER, BILIARY TRACT: While innumerable subcentimeter hypodensities persist in the liver, there appears to be substantially fewer than seen on prior examination suggesting decreased tumor burden. These are all subcentimeter and too small to measure for objective delineation. 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 lymphadenopathy or other significant masses seen.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. -- no adnexal masses are seen in prior reported abnormalities most likely represented physiologic changes in the ovaries..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. Minimal change in two right lung nodules as measured and reported above. 2. Scattered small mediastinal lymph nodes again seen -- referenced lymph node, without significant change. 3. Decreasing tumor burden seen diffusely in liver with lesions too small to accurately measure. 4. Postsurgical changes in the spine with no evidence of no metastatic bony lesions.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 66-year-old male with prostate cancer and rising PSA ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Several enlarged, and, probably enhancing lymph nodes are seen in the distal left periaortic and aorta caval space (see series 4, image 64). Left periaortic node measures 1.4 x 1.4 cm. Scattered smaller lymph nodes are seen. As well and extending to the proximal left common iliac region.BOWEL, MESENTERY: Hiatal hernia -- no other significant abnormalities in the stomach, small bowel, ascending, transverse, and descending colons. Scattered sigmoid diverticular changes are seen in sigmoid colon without complication. No free mesenteric fluid.BONES, SOFT TISSUES: Sclerotic foci over a broad region in the left iliac bone (series 4, image 77) is seen suspicious for bone metastasis. Bone scan scheduled for today would better be able to answer status of musculoskeletal system for metastases. No other sclerotic foci to suggest metastases are seen in the abdominal or pelvic bony structures.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: While enlarged distal periaortic lymph nodes are seen as described above, no enlarged lymph nodes are seen in the pelvis.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Sclerotic foci over a broad region in the left iliac bone (series 4, image 77) is seen suspicious for bone metastasis. Bone scan scheduled for today would better be able to answer status of musculoskeletal system for metastases. No other sclerotic foci to suggest metastases are seen in the abdominal or pelvic bony structures.OTHER: No significant abnormality noted | 1. Abnormally enlarged distal left periaortic lymph nodes as reported above, worrisome for metastatic disease. 2. Sclerotic foci in left iliac bone worrisome for metastatic disease but will be better evaluated by bone scan.. |
Generate impression based on findings. | Breast cancer CHEST:LUNGS: Left lower lobe nodule is unchanged measuring 1 x 1.2 cm on image number 79, series number 5. Peripheral scarring is again noted in the left lung.MEDIASTINUM: Stable appearance of the descending aortic aneurysm measuring 5-cm on image number 36, series number 3. Index left paratracheal lymph node measures one .2 x 1.4 cm on image number 31, series number 3, no significant change from previous study. Other mediastinal lymph nodes are also grossly unchanged.:Left mastectomy and postoperative changes, unchanged.ABDOMEN:LIVER, BILIARY TRACT: In benign-appearing liver lesions are stable. Previously measured index cystic lesion is unchanged measuring 1.6 x 1.5 cm on image number 85, series number 3.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: Sclerotic lesions in the bones suspicious for metastatic disease are grossly unchanged.OTHER: 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: Sclerotic lesions in the bones suspicious for metastatic disease are unchanged.OTHER: No significant abnormality noted | No significant change from previous study. |
Generate impression based on findings. | Female 54 years old; Reason: r/o metastases in pt with h/o triple negative br ca and endometrial ca with bone lesions History: back pain CHEST:Neck base: Numerous supraclavicular and neck base lymph nodes are noted not completely visualized on this examination.LUNGS AND PLEURA: Numerous pulmonary nodules are noted throughout the lungs bilaterally, with index lesions measuring 1 x 1 cm and the left upper lobe, and 1.2 x 0.9 cm and the left lower lobe.MEDIASTINUM AND HILA: Extensive mediastinal adenopathy is seen with and index prevascular node measuring 11 x 11 mm (series 3 image 29). Index Right hilar lymph node measures 1.4 x 1.6 cm.CHEST WALL: Surgical clips are seen along the left chest wall and left axilla. There is no axillary adenopathy.ABDOMEN:LIVER, BILIARY TRACT: There is no focal lesion the liver. Gallstones are seen within the gallbladder without evidence of cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Numerous borderline enlarged lymph nodes are noted in the retroperitoneum, none enlarged by CT standards. Index node measures 9 x 11 mm (series 3 image 103)BOWEL, MESENTERY: Surgical sutures are seen along the lesser curvature of the stomach from prior gastrectomy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: surgically absent.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mottled mixed lytic and sclerotic appearance of L2 is worrisome for metastatic focus.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Numerous pulmonary nodules and mediastinal lymphadenopathy compatible with metastatic disease.2. Mottled mixed lytic and sclerotic appearance of L2 worrisome for metastatic disease.3. No metastatic disease to the abdomen or pelvis4. cholelithiasis |
Generate impression based on findings. | speech disturbance The CSF spaces are appropriate for the patient's stated age with no midline shift. Periventricular and subcortical white matter hypodensities of a moderate degree are present. These have only mildly progressed since the prior examNo abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin. | 1.No evidence for acute intracranial hemorrhage mass effect or edema.2.CT is insensitive for the early detection of nonhemorrhagic CVA3.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. These have only mildly progressed since the prior exam |
Generate impression based on findings. | History of bladder cancer This study is limited due to lack of IV contrast.CHEST:LUNGS AND PLEURA: Emphysematous changes are stable. Calcified right lung nodules are stable. A new subcentimeter nodule adjacent to the fissure of the left upper lobe on image number 15, series number 7, nonspecific. New somewhat nodular air space opacities in the lingula image number 44, series number 7, again nonspecific. Follow-up imaging with chest CT is recommended.MEDIASTINUM AND HILA: Index nodule in the pretracheal space is stable measuring 1.1 by 2.8-cm image number 30, series number 6. Other mediastinal lymph nodes are also stable.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Hypodense lesion in the spleen, unchanged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Bilateral diffuse is thickened adrenal glands are unchanged.KIDNEYS, URETERS: Small hypodense lesions in both kidneys are unchanged.RETROPERITONEUM, LYMPH NODES: Abdominal aortic aneurysm is unchanged.BOWEL, MESENTERY: Herniations of the bowel loops into right lower ostomy area, unchanged. No evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Status post cystectomy.LYMPH NODES: Previously described external iliac lymph node measures 2.2 by 1.8-cm image number 171, series number 6, not significantly changed from previous study. Other pelvic borderline enlarged lymph nodes are also stable.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Limited study to lack of IV contrast. No significant change from previous study. |
Generate impression based on findings. | Reason: 46M with history of buccal scc, osteoradionecrosis, recurrent carcinoma in situ, eval for lung mets History: head and neck ca LUNGS AND PLEURA: Apical radiation fibrosis.There is no evidence of pulmonary or pleural metastases.MEDIASTINUM AND HILA: Common origin right brachiocephalic and left carotid artery, a normal variant.There is no mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | No evidence of metastases, or other significant abnormality. |
Generate impression based on findings. | 45 year-old female with elevated CPK CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Borderline enlarged [lymph nodes, nonspecific.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. | Unremarkable study. |
Generate impression based on findings. | SCC buccal mucosal, s/p mandibulectomy for ORN, now with recurrent mucosal carcinoma in situ. Evaluate for extent of disease. There are postoperative findings related to left segmental mandibulectomy with temporomandibular joint disarticulation with hemimandibular prosthesis and graft reconstruction. There is no evidence of mandibular erosions or hardware complications. There is associated deficiency of the left lateral oral cavity and parapharyngeal soft tissues. There is diffuse thickening of the right tonsillar fossa and glossotonsillar sulcus, which may be treatment-related. However, no discernable mass lesions are identified amidst the distorted surgical anatomy and extensive streak artifact, which limits assessment. There is no evidence of significant cervical lymphadenopathy. The imaged intracranial structures are unremarkable. There are mild periodontal lucencies involving portions of the left maxillary dentition. The imaged paranasal sinuses and mastoid air cells are clear. There are secretions in the posterior lumen of the trachea. There is biapical scarring. | Postoperative findings related to left segmental mandibulectomy with temporomandibular joint disarticulation with hemimandibular prosthesis and graft reconstruction for treatment of buccal squamous cell carcinoma. No evidence significant cervical lymphadenopathy or discernable locoregional tumor, although assessment is limited by hardware-related artifact. |
Generate impression based on findings. | History of metastatic cancer ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post resection of patient's known left renal cell carcinoma. There is a 5.8 x 2.4 cm fluid density collection anterior to the left kidney. There are also additional postsurgical changes involving the left kidney. Follow-up imaging is recommended.RETROPERITONEUM, LYMPH NODES: New left para-aortic adenopathy measuring 3.5 x 2.9 cm image number 46, series number 5.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 | Postoperative changes involving the left kidney. Follow-up imaging is recommended to exclude recurrence.Metastatic left para-aortic adenopathy. |
Generate impression based on findings. | Testicular cancer ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Postoperative changes in the retroperitoneum from previous lymph node dissection. Index bilobed lymph node adjacent to the left posterior diaphragm is unchanged measuring 1.9 x 0.7 cm image number 37, series number 3.Fluid attenuation hypodense lesion between the aorta and inferior vena cava is unchanged measuring 1.5 by 2.1-cm image number 63, series number 3.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 | No significant change from previous study. |
Generate impression based on findings. | Vomiting and decreased bowel movements This study is limited due to lack of IV contrast.ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is significant distention of proximal small bowel loops measuring up to 4 cm. Distal small bowel loops in the right lower quadrant are decompressed. These findings are consistent with small bowel 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: No significant abnormality notedBONES, SOFT TISSUES: Postsurgical changes in the proximal left thigh. Lack of intravenous contrast limits optimal evaluation.OTHER: No significant abnormality noted | Very limited study due to lack of intravenous contrast, lack of intra-abdominal fat and suboptimal opacification of the small bowel loops due to distal small bowel obstruction. Transition point is likely to be in the right lower quadrant.Postsurgical changes in the left thigh |
Generate impression based on findings. | 70 year-old male with history of empyema. Evaluate for resolution. LUNGS AND PLEURA: Bilateral postsurgical changes. Interval decrease in the left posterior upper lobe consolidation and adjacent loculated fluid collection. There is still a small amount of the fluid with small pockets of air and overlying consolidation. Interval resolution of left basilar atelectasis and subpulmonic effusion with likely residual scarring around prior left lower lobe wedge resection site. Subpleural left upper lobe nodule is again not visualized due to superimposed consolidation/loculated pleural effusion.Right lobe atelectasis/scarring is unchanged from prior exam.MEDIASTINUM AND HILA: Normal heart size. No pericardial effusion. Moderate to severe coronary artery calcifications. Scattered mild mediastinal and hilar lymphadenopathy unchanged from prior exam.CHEST WALL: Anterior osteophytes of the thoracic spine. Right fifth and sixth rib deformities are unchanged. Evidence of prior clamshell sternotomy.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Scattered nonspecific para-aortic lymph nodes. Punctate calcification in the spleen unchanged and likely present a granuloma. Mild to moderate atherosclerotic calcifications of the descending aorta and splenic artery. Degenerative changes with vacuum disk phenomenon at L1-L2. Unchanged sclerotic focus with coarse trabeculations in the L1 vertebral body likely a hemangioma. | 1.Interval decrease in left posterior upper lobe consolidation and adjacent fluid collection. Small residual amount of fluid with small pockets of air and overlying consolidation compatible with resolving empyema or parapneumonic effusion.2.Interval resolution of left basilar atelectasis and subpulmonic effusion. |
Generate impression based on findings. | 56 year old female with metastatic breast cancer. Evaluate for pulmonary embolus. PULMONARY ARTERIES: Diagnostic quality exam with extensive bilateral pulmonary emboli involving lobar, segmental, and subsegmental pulmonary artery branches (series 12, images 145, 160, 167, 126).LUNGS AND PLEURA: Small bilateral pleural effusions, left more than right, with associated subsegmental consolidation/atelectasis in the left base.Linear opacities in right apex, likely scarring. Several areas of subpleural ground glass opacity in right upper lobe are not specific but may represent hemorrhage/infarction given presence of pulmonary emboli (series 14, image 45, 30); this may also represent focal edema.Nodular pleural soft tissue foci in both bases, suspicious for metastases; right base focus measures 9 x 22 mm (series 12, image 237, 203). Punctate micronodule in anterior aspect of right middle lobe likely benign (series 14, image 79). No other suspicious lung nodules or masses, however, evaluation of left base is limited due to consolidation.MEDIASTINUM AND HILA: No evidence of right heart strain. Heart normal in size without pericardial effusion. Right central venous catheter terminates in right atrium.Enlarged left supraclavicular node measures 11 x 20 mm (series 12, image 35). Otherwise no mediastinal adenopathy.CHEST WALL: Right chest wall port catheter noted. Status post bilateral mastectomy and axillary lymph node dissection, with surgical clips and residual increased soft tissue attenuation, likely scarring, in both axilla . No enlarged axillary lymph nodes.Diffuse heterogeneity of bone marrow, suspicious for involvement by metastatic disease. Vertebral body heights are preserved.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Moderate ascites fluid. Heterogeneity of liver parenchyma with capsular retraction in left lobe, suspicious for diffuse involvement by metastatic disease; please see dedicated abdominal CT report for abdominal findings. | 1.Multiple bilateral pulmonary emboli, as described above, without evidence of right heart strain.2.Bilateral small pleural effusions, with pleural-based soft tissue nodules bilaterally suspicious for metastatic deposits.3.Diffuse heterogeneity of bone marrow compatible with metastatic disease. 4.Heterogeneous attenuation of liver parenchyma with moderate ascites fluid, most likely related to metastatic disease; please see dedicated abdominal/pelvis CT report for abdominal findings.Results were conveyed to Dr. Hoffman by phone at 1:30 p.m., 10/31/2013. |
Generate impression based on findings. | 57-year-old male evaluated fluid collections after drain placement. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No focal hepatic lesions. Pneumobilia is again noted. A biliary stent is unchanged in position, extending to the duodenum. Air is again noted within the gallbladder.SPLEEN: No significant abnormality notedPANCREAS: Loculated fluid collection containing gas abutting the uncinate process of the pancreas contains a drain and has decreased in size and now measures 2.6 x 8.3 cm (image 70, series 80228), and previously measured 3.9 x 9.0 cm. The inferior extension of this collection along the paracolic gutter measures 1.8 x 2.4 cm and previously measured 2.0 x 2.5 cm (image 107, series 8, 0228). A new heterogeneously attenuating gas containing collection superior to the drain abutting the inferior surface of the liver is now present, with a substantial amount of high density material that is most suggestive of contained hemorrhage.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left simple cyst is again noted. Moderate right hydronephrosis similar to the prior study likely related to partial ureteral obstruction from adjacent inflammatory fluid collection. Extensive perinephric fluid collections as described below. Symmetric renal cortical enhancementRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Dilated fluid-filled stomach suggesting delayed emptying, possibly due to inflammatory collection adjacent to the pancreas, and duodenum. An enteric tube extends into the jejunum. Postsurgical change duodenojejunostomy.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. Mild interval decrease in size in right perinephric fluid collection containing a new percutaneous drain.2. New, heterogeneous collection superior to the drain, and inferior to the liver/gallbladder containing hemorrhage with foci of gas which may be post procedural in etiology, although perforation of a viscus cannot be excluded.3. Persisting gastric outlet obstruction.These findings were discussed with Dr. Bishop (pager 7874) at the time of dictation. |
Generate impression based on findings. | 84-year-old female patient with copious feculent material from old fistula tract and two recent subcutaneous abscesses. Assess for fluid collections in pelvis and abdomen. ABDOMEN:LUNG BASES: Resolution of bilateral pleural effusions.LIVER, BILIARY TRACT: Liver morphology within normal limits. Hypoattenuating lesion in segment IVb adjacent to the falciform ligament is consistent with a benign perfusion defect.Cholelithiasis, stable.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Superior pole left renal cyst is unchanged. Multiple subcentimeter hypoattenuating lesions in the left renal cortex are too small to characterize and are stable compared to prior examination. Right renal hypoattenuation is too small to characterize, unchanged. Renal cortical scarring is again noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic changes in the abdominal aorta and iliac arteries.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild multilevel degenerative changes in the thoracic and lumbar spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Atrophic or absent.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Oral contrast rapidly progressing normal-appearing stomach and small bowel. Postoperative changes from previous bowel surgery in the right lower quadrant. Transverse and descending colon containing mild amount of stool. Sigmoid colon and rectum with moderate stool burden.BONES, SOFT TISSUES: Mild multilevel degenerative changes in the thoracic and lumbar spine.OTHER: Collection with enhancing rim containing debris and air extends superiorly to the iliopsoas space and involves the left iliac fossa. Anterior to the iliacus muscle the collection measures 5.2 x 1.8 cm (series 5 image 97). There appears be a fistulous connection to a collection in the subcutaneous tissue of the overlying pannus that contains air and debris that measures 6.5 x 2.7 cm (5 image 92). The collection extends inferiorly and laterally to the anterior hip, lateral to the external iliac vessels (series 5 image 111). Compared to prior CT examinations, the collection appears to have increased size and increased rim enhancement.The left iliac fossa collection abuts a loop of the sigmoid colon, which may represent a connection. | Left iliac fossa collection with rim enhancement containing debris and air is enlarged and has increased wall enhancement compared to examinations from 8/26 and 7/29/2013. New involvement in the subcutaneous tissue of pannus.Finding of enlarging, wall enhancing collection communicated to Dr. David via telephone at 2:59 p.m. on 10/31/2013 by Dr. Stephanie McCann. |
Generate impression based on findings. | 55 year-old male with chronic hepatitis C and HCC -- restaging status post Therasphere treatment CHEST:LUNGS AND PLEURA: Emphysematous changes are again seen. The focal right upper lobe focal pleural thickening appears stable. Scattered small micronodules are stable and unchanged.MEDIASTINUM AND HILA: No significant mediastinal lymph node enlargement or other masses seen. Stable appearance.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology again seen in liver.. Extensive tumor seen in the liver with reference measurements as follows:Right hepatic dome segment 8 (series 9, image 15) measures 4.1 x 3 .6 cm, previously 2.9 x 2.2 cm. While this lesion is increased in size, the enhancement in the posterior lesion has decreased suggesting decreased vascularity responding to treatment.Reference segment (referred to in past report as segment 7, but appears to lie in segment 6) (series 9, image 44) measures 7.5 x 4.1 cm compared with 8.8 x 6.8 cm previously. In addition, there is less arterial enhancement, indicating response to treatment.Multiple other enhancing foci are seen scattered throughout the liver -- most of these are subcentimeter but do appear smaller than on 8/2113 examination.Main portal vein and large proximal branches of the right and left portal veins appear patent. The more peripheral distal branches are difficult to see in some portions and the liver, but do not appear to have thrombus.Distal hepatic veins appear patent.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Right adrenal gland mass (series 11, image 109) measures 2.4 x 1 .7 cm, unchanged. Left adrenal gland appears normal. KIDNEYS, URETERS: Punctate calcification again seen indicative of nonobstructing calyceal calculus, unchanged. No other significant abnormality. RETROPERITONEUM, LYMPH NODES: Referenced an enlarged portacaval lymph node measures 2.6 x 1.8 cm (series 11, image 117) slightly decreased from previous measurement of 3.2 x 1.8 cm.. Other retroperitoneal lymph nodes are subcentimeter and stable in appearance.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. Overall decreased liver tumor burden as demonstrated by decrease in size of most reference lesions and other small enhancing nodules throughout liver. 2. Stable right adrenal mass without change. 3. No evidence metastatic disease in the chest. |
Generate impression based on findings. | Dizziness. There is a isodense left paraclinoid mass with peripheral, calcification that measures up to approximately 2.5 cm with mild mass effect upon the adjacent brain parenchyma. There is mild cerebral white matter hypoattenuation, which likely represents microangiopathy. There is no evidence of intracranial hemorrhage 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. There are bilateral lens implants. The skull and extracranial soft tissues are otherwise unremarkable. | 1. Left paraclinoid meningioma, which may have gradually increased in size over the course of several years, now measuring up to approximately 2.5 cm, although the lesion is difficult to delineate on non-contrast CT. A brain MRI with contrast may be useful for further delineate assuming there are no contraindications for this modality.2. No evidence of acute intracranial hemorrhage or cerebral edema. |
Generate impression based on findings. | 78-year-old female with vomiting, evaluate for SBO. ABDOMEN:LUNG BASES: Mild basilar atelectasis.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Atrophic native kidneys.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The small bowel is normal in caliber. Tortuosity of the ascending colon, hepatic flexure is noted. No evidence of bowel obstruction.BONES, SOFT TISSUES: Marked degenerative changes of the thoracolumbar spine. OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Nonspecific cystic left adnexal lesion measures 4.8 x 4.0 cm (image 89, series 4), larger than can be expected for the patient's age.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: The small bowel is normal in caliber. Tortuosity of the ascending colon, hepatic flexure is noted. No evidence of bowel obstruction.BONES, SOFT TISSUES: Marked degenerative changes of the thoracolumbar spine. Sacralization of L5.OTHER: No significant abnormality noted | 1. No evidence of bowel obstruction or specific findings to account for the patient's vomiting.2. 4.8-cm nonspecific left cystic adnexal lesion for which further evaluation is recommended as this is larger than can be normally expected for age and a neoplasm cannot be excluded. |
Generate impression based on findings. | Reason: h/o HNC, compare to previous, measurements pls History: none LUNGS AND PLEURA: Mild apical scarring with emphysema is stable.There is no evidence of pulmonary or pleural metastases.Scattered calcified benign appearing micronodules are unchanged.MEDIASTINUM AND HILA: Aortic root calcifications are stable. There is no mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Right Bochdalek hernia. | No change, and no evidence of metastases or other significant findings. |
Generate impression based on findings. | 56 year old female with metastatic breast cancer, evaluate for progression ABDOMEN:LUNG BASES: Bilateral pleural effusions and adjacent atelectasis. Refer to CT chest report for further detail.LIVER, BILIARY TRACT: Hypoattenuating right hepatic lesion. Diminutive left hepatic lobe portal vein.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: Markedly dilated loops of small bowel in the upper abdomen with distal collapsed loops consistent with obstruction. Hyperenhancing mucosa and mesenteric fluid are suspicious for ischemia. There is widespread peritoneal disease with thickening and nodularity of the peritoneal folds. One pelvic peritoneal nodule measures 1.6 x 2.4 cm (image 125, series 15).BONES, SOFT TISSUES: Multiple sclerotic foci involving ribs and spine indicating metastatic disease.OTHER: Marked abdominal ascites.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Markedly dilated loops of small bowel in the upper abdomen with distal collapsed loops consistent with obstruction. The transition point appears to be in the mid pelvis. Hyperenhancing mucosa and mesenteric fluid are suspicious for ischemia. There is widespread peritoneal disease with thickening and nodularity of the peritoneal folds. One pelvic peritoneal nodule measures 1.6 x 2.4 cm (image 125, series 15).BONES, SOFT TISSUES: Multiple sclerotic foci involving the femurs, pelvis, and spine consistent with metastatic disease.OTHER: Marked pelvic ascites. | 1. High-grade small bowel obstruction with hyperenhancing bowel wall indicating ischemia.2. Marked abdominal and pelvic ascites. While this in part may relate to the patient's known metastatic disease, ischemia is also suspected.3. Widespread abdominal/peritoneal and osseous metastatic disease.These findings were discussed with Dr. Daly (pager 3963) at the time of dictation. |
Generate impression based on findings. | 62-year-old male patient with prostate cancer. Evaluate for lymphadenopathy. Note that the lack of intravenous contrast limits evaluation of lymph nodes, vasculature and solid viscera.ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal nodule with fat density measures 1.2 x 1.4 cm (series 3 image 44) and appears stable compared to prior examination.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Distal left internal iliac lymph node measures 1.1 x 1.6 cm in (series 3 image 132), stable compared to prior examination on 6/20/2009. Otherwise, no lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumbar spine. Punctate sclerotic foci in the thoracic and lumbar spine are stable compared to examination in 2009. No suspicious bony lesions.OTHER: No significant abnormality noted. | 1.No new lymphadenopathy or signs of metastatic disease.2.Adrenal adenoma. |
Generate impression based on findings. | Male 66 years old; Reason: r/o appy History: anorexia and abd pain ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No focal lesions detected. Pneumobilia and mild intrahepatic ductal dilation is seen.Distal Common bile duct is dilated measuring 12 mm. Suggestion of a hepaticojejunostomy anastomosis is 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: The appendix is clearly visualized morphologically unremarkable.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.No evidence of appendicitis2.S/P Hepaticojejunostomy with pneumobilia |
Generate impression based on findings. | Female 41 years old Reason: Evaluate for septic joint vs soft tissue infection History: right wrist pain and swelling There is diffuse soft tissue swelling and fat stranding extending from the dorsal distal forearm to the dorsal aspect right hand. There is an area of low density (image 20, series 4) just superficial to the carpal bones suggestive of a possible loculated fluid collection. There is an oblique minimally displaced fracture of the waist of the scaphoid. The remaining bones appear well corticated and there is no evidence of underlying osteomyelitis. | 1. Diffuse soft tissue swelling of the dorsum of the hand and proximal wrist with possible small loculated fluid collection.2. Scaphoid fracture as above. |
Generate impression based on findings. | 24-year-old male with testicular cancer. LUNGS AND PLEURA: Several punctate micronodules that have morphology suggestive of intrapulmonary lymph nodes (series 5, images 70, 59). No consolidation or pleural effusions.MEDIASTINUM AND HILA: No significant abnormality noted. Residual thyroid tissue noted in anterior mediastinum.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Several punctate micronodules which are most likely benign, perhaps intrapulmonary lymph nodes; however, given the history of testicular cancer, follow-up CT in about 3 months is recommended to confirm stability. |
Generate impression based on findings. | 81-year-old female with abdominal aortic aneurysm. Within the limitations of a non-IV contrast enhanced examination limiting the evaluation of solid parenchymal organs and vascular structures, the following observations can be made:ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No change in appearance of the liver with scattered calcified granulomas and without other abnormality. Gallbladder and biliary tract appear normal.SPLEEN: No change in the peripherally calcified lesions at the hilum of the spleen, most consistent with calcified splenic artery aneurysms. No other significant abnormality seen.PANCREAS: No significant abnormality noted -- again, most of parenchyma is replaced by fatty tissue with minimal residual.ADRENAL GLANDS: Left adrenal nodule measures 2.6 cm in diameter, unchanged and measures near water density. This is characteristic of a benign adrenal adenoma. Right adrenal gland appears normal.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Infrarenal abdominal aortic aneurysm. Again seen with maximum diameter of 5.1 cm, unchanged. Aneurysm ends at the aortic bifurcation, similar to prior study.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Absent or atrophic.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Sigmoid colon diverticulosis without complication.BONES, SOFT TISSUES: Degenerative bony changes diffusely with some narrowing of the spinal canal.OTHER: No significant abnormality noted | 1. Stable aortic aneurysm. 2. Stable splenic artery aneurysms. 3. Left adrenal adenoma, stable. |
Generate impression based on findings. | Clinical question: Follow-up right PCA occlusion. Signs and symptoms: As above. Nonenhanced head CT:Termination demonstrate no detectable acute intracranial process. CT however is insensitive for detection of acute nonhemorrhagic ischemic stroke.Chronic changes of a right MCA territory frontal, temporal and right basal ganglia stroke with resultant parenchymal encephalomalacia and ex vacuo dilatation of right lateral ventricle remains similar to prior exam from 10 -- 30 -- 2013.There is negative rightward midline shift similar to prior exam.There is no detectable ischemic changes along the right PCA territory. Recent cerebral angiogram demonstrated complete occlusion of right middle cerebral artery and patent right posterior cerebral artery. Provided clinical data contradict with recent angiographic findings and likely was entered erroneously.No detectable left hemispheric abnormalities.Unremarkable images through posterior fossa.Calvarium and paranasal sinuses, mastoid air cells and partially visualized orbits are unremarkable. | 1.No detectable acute intracranial process.2.Large region of encephalomalacia in the right MCA territory involving the right frontal, right anterior temporal and right basal ganglia with resultant ex acute dilatation of right lateral ventricle unchanged since prior exam. |
Generate impression based on findings. | 61-year-old male unable to forward, follow commands. There is no evidence of hemorrhagic transformation of the patient's known left basal ganglia infarct. The hyperdense left MCA is no longer identified. There is no evidence of midline shift or herniation. The ventricles are stable in size and configuration. There is partial opacification of the right maxillary sinus; otherwise, the visualized portions of the paranasal sinuses are clear. The imaged portions of the mastoid air cells are clear. The imaged portions of the orbits are intact. There is congenital non-union of the posterior arch of C1. | No evidence of hemorrhagic transformation of the known left basal ganglia infarct. |
Generate impression based on findings. | 79-year-old male with history of severe weight loss and positive interferon, evaluate for TB. CHEST:LUNGS AND PLEURA: Left basilar scarring. No nodules or masses. No pleural effusions.MEDIASTINUM AND HILA: No mediastinal lymphadenopathy. The heart size is normal.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Multiple hypoattenuating lesions, likely representing cysts. 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: Marked degenerative changes of the thoracolumbar spine. Paucity of abdominal fat.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prominent prostate.BLADDER: Probable left bladder diverticulum is again noted.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Loss of height of the L3 vertebral body, unchanged from the prior study. Marked degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality noted | No evidence of tuberculosis or significant interval change from the prior study. |
Generate impression based on findings. | Reason: chest pain History: chest pain, lupus, fibromyalgia, diabetes, hypertension, morbid obesity, obstructive sleep apnea, asthma Coronary arteries: LM: The left main coronary artery arises normally from the left sinus of Valsalva and bifurcates into the left anterior descending and left circumflex coronary arteries. There are no significant stenoses present in the left main.LAD: The left anterior descending coronary artery is very tortuous, coursing within the anterior interventricular groove. It supplies 4 diagonal and several septal branches. There are no significant stenoses in the left anterior descending artery. Within D1, there is proximal eccentric, non-calcified plaque that contributes to mild stenosis. D2 is unremarkable. D3 and D4 are diminutive in caliber.LCx: The left circumflex coronary artery courses normally in the left atrioventricular groove. It gives rise to two obtuse marginal branches. The first obtuse marginal branch is large. There is proximal, noncalcified plaque that contributes to mild stenosis. OM2 is diminutive. Although by axial assessment, there are no significant stenoses in the left circumflex coronary artery, only the first 3.2 cm can be evaluated on the postprocessing workstation. No significant stenosis is identified. The circumflex terminates at the inferior left AV groove, providing posterior lateral branches to the inferior wall. This is suggestive of a co-dominant system.RCA: The right coronary artery is moderate in size and arises normally from the right sinus of Valsalva. It is visualized to the inferior right atrioventricular groove, providing small posterior lateral branches, consistent with a codominant system. An early acute marginal branch provides flow to the apical inferior wall. There are no significant stenoses in the right coronary artery. A posterior descending artery is not well-visualized; however, several posterior lateral branches supply flow to the basal inferior ventricular walls.Left Ventricle: The left ventricular late diastolic volume is normal.Right Ventricle: Visually the right ventricular late diastolic volume is within normal limits.Left Atrium: Visually, the left atrial volume appears to be normal in size. There are four distinct pulmonary veins which drain normally into the left atrium. There is no evidence of left atrial appendage thrombus.Right atrium, vena cavae, and coronary sinus: The right atrial volume is normal in size. The superior and inferior vena cavae are unremarkable. The coronary sinus is normal in size. Valves: There is no calcification on the aortic or mitral valves.Great vessels: The visualized portions of the thoracic aorta demonstrate no evidence of dissection or aneurysm. The aortic arch is not visualized. The main pulmonary artery is normal in size.Pericardium: The pericardium is normal in thickness. There is no pericardial effusion. | There are no significant coronary artery stenoses present. |
Generate impression based on findings. | Clinical question: Rule-out leak. Signs and symptoms: Loss of consciousness. Unenhanced head CT:No detectable acute intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus.CT is insensitive for the detection of acute nonhemorrhagic ischemic stroke.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation.Unremarkable calvarium and soft tissues of the scalp.Unremarkable images through the orbits, paranasal sinuses, mastoid air cells and middle ear cavities. | Unremarkable exam and without evidence of an acute intracranial findings. |
Generate impression based on findings. | 65-year-old male with gross hematuria -- rule-out renal/ureteral/bladder mass or urolithiasis. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Punctate calcified granulomas. No significant mass lesions otherwise seen. Vasculature appears normal. Gallbladder and biliary tract appears normal.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Both kidneys are of normal shape. Small, approximately 1 cm benign cortical cysts are seen in both kidneys. 8 x 4 mm nonobstructing calculus is seen in the left mid-polar region calix. No other calcifications are seen. No parenchymal mass lesions of the, solid, or worrisome nature are seen. No perinephric fluid collections, and no hydronephrosis.Prompt and symmetric excretion of contrast is seen into normal. Pyelocaliceal systems bilaterally. No evidence of urothelial lesion is seen. The right ureter is well opacified to its entire course without abnormality. The left ureter is seen throughout most of its entire length with the very distal few centimeters not visualized. No abnormalities are seen in the left ureter.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prominent size prostate is seen measuring 5.3 x 4.4 cm cross-sectional dimension. No other abnormalities are seen about the prostate.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. 8 x 4 mm left renal nonobstructing calyceal calculus. 2. No other significant urinary tract abnormality seen. 3. No other significant abnormality seen in the abdomen or pelvis. |
Generate impression based on findings. | 63 year-old female with pancreatic adenocarcinoma CHEST:LUNGS AND PLEURA: Redemonstration of postoperative changes in the right upper lobe. Scarlike opacities are again noted in the right lower lobe measuring 1.3 x 1.1 cm number 62, series number 9.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: There is a hypodense mass in the region of the head of the pancreas measuring 3.1 x 2 .4-cm on image number 107, series number 11 consistent with patient's known history of adenocarcinoma. The mass likely Meza duodenum. Pancreatic duct in the body and tail is dilated. No evidence of vascular invasion by the mass. Borderline enlarged peripancreatic lymph nodes are present.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Postoperative changes in the right upper lobe and scarlike opacity in the right lower lobe, unchanged.Large pancreatic head mass without any vascular invasion or hepatic metastases. Borderline enlarged peripancreatic lymph nodes are present. |
Generate impression based on findings. | Clinical question: Operative planning for ESS. Signs and symptoms: Recurrent orbital cellulitis; chronic sinusitis; chronic nasal obstruction. Medtronic fusion sinus CT:Frontal sinuses are pneumatized and without evidence of disease. Stable since prior exam.Ethmoid sinuses demonstrate left-sided chronic ethmoid sinusitis without significant change since prior exam. Unremarkable otherwise.Sphenoid sinus demonstrate diffuse chronic mucosal thickening of the left chamber with resolution of previously noted acute sinusitis findings. There is occluded left sphenoethmoidal recess. Unremarkable right chamber of sphenoid sinusMaxillary sinuses are well pneumatized. There is minimal mucosal thickening at the level of ostiomeatal units of bilateral maxillary sinuses with resultant occluded right and compromised left. There is mild interval improvement of the findings since prior exam.Nasal cavity is unremarkable.Bilateral mastoid air cells and middle ear cavities remain well pneumatized.Unremarkable images through the orbits. | 1.Compromised bilateral ostiomeatal units of maxillary sinuses secondary to regional mucosal thickening and unremarkable otherwise.2.Chronic mucosal thickening of left chamber of the sphenoid sinus with resultant occlusion of left sphenoethmoidal recess.3.Mild left ethmoid chronic sinusitis. |
Generate impression based on findings. | 27 year-old female with left-sided abdominal pain ABDOMEN:LUNG BASES: Nonspecific somewhat nodular air space opacities in the left lower lobe, suspicious for pneumonia. Clinical correlation is recommended.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: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Possible left lower lobe pneumonia. Clinical correlation and if necessary further evaluation with chest CT may be helpful. |
Generate impression based on findings. | 77-year-old male with history of monoclonal gammopathy and worsening anemia ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Cirrhotic liver. No focal liver lesion suspicious for hepatocellular carcinoma. SPLEEN: Splenomegaly.PANCREAS: There is a new hypodense lesion in the body of the pancreas measuring 1.8 x 1.9 cm number 45 Caceres on the eighth. Further evaluation with M.R.C.P. may be helpful. Another cystic lesion in the uncinate process measuring 1.4-cm in diameter is stable. No evidence of pancreatic ductal.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral simple appearing renal cysts.RETROPERITONEUM, LYMPH NODES: Borderline enlarged retroperitoneal lymph nodes. An index left para-aortic node measures 1.2-cm image number 73, series number 8.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostate gland is very heterogeneous and enlarged.BLADDER: No significant abnormality notedLYMPH NODES: Left para iliac index node measures 2.3 x 1.4 cm image number 91, series number 8. This lymph node was measuring 1.1 x 0.6 cm in the previous study. Other pelvic adenopathy is also present. Bilateral inguinal adenopathy. Right inguinal enlarged lymph node measures 3 by 1.8 cm on image number 146, series number 8. This lymph node was measuring 2.8 x 1.4 cm on the previous study.BOWEL, MESENTERY: Small amount of ascites is present.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Findings consistent with cirrhosis and portal hypertension.Small amount of ascites. Interval increase in the size of the retroperitoneal and pelvic adenopathy.Interval development of a small pancreatic body cystic lesion. Further evaluation with M.R.C.P. may be helpful. |
Generate impression based on findings. | Clinical question: Rule-out intracranial bleed or other pathology to explain AMS. Signs and symptoms: AMS Nonenhanced head CT:There is no acute intracranial findings. CT however is insensitive for early detection of acute nonhemorrhagic ischemic stroke. Unremarkable central cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation for patient's stated age of 68. There is no appreciable interval change since prior exam from 9 -- 13 -- 2013.Unremarkable calvarium and soft tissues of the scalp.Unremarkable orbits, mastoid air cells, middle year cavities.Paranasal sinuses demonstrate extensive chronic sinusitis of the right maxillary sinus and mild bilateral ethmoid sinus disease. | 1.No acute intracranial process.2.Right maxillary and bilateral ethmoid sinusitis. |
Generate impression based on findings. | 55-year-old female with tongue cancer status post chemo and radiation, reevaluate. The paranasal sinuses and mastoid air cells are clear. Limited views of the intracranial structures are unremarkable.Redemonstration of extensive postsurgical changes including a partial glossectomy, unchanged. Multiple surgical clips in the submandibular region and obscuration of the fat planes of the neck bilaterally compatible with previous neck dissections and submandibular gland resections. No specific evidence of recurrent mass or cervical lymphadenopathy by CT size criteria. Scattered subcentimeter lymph nodes are noted without specific pathological features. Small hypodense thyroid nodules.The airways are patent. The epiglottis, vallecula and piriform sinuses are within normal limits. The carotid arteries and jugular veins are patent. Mixed sclerotic and lucent appearance of the mandible suggestive of the sequela of radiation therapy, unchanged. No suspicious osseous lesions are identified. Multilevel degenerative changes of the visualized cervicothoracic spine. Centrilobular and paraseptal emphysema of the lung apices. Please see dedicated chest CT for further thoracic findings. | Stable postsurgical changes without evidence of tumor recurrence or lymphadenopathy by CT criteria. |
Generate impression based on findings. | Clinical question: Evidence of hemorrhage? Signs and symptoms: Patient reportedly fell at home yesterday, down on ground overnight, today does not remember events. Nonenhanced head CT:There is no detectable acute posttraumatic intracranial, calvarial or soft tissues of the scalp the findings.CT is insensitive for early detection of acute nonhemorrhagic ischemic strokes.Examination demonstrates fairly extensive subcortical and periventricular low-attenuation white matter grossly similar to prior exam and representing age indeterminate small vessel ischemic strokes. In addition note is made of a focus of parenchymal encephalomalacia in the right occipital lobe similar to prior exam and consistent with a chronic right occipital cortical stroke.A small right pica territory facet of the stroke is also again identified and unchanged since prior exam.There is fairly heavy calcification of bilateral intracranial vertebral arteries and bilateral cavernous and supraclinoid (left greater than right) arteries. These findings are similar to prior exam. Images through the orbit demonstrate no posttraumatic changes there is some prior cataract surgery.Unremarkable calvarium and soft tissues of the scalp.Unremarkable paranasal sinuses and the mastoid air cells and middle ear cavities. | No acute intracranial findings. Stable extensive findings of small vessel ischemic strokes of indeterminate age and a chronic right occipital and right cerebellar chronic ischemic strokes. |
Generate impression based on findings. | Right abdominal pain ABDOMEN:LUNG BASES: Hiatal hernia.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: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Not visualized.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No evidence of renal stones. No evidence of appendicitis. No CT findings to explain patient's acute right-sided abdominal pain.Large lateral hernia. |
Generate impression based on findings. | 84 year old female with shortness of breath and history of pulmonary embolus. PULMONARY ARTERIES: Suboptimal study due to incomplete opacification of pulmonary artery branches. The study is diagnostic down to the segmental level, without evidence of acute pulmonary embolus.LUNGS AND PLEURA: Lungs underinflated with dependent subsegmental atelectasis not significantly changed. Basilar bronchiectasis may be related to chronic aspiration. Scattered calcified and noncalcified pulmonary micronodules, likely benign in etiology.MEDIASTINUM AND HILA: Heart size stable. No mediastinal or hilar lymphadenopathy. Moderate coronary artery calcifications.CHEST WALL: Definite changes in the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.Suboptimal study without evidence of acute pulmonary embolus down to the segmental level.2.No significant change in bilateral basilar atelectasis. |
Generate impression based on findings. | 26-year-old female patient with a liver lesion seen on ultrasound. ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Hypoattenuating liver lesion in the left lobe of the liver measures 5.7 x 5.4 cm (series 9 image 15). This lesion has soft tissue density and demonstrates minimal peripheral nodular wall enhancement.Well circumscribed lesion in the right lobe of the liver measures 2.0 x 1.8 cm (series 9 image 48). Lesion does not demonstrate enhancement and has soft tissue and fluid density areas.No ductal dilatation. Patent vasculature. Vascular flow phenomena on the arterial phase noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Two atypical liver lesions without characteristic enhancement patterns. Dominant lesion in left lobe likely represents a hemangioma. Recommend correlation with prior ultrasound study. If ultrasound study is unavailable, recommend further characterization with MRI. |
Generate impression based on findings. | Female 99 years old Reason: concern for fx within R knee. History: Fell at home yesterday, R knee pain today, radiology was unsure based on X ray and recommended CT There is severe tricompartmental osteoarthritis, but no fracture is evident. There is a moderate-sized joint effusion which extends posteriorly to a Baker's cyst, which measures approximately 6 cm in the craniocaudal dimension. No lipohemarthrosis is evident. Chondrocalcinosis and arterial calcifications are present. A lipoma arises from the semimembranosus muscle. There is mild subcutaneous edema particularly along the lateral aspect of the knee. | Degenerative changes, joint effusion and other findings as described above. No fracture is evident. |
Generate impression based on findings. | Female 40 years old; Reason: pulmonary embolism History: SOB, chest pain. PULMONARY ARTERIES: Suboptimal study for the evaluation of the pulmonary arteries secondary to under opacification of the pulmonary arteries and increased noise signal secondary to body habitus. Within these limitations, no evidence of pulmonary emboli to the lobar artery branches.LUNGS AND PLEURA: Within the right upper lobe is a spherical soft tissue lesion with poorly defined margins measuring 2.6 x 3.6 cm (series 9, image 47). MEDIASTINUM AND HILA: Multiple enlarged mediastinal and hilar lymph nodes. For reference the largest right paratracheal lymph node measures 1.5 cm in shortest dimension (series 8, image 69). A reference right hilar lymph node measures 1.1 cm (series 8, image 107 and). Mild cardiomegaly but no pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.Suboptimal evaluation of the pulmonary arteries. Within these limitations no pulmonary emboli to the lobar level.2.Right upper lobe lesion could represent atypical infection such as fungal pneumonia in the appropriate clinical context however given the extent of lymphadenopathy it is suspicious for malignancy. Recommend follow-up chest CT in 6 weeks. If there is a low suspicion for infection, further assessment may be made with PET and/ or tissue and cultures.3.Mediastinal and hilar lymphadenopathy. |
Generate impression based on findings. | 69-year-old female patient with abdominal pain and is unable to tolerate oral. Evaluate for small bowel obstruction. ABDOMEN:LUNG BASES: Trace bilateral dependent atelectasis.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter hypoattenuating, nonenhancing lesion in the intrapolar region of the right kidney is too small to characterize and likely represents a cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Stomach, small bowel and large bowel normal in caliber. Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumbar spine. Vacuum disk phenomenon between L4 and L5 with chronic degenerative changes.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Thickened endometrium, greater than expected in this 69 year old female.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Bowel normal in caliber. Clonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Degenerative changes in the left hip. Multilevel degenerative changes in the thoracic and lumbar spine. Vacuum disk phenomenon between L4 and L5 with chronic degenerative changes.OTHER: No significant abnormality noted | 1.Bowel normal in caliber without evidence of obstruction.2.Thickened endometrium. Suggest further evaluation with gynecologic ultrasound.Findings discussed with Dr. Mo via telephone at 9:27AM on 11/1/2013 by Dr. Stephanie McCann. |
Generate impression based on findings. | Reason: 51 yo male with HOCM and endocarditis with acute onset sob and hypoxia History: sob, hypoxia PULMONARY ARTERIES: Technically adequate examination. No evidence of pulmonary embolism.LUNGS AND PLEURA: Interval increase of bilateral diffuse groundglass opacities. Interval increase in bronchial wall thickening and septal thickening. No significant change in bilateral pleural effusions. Previous area of groundglass opacity overlying the left pleural effusion now appears consolidated/atelectatic. Previous area of consolidation overlying the right pleural effusion with interval improvement. There is fluid tracking into the fissures.MEDIASTINUM AND HILA: Significant left ventricular hypertrophy. The apex of the right ventricle is also hypertrophied and the chamber is small. Although this is not optimized for evaluation of the heart, this is suspicious for a biventricular hypertrophic cardiomyopathy. Left atrial chamber dilation, raising a question of associated mitral regurgitation. Small circumferential left pericardial effusion. Mild coronary artery calcifications. Mild mitral annular calcification. Enlarged mediastinal or hilar lymph nodes are stable in size.CHEST WALL: Mild left axillary lymphadenopathy.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.No evidence of pulmonary embolism.2.Interval increase in bilateral diffuse groundglass opacities, bronchial wall thickening and septal thickening consistent with worsening pulmonary edema.3.Given the history of endocarditis, there are no foci of septic emboli identified. Edema may obscure the identification of septic emboli. If there is high clinical suspicion for septic emboli, consider repeat imaging after diuresis.4.No significant change in bilateral pleural effusions with subsegmental basilar consolidation/atelectasis.5.Significant left ventricular hypertrophy and right ventricular apical hypertrophy suspicious for biventricular hypertrophic cardiomyopathy. Cardiac MRI is recommended for further evaluation. |
Generate impression based on findings. | Abdominal pain in the left lower quadrant. Assess for diverticulitis. Bloating. ABDOMEN:LUNG BASES: Minimal subsegmental atelectasis or scarring at the lung bases.LIVER, BILIARY TRACT: Trace perihepatic ascites. Cirrhotic appearing liver. Portal vein is patent.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Left para-aortic lymph node measures 1.5 x 0.9 cm (image 50)BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: There is peritoneal carcinomatosis. For reference purposes, implant in the left upper quadrant measures 3.1 x 5.1 cm (image 50; series 3).PELVIS: Views of the lower pelvis are obscured by streak artifact from hip replacements.UTERUS, ADNEXA: Difficult to assess secondary to carcinomatosis and streak artifact in the pelvis.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Peritoneal carcinomatosis. | Peritoneal carcinomatosis; ovarian carcinoma would be the diagnosis of exclusion although views of the pelvis are limited secondary to streak artifact from the patient's hip replacements. Cirrhosis. Ascites.Findings were communicated by telephone to Dr. Harper's nurse (2-1217)at the time of dictation.PWR |
Generate impression based on findings. | Male, 75 years old, ataxia, unspecified fall, evaluate for stroke. Bilateral parietal burr holes are again seen. No calvarial fracture is demonstrated.Periventricular hypoattenuation has progressed, a nonspecific finding most likely representing age indeterminate small vessel ischemic disease. No CT evidence of acute territorial ischemia is demonstrated. No intracranial hemorrhage or abnormal extra-axial fluid collection is seen. There is no evidence of mass effect or midline shift. The ventricles and basal cisterns are patent and normal in size. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. | 1. Age indeterminate small vessel ischemic disease.2. No acute intracranial abnormality. |
Generate impression based on findings. | Chest pain. Rule out aortic dissection. CHEST:LUNGS AND PLEURA: Mild upper lobe predominant emphysema. New moderate right pleural effusion with multiple pulmonary emboli to both upper lobes.MEDIASTINUM AND HILA: No dissection. Cardiomegaly, and postsurgical changes of CABG. Extensive atherosclerotic disease. Bowing of the interventricular septum and reflux into the hepatic veins may indicate right heart strain or failure. Stable ascending aortic aneurysm. Intraluminal filling defects in the descending thoracic aorta may represent clot or intraluminal webs versus an artifact.CHEST WALL: Sternotomy wires.ABDOMEN: Findings are limited by arterial weighting the study and poor visceral perfusion. LIVER, BILIARY TRACT: Gallbladder edema. Perihepatic ascites.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Striated nephrogram in both kidneys which may reflect underlying shock.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Ascites with small bowel thickening which may reflect nonocclusive mesenteric ischemia given poor perfusion of the kidneys and small size of the superior mesenteric artery. Correlate clinically.BONES, SOFT TISSUES: No significant abnormality.OTHER: Proximal celiac remains occluded and is reconstituted via collaterals.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Pelvic ascites. | Bilateral pulmonary emboli with possible right heart failure. Hypoperfusion of the kidneys and bowel which may reflect underlying shock and nonocclusive mesenteric ischemia. Findings discussed with the clinical service by the radiology resident on-call. |
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