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Generate impression based on findings. | Reason: ? PE. SOB X 2 weeks History: SOB PULMONARY ARTERIES: There are bilateral pulmonary emboli. The largest is on the right, within a branch point of several right upper lobe segmental arteries (series 7 image 101). On the left, a nearly occlusive thrombus occupies a left lower lobe are branch (series 7 image 106). A smaller linear thrombus occupies a left upper segmental pulmonary artery (series 7 image 89).LUNGS AND PLEURA: Several calcified granulomas.Multifocal regions of groundglass with tree in bud opacities in a distribution that is atypical for pulmonary infarct. There is associated mild bronchial wall thickening. In the setting of a hiatal hernia, the appearance is suspicious for a aspiration.MEDIASTINUM AND HILA: Small hiatal hernia.The heart size is normal. The right atrium is normal in size. No pericardial effusion is present. Mild quantity of coronary artery calcification noted in the proximal LAD and circumflex coronary arteries. A small amount of calcification is noted at the aortic valve.No mediastinal or hilar lymphadenopathy. The main pulmonary artery is mildly enlarged, 33 mm transverse. This is increased from 30 mm from 2006.CHEST WALL: Right port terminates at the superior caval atrial junction.Extensive degenerative changes of the thoracic vertebral bodies.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Stable hypodensity within the left hepatic lobe (series 7 image 227) which likely represents a cyst, less likely hemangioma. Several calcified splenic granulomata. Right Bochdalek hernia. | 1.Bilateral pulmonary emboli, as described above.2.Diffuse groundglass with tree in the opacities and mild bronchial wall thickening suspicious for aspiration. No specific evidence of pulmonary infarct. |
Generate impression based on findings. | 31-year-old male patient. Assess for potential primary tumor. Note that the lack of intravenous contrast limits evaluation of vasculature, lymph nodes and solid viscera.ABDOMEN:LUNG BASES: Small left pleural effusion. Moderate right pleural effusion with associated 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: 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: Ascites in the lower abdomen and pelvis.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Ascites in the lower abdomen and pelvis. | 1.Small amount of ascites in the lower abdomen and pelvis of unclear etiology.2.Bilateral pleural effusions. |
Generate impression based on findings. | Female, 73 years old, dizziness and gait instability. The cerebral and cerebellar hemispheres and brainstem are normal in attenuation and morphology. No intracranial hemorrhage or abnormal extra-axial fluid collection is seen. There is no evidence of mass effect or midline shift. The ventricles and basal cisterns are patent and normal in size. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.The bones of the calvarium and skull base are intact. | Unremarkable evaluation with no specific findings to account for the patient's symptoms. |
Generate impression based on findings. | Female, 50 years old, status post fall, evaluate for bleed, C-spine tenderness. CT head:The cerebral and cerebellar hemispheres and brainstem are normal in attenuation and morphology. No intracranial hemorrhage or abnormal extra-axial fluid collection is seen. There is no evidence of mass effect or midline shift. The ventricles and basal cisterns are patent and normal in size. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.The bones of the calvarium and skull base are intact. CT cervical spine:Straightening of the cervical lordosis may be positional. No acute malalignment is detected. Vertebral body heights are preserved. No fractures are seen.Motion artifact obscures the C3-4 level to some degree. There is loss of disk height at this level as well as at C5-6 and C6-7. Posterior disk-osteophyte complexes are present at least at C3-4 and C6-7. No compromise of the bony spinal canal is seen. There is moderate narrowing of the left neural foramen at C3-4.Incidental note is made of a 1.4 x 1.0-cm soft tissue nodule which sits adjacent to the inferior pole of the left thyroid lobe. This finding has not changed compared to prior chest CT. | 1. No acute intracranial abnormality.2. No definite cervical spine fracture or acute malalignment is seen, though image quality is slightly degraded by motion artifact.3. Incidentally noted soft tissue nodule at the inferior pole of the left thyroid lobe, unchanged and of uncertain significance. This may represent a lymph node or a nodule arising from the thyroid itself. Further evaluation with ultrasound can be considered if clinically warranted. |
Generate impression based on findings. | 67-year-old female patient with neutropenia and bacteremia. Assess for source of infection and septic emboli from central venous catheter. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Right chest wall port with catheter tip at the cavoatrial junction.ABDOMEN:LIVER, BILIARY TRACT: Few punctate calcifications in the liver likely represent granulomas.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left extrarenal pelvis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumbar spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Atrophic or absent uterus.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Left hip arthroplasty. Multilevel degenerative changes in the thoracic and lumbar spine.OTHER: No significant abnormality noted. | 1.No acute intra-abdominal abnormalities.2.No evidence of septic emboli in the lungs. |
Generate impression based on findings. | Valuate for malignancy. Penile bleeding, decreased appetite and weight loss. Elevated PSA level. ABDOMEN:LUNG BASES: Subsegmental atelectasis versus scarring at both lung bases. Coronary artery calcifications. 5-mm nodule at the lateral right lung base (image 5; series 6); consider CT follow-up in 6 to 12 months as clinically indicated.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Calcified splenic granulomas.PANCREAS: 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: Degenerative changes throughout the spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Relatively small prostate for age with numerous calcifications.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 | 5 mm pulmonary nodule at the right lung base; consider 6 to 12 month follow up CT. No definite evidence of malignancy in the abdomen or pelvis. |
Generate impression based on findings. | Evaluate for pancreatitis or acute cholecystitis. ABDOMEN:LUNG BASES: Mobile at the right lung base. Equivocal edema.LIVER, BILIARY TRACT: A fatty infiltration of the liver without focal abnormality.SPLEEN: No significant abnormality notedPANCREAS: Pancreas is edematous with a small amount of peripancreatic fluid and inflammation compatible with acute pancreatitis. Subcentimeter hypodense nodule in the uncinate process may represent a cyst/pseudocyst versus a small IPMN. Several even smaller hypodense nodule is noted in the body and tail. These can be followed. ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: This fluid density structures in the region of vagina may represent nabothian or Bartholin's cysts. Correlate with direct physical examination. BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Compression of the left common iliac vein by the right common iliac artery is compatible with May-Thurner syndrome. If the patient has symptoms related to this (left leg swelling with exercise or prolonged standing) consider IR stent placement. This anatomic variant also predisposes to increased risk of left-sided DVT. | Acute pancreatitis without evidence of pancreatic necrosis. May-Thurner syndrome. Fatty liver. |
Generate impression based on findings. | Mixed hearing loss in bilateral ears, left worse than right, with visible left attic cholesteatoma. On the left, there is thickening of the tympanic membrane. There is a sphenoid opacity that measures approximately 5 mm in diameter opacity along the medial aspect of pars flaccida with associated blunting of the scutum. There is also an opacity within the anterior epitympanum that appears to be associated with scalloping of the anterior wall of the epitympanum and irregularity of the head of the incus. In addition, there is a globular calcification occupying much of the epitympanic recess, which appears to contact the head of the malleus. The facial nerve describes a normal course, although there is probable dehiscence along the tympanic segment. The mastoid air cells are severely underpneumatized with only pneumatization of the aditus ad antrum. The inner ear structures are intact, without evidence of semicircular canal dehiscence. There appears to be an anomalous channel along the anterior wall of the medial external auditory canal and middle cranial fossa, which may be venous in nature.On the right, there is thickening of the pars tensa portion of the tympanic membrane, but there is an apparent defect in the pars flaccida. There is opacification of Prussak's space with blunting of the scutum. There is also opacification within the mesotympanum surrounding the stapes superstructure and anterior epitympanum surrounding the head of the incus, as well as thinning and perhaps dehiscence of the overlying tegmen tympani. The ossicles are intact. The mastoid air cells are severely underpneumatized with only pneumatization of the aditus ad antrum. The facial nerve describes a normal course, although there is probable dehiscence along the tympanic segment. The inner ear structures are intact, without evidence of semicircular canal dehiscence. | 1. Findings of long-standing otomastoiditis with evidence of cholesteatoma formation in the bilateral middle ears, as described in the findings section. In particular, there are findings compatible with bilateral Prussak space and attic cholesteatomas and possible associated dehiscence of the right tegmen tympani for which a small associated encephalocele cannot be excluded. Further evaluation via high-resolution temporal bone MRI with diffusion weighted imaging may be useful for further characterization.2. A globular calcification within the left epitympanic recess appears to contact the head of the malleus is likely a manifestation of tympanosclerosis and may be associated with malleus fixation. |
Generate impression based on findings. | Injury, possible choking. Evaluation of retropharyngeal abscess. LUNGS AND PLEURA: Small anterior right pneumothorax. Right lung apicoposterior and posterior basilar opacities likely represent aspiration and atelectasis. No pleural effusions.MEDIASTINUM AND HILA: Normal sized heart without pericardial effusion. No mediastinal or hilar lymphadenopathy. No midline shift.CHEST WALL: ET tube tip above the thoracic inlet. Small foci of subcutaneous air anterior to the ET tube at the level of the clavicles/1st ribs. Small foci retropharyngeal air at the level of C6/C7. Right-sided chest tube kinked with tip in the chest wall soft tissues, lateral to the pleural space. The examination suffered from motion artifact and within this limitation no definite rib fracture.UPPER ABDOMEN: Normal appearance of the upper abdomen | 1. Small right pneumothorax. Right chest tube tip in the chest wall soft tissues.2. Subcutaneous and retropharyngeal air about the trachea, as described above. |
Generate impression based on findings. | Abdominal pain and distention. Metastatic melanoma. ABDOMEN:LUNG BASES: Numerous metastases which appear stable. Enlarging left pleural effusion.LIVER, BILIARY TRACT: Hepatic metastases are unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Air described previously within the collecting system and ureter of the left kidney has resolved. Mild left-sided hydronephrosis is unchanged.RETROPERITONEUM, LYMPH NODES: Retroperitoneal adenopathy is unchanged.BOWEL, MESENTERY: Extensive peritoneal carcinomatosis, stable. No evidence of small bowel obstruction. BONES, SOFT TISSUES: Index posterior subcutaneous soft tissue nodule is unchanged.OTHER: Increasing ascites.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Suprapubic Foley catheter to terminate within the ileal pouch, stable.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small amount of ascites, unchanged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Extensive metastatic disease. Increasing left pleural effusion and abdominal and pelvic ascites. Other index lesions appear stable. |
Generate impression based on findings. | 57 year-old male with hemorrhage and hemiparesis. Right basal ganglia/thalamic hematoma is unchanged in size and extent. The degree of surrounding parenchyma edema has also not substantially changed.There remains a small amount of blood at the level of the foramina of Monro and within the third and lateral ventricles, unchanged. Blood product continues to be evident within the cerebral aqueduct and filling the fourth ventricle. Also unchanged is a small amount of subarachnoid blood product in the occipital region and posterior interhemispheric fissure and right tentorium. Caliber of the ventricles remains mildly enlarged but not significantly changed from prior. Right frontal approach the shunt catheter remains in stable position just anterior to the level of the foramina of Monro. No brain herniation is evident. | 1. Stable right basal ganglia/thalamic parenchymal hemorrhage.2. Persistent intraventricular hemorrhage with stable mild ventriculomegaly.3. Stable posterior interhemispheric fissure and right tentorium hemorrhage. 4. No definite evidence of new hemorrhage. |
Generate impression based on findings. | Evaluate for intra-abdominal infection. Abdominal pain in the right lower quadrant. ABDOMEN:LUNG BASES: Minimal subsegmental atelectasis at the left lung base.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: Small amount of fluid in the cecum and ascending colon may represent mild gastroenteritis or focal ileus. Appendix appears normal.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Uterus is enlarged and heterogeneous which reflect underlying fibroids but is nonspecific. Correlate with gynecologic ultrasound as clinically indicated.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 | Possible gastroenteritis. No evidence of appendicitis. Subsegmental atelectasis at the left lung base. |
Generate impression based on findings. | 37-year-old female patient with right upper quadrant pain, unclear etiology. Abdominal ultrasound suggestive of nephrolithiasis. Elevate for nephrolithiasis. Note that the lack of intravenous contrast limits evaluation of vasculature, lymph nodes 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: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis, hydroureter or renal calculi.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Bowel is normal in caliber. Appendix is well visualized and within normal limits. BONES, SOFT TISSUES: Mild multilevel degenerative changes in the thoracic and lumbar spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA:No significant abnormality noted.BLADDER: No bladder calculi.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild multilevel degenerative changes in the thoracic and lumbar spine.OTHER: No significant abnormality noted. | No hydronephrosis or renal calculi. |
Generate impression based on findings. | 83 year-old woman with pelvic fracture. Concern for persistent pelvic hematoma or bleed. Please evaluate. ABDOMEN:LUNG BASES: Slight interval enlargement of right and left pleural effusions. Overlying compressive atelectasis is noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Nonspecific, bilaterally renal lesions are incompletely evaluated on this study, some of which are hyperdense.RETROPERITONEUM, LYMPH NODES: High density density tracking along the posterior pararenal space consistent with hemorrhage.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Moderate degenerative change of the thoracolumbar spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Multiple pelvic hematomas are again demonstrated and appear similar to minimally increased in size compared to prior. For example, a right anterior collection currently measures 6.5 x 5.8 cm (image 123; series 80290) and previously measured 5.8 x 6.3 cm. If an underlying vascular injury suspected (e.g., traumatic pseudoaneurysm), a contrast enhanced study would be required to detect the anomaly.BONES, SOFT TISSUES: Comminuted, mildly displaced fracture of the right superior and inferior pubic rami. Left hip total arthroplasty. Moderate degenerative changes of the lumbar spine.OTHER: No significant abnormality noted. | 1. Comminuted mildly displaced right pubic rami fractures unchanged.2. Pelvic hematomas appear similar in size to minimally larger. 3. Bilateral renal cysts, some of which do not meet the criteria for simple cysts, are incompletely evaluated on this study and described in detail previously.4. Slight interval enlargement of bilateral pleural effusions. |
Generate impression based on findings. | Male 75 years old Reason: evaluate for fracture History: pain, fall, neg OSH xray No fracture is evident and the bony alignment is within normal limits. Mild osteoarthritis affects the glenohumeral and acromioclavicular joints, and no frank joint effusion is evident. The rotator cuff musculature appears slightly atrophic, but we cannot confirm or exclude a rotator cuff tear on the basis of this study. There is no large hematoma. Mild chronic interstitial disease affects the lung bases and there are scattered calcified and noncalcified nodules, which likely reflect chronic granulomatous disease. | Degenerative changes as described above, but no fracture is evident. |
Generate impression based on findings. | 49 year-old male with lytic lesion seen on the prior CT. There is a small area of encephalomalacia in the right parietal cortex. There is a focus of hypoattenuation in the right caudate head, consistent with a chronic lacunar infarct. The ventricles, sulci, and cisterns are symmetric and diffusely prominent, consistent with moderate cerebral and cerebellar volume loss. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. There multiple foci of lucency in the calvarium and clivus, unchanged. The paranasal sinuses are clear. The mastoid air cells are opacified. | 1. Stable intracranial findings. 2. Stable multiple lytic lesions in the calvarium, which are nonspecific and can be seen in multiple myeloma, lytic metastases, hyperparathyroidism and hemangiomas. |
Generate impression based on findings. | Male 53 years old; Reason: lung Ca, no known abdominal involvement. Intermittent abdominal pain and distention, and mesenteric panniculitis possibly found on prior CT's. Eval for mesenteric abnormality, other. History: intermittent abdominal pain and distention ABDOMEN:LUNGS BASES: There is interval resolution of the left pleural effusion. Nodularity along the left inferior pleura is noted and slightly worse. No definite nodule or mass detected.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic right kidney. Nonobstructing calculus left kidney.PANCREAS: Stable pancreatic calcifications.RETROPERITONEUM, LYMPH NODES: Portacaval node now 14 mm, previously 15, series 4 image 42.BOWEL, MESENTERY: Increasing inflammatory process that affects the pancreatic head/duodenal sweep, and should be further evaluated with upper endoscopy. Mild increase in opacity in the mesentery is stable, unknown significance. 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 evident metastatic disease in the abdomen or pelvis.2.Stable pulmonary findings on this limited view of the lung bases.3.Increasing inflammatory process that affects the pancreatic head/duodenal sweep, and should be further evaluated with upper endoscopy. |
Generate impression based on findings. | End-stage renal disease on peritoneal dialysis. Abdominal pain. Peritoneal fluid. Rule-out intra-abdominal process. The following observations are made given the limitations of an unenhanced study.ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Endstage kidneys.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Peritoneal dialysis catheter coiled in the right lower quadrant. A small amount of free air.PELVIS:UTERUS, ADNEXA: Intrauterine device.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Approximately 1 cm vulvar skin nodule; consider sebaceous cyst correlate with direct physical exam as clinically indicated. | Small amount of free air which may reflect recent peritoneal dialysis catheter intervention. No intra-abdominal fluid collection. Endstage kidneys. |
Generate impression based on findings. | Recent intra-abdominal infected fluid collection. Status post drain removal with recent fever. Evaluate for recurrent collection. ABDOMEN:LUNG BASES: Subsegmental atelectasis at the left lung base. 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: Mushroom retained jejunostomy catheter. Appendix remains enlarged and mildly inflamed. No evidence of recurrent or residual periappendiceal fluid collection.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 | Appendix remains enlarged and inflamed but there is no evidence of a recurrent or residual periappendiceal fluid collection. |
Generate impression based on findings. | Male 59 years old; Reason: CRC history Stage II resected 2/2011. Restaging CT surveillance. History: none CHEST:LUNGS AND PLEURA: Right middle lobe granulomata. No dominant lung lesion. The pleural spaces are clear. MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. No mediastinal lymphadenopathy. Calcified right hilar lymph nodes.CHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: Mild fatty infiltration of the liver. Left hepatic lobe hemangioma, unchanged in size.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Interval resolution of the right-sided renal and ureteral stones with normal appearing nephrogram and resolution of the hydronephrosis. No residual stones, masses, or delayed enhancement detected. Very mild residual hydronephrosis of the right kidney is noted.Stable non obstructive nephroliths in the left kidney.Stable bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: Calcific arteriosclerotic disease of the aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postoperative changes in the anterior abdominal wall with small omental hernia, stable.OTHER: No significant abnormality notedPELVIS: Streak artifact from the right hip prosthesis limits evaluation of the pelvis.PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Coloanal anastomosis. Post operative changes in the rectumBONES, SOFT TISSUES: Interval right hip prosthesis. Moderate to severe degenerative changes of the left hip.OTHER: No significant abnormality noted | 1.Stable exam without evidence of metastatic disease. 2.Interval resolution of the right ureteral stone. |
Generate impression based on findings. | Male 48 years old; Reason: Pre-renal transplant; assess calcification in the iliac vessels History: ESRD on dialysis ABDOMEN: The absence of intravenous and oral contrast limits evaluation of the solid organs and of the bowels. Given its, the following observations were made:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Numerous low attenuating lesions in the liver, represent cysts. Patient is status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Nodularity of the bilateral adrenal glands, nonspecific.KIDNEYS, URETERS: The kidneys are markedly atrophic bilaterally, with numerous lesions, some of which are cysts, some are hyperattenuating and incompletely characterized given lack of IV contrast. Shrunken calcified mass in the right lower quadrant along the right iliac artery likely represents a prior transplanted kidney.RETROPERITONEUM, LYMPH NODES: Mild calcifications of the abdominal aorta are noted. Approximately 180 degree posterior medial calcifications are seen in the right common iliac artery. The left common, internal, and external iliac arteries all demonstrate mild (approximately 90 degree) complications.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic bones are likely secondary to renal osteodystrophyOTHER: 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: Sclerotic bones are likely secondary to renal osteodystrophyOTHER: No significant abnormality noted. | 1.End stage renal failure with shrunken calcified prior renal transplant and calcifications of the vessels as described above. |
Generate impression based on findings. | 65-year-old female with history of subdural hemorrhage evacuation. Redemonstration of two right parietal burr holes. Similar to the prior, catheter courses through the more anterior of these burr holes and resides within the right subdural space, unchanged.Interval decrease in right pneumocephalus with interval increase in rightward brain reexpansion. A small mixed density fluid collection is again identified in the right subdural space. Hemorrhage again layers along the posterior interhemispheric falx and along the tentorium. Interval decrease in leftward midline shift which now measures up to 4 mm, previously measured 6 mm. Basal cisterns are patent.Subtle hypoattenuation in the right corona radiata adjacent to the caudate head, unchanged. | Postsurgical changes of a right subdural hematoma evacuation with decreasing mass effect and improving midline shift. |
Generate impression based on findings. | Female, 76 years old, history of an external auditory canal lesion on the right which on pathology was a paraganglioma. Head:The cerebral and cerebellar hemispheres and brainstem are normal in attenuation and morphology. No pathologic parenchymal or extra-axial enhancement is seen.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. Neck:There is mild soft tissue thickening along the periphery of the right external auditory canal. The right middle ear cavity and mastoid air cells are completely opacified. The nature of this tissue cannot be accurately assessed on CT.Asymmetric effacement of the left fossa of Rosenmueller is noted. This may represent anatomic asymmetry or trapped secretions. No definite mass lesions are seen. The left middle ear cavity and mastoid air cells are normally aerated.Bilateral tonsilliths are present in the palatine tonsils. The aerodigestive tract is otherwise within normal limits. No pathologic adenopathy is seen by size criteria.The parotid glands are unremarkable. The right submandibular gland is smaller than the left but this may be normal variation. There is a well-circumscribed 8-mm hypodense focus within the left thyroid lobe, and a much smaller focus in the right. These are nonspecific.Substantial calcified and noncalcified atherosclerotic disease is evident at the level of the carotid bifurcations. The proximal ICAs are narrowed, but the vessels do remain patent. The left IJ vein is small and not discretely seen throughout the neck, likely a congenital finding given the small size of the bony jugular fossa.Severe emphysema is present in the lung apices. The cervical lordosis and thoracic kyphosis are exaggerated in addition to the presence of a scoliotic curvature. The bone mineral characteristics are heterogeneous. There are scattered bony lucencies in the vertebral bodies which, due to their nonaggressive features and location adjacent to endplates, are suggestive of degenerative change. | 1. Mild peripheral soft tissue thickening along the right external auditory canal. Complete opacification of the right middle ear cavity and mastoid air cells. The nature of these findings cannot be accurately assessed on CT. IAC protocol MRI with contrast may provide more information.2. Asymmetric effacement of the left fossa of Rosenmuller is demonstrated. This can be a normal variation or may reflect trapped secretions. The middle ear cavity remains well pneumatized suggesting patency of the eustachian tube. As such, concern is low, but direct visualization may be considered as clinically warranted.3. No evidence of pathologic adenopathy in the neck.4. No specific intracranial abnormalities. |
Generate impression based on findings. | 51-year-old female patient with nausea, vomiting and lactate of 12. Evaluate for intra-abdominal pathology. ABDOMEN:LUNG BASES: Bilateral dependent atelectasis.LIVER, BILIARY TRACT: Hypoattenuating lesion adjacent to the middle portal vein (series 3 image 35) is too small to characterize.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Minimal fat stranding along the lateral left kidney. Exophytic, hypoattenuating subcentimeter lesion in the intrapolar region of the left kidney is too small to characterize and likely represents a cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small hiatal hernia. Mildly dilated loops of jejunum in the left hemiabdomen (coronal series 80240 image 57). No associated wall thickening or free fluid. There appears to be a transition point in the mid lower abdomen with nondilated small bowel distally (coronal series 80240 image 50).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Calcified lesion in the uterus, consistent with uterine fibroid.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes in the thoracic and lumbar spine with L1 vertebral body height loss, stable compared to prior examination.OTHER: No significant abnormality noted. | Mildly dilated loops of jejunum with collapsed small bowel distally suggestive of partial small bowel obstruction. |
Generate impression based on findings. | 55-year-old male with SIADH, assessment of cerebral edema Redemonstration of postsurgical changes of a large right hemispheric MCA territory ischemic stroke. Trace leftward midline shift, unchanged. No significant interval change in the size of the supratentorial ventricular system. Subtle ex vacuo dilatation of the right lateral ventricle. Bulge of the right hemisphere through a large right-sided craniectomy defect is similar in extent to the prior.Redemonstration of linear and punctate increased densities involving the cortex of the right hemispheric stroke which likely represent mineralization/petechial hemorrhage. Hypoattenuation within the right basal ganglia, unchanged.Opacification of the right mastoid air cells. Left sphenoid sinus mucus retention cyst. Right staphyloma. | No significant interval change in trace leftward midline shift and appearance of the ventricular system. |
Generate impression based on findings. | Evaluate for obstruction or colitis. Nausea and vomiting ABDOMEN:LUNG BASES: Small bulla at the right lung base. No effusions. Motion artifact.LIVER, BILIARY TRACT: Unchanged hypodense nodule in segment 7. Additional smaller near anechoic nodules in the liver are also stable.SPLEEN: Hypodense nodule the spleen described on prior chest CT is unchanged.PANCREAS: 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 | No specific abnormalities on CT to account for the patient's symptoms. |
Generate impression based on findings. | 64 year old female with history of head and neck cancer, neoplasm of the larynx, status post chemo radiation therapy, reevaluate Limited intracranial views and views of the orbits are unremarkable. Right maxillary mucous retention cyst. The mastoid air cells are clear.Post therapy changes include edema of the pharyngeal mucosal space. Similar to the prior, the left arytenoid cricoid cartilage remain partially eroded and sclerotic. Slight mucosal irregularity of the left vocal cord. A measurable mass is no longer identified in this location.No evidence of cervical lymphadenopathy by CT size criteria. The submandibular and parotid glands are free of focal lesions. The thyroid gland is unremarkable. Nodule posterior to the left lobe of the thyroid measures 7 x 6 mm (series 7 image 57), previously measured 7 x 9 mm.No soft tissue masses are identified in the neck. The airway remains patent. The cervical vasculature remains patent.No suspicious osseous lesions are identified. Redemonstration of multilevel degenerative changes of the visualized cervicothoracic spine including endplate and uncovertebral osteophyte formation.The lung apices are unremarkable. Partially visualized right chest port catheter. | 1. Mild mucosal irregularity of the left vocal fold without discrete identification of a measurable mass at this location. Redemonstration of distortion of the left cricoid cartilage and arytenoid cartilage again suggestive of invasion.2. No CT evidence of lymphadenopathy by size criteria. |
Generate impression based on findings. | 63-year-old female patient with likely pancreaticobiliary malignancy presents with ascites, nausea and vomiting. Evaluate for cause of SBO and primary malignancy of unknown etiology. CHEST:LUNGS AND PLEURA: Bilateral moderate pleural effusions, left greater than right.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Heterogeneous, ill-defined bladder fundus wall (series 10 image 113 and coronal series 80992 image 74). There is potential invasion of the liver, which is poorly demonstrated.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right inferior pole nonobstructing renal calculus.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Enteric tube with tip in distal stomach.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumbar spine.OTHER: Redemonstrated are multiple loculated fluid collections and nodularity in the omentum and mesentery, consistent with metastatic disease and mildly increased since prior examination. Free fluid in the pelvis.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: Redemonstrated are multiple loculated fluid collections and nodularity in the omentum and mesentery, consistent with metastatic disease and mildly increased since prior examination. Free fluid in the pelvis. | 1.Ill-defined gallbladder fundus wall with equivocal invasion into the liver parenchyma. This region is poorly demonstrated on this examination secondary to patient motion and large body habitus.2.Redemonstration of multiple loculated fluid collections and nodularity in the omentum and mesentery, consistent with known metastatic disease. |
Generate impression based on findings. | Male, 90 years old, orthostatic generalized weakness. Moderately advanced periventricular hypoattenuation is a non-specific finding which most commonly represents age-indeterminate small vessel ischemic disease.No intracranial hemorrhage or abnormal extra-axial fluid collection is seen. There is no evidence of mass effect or midline shift. Ventricles and sulci are prominent but within acceptable limits for age. Intracranial vascular calcifications are noted.The visualized paranasal sinuses and mastoid air cells are normally pneumatized with the exception of a small mucous retention cyst or polyp in the left maxillary sinus.The bones of the calvarium and skull base are intact. | No acute intracranial abnormalities. |
Generate impression based on findings. | 55 year old male with prostate cancer, rising PSA. Please evaluate. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Coronary artery calcifications.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Enlarged left adrenal is unchanged measuring 3.9 x 1.7 cm (image 95; series 3).KIDNEYS, URETERS: Small bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: Borderline enlarged retrocaval node measures 1.2 x 1.1 cm (image 130; series 3), unchanged. This previously measured 1.2 x 1.0 cm (image 131; series 3; 2/1/2013 study).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes in the lumbosacral spine and pelvis.OTHER: No significant abnormality noted | Enlarged left adrenal. Status post prostatectomy. Borderline enlarged retroperitoneal nodes probably haven't changed substantially since the prior exam. |
Generate impression based on findings. | 52-year-old male with malignant neoplasm anterior two thirds of the time, status post chemoradiation therapy, evaluate Limited intracranial views are unremarkable. Limited views of the orbits are unremarkable. Partial opacification of the left posterior ethmoid air cells and maxillary sinuses. The mastoid air cells are clear.Redemonstration of postsurgical changes including right partial glossectomy and obscuration of neck planes secondary to prior neck/lymph node dissection. On this background, there is no exophytic mass or focal area of effacement in the aerodigestive tract.No enlarged lymph nodes by CT criteria. The bilateral submandibular glands have been resected. Remaining salivary glands are unremarkable. The thyroid gland is within normal limits. The cervical vasculature is patent. Minimal right carotid bifurcation calcification. No suspicious osseous lesions identified. Mild multilevel degenerative changes.The lung apices are clear. Please see dedicated chest CT for further details. | Stable postsurgical/post treatment changes without evidence of cervical lymphadenopathy or recurrent neck mass. |
Generate impression based on findings. | Male 19 years old; Reason: diffuse lymphadenopathy History: diffuse lymphadenopathy. LUNGS AND PLEURA: Scattered micronodules bilaterally. No focal pulmonary opacities or pleural effusions.MEDIASTINUM AND HILA: Scattered nonenlarged mediastinal and hilar lymph nodes. No cardiomegaly or 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. | No findings to indicate lymphadenopathy, likely resolved. |
Generate impression based on findings. | Reason: h/o HNC, s/p CRT, compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: Benign-appearing pulmonary micronodules are stable.Mild dependent linear atelectasis is present.There is no evidence of pulmonary or pleural metastases.MEDIASTINUM AND HILA: There is no mediastinal or hilar lymphadenopathy.Mild coronary artery calcifications are present in the LAD distribution.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No sign of metastases, or other significant abnormality. |
Generate impression based on findings. | 59-year-old male patient with metastatic non-small cell lung cancer presents with bacteroides bacteremia of unclear source. Acute bilateral lower quadrant abdominal pain. Evaluate for infectious source in the abdomen. CHEST:LUNGS AND PLEURA: Marked interval progression of lung lesions with numerous new sites of disease in bilateral lungs.Left upper lobe mass measures 6.3 x 5.3 cm (series 6 image 29), previously 4.8 x 5.8 cm. This tumor invades and obliterates the left upper lobe branches of the pulmonary artery.Right upper lobe mass measures 9.2 x 6 .0 cm (series 6 image 36), previously 5.9 x 5.5 cm.MEDIASTINUM AND HILA: Reference subcarinal lymph node measures 1.4 cm (series 4 image 50), previously 1.5 cm.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Interval increase in reference hypoattenuating liver lesion in the left lobe that currently measures 6.3 x 6.4 cm (series 4 image 118), previously 2.8 x 2.8 cm. Numerous new hypoattenuating lesions in the liver parenchyma.SPLEEN: Hypoattenuating lesion, consistent with metastatic disease.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Redemonstration of left adrenal lesion, stable.KIDNEYS, URETERS: Multiple hypoattenuating lesions in bilateral kidneys, consistent with metastatic disease.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Multiple metastases in the bowel and mesentery. Associated bowel thickening and aneurysmal dilatation of loops of small bowel, more pronounced in the left hemiabdomen. No evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate abdominal and pelvic fluid.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Multiple metastases in the bowel and mesentery. Associated bowel thickening and aneurysmal dilatation of loops of small bowel, more pronounced in the left hemiabdomen. No evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate abdominal and pelvic fluid. | 1.Marked progression of metastatic disease in the chest, abdomen and pelvis.2.Metastatic disease to bowel and mesentery with aneurysmal dilatation of loops of small bowel. No evidence of obstruction.3.Moderate abdominal and pelvic fluid. |
Generate impression based on findings. | Reason: ho hnc, s/p crt, compare to previous measurements pls History: none CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Mild to moderate coronary calcifications are present.There is no evidence of mediastinal or hilar lymphadenopathy.CHEST WALL: Degenerative abnormalities affect the thoracic spine. Right chest wall port time of the jugular catheter terminating in the SVC.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Multiple hepatic cysts like hypodensities are unchanged.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Stable left adrenal lesion.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No evidence for metastases, or other significant abnormality. |
Generate impression based on findings. | 68-year-old male with rectal cancer follow-up. Stage II colorectal cancer. Routine surveillance. CHEST:LUNGS AND PLEURA: Centrilobular emphysema. Scarring/atelectasis in the left lung base.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Hypodense nodule in the right lobe of the thyroid described previously is poorly seen on today's exam. CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions.SPLEEN: No significant abnormality notedPANCREAS: Punctate focus of calcification within the pancreatic tail is unchanged.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: Small periaortic lymph nodes are stable. Unchanged atherosclerotic calcification of the aorta.BOWEL, MESENTERY: Reference mesenteric lymph node has resolved. Postoperative changes of a colonic resection and ileocolonic anastomosis. No evidence of bowel obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Enlarging soft tissue in the region of the right paracolic gutter (image 152; series 3) which measures 1.3 x 1.2 cm. In retrospect, there may have been a subcentimeter nodule in this location on the prior exam but this was indistinguishable from adjacent bowel and vascular structures. This presumably represents a metastatic implant.PELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate.BLADDER: No significant abnormality notedLYMPH NODES: Left common iliac lymph node (image 159; series 3) measures 1 x 1 cm and is unchanged from prior (image 154; series 3; 8/15/2001 study).BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Presumed metastatic implant in the region of the right paracolic gutter as described. Findings discussed with Dr. Catenacci at the time of dictation. |
Generate impression based on findings. | Male 66 years old; Reason: mets lung cancer, s/p resection for early lung cancer in the past. S/p cycle 16 of Nivolumab, pls c/w previous study and evaluate tx response. History: lung cancer. LUNGS AND PLEURA: Again seen are postoperative changes involving the left lung with a small amount of thickening involving the suture line (series 5, image 44) not significantly changed. Emphysema redemonstrated. Scattered punctate calcified and noncalcified micronodules are stable. No new suspicious pulmonary nodules.MEDIASTINUM AND HILA: Reference right lower paratracheal lymph node measures 0.7 cm (series 4, image 32), previously 0.9 cm. Reference subcarinal lymph node measures 1.6 cm (series 4, image 47), previously 2.2 cm. Right supraclavicular soft tissue density measures 1.5 x 1.8 cm (series 4, image 6), previously 1.6 x 2.1 centimeters and is therefore slightly smaller. Atherosclerotic calcification of the aorta and its branches as well as coronary artery calcification. Heart size is normal. Trace pericardial effusion, unchanged. Moderate coronary artery and thoracic aortic calcification.CHEST WALL: Degenerative thoracic spine changes and multilevel wedging deformity of multiple thoracic vertebral bodies, unchanged.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Punctate hypodensity in hepatic dome is again too small to characterize but stable and presumably benign.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Left adrenal nodule measures 1.5 x 2.0 centimeters (series 4, image 84), unchanged.KIDNEYS, URETERS: Accessory right renal artery.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: IVC filter. Atherosclerotic calcification of the aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Small fat-containing umbilical hernia unchanged. BONES, SOFT TISSUES: Multilevel degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality noted. | Stable to improved lymphadenopathy. No new suspicious lesions. |
Generate impression based on findings. | 68-year-old female patient with abdominal pain and left lower quadrant pain. Evaluate for etiology. 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: Homogeneously hypoattenuating liver parenchyma, consistent with fatty infiltration. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right superior pole hypoattenuating lesion is unchanged compared to prior and likely represents a cyst.RETROPERITONEUM, LYMPH NODES: Previously identified mesenteric lymph node measures 7 mm (series 3 image 107), previously 8 mm.BOWEL, MESENTERY: Bowel is normal in caliber. Colonic diverticulosis without CT evidence of diverticulitis. No mesenteric fat stranding.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Calcified lesion in uterus most likely uterine fibroid.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumbar spine. L5 vertebral body hemangioma stable compared to prior examination.OTHER: No significant abnormality noted. | Diverticulosis without CT evidence of diverticulitis. Note that early or mild diverticulitis may be occult on CT examination. |
Generate impression based on findings. | 55-year-old male patient. Rectal cancer, recurrent locally. Chemo holiday. CHEST:LUNGS AND PLEURA: Calcified granuloma within the right middle lobe and cluster of nodular opacities within the right lower lobe are stable from the prior exam. Right middle lobe micronodules are unchanged.MEDIASTINUM AND HILA: Calcification within the mediastinum likely representing prior granulomatous disease is unchanged. CHEST WALL: Right chest wall venous access device with catheter tip terminating at the atriocaval junction.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: There is a small splenule. PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Umbilical hernia containing a loop of small bowel without evidence of obstruction. Status post resection of the rectum and a large amount of the colon. Ostomy in the left lower quadrant. Parastomal hernia is unchanged.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: Status post resection of rectum and large portion of the colon.BONES, SOFT TISSUES: No significant abnormality notedOTHER: The previously noted presacral soft density lesions with central hypodensity are redemonstrated. The presacral lesion on the right measures 2.9 x 2.8 cm (image 185; series 3), stable to equivocally larger compared to prior. The presacral lesion on the left measures 2.9 x 2.0 cm (image 185, series 3), is unchanged. Left testicular varicocele. | No substantial interval change. Equivocal enlargement of one of the presacral nodules described previously. Measurements are given above. |
Generate impression based on findings. | Male 61 years old; Reason: prior pna, eval resolution History: pna, septic shock, ards. LUNGS AND PLEURA: Persistent right upper lobe ground glass opacities and adjacent bronchiolectasis consistent with chronic lung changes suspicious for recurrent aspiration. There is diffuse persistent bilateral lower lobe bronchiolar thickening with tree in bud opacities consistent with active bronchiolitis likely related to recurrent aspiration. There has been interval increase in the size of the pleural effusions bilaterally, right greater than left, with associated atelectasis. Interval removal of the right-sided pleural catheter.MEDIASTINUM AND HILA: Multiple subcentimeter size lymph nodes especially noted in the right paratracheal and subcarinal distribution which are unchanged. Right internal jugular central venous catheter tip terminates in the right atrium. Heart size is within normal limits. No pericardial effusion. Severe coronary artery calcifications are again noted. No change in the tracheostomy tube.Fluid and mucus within the left main bronchus consistent with aspirated secretions.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Status post liver transplant with multiple hilar surgical clips and extrahepatic biliary stent. There has been interval development of ascites. The spleen is enlarged but unchanged.Mild body wall edema. Gynecomastia. | 1.Interval increase in the size of the pleural effusions, right greater than left.2.Bilateral lower lobe ground glass and tree in bud opacities consistent with bronchiolitis. Fluid and mucus in the left main bronchus. Persistence of the right upper lobe ground glass opacities with bronchiolectasis suggestive of recurrent aspiration.3.Stable mediastinal lymphadenopathy.4.Status post liver transplant with interval development of ascites. |
Generate impression based on findings. | Female, 58 years old, breast cancer, growing right supraclavicular mass, evaluate for recurrence. A large enhancing mass is evident within the right supraclavicular fossa measuring 4.6 x 3.8 cm transaxial (image 38 series 7) and 5.0 cm in the coronal plane (image 32 series 80646). It is likely that this lesion developed from a subcentimeter nodule in the supraclavicular fossa seen on the prior neck CT from 2012. This lesion is partially visualized on a more recent chest CT as well.Adjacent to the dominant mass there are a few scattered smaller enhancing nodules as well spanning levels 4, 3 and 2. Bilateral jugulodigastric nodes are again seen. On the right, the node measures 2.2 x 1.2 cm (image 23 series 7), previously 1.7 x 0.9 cm. The left jugulodigastric node has not significantly changed in size.The palatine tonsils and lingual tonsillar tissues remain markedly prominent, but similar to what was seen previously. The aerodigestive mucosa is otherwise unremarkable.The salivary glands are free of suspicious lesions as is the thyroid. Cervical vessels remain patent.Scarring, fibrosis and reticulation are demonstrated in the lung apices, right side greater than left, similar to prior.No concerning osseous lesions are seen. | Since the prior neck CT from 2012, a large enhancing mass has developed in the right supraclavicular fossa consistent with recurrence of disease. Scattered additional pathologic nodules are also seen spanning levels 2 through 4 on the right, potentially involving the right jugulodigastric node. |
Generate impression based on findings. | Metastatic lung CA (adenocarcinoma) status post chemo and brain RT. doing well. CHEST:LUNGS AND PLEURA: Spiculated mass in the left lower lobe measures 2.3 x 1.6 cm (4/74), previously 2.5 x 1.6 cm.Scattered subs select and groundglass micronodules not significantly changed. Moderate centrilobular emphysema. No pleural fluid or pneumothorax.Questionable new pleural lesion in the deep right costophrenic angle (3/98) versus atelectasis, this can be monitored on subsequent studies.MEDIASTINUM AND HILA: Chest port in the right atrium. Normal heart size. No pericardial fluid. Coronary artery calcifications. Mass at the diaphragmatic hiatus measures 2.2 x 2.2 cm (3/77), present previously in retrospect where it measured 2.3 x 2.3 cm. Small enhancing lymph node adjacent to the GE junction (3/75) is unchanged.Although not significantly enlarged, left hilar, interlobar, inferior lobar and inferior pulmonary ligament lymph nodes remains asymmetrically enlarged compared to the right. The index left hilar lymph node measures 11 x 14 mm (3/50) unchanged. CHEST WALL: Right chest port.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter cortical lesions too small to characterize.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic disease.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No significant change in left lower lobe mass or in reference nodal metastases. Diaphragmatic hiatus mass is unchanged. |
Generate impression based on findings. | Female 46 years old; Reason: 46 year old female with large B cell lymphoma in remission after chemotherapy. Compare to prior scan. History: none CHEST:LUNGS AND PLEURA: Scattered linear and ground glass opacities; atelectasis is favored.MEDIASTINUM AND HILA: Mild cardiomegaly. Engorged pulmonary venous system suggestive of heart failure..CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Normal hepatic contour. Hepatic steatosis is suggested similar to prior study. Status post cholecystectomy. Hepatomegaly with liver measuring 18 cm. SPLEEN: Spleen size at the upper limits of normal, craniocaudal length of 12.9 cm, not significantly changed.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Hypodensity posterior aspect of the upper pole right kidney measures 1.3 x 1.3 cm previously 1.5 cm x 1.3 cm (series 3 image 94) and does not meet criteria for simple cyst, stable in size on review of prior studies since at least January 2010. Other subcentimeter renal hypodensities are stable and too small to characterize.RETROPERITONEUM, LYMPH NODES: No enlarged abdominal or retroperitoneal lymph nodes. Index subcentimeter aortocaval lymph node BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Uterine hypodensity is unchanged likely fibroidBLADDER: No significant abnormality noted.LYMPH NODES: No enlarged pelvic lymph nodes.BOWEL, MESENTERY: Nondilated pelvic bowel loops. No ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. No enlarged lymph nodes in the chest, abdomen, or pelvis. Stable index aortocaval lymph nodes.2. Stable hypodensity upper pole right kidney; continued attention on follow-up is suggested.Mild congestive heart failure. |
Generate impression based on findings. | Reason: Hx of kidney cancer s/p right nephrectomy. Eval for recurrent or metastatic disease History: See above CHEST:LUNGS AND PLEURA: Scattered benign-appearing micronodules and right basilar scarring are unchanged.Right pleural lipoma is stable.Moderate upper lobe centrilobular emphysema stable.No sign of pulmonary or pleural metastases.MEDIASTINUM AND HILA: Multiple thyroid calcifications are unchanged.There is no mediastinal or hilar lymphadenopathy.Severe coronary artery calcifications are present.CHEST WALL: Degenerative abnormalities affect the thoracic spine.ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholecystectomy clips are seen.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: The right adrenal may have been resected along with the right kidney.KIDNEYS, URETERS: Right nephrectomy.Left renal cystlike lesion unchanged although incompletely evaluated without IV contrast. 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: Degenerative abnormalities affect the lumbar spine.OTHER: No significant abnormality noted. | 1. No sign of metastases.2. Right nephrectomy and probable adrenalectomy.3. Centrilobular emphysema.4. Severe coronary artery calcifications. |
Generate impression based on findings. | Reason: s/p 8 mo after robotic assisted, VATS left upper lobectomy for management of a T3N0M0 stage IIB small cell cancer History: 3 mo f/u LUNGS AND PLEURA: Interval resection of posterior left upper lobe nodule with postoperative changes noted. No evidence of residual or new suspicious nodules or masses.Severe centrilobular and paraseptal emphysema.MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. Heart size is normal. No pericardial effusions.CHEST WALL: Sclerotic foci within the vertebral bodies of T9, T10, T11, T12 are unchanged from prior exam and benign in appearance. UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Nodularity of the left adrenal gland unchanged. Previously noted hypodense lesion in the caudate lobe is not well visualized in this study. Hypodense lesion in the dome of the left lobe remains unchanged. Scattered punctate calcifications of the pancreas unchanged and likely represent sequelae of chronic pancreatitis. | 1.Severe centrilobular and paraseptal emphysema without interval change.2.Postoperative changes from left upper lobectomy without evidence of residual or new suspicious nodules or masses. |
Generate impression based on findings. | Female 59 years old; Reason: COLON CANCER S/P LEFT LATERAL HEPATECTOMY IN OCTOBER 2013. POST OPERATIVE BASELINE History: COLON CANCER ABDOMEN:LUNGS BASES: Extensive mediastinal and hilar adenopathycompatible with patient's known history of sarcoidosis is incompletely evaluated.LIVER, BILIARY TRACT: Patient is status post left hepatectomy with residual hypoattenuation in the lateral segment left lobe liver measuring 1.5 x 5.5cm. Small focus of gas noted within the lesion. Stable cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts are unchanged. Small subcentimeter hypodense foci bilaterally are too small to characterize but not significantly changed.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy. Atherosclerotic calcification of the abdominal aorta.BOWEL, MESENTERY: Status post left hemicolectomy with surgical anastomosis in the left lower quadrant. Normal caliber of bowel. BONES, SOFT TISSUES: Post surgical changes with edema in the anterior abdominal wall.. Tiny fat containing umbilical hernia stable.OTHER: No significant abnormality noted. | 1. Residual low attenuating lesion in the site of hepatectomy with a focus of gas likely postoperative in nature. |
Generate impression based on findings. | History of invasive thymoma status post chemo. CHEST:LUNGS AND PLEURA: Post therapeutic changes in the right lung consistent with radiation fibrosis. No new or suspicious pulmonary nodules. MEDIASTINUM AND HILA: Mediastinal surgical clips. Anterior mediastinal soft tissue stranding unchanged over multiple previous studies and is likely post therapeutic. No evidence of recurrent mass.CHEST WALL: Healed median sternotomy with wires in place. Probable bone island right humeral head unchanged. Scattered areas of demineralization in the spine are nonspecific. Mild degenerative change.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter low attenuation lesions too small to characterize.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: New large expansile lytic lesion in L3 vertebral body with breakthrough of the superior endplate cortex. Schmorl's nodes at the endplates of L1 and L2. Stable lucent well corticated lesion in the spinous process of L1., Unchanged since 2009. A very small lytic lesion in the L5 vertebral body on the right is new from 2009 but nonspecific and could be degenerative.OTHER: No significant abnormality noted. | New expansile lytic lesion in the L3 vertebral body with breakthrough of the cortex is suspicious for a metastasis as it is larger than typically seen for a Schmorl's node and occurred rapidly without pre-existing lesion. Further characterization with MRI is recommended. If the lesion has characteristics consistent with metastasis, PET scan would be recommended to search for an occult extrathoracic primary neoplasm as thymoma metastatic to bone would be highly unusual, especially this many years after primary diagnosis. |
Generate impression based on findings. | 51 year-old female with right thyroid nodules, evaluate. Limited intracranial views are unremarkable. Limited views of the orbits are unremarkable. The visualized paranasal sinuses are clear.No soft tissue masses are identified. Bilateral small nonspecific hypodense thyroid nodules.No pathologic lymphadenopathy by CT size criteria. The submandibular and parotid glands are free of focal lesions. No exophytic mass or focal effacement of the aerodigestive tract.The cervical vasculature is patent. The lung apices are clear bilaterally.Straightening of the cervical spine which may be secondary to muscle spasm or positioning. No suspicious osseous lesions are identified. Multilevel degenerative changes of the cervical spine including loss of disk height and osteophyte formation. | 1. Small bilateral hypodense thyroid nodules.2. No cervical lymphadenopathy or suspicious mucosal or soft tissue lesions of the neck. |
Generate impression based on findings. | Female, 6 years old, with left-sided polyp on anterior rhinoscopy. The visualized paranasal sinuses, including frontal, ethmoidal, sphenoidal and maxillary, are completely opacified with mixed hyper and hypoattenuating material. The walls of the maxillary sinus are thinned and expanded as a result.The nasal cavity is also opacified at least partially. Soft tissue thickening is seen within the anterior left nasal cavity extending to the level of the nare, likely representing the abnormality seen on rhinoscopy.No frank osseous erosion is seen. The premaxillary and retromaxillary fat planes are preserved. The fat planes of the pterygopalatine fossae are also preserved. The nasal septum is intact. Nasal turbinates are difficult to visualize given the near complete nasal cavity opacification. | The paranasal sinuses and nasal cavity are filled with mixed hypo- and hyperdense material which results in expansion of the sinus walls. These findings can be seen in allergic fungal sinusitis. Alternately, it is possible that these findings represent a diffuse polyposis with entrapped hyperdense secretions. |
Generate impression based on findings. | Breast cancer and growing right supraclavicular mass. CHEST:LUNGS AND PLEURA: Radiation fibrosis at the lung apices and anterior lung fields. Right apical bronchiectasis. Nonspecific pulmonary micronodules, not appreciably changed. Small but poorly defined subpleural lymph nodes in the right major fissure (4/34) unchanged and nonspecific. No pleural fluid or pneumothorax.MEDIASTINUM AND HILA: Unchanged small lymph node in the left inferior pulmonary ligament, mildly enlarged as it is not normally visible. Small left hilar and normal heart size. Left chest port tip at the SVC/RA junction. left interlobar level lymph nodes also unchanged. CHEST WALL: Right supraclavicular fossa lesion measures 2.8 x 3.9 cm, previously 2.2 x 3.1-cm (3/1). Caudal extent has increased. Right cervical lymph node (3/5) minimally larger. Please refer to dedicated neck CT for further assessment of cervical lymphadenopathy.Left chest port.Right mastectomy and axillary dissection. Right axillary lymph node 8mm, previously 7-mm (3/28). Index left axillary lymph node stable at 3-mm (3/33).Small subcutaneous soft tissue nodule right chest wall overlying the scapula, a faintly seen soft tissue nodule posterior to the coracoid process and an enhancing irregular soft tissue lesion in the antero-lateral right chest wall are consistent with subcutaneous soft tissue metastases.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted..SPLEEN: No significant abnormality noted..ADRENAL GLANDS: No significant abnormality noted..KIDNEYS, URETERS: No significant abnormality noted..PANCREAS: No significant abnormality noted..RETROPERITONEUM, LYMPH NODES: No significant abnormality noted..BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted..BONES, SOFT TISSUES: No significant abnormality noted..OTHER: No significant abnormality noted.. | 1. Right supraclavicular fossa lesion appears larger however please refer to dedicated neck CT for measurements as it is incompletely included in the scanning range. 2. Unchanged small mediastinal lymph nodes.3. Subcutaneous soft tissue metastases right chest wall.4. Although no intra-abdominal metastases are appreciated, suggest correlation with dedicated triple phase hepatic CT as small lesions may not be visible by this single phase technique. |
Generate impression based on findings. | Reason: s/p almost 2 yrs after RML and RLL for two T1N0M0 Stage IA typical carcinoid tumors History: f/u LUNGS AND PLEURA: A 6 x 6 mm nodule has enlarged, along the right mediastinal pleura adjacent to the ascending aorta. This most likely is a node in the adjacent mediastinum, and although present since 2009 has suddenly increased in size. This is best seen on the source image series 3, image 150.Scattered benign appearing micronodules are unchanged, and the patient has undergone right middle and right lower lobe resections. MEDIASTINUM AND HILA: Scattered upper normal sized mediastinal lymph nodes are stable.CHEST WALL: Status post right thoracotomy.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Enlarging right paramediastinal nodule or lymph node, unlikely to be a metastasis from the patient's carcinoid but continued follow-up within 6 months is recommended. |
Generate impression based on findings. | Male, 29 years old, left ear pain and tinnitus, allergic rhinitis. MAXILLOFACIAL | 1. No evidence of active sinus inflammatory disease.2. No specific temporal bone abnormalities are detected to account for the patient's symptoms. |
Generate impression based on findings. | Reason: f/u of lung nodules History: cough LUNGS AND PLEURA: Severe emphysema, likely centrilobular that extends to the bases. No interval pneumothorax or pleural effusion.Upper lobe pulmonary nodules have remained stable in a size (series 6 image 30). On the right, the reference nodule measures 11 x 11 mm. The reference left upper lobe nodule is 6 x 9 mm. Previously described new nodule that that was contiguous with the superior wall of the distal right main bronchus has decreased in size and is separate from the bronchus. It is now an independent pulmonary nodule, 7 x 9 mm (as compared to 8 by 23 mm on previous exam) with residual thickening of the superior wall of the main bronchus. Interval decreased or stability of size of right lower lobe nodules. One right lower lobe nodule (series 6 image 66) is now 5 mm, as compared to 6 mm previously. Pleural based right lower lobe nodule is stable at 5 x 9 mm (series 6 image 83). More inferiorly, within the lateral basal segment right lower lobe, the solid nodule is slightly smaller at 8 by 7 mm (series 6 image 101), as compared to 8 x 8 mm. pleural-based left lower lobe nodule measures 5 x 7 mm (series 6 image 102), unchanged.MEDIASTINUM AND HILA: Heart size remains normal. No pericardial effusion. Extensive coronary artery calcification.Low right paratracheal lymph node is smaller, 8 mm, as compared to 10mm(series 4 image 47). Stable size of left AP window lymph node at 10 mm.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Contour abnormality of the upper pole of the left kidney measuring approximately 22mmm slightly smaller but incompletely characterized. Right hepatic lobe cystand additional hypoattenuating hepatic lesion also grossly unchanged. | 1. Interval stability or decrease size of multiple pulmonary nodules. Although these remain of indeterminate etiology, benignity is favored.2. Stable or reduced size of mediastinal lymph nodes. |
Generate impression based on findings. | Female 75 years old; Reason: 75 yr old patient with a hx of cervical and uterine cancer. hx of radiation, surg, and chemo. S/P 3 cycles of Doxil eval disease process compare to 7-29-13 scan please History: vag bleeding NECK BASE: Enlarged heterogeneous thyroid nodule appears stable since previous exam although incompletely characterized on this CT chestCHEST:LUNGS AND PLEURA: Numerous new ill-defined pulmonary nodules are noted throughout the lungs with index lesion in the right lower lobe measuring 0.8 x 1.4 cm (series 5 image 193). A second new nodule measures 0.7 x 1.4 cm (series 5 image 156) also new. MEDIASTINUM AND HILA: Interval stability of enlarged AP window lymph node, which measures 2.0 x 1.2 Cm (axial image 30) previously 2 x 0.9cm. There is new area of low attenuation centrally. Calcified right hilar and subcarinal lymph nodes compatible with prior granulomatous disease. Enlarged, heterogeneous thyroid is unchanged. CHEST WALL: Right chest port with catheter tip at the cavoatrial junction.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: Stable multiple left renal cysts. Right extrarenal pelvis is again noted. Mild dilatation of the right proximal ureter is unchanged. RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy. Thrombosed bilateral gonadal veins are unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Changes status post hysterectomy and bilateral salpingo-oophorectomy. Soft tissue thickening of the vaginal cuff on the right is unchanged.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis.BONES, SOFT TISSUES: Reticulation of the anterior subcutaneous fat is again noted, likely due to prior radiation therapy.OTHER: No significant abnormality noted. | 1. Numerous new pulmonary nodules with index nodes as above.2. Interval stability/slight enlargement of AP window lymph node.3. Soft tissue thickening of the vaginal cuff, not significantly changed. |
Generate impression based on findings. | Male 67 years old; Reason: prostate cancer newly diagnosed. needs staging History: prostate cancer ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver has a smooth contour. No suspicious hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Calcific arteriosclerotic disease of the aorta. No retroperitoneal lymphadenopathy. There are multiple small retroperitoneal lymph nodes.BOWEL, MESENTERY: Colonic diverticulosis.BONES, SOFT TISSUES: Degenerative changes of the lumbar spine.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Left external iliac lymph node measures 2.1 x 0.9 cm (image 131/series 3). BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes affects the left hip. Mild trabecular thickening of the left femoral head and neck.OTHER: No significant abnormality noted. | 1.Small pelvic and retroperitoneal lymph nodes.2.Trabecular coarsening of the left femoral head and neck suggestive of Paget's. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 77-year-old male. Gastric cancer, restaging. CHEST:LUNGS AND PLEURA: Right lower lobe granulomas are unchanged. No new suspicious pulmonary nodules. Calcified pleural plaques are again noted. MEDIASTINUM AND HILA: Cardiac size is normal. No pericardial effusion. Atherosclerotic calcification of the coronary arteries. No mediastinal or hilar lymphadenopathy. Calcified lymph nodes compatible with prior granulomatous disease. Air noted in the main pulmonary artery likely from injection.CHEST WALL: Median sternotomy hardware. Left chest port with tip at the cavoatrial junction.ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesion.SPLEEN: Accessory splenule is again noted.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Punctate, nonobstructing renal calculus bilaterally, unchanged.RETROPERITONEUM, LYMPH NODES: Moderate after atherosclerotic calcification of the abdominal aorta and its branches. Portal caval lymph node measures 7 mm in short axis (image 100 series 3) unchanged.BOWEL, MESENTERY: Ill-defined thickening of the gastric antrum/pylorus, compatible with patient's known gastric cancer. The mass abuts the adjacent liver and colon, appearing to invade these structures. These findings have not significantly changed. Right lateral abdominal wall hernia, containing loops of small bowel without evidence of obstruction.BONES, SOFT TISSUES: Degenerative changes in the lumbar spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Moderate prostate hypertrophy with calcifications.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 | Unchanged appearance of the mass in the gastric antrum/pylorus with probable invasion into the liver and colon. No specific evidence of metastatic disease. |
Generate impression based on findings. | COPD. Questionable lung mass. Long history of constipation and diarrhea with new rectal prolapse. CHEST:LUNGS AND PLEURA: Epicenters changes and central lobular emphysema noted bilaterally. Ground glass opacity anteriorly in the left upper lobe (image 25; series 4). Scattered subpleural micronodules are nonspecific. Mild bi-basilar bronchiectasis. Calcified right lower lobe granuloma with adjacent thickening of bronchovascular bundle.MEDIASTINUM AND HILA: Coronary artery calcifications. Subcentimeter mediastinal lymph nodes.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. Mild intrahepatic and extrahepatic biliary ductal dilatation with the common duct measuring 9 mm in diameter. Air fluid level in the region of the duodenal C-loop which may represent a diverticulum.SPLEEN: Calcified splenic granulomas.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 colon is dilated and filled with stool throughout. There appears to be a jejunojejunal intussusception (image 130; series 3 and image 64; series 80236). This does not appear to be obstructive and may represent a transient phenomenon.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Atherosclerotic aortic disease.PELVIS:UTERUS, ADNEXA: Status post hysterectomy. Ovaries not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Dilated colon filled with fecal material.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. No definite evidence of bowel obstruction although the entire colon is mildly dilated and filled with feces.2. Mild biliary ductal dilatation and possible duodenal diverticulum. Status post cholecystectomy3. Jejunojejunal intussusception; this is not appear to be obstructive and may be a transient phenomenon. Correlate clinically.4. Centrilobular emphysema with ground glass opacity anteriorly and superiorly in the left lung. |
Generate impression based on findings. | Male, 80 years old, subdural hemorrhage, history of VP shunt/normal pressure hydrocephalus. Right frontal approach ventricular shunt catheter is in stable position, tip situated at the level of the septum pellucidum. Bilateral parietal burr holes are redemonstrated.Previous very thin left parietal region subdural collection has resolved. No detectable extra axial fluid is seen on the left.Predominantly low density right hemispheric subdural collection with hyperdense stranding suggestive of membrane formation continues to diminish in size. This collection measures maximally 11 mm in thickness, previously 17 mm.No new extra-axial collections or evidence of acute intracranial hemorrhage is seen. Extra-axial pneumocephalus noted on the prior exam has resolved. Mild mass-effect persists in the right hemisphere in the form of sulcal narrowing. No significant midline shift or evidence of brain herniation is seen.The ventricles remain enlarged relative to the sulci. The caliber of the ventricles has increased to a mild degree compared to the prior examination. This is most easily seen when bifrontal measurements are taken in the coronal plane which yield 5.9 cm, previously 5.2 cm. Third ventricular caliber is also mildly increased. The fourth ventricle is unchanged.Bilateral left greater than right inferior frontal, and left superior frontal, encephalomalacia is demonstrated, stable. | 1. Continued improvement in the caliber of a right hemispheric subdural collection. A left sided subdural collection seen on prior exams has resolved. No new hemorrhage or extra-axial collections are seen.2. Stable positioning of the shunt catheter. Mild increase in the caliber of the supratentorial ventricles. This change could, in part or in total, represent reexpansion secondary to reduced mass effect from improving subdural collections. Correlation with clinical status is suggested.3. Stable bilateral areas of parenchymal encephalomalacia. |
Generate impression based on findings. | Reason: h/o HNC, s/p CRT, compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Left jugular catheter, tip in SVC/RA junction region.There is no mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Nonobstructive right renal calculus.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No evidence of metastases. Nonobstructing right renal calculus unchanged. No other significant abnormality. |
Generate impression based on findings. | Lung nodule follow-up. Cough. LUNGS AND PLEURA: Left upper lobe nodule appears spiculated on the high resolution series, now measuring 16 x 13 mm, previously 15 x 13 mm (5/76). There is adjacent atelectasis and several small airways distal to the lesion contain endobronchial debris. There is a somewhat nodular thickening of the scar associated with the lesion.Ground glass and part solid lesion in the right lower lobe postero-medially is unchanged; this lesion is difficult to measure, approximately 2.3 by 2.1-cm in size (5/156) and has been present since at least 2011.Nodule in the right upper lobe (6/35) measures 10 x 7 mm, previously 8 x 6 mm on 4/26/13 and a by 6-mm on 10/12/2012.Subcentimeter left apical nodule associated with a scar is not conclusively changed compared to prior studies.Small scar like linear opacity in the anterior left lower lobe is unchanged (5/26).Ground glass density nodule in the right upper lobe (5/85) appears decreased in density with more internal lucency but unchanged in size, measuring up to 11 mm, previously 11-mm when remeasured.Scar with associated ground glass opacity in the posterior aspect of the right upper lobe (5/93) is unchanged compared to previous studies.Right lower lobe nodule abutting the diaphragm measures 8 mm, previously 10-mm (5/249) please note that measurements of this lesion may be variable depending upon position of the diaphragm.MEDIASTINUM AND HILA: Severe atherosclerotic calcifications of the aorta and its branches. Patulous thoracic esophagus. Severe coronary artery calcifications. Normal heart size. No significant lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Severe atherosclerotic calcifications. Upper pole left kidney exophytic lesion measures hyperattenuating to simple fluid but is unchanged in size. An additional lesion isoattenuating to the left kidney is seen anteriorly. A small exophytic cyst arises from the apex of the left kidney. These are all incompletely assessed without IV contrast. Severe vascular calcifications of the aorta and renal arteries. | 1. Spherical ground glass lesion in the right upper lobe has a configuration and growth rate most consistent with an indolent adenocarcinoma, possibly AIS or MIA.2. Left upper lobe spiculated nodule may have minimally increased in size however differences could be due to variability in slice selection. Thickening of the adjacent scar compared to remote earlier exams is noted. This may be a result of chronic indolent infection however a scar carcinoma cannot be excluded. Recommend correlation with PET scan.3. Part solid nodule in the right lower lobe is unchanged, highly suspicious for an indolent adenocarcinoma, possibly minimally invasive or invasive type.4. Spiculated right upper lobe nodule continues to increase in size, compatible with a primary pulmonary neoplasm. Recommend correlation with PET scan.5. Left apical lesion unchanged but has a configuration most suggestive of postinflammatory scarring.6. Right basal nodule abutting the diaphragm unchanged allowing for differences in technique but should continue to be monitored. |
Generate impression based on findings. | Male 80 years old; Reason: metastatic rectal cancer (liver and bone mets) currently on chemotherapy, re-evaluate disease History: rectal pain CHEST:LUNGS AND PLEURA: Nonspecific nodular thickening along the left major fissure (image 58 series 6) scattered micronodules (image 58/series 6, image 64). The pleural spaces are clear.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. Aberrant course of the right subclavian artery posterior to the esophagus.Hypodense left thyroid nodule. Thrombosis of the right jugular vein superior to the port entry site.CHEST WALL: Right chest wall port terminates at the cavoatrial junction.OTHER: ABDOMEN:LIVER, BILIARY TRACT: No masses or contour. Nonspecific hypodensity in segment IVb adjacent to the falciform. The segment 6 lesion has decreased in size. Hepatic and portal veins are patent. No definite metastatic disease to the liver.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: Index retrocrural node has resolved and is not measurable. Theresmall retropectoral lymph nodes a left para-aortic node measure 1.1 cm (image 131/series 4) previously, 1.3-cmBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: The prostate is enlarged.BLADDER: No significant abnormality notedLYMPH NODES: Reference right external iliac lymph node measures 1.1-cm (image 178/series 4) previously, 1.2-cmBOWEL, MESENTERY: Rectal thickening has decreased measuring 1.3-cm in thickness on image 195/series 4 previously, 1.4-cm.BONES, SOFT TISSUES: Stable sclerotic focus in the right iliac wing. Degenerative changes affect the lumbar spine.OTHER: No significant abnormality noted | 1.Decrease in the size of the reference lesions.2.Thrombus in the right jugular vein superior to the catheter. |
Generate impression based on findings. | 42-year-old male pre-renal transplant. Evaluate vasculature. ABDOMEN:LUNG BASES: Coronary artery calcification.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Renal vascular calcification bilaterally.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Hiatal hernia.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Mild calcification in the abdominal aorta.Mild calcification in the common iliac arteries.Mild to moderate calcification right external iliac artery.Mild calcification left external iliac artery.Severe calcification both internal iliac arteries.PELVIS:PROSTATE, SEMINAL VESICLES: Prostate calcification.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Hiatal hernia.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Mild calcification in the abdominal aorta.Mild calcification in the common iliac arteries.Mild to moderate calcification right external iliac artery.Mild calcification left external iliac artery.Severe calcification both internal iliac arteries. | Vascular calcification as noted. |
Generate impression based on findings. | Right chest pain. CXR suggestive of right PE. Rule out pulmonary embolism. Patient is status post cystectomy and ileal conduit. PULMONARY ARTERIES: Technically adequate infusion quality with no pulmonary arterial filling defects to suggest acute pulmonary embolus. Main pulmonary artery is normal in caliber.LUNGS AND PLEURA: Mild centrilobular emphysema. Mild to moderate bronchial wall thickening. Bilateral subpleural fat deposition, but no pleural fluid.Pleural thickening in the right costophrenic sulcus is seen laterally. Subsegmental atelectasis in the right middle and lower lobes.MEDIASTINUM AND HILA: Normal heart size. No evidence of right heart strain. The left ventricular apex appears thickened with reduced size of the ventricular cavity at the apex, especially along the lateral aspect of the free wall of the ventricle. This is poorly assessed due to cardiac motion artifact and timing of IV contrast bolus.Right chest port tip at the superior vena cava. Coronary artery calcifications or stent. Mild to moderate thickening of the hilar lymphatic tissues bilaterally.CHEST WALL: Right chest port.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. The lateral aspect of the right hemidiaphragm appears thickened and there is a trace volume of perihepatic fluid noted which is presumably postoperative but nonspecific in the early postoperative setting. Small foci of intraperitoneal air are presumably postoperative. | 1. Technically adequate study with no evidence of acute pulmonary embolus.2. Diffuse bronchial wall thickening with enlargement of the peri-bronchovascular lymph nodes in and surrounding the hila may be postinflammatory however the distribution is atypical for aspiration unless the patient was positioned both supine and prone during surgery. Correlate for history of asthma or chronic bronchitis which may have a similar radiographic appearance. If the patient has risk factors for malignancy, conservative CT follow up may be obtained in 6 weeks. Otherwise if the patient has no risk factors, plain film follow up may be obtained only if clinically warranted.3. Thickening of the right hemidiaphragm and adjacent pleura, trace perihepatic fluid and a small amount of pneumoperitoneum are presumably postoperative.4. Nonspecific atelectasis in the right lung. |
Generate impression based on findings. | 61-year-old male with history of left MCA stroke and right upper extremity weakness No evidence of hemorrhagic transformation of the patient's known left basal ganglia/MCA distribution infarct. No evidence of midline shift or herniation. The ventricles are stable in size and configuration. Partial opacification of the right maxillary sinus, otherwise the visualized portions of the paranasal sinuses are clear. The mastoid air cells are clear. The visualized orbits are intact. Congenital non-union of C1. | No evidence of hemorrhagic transformation of the patient's known left basal ganglia/MCA distribution infarct. |
Generate impression based on findings. | Reason: r/o PE, hx of eosinophilic colitis, pericardial effusion/pleural effusion History: pleuritic CP, SOB PULMONARY ARTERIES: Diagnostic quality exam. No evidence of pulmonary embolism.LUNGS AND PLEURA: Extensive, left greater than right, calcified and smoothly thickened pleura, correlate for prior empyema or pleurodesis. No suspicious nodules or masses noted. There is bronchial wall thickening. Groundglass opacities on the right and bilateral mild septal and fissural thickening. Minimal pleural effusion. Left lung with low lung volumes. Loculated small subpleural collection of fluid in the left lung.MEDIASTINUM AND HILA: Diffuse scattered pericardial calcifications. Enlarged mediastinal lymph nodes are not significantly changed from prior PET/CT . Heart size is normal. No pericardial effusions.CHEST WALL: Enlarged lower cervical lymph nodes.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Calcifications of the mesentery are noted. Calcified foci within the liver may represent granulomata. No significant lymphadenopathy in the upper abdomen. | 1.No evidence of pulmonary embolism.2.Extensive, right greater than left, calcified pleural thickening.3.Loculated small subpleural collection of fluid in the right lung.4.Groundglass opacities with mild septal thickening and fluid tracking along the fissure may be due to chronic passive congestion.5.Chronic appearing calcific pericardial disease with small size of the right ventricular lumen, enlargement of right atrium, and severe reflux into the IVC. This is consistent with chronic pericardial constriction. |
Generate impression based on findings. | Female, 64 years old, metastatic thyroid cancer. No mass effect, focal edema or suspicious enhancement is seen to suggest brain parenchymal metastatic disease. Bilateral prominence of the superior ophthalmic veins is unchanged. The bones of the calvarium and skull base are intact. Postsurgical change compatible with thyroidectomy is again seen. The fascial planes anterior to the resection bed are blurred, similar to prior, which is at least in part due to artifact. There may be a small amount of residual soft tissue bilaterally at the inferior margins of the resection bed, but this is unchanged.Right paratracheal soft tissue thickening within the high mediastinum continues to progress, now measuring 10 mm (image 53 series 8), previously 7 mm, and on a more remote study, about 2 mm. This tissue is contiguous with right pretracheal soft tissue which has also increased in prominence (see image 55 series 8).Elsewhere in the neck, no mass lesions or pathologic adenopathy is detected. The aerodigestive mucosa is unremarkable. Focal hypodensity within the left parotid gland is unchanged and may represent ductal dilatation or a cystic lesion. The salivary glands are otherwise unremarkable. The right IJ vein ceases to opacify at the level of the thyroid resection bed, a stable finding. Vessels are otherwise unremarkable. Multiple pulmonary nodules are demonstrated. A dedicated chest CT will be reported separately.No suspicious osseous lesions are demonstrated. | 1. Stable appearance of the thyroidectomy bed.2. Inferior to the thyroidectomy, within the upper mediastinum, paratracheal and pretracheal soft tissue continues to increase slowly in thickness. This remains concerning for slow progression of disease.3. No mass or pathologic adenopathy is detected elsewhere in the neck.4. Multiple pulmonary nodules. A dedicated chest CT will be dictated separately.5. No intracranial metastatic disease. |
Generate impression based on findings. | Male 67 years old; Reason: metastatic small cell lung cancer completed induction chemotherapy and evaluating response with re-imaging History: none CHEST:LUNGS AND PLEURA: Mild emphysematous change. Spiculated, solid mass in the left upper lobe (on image 49/105) measuring 1.2 x 1.2 cm previously 2.4 x 2.9 cm has markedly decreased in size. No other focal lung mass identified.MEDIASTINUM AND HILA: Presumed necrotic adenopathy in the aorto -- pulmonary window with smaller node measuring 1.2 x 2.4 cm previously 2.1 x 2.4 cm (image 42/ series 3).CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No focal hepatic mass. There is mild intrahepatic biliary tract dilatation with very mild dilatation of the common duct to the level of the pancreatic head. No definite obstructing mass or stone identified.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Mild dilatation right renal collecting system including renal pelvis without significant ureterectasis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Vascular calcification. Mild ectasia mid -- distal abdominal aorta.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Mass or calcification. | 1. Interval decrease in size of primary lung neoplasm and associated mediastinal adenopathy.2. Mild biliary tract dilatation of uncertain etiology. If liver function is abnormal, MRCP may be useful. |
Generate impression based on findings. | Female 64 years old; Reason: h/o met thyroid ca, compare to previous, measurements pls History: none. CHEST:LUNGS AND PLEURA: Again seen are multiple pulmonary metastases bilaterally. Reference left upper lobe nodule measures 1.1 x 1.3 cm (series 5, image 26), previously measured 1.2 x 1.4 cm. And additional nodule in the right middle lobe measures 1.0 x 1.2 cm (series 5, image 30), previously measured 0.7 x 1.1 cm. The reference nodule in the left lower lobe measures 0.6 x 0.7 (series 5, image 39), previously measured 0.5 x 0.6 cm. While subtle, overall all measured nodules have increased slightly in size.MEDIASTINUM AND HILA: Scattered borderline enlarged lymph nodes in the mediastinum. Reference precardiac lymph node measures 1.0 cm (series 3, image 24), previous images 0.9 cm. Right paratracheal lymph node measures 1.0 cm (series 3 image 26), previously measured 0.9 cm. no cardiomegaly or pericardial effusion. An additional enlarged lymph node at the right medial costophrenic angle which was not present previously measures 1.4 cm (series 3, image 55).CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Subtle slight increase in size of all measured bilateral pulmonary metastases. 2.Overall increase in the lymphadenopathy, especially at the right medial costophrenic angle. |
Generate impression based on findings. | 39-year-old male patient with history of diffuse large B-cell lymphoma stage IA/E involving the left maxillary sinus and orbit status post 6 cycles of R CHOP chemotherapy. Please compare to prior examination. ABDOMEN:LUNG BASES: Stable pulmonary micronodules. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild multilevel degenerative changes in the thoracic and lumbar spine.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild multilevel degenerative changes in the thoracic and lumbar spine.OTHER: No significant abnormality noted. | No lymphadenopathy or evidence of metastatic disease. |
Generate impression based on findings. | Female 66 years old; Reason: evaluate for diverticulitis History: RLQ pain, history of diverticulitis ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Numerous low attenuating lesions in the liver are presumed cyst the largest measures 5.7 cm.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Numerous diverticula noted without diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Atrophic or surgically absent.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 acute intra abdominal pathology detected. |
Generate impression based on findings. | Esophageal reflux with abdominal pain. Left lower quadrant and pelvic pain for 3 months. ABDOMEN:LUNG BASES: No significant abnormality noteddLIVER, BILIARY TRACT: Status post cholecystectomy. SPLEEN: No significant abnormality noteddPANCREAS: Cyst in the pancreas described previously is resolved.ADRENAL GLANDS: No significant abnormality noteddKIDNEYS, URETERS: 5.7-cm left renal simple cyst enlarged since previous. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted..BOWEL, MESENTERY: No significant abnormality noted..BONES, SOFT TISSUES: No significant abnormality noteddOTHER: No significant abnormality noteddPELVIS:UTERUS, ADNEXA: Status post hysterectomy. Ovaries not visualized. BLADDER: No significant abnormality noteddLYMPH NODES: No significant abnormality noteddBOWEL, MESENTERY: Colonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality noteddOTHER: No significant abnormality notedd | No findings to explain left lower quadrant abdominal pain. Large left renal cyst. |
Generate impression based on findings. | Clinical information LUNGS AND PLEURA: The left lower lobe nodule measures 0.3 x 0.5 cm (series 5, image to 31), previously measured 0.4 x 0.6 cm and is therefore not significantly changed. Scattered bilateral calcified and noncalcified micronodules in what are nonspecific and unchanged. Centrilobular emphysema.MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. No cardiomegaly or pericardial effusion. Severe coronary artery calcifications are present.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Unchanged left lower lobe nodule. No new lesions. Followed up CT recommended in 6-12 months. |
Generate impression based on findings. | Malignant neoplasm of the pharynx and larynx with secondary malignant neoplasm of the lung. CHEST:LUNGS AND PLEURA: Index left lower lobe nodule 1 mm, previously 2-mm (5/63). Index right lower lobe nodule is not conclusively identified. Left upper lobe nodule (5/30) is unchanged.Interval decrease in size in poorly defined soft tissue opacity adjacent to the right middle lobe suture line, 8 x 17 mm (5/74), previously 14 x 19 mm. Suture line from left apical resection. No pleural fluid or pneumothorax. MEDIASTINUM AND HILA: The native coronary arteries are severely calcified. Normal heart size. No significant lymphadenopathy. Previously mildly enlarged right hilar lymph node is now normal in size. Vocal prosthesis and tracheostomy tube in place.CHEST WALL: Post operative change the neck, please refer to and reported neck CT.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Left renal vein appears narrowed as it passes between the abdominal aorta and superior mesenteric artery and proximally dilated. Slightly below this level there is nonspecific retroperitoneal soft tissue lesion anterior to the aorta which has been present dating back to 2003 and is unchanged. This was not visible on prior chest studies due to isoattenuation with adjacent bowel previously. A mildly enlarged right pericaval lymph node (3/122) appears minimally larger compared to the most recent previous study but smaller compared to the exam of 10/23/12.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Gastrostomy tube retention device in the stomach but the bumper is partially buried in the soft tissues. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Stable to improved pulmonary nodules.2. Parenchymal lesion adjacent to the right middle lobe suture line is smaller.3. Diminished size of right hilar lymph node.4. Mildly enlarged right pericaval lymph node in the abdomen slightly increased in size.5. Gastrostomy tube retention device is partially buried in the soft tissues of the tube tract, chronic and unchanged.6. Possible nutcracker syndrome with apparent narrowing of the left renal vein, correlate for symptoms and/or renal function abnormalities. |
Generate impression based on findings. | Two year old patient with sensorineural hearing loss. The examination is significantly limited by motion artifact which obscures assessment of small structures, despite repeated imaging.Right temporal bone: There has been interval placement of a right cochlear implant, with likely partial mastoid septae resection. Leads are demonstrated traversing the right mastoid air cells with the cochlear component traversing the middle ear to rest in the cochlea. There is a T-tube spanning the tympanic membrane. The mastoid cells are aerated and no fluid or soft tissue is demonstrated within the middle ear cavity. Semicircular canals have a normal configuration. Vestibular aqueduct, facial canal and IAC are normal. External auditory canal and auricle are normal. Left temporal bone: There is a new T-tube traversing the tympanic membrane. There are postoperative changes including partial mastoidectomy with fluid and/or soft tissue attenuation within the more lateral mastoid air cells. The mastoid air cells and middle ear are well aerated. There is a questionable focus of nonspecific soft tissue attenuation possibly overlying the anterior oval window along the anterior crus of the stapes (series 3 image 49), though characterization is complicated by motion artifact. This could conceivably represent the granulation tissue noted in the recent operative report, or may be artifactual related to motion. Ossicles are normal. Semicircular canals and cochlea demonstrate normal appearance. Vestibular aqueduct and internal auditory canal are unremarkable. Tympanic membrane, external auditory canal and auricle are normal. There is trace debris along the dependent left external auditory canal. | 1.Significant motion artifact limiting sensitivity. In addition, the appropriate reformats were not provided despite repeated requests.2.New right cochlear implant and bilateral T. tubes. Sequela of recent left mastoid surgery.3.A questionable area of intermediate attenuation overlying the left anterior oval window/stapes which may represent granulation tissue as described in the recent operative note, or alternately sequela of motion artifact. |
Generate impression based on findings. | 61-year-old male patient with history of metastatic small cell prostate cancer to the brain, currently receiving treatment with etoposide/temozolomide. Please assess for disease progression. CHEST:LUNGS AND PLEURA: Multiple micronodules, decreased in size. Previously measured left upper lobe nodule is no longer visualized.MEDIASTINUM AND HILA: Interval decrease in mediastinal lymphadenopathy. Reference aorticopulmonary window lymph node measures 1.2 x 0.7 cm (series 3 image 45), previously 1.7 x 1.9 cm.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Reference segment IVb lesion measures 0.6 x 0.6 cm (series 3 image 87), previously 0.9 x 0.8 cm. Segment 3 lesion measures 1.1 x 0.9 cm (series 3 image 95), previously 2.4 x 2.7 cm.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Interval decrease in retroperitoneal lymphadenopathy. Reference lymph node measures 1.3 x 1.9 cm (series 3 image 131), previously 2.6 x 1.6 cm.BOWEL, MESENTERY: Small hiatal hernia.BONES, SOFT TISSUES: Multilevel degenerative changes of the thoracic and lumbar spine.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate with internal calcifications, stable.BLADDER: No significant abnormality noted.LYMPH NODES: Reference left external iliac lymph node measures 1.2 x 1.3 cm (series 3 image 179), previously 1.9 x 1.6 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Lesion in the vertebral body of L1 was seen on prior examinations and has increased sclerotic changes on current examination, nonspecific finding.OTHER: No significant abnormality noted. | Interval regression of lung lesions, liver lesions and lymphadenopathy. |
Generate impression based on findings. | 78 year-old male with laryngeal squamous cell carcinoma and infiltrating hypodensity in the right larynx on prior CT, evaluate Limited intracranial views are unremarkable. Limited views of the orbits are unremarkable. The visualized paranasal sinuses and mastoid air cells are clear. Secretions are identified in the posterior aspect of the nasal cavity.Diffuse edema of the neck with soft tissue swelling of the superficial and deep spaces. Avid thin enhancement of the mucosa. The nasopharyngeal, oropharyngeal and laryngeal airways are completely effaced by extremely edematous enlarged mucosal and tonsillar tissue significantly limiting evaluation of these structures for focal lesions. Edema is identified in the retropharyngeal space most pronounced at the level of the superior cornu of the thyroid cartilage measuring approximately 6 to 7 mm in AP dimension. There is rightward extension of this fluid collection from the retropharyngeal space along the medial aspect of the right lobe of the thyroid.No rim enhancing fluid collections to suggest abscesses are identified.Tracheostomy tube remains in place.Reference right level 3 lymph node measures 8 x 6 mm (series 8 image 40), previously measured 5 x 8 mm. Reference right level 4 lymph node measures 6 x 7 mm (series 8 image 56), previously measured 8 x 7 mm.The cervical vasculature remains patent. Atherosclerotic vascular calcifications at the carotid bifurcations, with significant narrowing on the left.Multilevel degenerative changes of the visualized cervicothoracic spine. Nonspecific lucencies are identified in a mid C2 to superior C4 endplates, unchanged and likely degenerative. Sclerotic changes in the mandible likely represent post therapeutic findings.Incompletely characterized, possibly enlarged superior mediastinal lymph nodes. Bilateral clustered lung nodules, right greater than left, some with a tree in bud appearance. Partially visualized right chest port catheter. Partially visualized dependent subsegmental atelectasis/consolidation. | 1. Diffuse edema of the neck including the superficial and deep spaces completely effacing the airway above the level of the tracheostomy tube. These findings are nonspecific with differential considerations including angioedema/autoimmune hypersensitivity response, infection and less likely radiation changes.2. Tree in bud opacities in the lung apices suggestive of infection/aspiration including atypical and fungal etiologies. |
Generate impression based on findings. | Male, 50 years old, tonsil cancer status post CRT. Previously seen right palatine tonsillar mass has substantially decreased in size and is no longer discretely visualized.No pathologic adenopathy is detected by size criteria. A reference right level 3 node measures 3 mm short axis (image 53 series 8), previously 10 mm. A reference left level 2 lymph node measures 8 mm short axis (image 34 series 8), previously 10 mm.Mild mucosal edema is seen in the supraglottic region, particularly along the right aryepiglottic fold. This is likely related to therapy. The aerodigestive mucosa is otherwise unremarkable. Scarring and infiltration along the right sternocleidomastoid muscle are again seen compatible with prior surgery and treatment. A seroma seen within this space on the prior exam has resolved.The salivary glands and thyroid are free of focal lesions. The cervical vessels remain patent. Lung apices are unremarkable. No worrisome osseous lesions are seen. | 1. Right palatine tonsillar mass has substantially decreased in size and is no longer discretely visualized.2. No pathologic adenopathy is detected in the neck by size criteria. |
Generate impression based on findings. | Male 85 years old; Reason: further evaluation of lung nodule on CXR in patient with dementia, ESRD, and prostate ca History: see above. LUNGS AND PLEURA: Bilateral pleural effusions are noted with overlying atelectasis. The questionable pulmonary nodule seen on recent previous chest radiograph is not definitely visualized on this chest CT likely secondary to being obscured by the pleural effusions or is a lateral osteophyte.MEDIASTINUM AND HILA: Moderate sized cardiomegaly with severe coronary artery calcifications. Postsurgical changes from a recent previous coronary revascularization procedure. Right supraclavicular node measures 1.0 cm (series 3, image 37) the remaining lymph nodes in the mediastinum are subcentimeter.CHEST WALL: Multilevel degenerative changes are noted throughout the thoracic spine. A lytic lesion is visualized in the right T5 vertebral body which could represent possible prostate metastasis.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Calcification within the gallbladder likely represents gallstone. | 1.Bilateral pleural effusions with overlying atelectasis. 2.The questionable pulmonary nodule seen on recent previous chest radiograph is not definitely seen on this chest CT which is likely obscured by the pleural effusions.3.Postsurgical changes from a recent coronary revascularization procedure with moderate cardiomegaly.4.T5 vertebral body lytic lesion, could represent prostate metastasis. |
Generate impression based on findings. | Malignant neoplasm the cardia. Adenocarcinoma of the esophagus, stage IV, type 2/3. CHEST:LUNGS AND PLEURA: Scarring at the left lung apex and by basilar bronchiectasis with scarring noted at both lung bases medially.MEDIASTINUM AND HILA: Subcentimeter mediastinal lymph nodes appear stable. Coronary artery calcifications. Thickening of the distal esophagus noted without measurable mass.CHEST WALL: Right internal jugular vein chest port.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Enlarged left adrenal gland measuring 3.6 x 2.3 cm (image 114; series 4) appears unchanged compared to prior.KIDNEYS, URETERS: Large left renal cyst with rim calcification laterally is unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of bowel obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostatic calcifications are unchanged.BLADDER: No significant abnormality notedLYMPH NODES: Multiple perirectal implants versus lymph nodes are noted prefer for purposes, a presacral nodule measures 1.5 x 1.2 cm (image 190; series 4). This is unchanged.BOWEL, MESENTERY: There is a 1.6 x 2.0 cm enhancing nodule which is contiguous with the posterior right lateral wall of the rectum (image 29; series 4) and presumably represents a metastatic implant.BONES, SOFT TISSUES: Multiple lower thoracic and upper lumbar compression fractures.OTHER: Bilateral renal hernias containing fat. | No substantial interval change compared to prior outside exam. Multiple presacral implants versus lymph nodes with measurements given above. Enlarged left adrenal gland. Multiple compression fractures in the spine. |
Generate impression based on findings. | Male 49 years old; Reason: Rule out PE History: tachycardia w/ known DVT. PULMONARY ARTERIES: Adequate evaluation of the pulmonary arteries. No pulmonary emboli. Nonenlarged main pulmonary artery.LUNGS AND PLEURA: Interval development of bibasilar consolidation with air bronchograms left greater than right concerning for aspiration/pneumonia. There is also centrilobular nodules superior to the left basilar consolidation, consistent with bronchiolitis or aspiration.MEDIASTINUM AND HILA: Patulous fluid filled esophagus is noted. Tracheostomy tube in place with adjacent mucous secretions in the trachea lumen. Mild cardiomegaly. No pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Gastrostomy tube in place. There is air tracking along subcutaneous tissues adjacent to G-tube catheter with subcutaneous edema. No discrete fluid collections although this portion of the abdomen is only partially visualized. | 1.No pulmonary emboli.2.Bibasilar consolidation with air bronchograms especially in the left and centrilobular nodular opacities concerning for aspiration/aspiration pneumonia.3.Patulous fluid filled esophagus with mucous secretions adjacent to the tracheostomy tube which heighten the risk of aspiration. |
Generate impression based on findings. | Female 62 years old; Reason: rt kidney mass History: ABDOMEN: The absence of intravenous and oral contrast limits evaluation of the solid organs and of the bowels. Given these limitations, the following observations were made:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No focal liver lesion detected. Cholelithiasis without evidence of cholecystitis. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: 2.5-cm hypoattenuating lesion in the right kidney measures water density on this noncontrast CT. This lesion is incompletely characterized given lack of IV contrast. No other focal renal lesion or hydronephrosis detected.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Low attenuating lesion in the right kidney is most likely a cyst, although for full characterization, enhanced and unenhanced renal CT or MRI is advised.2.Cholelithiasis |
Generate impression based on findings. | Male, 53 years old, history of pharyngeal cancer. Extensive post surgical findings are redemonstrated including laryngectomy with tracheostomy, soft tissue flap construction, and scarring through the bilateral fascial planes. The appearance of the surgically altered anatomy is stable and there is no evidence of disease recurrence. No pathologic adenopathy is detected in the neck by size criteria.The parotid glands and left submandibular gland are unremarkable. The right submandibular gland is difficult to see. The thyroid has been resected. Cervical vessels are patent and similar to prior. Mild biapical lung scarring seen. No concerning osseous lesions are detected. Again seen are posterior disk-osteophyte complexes at the C5-6 and C6-7 levels which likely cause some degree of spinal canal stenosis. Congenital fusion of the C4 and C5 vertebral bodies is suspected. | Stable postsurgical findings with no evidence of recurrent disease or pathologic adenopathy. |
Generate impression based on findings. | Male 42 years old Reason: is medial malleolus healed? History: loose hardware Again seen is a side plate and screw device affixing an intra-articular malleolus fracture. Metallic streak artifact from the orthopedic device limits evaluation of the ankle joint. There is a patent cleft between the distal fracture fragment and the distal tibia extending to the articular cartilage, which has sclerotic edges and patent fracture lines, consistent with non-union. The tibiotalar joint is in near-anatomic alignment and appears grossly similar in appearance to the prior study.Similarly, the transverse distal fibular fracture demonstrates a patent fracture line and sclerotic margins, consistent with nonunion. There is prominent soft tissue swelling about the ankle without evidence of a loculated fluid collection. | Findings compatible with nonunion of a transverse fibular and medial malleolar fracture. |
Generate impression based on findings. | Male 70 years old; Reason: pe History: chest pain. PULMONARY ARTERIES: Adequate evaluation of the pulmonary arteries. No evidence of pulmonary emboli. Enlarged main pulmonary artery.LUNGS AND PLEURA: Mild apical septal emphysema. Bibasilar atelectasis. Possible left lung base aspiration. Calcified granulomata are present.MEDIASTINUM AND HILA: Left ventricular hypertrophy. No pericardial effusion. Coronary calcifications are noted. Biventricular pacemaker wires are in place. Scattered subcentimeter mediastinal and hilar lymph nodes.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted except for bilateral renal cysts. | No pulmonary emboli.Bibasilar atelectasis. No focal consolidations or pleural effusions.Left ventricular hypertrophy and enlarged main pulmonary artery. |
Generate impression based on findings. | 64-year-old female patient with history of nephrectomy, now with carcinoma in situ of bladder. Please evaluate with delayed imaging. ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy. Left kidney without abnormalities.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumbar spine. Sclerotic lesion in the anterior portion of the L2 vertebral body.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Ovarian varices.BLADDER: Irregular thickening and enhancement of the bladder wall, consistent with history of bladder cancer.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumbar spine. Sclerotic lesion in the anterior portion of the L2 vertebral body.OTHER: No significant abnormality noted | 1.Irregular thickening and enhancement of the bladder, consistent with bladder cancer history.2.L2 vertebral body sclerotic lesion.3.Native left kidney without abnormalities. |
Generate impression based on findings. | Reason: s/p right lung resection for lung cancer History: follow up LUNGS AND PLEURA: Postsurgical changes in the right lung. Numerous nodules, predominantly in the left lung. Interval increase in size and number of nodules in the left lower lobe. Bronchiectasis in the right lung. No pleural effusion. There is bilateral fissural thickening. Interval increase of the left lower lobe reference nodule measuring 11 mm (series 5, image 71), previously measuring 7 mm. Micronodule in the right lower lobe remains unchanged. Right upper lobectomy resection site is unchanged in appearance.MEDIASTINUM AND HILA: No significant lymphadenopathy. Heart size is normal. No pericardial effusion. Reference right paratracheal lymph node measures 8 mm and is unchanged from prior exam (series 3, image 22).CHEST WALL: Scattered small nonspecific cervical lymph nodes unchanged. Unchanged sclerotic focus in the T1 posterior element. Sclerosis of the right lamina and spinous process of T12 is unchanged. UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Scattered mesenteric lymph nodes. | 1.Interval increase in size and number of nodules in the left lower lobe. Metastatic disease remains the most likely etiology especially given skeletal lesions. However, the peribronchial location and asymmetric distribution raises the possibility of atypical mycobacterial infection in the appropriate clinical context.2.Stable focal sclerosis of the posterior elements of T1 and T12.Findings were discussed with thoracic resident, pager 8467, over the phone at 1722 on 11/1/2013 by Dr. Alexander. |
Generate impression based on findings. | Male 49 years old; Reason: abdominal wall tenderness and induration, ? abdominal wall hematoma vs abscess History: as above ABDOMEN:LUNGS BASES: Please refer to chest CT for the lung base information.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Percutaneous gastrostomy catheter terminates in the gastric lumen. No bowel obstruction.BONES, SOFT TISSUES: Soft tissue hematoma in the left muscle extending to the left flank with edema of the soft tissues. There is gas in the left rectus muscle but no definite collection. No intra-abdominal bleed is evident.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: As aboveOTHER: No significant abnormality noted. | 1.Left rectus hematoma and gas in the left rectus extending to the left body wall. This originates adjacent to the percutaneous gastrostomy catheter. Imaging features of hematoma and possible infection.2. If inflammation increases, consider CT angiogram to evaluate for a bleeding vessel.Findings discussed with ICU physician by telephone at the time of this dictation. |
Generate impression based on findings. | Headache. History of subdural hematoma. Exam is slightly limited by Stealth technique as ordered, which results in beam hardening artifact along the calvarium. There has been interval resolution of the previously described subdural hematoma. There is no new intracranial fluid collection, mass, hydrocephalus or CT evidence of acute ischemia. The midline is intact. Orbits, bones and paranasal air sinuses are unremarkable. A few of the more inferior mastoid air cells are opacified, which is unchanged from previous. | Interval resolution of previously described subdural hematoma with no new intracranial fluid collection or abnormality demonstrated. |
Generate impression based on findings. | NSCLC. Assess for recurrent or metastatic disease. CHEST:LUNGS AND PLEURA: Severe emphysema. Multiple pulmonary lesions as follows:Left upper lobe nodule measures 7 x 4 mm, previously 8 x 5 mm. This is surrounded by a large region of groundglass opacity containing at least one additional solid component centrally, previously referred to as the part solid lesion, not significantly changed (4/21).Large poorly defined right lower lobe lesion associated with atelectasis and areas of increased density suspicious for internal solid components unchanged (4/44).Subpleural groundglass nodule with a central lucency measures 11 x 11 mm, previously 8 x 10 mm (4/61).Linear ovoid groundglass opacity posteriorly in the right lower lobe (4/69) is unchanged. Postsurgical volume loss.MEDIASTINUM AND HILA: Small volume of pericardial fluid. Distal esophageal mass shifted in position due to herniation of the proximal stomach into the thoracic cavity, not conclusively changed. Esophageal lumen appears focally obstructed on series 3 image 76, however there is no proximal esophageal dilatation or retained esophageal debris. CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Circumaortic left renal vein, normal variant anatomy.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Distal small bowel is dilated and filled with fluid, suspicious for ileus or obstruction. The abdomen is incompletely included in the scanning range however there is a questionable point of focal narrowing in the left lower quadrant seen on series 3 image 135.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No significant change in pulmonary lesions consistent with neoplasm. No conclusive change in distal esophageal mass, correlate for symptoms of obstruction. Possible ileus versus distal small bowel obstruction incompletely assessed. Dr. MALIK verbally notified at 4:18 p.m. on 11/1/13. |
Generate impression based on findings. | Male 60 years old; Reason: Assess vasculature prior to kidney transplant History: Absent DP pulses bilaterally ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small cyst in the right kidney. No hydronephrosis or nephrolithiasis.RETROPERITONEUM, LYMPH NODES: Calcific arteriosclerotic disease of the aorta. Focal dissection and aneurysmal dilatation of infrarenal abdominal aorta measuring 3.2-cm in dimension.Severe arthrosclerotic disease of the aorta.Moderate to severe calcific arteriosclerotic disease of the common, external and internal iliac arteries.BOWEL, MESENTERY: Postoperative changes with clips in the mesentery.BONES, SOFT TISSUES: Abdominal wall laxity with small bowel and colon loops.Sclerotic lesions involving the right portion of the vertebral bodies and pedicles from T8 to L3. Where there is trabecular coarsening.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: Fusion of the right SI joint.OTHER: No significant abnormality noted. | 1.Abdomen aortic aneurysm with moderate to severe calcific arteriosclerotic disease.2.Nonspecific sclerotic lesions in the spine. The lesions are more linear morphology suggestive of a benign etiology. However, given the patient is for a transplant, further work up is suggested. |
Generate impression based on findings. | Follow up for lung nodule LUNGS AND PLEURA: New 6-mm groundglass nodule left upper lobe abutting the fissure (4/57).5-mm groundglass nodule left upper lobe at the level of the aortic arch (4/82), previously 4-mm. Both may reflect areas of atypical adenomatous hyperplasia but should continue to be monitored to exclude AIS.Right apical ground glass nodule slightly increased in size and density, now with a possible punctate internal solid component versus mucous plug. Lesion measures 5-mm compared to 4-mm previously (4/47). This may also reflect an area of the AAH but is too small to characterize and a small adenocarcinoma cannot be excluded without continued follow-up.Very small serpiginous opacities in the anterior left upper lobe (4/79) present previously and unchanged. Although too small to accurately characterize, this could represent a small vascular lesion such as an AVM.Right upper lobe calcified granuloma.MEDIASTINUM AND HILA: Atherosclerotic calcifications of the aorta and its branches including the coronary arteries. No significant lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Splenic granulomas. | Pulmonary nodules are too small to characterize, one of which is new. These may represent areas of atypical adenomatous hyperplasia or small indolent adenocarcinoma such as adenocarcinoma in situ or less likely minimally invasive adenocarcinoma. One year CT follow-up recommended. |
Generate impression based on findings. | Reason: metastatic breast cancer CHEST:LUNGS AND PLEURA: Left apical and anterior parenchymal scarring with pleural thickening compatible with radiation reaction. Unchanged left basilar pleural thickening with consolidation/atelectasis. Mild enhancement of the pleura may be due to metastases or infection in the pleural space. There is mild septal thickening and fluid tracking within the right fissures. Right and left lower lobe calcified granulomas unchanged from prior exam. No new suspicious pulmonary nodules.MEDIASTINUM AND HILA: Heart size is normal without evidence of pericardial effusion. Moderate coronary artery calcifications. Reference right hilar lymph node (series 7, image 44) measures 7 mm, unchanged. Scattered small mediastinal and hilar lymph nodes unchanged.CHEST WALL: Interval worsening of numerous osteoblastic metastatic foci within the vertebral bodies, ribs, and scapulae. Stable compression fracture of T12 vertebra.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Scattered irregularly marginated areas of hypoattenuation with capsular retraction suggestive of treated hepatic metastasis. The overall appearance has not significantly changed compared to prior exam.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Severe atherosclerotic calcification of the descending aorta.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Interval worsening of numerous osteoblastic metastatic foci within the vertebral bodies, ribs, and scapulae. Stable compression fracture of T12 vertebra.OTHER: No significant abnormality noted. | Interval worsening of numerous bony metastases. Appearance of the hepatic parenchyma is most suggestive of retraction due to treated underlying metastases. Recommend baseline dedicated hepatic CT when feasible for further characterization if diagnosis would alter clinical management. |
Generate impression based on findings. | Evaluate right lower lobe nodule history of left breast cancer status post lumpectomy with new RLL nodule and persistent cough LUNGS AND PLEURA: Numerous solid and sub solid pulmonary nodules and micronodules similar in number. Right lower lobe nodule seen previously has significantly decreased in density, now with a small central solid focus surrounded by groundglass. The overall size of the lesion is similar head 18-19 mm. The similar of left lower lobe poorly defined nodule has also decreased, now 5-mm in size compared to 13-mm previously. The remainder of the nodules are unchanged.MEDIASTINUM AND HILA: Small low cervical lymph nodes are unchanged. Coronary artery calcifications. No significant mediastinal or hilar lymphadenopathy is appreciated within the limitations of unenhanced technique.CHEST WALL: Left breast skin retraction and thickening again noted. Subcutaneous fat stranding slightly more prominent, nonspecific by CT.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. | Significant interval improvement in lower lobe nodules are disfavoring postinflammatory or postinfectious lesions. Recommend 6 week follow up CT to assess for complete resolution. The previously seen nodules are unchanged and likely benign. |
Generate impression based on findings. | Female 73 years old; Reason: gallbladder cancer restaging on chemo History: gallbladder cancer restaging on chemo CHEST:LUNGS AND PLEURA: Few subcentimeter poorly-circumscribed pulmonary nodules. A right upper lobe nodule measures 0.5 mm (5/21). Bibasilar subsegmental atelectasis without pleural effusions.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Normal sized heart without pericardial effusion.CHEST WALL: No axillary lymphadenopathy.ABDOMEN: LIVER, BILIARY TRACT: Small nonspecific hypodensities, which are too small to characterize. No focal hepatic lesions to suggest metastases.Status post cholecystectomy. There is soft tissue in the surgical bed (3/89) and lymphadenopathy in the adjacent mesentery (3/100).SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Prominent adrenal glands.KIDNEYS, URETERS: Left renal cysts.PANCREAS: Stable 1.5 x 1.2 cm calcified lesion at the pancreatic head. There is no pancreatic ductal dilatation.RETROPERITONEUM, LYMPH NODES: Enlarged retroperitoneal lymph nodes. A left para-aortic lymph node measures 1 x 1 cm, previously 1.3 x 1.3 cm (3/104).BOWEL, MESENTERY: Non dilated loops of bowel without wall thickening, associated mesenteric stranding, or fluid collections. Colonic diverticulosis without diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: A stable right pelvic sidewall node measures 2.0 x 1.7 cm (3/151).BOWEL, MESENTERY: Non dilated loops of bowel without wall thickening, associated mesenteric stranding, or fluid collections. Colonic diverticulosis without diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Stable soft tissue in the surgical bed and lymphadenopathy in the adjacent mesentery, likely related to prior gallbladder carcinoma and recent surgery.2. Stable enlarged retroperitoneal and pelvic lymph nodes, which are atypical for gallbladder carcinoma, suggestive of a second genitourinary or pelvic malignancy.3. Few scattered pulmonary nodules, which are nonspecific in appearance. Continued follow up is recommended. |
Generate impression based on findings. | Malignant neoplasm of the nasopharynx, unspecified site. Pre-chemo. The following observations are made given the limitations of an unenhanced study.CHEST:LUNGS AND PLEURA: Widespread pulmonary metastases. For reference purposes, a mass in the left lower lobe at the level of the confluence of pulmonary veins measures 2.3 x 2.4 cm (image 46; series 4).Small left pleural effusion. Left lower lobe atelectasis.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Left-sided chest port terminates in the right atrium. Sclerosis of the T5 vertebral body is indeterminate but could represent a bony metastasis. A few punctate areas of sclerosis and ribs are also indeterminate. Consider correlation with bone scan.ABDOMEN:LIVER, BILIARY TRACT: Multiple liver metastases. For reference purposes, segment 8 lesion measures 2.6 x 2.6 cm (image 84; series 3).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 1.0 x 1.3 cm (image 118; series 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: Anterior left sacrum wing sclerosis (image 170; series 3).OTHER: No significant abnormality noted | Widespread metastases with measurements given above. |
Generate impression based on findings. | 70 year-old female with confusion. The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. | No acute intracranial abnormality. CT is insensitive to early detection of CVA. MRI should be considered if clinical suspicion for CVA persists. |
Generate impression based on findings. | Male 62 years old; Reason: h/o RLQ infected fluid collection, s/p drain placement. Completed antibiotic course, but still + for bacteria. Please eval if adequately drained with current drain. History: +culture from current drain after completion of antibiotic course. ABDOMEN:LUNGS BASES: Diffuse left basilar pleural thickening with multiplepulmonary nodules.LIVER, BILIARY TRACT: Hypodense 1.4-cm segment IVb lesion (image 45/series 3). The hepatic and portal veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Right adrenal myolipoma. Left adrenal gland is normal in morphology.KIDNEYS, URETERS: Mild to moderate left hydronephrosis with narrowing of the left distal ureter. Right kidney is normal in morphology.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Post operative changes in the small bowel. Right lower abdominal ostomy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Right abdominal drain terminates within the pelvis. The more superior fluid collection has resolved. This is more inferior fluid collection adjacent to right external iliac vessels measuring 4.8 x 1.9 cm.PELVIS:PROSTATE/SEMINAL VESICLES: CystoprostatectomyBLADDER: CystoprostatectomyLYMPH NODES: New lymphadenopathy which measuring 3.8 x 2.7 cm (image 138/series 3). BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: A pelvic abscess has decreased. Residual fluid collection in the deep pelvis measures 6.1 x 3.0 cm (image 145/series 3). OTHER: No significant abnormality noted. | 1.Progression of disease at the lung base with extensive pleural based disease and pulmonary nodules.2.1.3cm hypodense hepatic lesion.3.Pelvic nodule suspicious for metastatic disease.4.Decrease in the size of the pelvic abscess.5.Mild to moderate left hydronephrosis. |
Generate impression based on findings. | 69-year-old female patient with history of ovarian cancer, currently receiving treatment. Please evaluate for disease progression/response. CHEST:LUNGS AND PLEURA: No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: No mediastinal lymphadenopathy the reference right hilar lymph node measures 1.0 x 1.0 cm (series 401 image 37), previously 1.0 x 0.9 cm.CHEST WALL: Left-sided chest port with catheter tip at the cavoatrial junction. Status post left mastectomy.ABDOMEN:LIVER, BILIARY TRACT: Left hepatic lobe cyst, stable.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: Reference aortocaval lymph node measures 1.5 x 0.8 cm (series 401 image 79), stable.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Stable examination with no significant interval change in reference nodes. |
Generate impression based on findings. | Reason: 57 yr old male with h/o CLL, pre-stem cell transplant evaluation History: evaluate LUNGS AND PLEURA: Subpleural focal consolidation is nonspecific. In addition, there are scattered regions of pleural thickening especially in the left paraspinous region of unknown etiology.No specific evidence of infection or failure.MEDIASTINUM AND HILA: There is no specific evidence of mediastinal or hilar lymphadenopathy.Low attenuation of the circulating blood pool is consistent with anemia.CHEST WALL: Mild degenerative abnormalities of the thoracolumbar spine region.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Status post splenectomy. | Left subpleural focal consolidation could be organizing pneumonia or prior infarct. Nonspecific left pleural thickening may be related to a prior hemothorax especially if the patient's spleen was removed as a result of trauma. PET may be helpful for this. |
Generate impression based on findings. | 39 year old patient with history of DLBCL (stage IA/E) involving left maxillary sinus and orbit. Status post 6 cycles of R-CHOP chemotherapy. Please compare to prior. There are postoperative changes of the left maxillary sinus which has undergone antrectomy and partial resection of the inferior turbinate. There is nonspecific lobulated soft tissue within the sinus which is slightly more prominent than on the prior exam. The right maxillary sinus is normal. The nasopharynx, oropharynx, hypopharynx, epiglottis and larynx are unremarkable. No prevertebral/retropharyngeal abnormality. There is no lymphadenopathy and vasculature is normal. There are no aggressive bony lesions demonstrated. | Postoperative changes and lobulated soft tissue within the left maxillary sinus which has slightly increased since previous. This is nonspecific but most likely represent sequela of inflammation. |
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