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Generate impression based on findings. | CLL, pre-stem cell transplant. There are bubbly secretions within an otherwise almost completely opacified paranasal sinus with fluid attenuation contents and possible underlying air-fluid level. There is sclerosis of the left sphenoid sinus walls as well. The right sphenoid sinus is clear. There is a left lamina papyracea fracture that bulges into the left ethmoid air cells by approximately 6 mm with contents that include both orbital fat and a small portion of the medial rectus muscle, which appears distorted, possibly due to tethering by scar tissue. The ethmoid sinuses are otherwise essential clear, as is the hypopneumatized right frontal sinus. The left frontal sinus is not pneumatized. There is mild left and moderate right maxillary sinus mucosal thickening and retention cyst formation. The ethmoid roofs are nearly symmetric and intact. The carotid grooves and optic canals are covered by bone. The imaged intracranial structures and orbits are grossly unremarkable. | 1. Scattered paranasal sinus opacification in a sporadic pattern with most notables bubbly secretions and possible air fluid level within the left sphenoid sinus, which raises the possibility of acute sinuitis in the appropriate clinical setting.2. Chronic-appearing left lamina papyracea fracture that bulges into the left ethmoid air cells by approximately 6 mm with contents that include both orbital fat and a small portion of the medial rectus muscle, which appears distorted, possibly due to tethering by scar tissue. |
Generate impression based on findings. | 54-year-old male with history of bladder cancer status post cystectomy ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Diffuse hepatic steatosis, mildly improved from the prior study. No focal hepatic lesions. No biliary ductal dilatation. The gallbladder appears unremarkable.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Several right renal cysts are unchanged. No filling defects in the collecting system. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Shotty retroperitoneal lymph nodes are again noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Status post cystectomy with neobladder creation.LYMPH NODES: Prominent inguinal and iliac lymph nodes are again noted, appearing similar to the prior study.BOWEL, MESENTERY: Diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Stable exam with no evidence of recurrent or metastatic disease. 2. Diffuse hepatic steatosis, mildly improved from the prior study. |
Generate impression based on findings. | Dizziness, headache and possible SIADH. The pituitary gland is not enlarged. However, assessment of the pituitary gland is limited on non-contrast CT. There is no evidence of intracranial hemorrhage, large mass, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. There are bilateral trochlear calcifications. The skull and extracranial soft tissues are otherwise unremarkable. | The pituitary gland is not enlarged. However, assessment of the pituitary gland is limited on non-contrast CT. A pituitary MRI may be useful for further characterization if clinically warranted and there are no contraindications. |
Generate impression based on findings. | Head injury. There are small bifrontal scalp contusions. However, there is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles are unchanged in size and configuration, reflecting mild cerebral volume loss. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull appears unremarkable without evidence of fracture. | Small bifrontal scalp contusions, but no evidence of intracranial hemorrhage, mass, or cerebral edema. |
Generate impression based on findings. | Syncope. There is no evidence of acute intracranial hemorrhage, mass, or cerebral edema. There is mild patchy cerebral white matter hypoattenuation that likely represents small vessel ischemic disease. The ventricles and sulci are diffusely prominent reflecting cerebral volume loss. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. | No evidence of acute intracranial hemorrhage, mass, or cerebral edema. Mild patchy cerebral white matter hypoattenuation likely represents small vessel ischemic disease. |
Generate impression based on findings. | Dementia. There is no evidence of intracranial hemorrhage, mass, or cerebral edema. There is mild cerebral white matter hypoattenuation, which likely represents microangiopathy. The ventricles and sulci are prominent, particularly in the bilateral medial temporal lobes. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. | 1. No evidence of acute intracranial hemorrhage, mass, or cerebral edema. However, non-contrast CT is not sensitive for detection of non-hemorrhagic infarction and MRI is recommended if clinically warranted and there are no contraindications.2. Cerebral volume loss that most prominent in the medial temporal lobe may be related to Alzheimer pathology. |
Generate impression based on findings. | Altered mental status. There is unchanged extensive encephalomalacia in the left anterior cerebral artery territory and mild scattered areas of cerebral white matter hypoattenuation that likely represent microangiopathy. There is no evidence of acute intracranial hemorrhage, mass, or cerebral edema. The ventricles and sulci are mildly diffusely prominent, reflecting cerebral volume loss. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. There is a chronic right inferior orbital wall fracture. | Chronic left anterior cerebral artery territory infarct, but no evidence of intracranial hemorrhage, mass, or cerebral edema. |
Generate impression based on findings. | Non-Hodgkin lymphoma and thrombocytopenia with altered mental status. There is a partially calcified extra-axial mass along the left lesser wing of the sphenoid, which measures up to approximately 7 mm in thickness. There is no evidence of acute intracranial hemorrhage or cerebral edema. The ventricles and basal cisterns are stable in size and configuration. There is no midline shift or herniation. There is minimal opacification of the right mastoid air cells. The imaged paranasal sinuses are clear. The skull and extracranial soft tissues are unremarkable. | 1. No evidence of acute intracranial hemorrhage.2. Small probable meningioma along the left lesser wing of the sphenoid. |
Generate impression based on findings. | Female 57 years old; Reason: Dx Breast Cancer History: Evaluate disease/ check for progression of disease. ABDOMEN:LUNGS BASES: No nodule detected. Reidentified right mastectomy.LIVER, BILIARY TRACT: Numerous new hypodensities are noted throughout the liver, for example, a reference lesion in the inferior right lobe currently measures 1.8 x 1.7 cm (image 59 series 3), previously not seen in 2012. The gallbladder and biliary tract are normal in appearance. SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Hypoattenuating lesions in the kidneys are likely cysts, and demonstrate no enhancement when compared to the previous non-enhanced study from 10/23/13. Largest of these lesions in the inferior pole right kidney measuring 2 x 2 cm.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No gross abnormalities noted.BONES, SOFT TISSUES: Numerous sclerotic foci in the thoracolumbar spine likely represent bone islands.OTHER: No significant abnormality noted. | 1. New hepatic lesions likely represent metastatic disease when compared to 2012. 2. No other sites of abdominal involvement. |
Generate impression based on findings. | Reason: 46-year-old female with metastatic breast CA, new onset shortness of breath, eval for PE History: shortness of breath PULMONARY ARTERIES: Diagnostic quality exam. No evidence of pulmonary embolism.LUNGS AND PLEURA: Multiple, primarily peripherally located parenchymal and pleural based micronodules bilaterally are new compared to CT on 2/24/2011 and are likely metastases. No pleural effusions.MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. Heart size is normal. No pericardial effusion.CHEST WALL: Enlarged left lobe of the thyroid with multiple hypodense lesions. Small hypodense lesion in the right lobe of the thyroid. Surgical clips in the right axilla. Hypodense lesion in the vertebral body of T1 unchanged from prior exam.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Numerous metastatic lesions are again seen. Hypodense lesions in the left kidney are not well seen on the prior exam. | 1.No evidence of pulmonary embolism. No other acute abnormalities.2.Numerous metastatic lesions in the liver and lungs.3.Multiple hypodense lesions in bilateral lobes of the thyroid. |
Generate impression based on findings. | Male 83 years old; Reason: history of bladder cancer post chemo-RT. eval for recurrence or mets History: bladder cancer CHEST: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: Noncalcified right lower lobe pulmonary nodules including a stable 0.5 cm nodule on series 5 image 16, stable compared to 2007 favoring benign etiology. Dependent atelectasis and/or scarring. Postsurgical changes of coronary artery bypass graft surgery. LIVER, BILIARY TRACT: Normal hepatic contour without evident suspicious hepatic lesion. Status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Atrophic left kidney. Stable simple cyst interpolar right kidney (series 4 image 44). Subcentimeter right renal hypodensities too small to characterize. No evident solid renal mass although limited given lack of IV contrast.New increase in dilation of the proximal ureter and fullness and dilation at the Ureto-pelvic junction. Gas within the left renal collecting system could be on the basis of reflux, and is stable compared to previous.RETROPERITONEUM, LYMPH NODES: Borderline enlarged aortocaval lymph node stable compared 2007. Mildly enlarged right common iliac lymph node has decreased in size measuring 1 x 0.6 cm (series 4 image 67) previously 1.2 cm x 0.8 cm.Stable postsurgical changes of abdominal aortic aneurysm repair. Unchanged aneurysmal dilatation of the common iliac arteries.BOWEL, MESENTERY: Wide-neck ventral containing loops of small bowel and mesenteric fat, without fluid in the hernia sac or evidence of bowel obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostateBLADDER: Partially distended urinary bladder. Diffuse thickening of the bladder wall with markedly enlarged prostate is stable, although limited evaluation given lack of IV contrast. Stable appearance of the bilateral dilated ureters at the UV junction with stable distal ureteral wall thickening.Interval removal of the Foley catheter.LYMPH NODES: Left external iliac lymph node not significantly changed from 2007. Borderline-enlarged bilateral external iliac lymph nodes and right internal iliac lymph node are also unchanged.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. New increased distention of the proximal right ureter with stable increased ureteric wall thickening at the ureto-vesicular junction. While these may be chronic benign findings, a stricture at the distal ureter cannot be excluded. 2. Stable bladder wall thickening and prostatic hypertrophy. 3. Borderline enlarged pelvic and retroperitoneal lymph nodes are stable to slightly decreased compared to prior CT from 2007.4. Right lower lobe pulmonary nodules stable from 2007 favoring benign etiology.5. Stable abdominal wall hernia |
Generate impression based on findings. | 26 year-old female with right superior gluteal fold chronic wound ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: 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: 3.9 x 4.9 cm loculated fluid collection adjacent to the rectum on the right with a thin tract extending to the left. The levator ani are poorly delineated but the abscess may extend superior to the levator ani on the right. The soft tissue infiltration extends posteriorly through the gluteal fold. | 5-cm perirectal abscess as detailed above |
Generate impression based on findings. | Female 36 years old; Reason: abdominal pain, right lower quadrant, now with leucocytosis History: as above ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The appendix is well visualized and normal. There is no inflammation in the right lower quadrant to suggest appendicitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality noted. Physiologic changes noted.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No CT findings to explain patient's acute abdominal pain. |
Generate impression based on findings. | 84-year-old female with severe left lower pelvic pain ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Scattered hypoattenuating lesions, likely representing cysts.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: The bladder is distended and otherwise, unremarkable.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Soft tissue calcification posterior to the gluteal muscles.OTHER: No significant abnormality noted. | No specific findings to account for the patient's pelvic pain. |
Generate impression based on findings. | Reason: r/o PE History: hypoxia, lung cancer PULMONARY ARTERIES: Diagnostic quality exam. No evidence of pulmonary embolism.LUNGS AND PLEURA: Interval improvement of right-sided malignant pleural effusion with overlying atelectasis/consolidation. Interval placement of right PleurX catheter. No left pleural effusion. Large right perihilar mass (series 6, image 151) measures 30 x 31 mm and previously measuring 39 x 39 mm. Interval increase size and number of bilateral metastatic pulmonary nodules. Interval increase in diffuse patchy ground glass opacities predominately in the left lung may represent edema or atypical infection. Reticulonodular opacities they represent lymphangitic spread of tumor. There is bronchial wall thickening.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion.. CHEST WALL: Right axillary lymphadenopathy with largest lymph node measuring 15 mm in diameter.. Multiple cutaneous nodules in the lateral and posterior chest wall.Patchy and sclerotic foci involved in several thoracic vertebral bodies are new from prior exam and likely represent metastatic lesions.UPPER ABDOMEN: Absence of enteric contrast material and acquisition of images in a different phase markedly limits sensitivity for abdominal pathology. Hypodense lesions in the liver and spleen may represent metastasis.. | 1.No evidence of pulmonary embolism.2.Marked interval increase in size and number of bilateral metastatic pulmonary nodules.3.Interval placement of PleurX catheter with improvement of right-sided malignant pleural effusion.4.New left-sided patchy groundglass opacities may represent edema or atypical infection.5.Interval increase in the extent of metastasis to spine. Liver and spleen lesions appear unchanged within the limitations noted above. |
Generate impression based on findings. | 50 year-old female with metastatic breast cancer, prior liver METs, altered mental status and hypercalcemia evaluate for disease progression. ABDOMEN:LUNG BASES: Basilar atelectasis.LIVER, BILIARY TRACT: Diffuse hepatic metastases persist but with interval increasing capsular retraction and lesion hypoattenuation compatible with treatment effect. Overall, many lesions have decreased in size and the number of hepatic metastases appears decreased, but several lesions appear larger but these all demonstrate increased central necrosis compatible with treatment effect (these lesions may have increased in size following last CT but before treatment response). The previously identified peripheral reference lesion now appears predominantly scarlike and measures 3.1 x 1.0 cm (image 22 series 4) and previously measured 4.5 x 3.2 cm.. For future reference a left hepatic lesion measures 2.7 x 2.7 cm (image 50 series 4) that remains and may make a better continuing lesion to follow for future tumor response.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Mild decrease in retroperitoneal adenopathy with reference right retroperitoneal lymph node measuring 1.1 x 0.8 cm (image 65, series 4) and previously measuring 1.5 x 1.2 cm. BOWEL, MESENTERY: The bowel is normal in caliber. Diffuse mesenteric carcinomatosis has improved with the largest measurable lesion now measuring and 2.5 x 3.0 cm (image 123, series 4) and demonstrating central necrosis. The previously largest conglomerate peritoneal carcinomatosis lesion measured 4.7 x 4.8 cm (image 112, series 4).BONES, SOFT TISSUES: Ventral hernia containing metastatic disease. Diffuse osseous metastases with chronic compression fracture of the L3 vertebral body. Right peripheral enhancing breast masses is again noted.OTHER: Marked abdominal and pelvic ascites.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: A catheter extends to the bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diffuse mesenteric carcinomatosis has improved with the largest measurable lesion now measuring and 2.5 x 3.0 cm (image 123, series 4) and demonstrating central necrosis. The previously largest conglomerate peritoneal carcinomatosis lesion measured 4.7 x 4.8 cm (image 112, series 4).BONES, SOFT TISSUES: Diffuse osseous metastases with chronic compression fracture of the L3 vertebral body.OTHER: Marked abdominal and pelvic ascites. | Diffuse metastatic disease of the liver, peritoneum, and bones with interval improvement in peritoneal carcinomatosis and treatment effect of liver metastases. |
Generate impression based on findings. | 83 year old female vomiting fecal material Evaluation of solid organ pathology is limited due to lack of IV contrast.ABDOMEN:LUNG BASES: Basilar consolidation, worse on the left. Calcified nodule at the left lung baseLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Small with multiple scattered calcifications.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Moderate atherosclerotic calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: Large hiatal hernia. Enteric tube extends to the fluid-filled stomach. Diffuse small bowel dilatation consistent with ileus. No bowel wall thickening is identified. Evaluation for ischemia is limited due to lack of IV contrast. No transition point. No pneumatosis or free air. Nodularity of the peritoneum consistent with carcinomatosis has progressed.BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine.OTHER: Increased abdominal ascites.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diffuse small and large bowel dilatation consistent with ileus. Colon shows diffuse distension in the ascending and transverse colon with slightly lesser distension of descending and sigmoid, but with fluid and feces there as well (these are nondependent loops and often show decreased caliber in supine position). No bowel wall thickening is identified. Evaluation for ischemia is limited due to lack of IV contrast. No transition point. No pneumatosis or free air. Nodularity of the peritoneum consistent with carcinomatosis has progressed.BONES, SOFT TISSUES: Moderate atherosclerotic calcification of the abdominal aorta and its branches.OTHER: Increased pelvic ascites. | 1. Interval progression of diffuse abdominal and pelvic carcinomatosis and ascites.2. Diffuse dilatation of the small and large bowel consistent with ileus. |
Generate impression based on findings. | 74-year-old male status post OHT. Assess for possible abscess. There is thickening of the skin along the medial aspect of the leg with reticulation of the subcutaneous fat compatible with edema. This edema becomes confluent as it extends inferiorly down the medial aspect of the leg, but does not have the typical appearance of an abscess. Also, confluent edema is identified about lateral aspect of the distal lower leg. There are numerous varicosities seen within the medial soft tissues of the leg. The musculature of the leg is within normal limits. There are no findings to suggest deep abscess formation. There is no evidence of osteomyelitis. Note is made of dense calcifications of the arteries of the leg. Minimal osteoarthritis affects the knee. | Skin thickening and confluent subcutaneous edema, as described above, could represent cellulitis. There are no specific imaging findings to suggest abscess formation. |
Generate impression based on findings. | Male 74 years old; Reason: Evaluate for lymphadenopathy or masses causing progressive weight loss. History: Progressive Weight Loss in smoker CHEST:LUNGS AND PLEURA: Emphysematous changes are noted in the lungs. No nodule or mass detected. Pleural spaces are clear.MEDIASTINUM AND HILA: Aberrant right subclavian artery noted. No lymphadenopathy detected. Atheromatous calcifications are noted in the coronary vessels.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Numerous too small to characterize hypoattenuating lesions throughout the liver are noted. These are stable when compared to the MRI, likely represent cysts.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Numerous hypoattenuating lesions throughout the kidneys, many of which are too small to characterize, but some are larger than a centimeter and have enhancement to 70 HU or more. Without noncontrast CT it is not possible to determine if these are high density cysts or solid enhancing lesions. When compared to the MRI done 7/2011 and CT done 2008, these have progressed in size and number and is worrisome for a diffuse infiltrating or multifocal process. A dedicated multiphase contrast CT is recommended to completely evaluate the kidneys.No hydronephrosis, or perinephric fluid collections detected.RETROPERITONEUM, LYMPH NODES: Moderate to severe atheromatous calcifications are noted in the abdominal aorta and branch vessels.Metallic artifact is noted at the root of mesentery.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Progression of the innumerable renal lesions when compared to the previous MRI of 2011 and CT of 2008. These lesions are incompletely characterized with single phase of contrast (see above discussion), and dedicated renal CT advised. 2.Moderate to severe atheromatous calcifications in the coronary, aorta, and branch vessels. |
Generate impression based on findings. | Head injury. Rule out bleed. There is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is soft tissue stranding, swelling and subcutaneous air overlying the left orbit related to a laceration. There is also a 2 mm thick right parietal scalp hematoma. There is no underlying fracture or intraorbital abnormality. The paranasal sinuses and mastoid cells are clear. | 1.No evidence of intracranial hemorrhage or skull fracture.2.Small right parietal scalp hematoma and left periorbital laceration and hematoma without underlying intraorbital abnormality.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Shortness of breath, worsening since yesterday. Evaluate for PE. PULMONARY ARTERIES: Motion artifact limits evaluation. Within these limitations there is no pulmonary artery embolus seen to the level of the segmental branches.LUNGS AND PLEURA: Hypoinflated lungs. Right basilar subsegmental atelectasis.MEDIASTINUM AND HILA: Cardiac size is normal. There is no pericardial effusion. There is no mediastinal or hilar lymphadenopathy.CHEST WALL: Rightward scoliosis is again noted. No focal osseous lesions. There is no axillary lymphadenopathy. Shunt catheter is noted in the anterior thorax.UPPER ABDOMEN: No significant abnormality noted. | No PE. |
Generate impression based on findings. | 49-year-old male with diffuse abdominal pain, evaluate for reaccumulation of fluid. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Subcentimeter left hepatic hypodensities, likely representing cysts.SPLEEN: No significant abnormality notedPANCREAS: Left-sided percutaneous drain extending to the pancreatic tail without evidence of fluid reaccumulation. The pancreas appears atrophic with minimal residual enhancing tissue. Thrombosis of the SMV and splenic vein is again noted.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Mild bilateral hydronephrosis is again noted.RETROPERITONEUM, LYMPH NODES: Right-sided retroperitoneal fluid collection overlying the right psoas muscle measures 5.1 x 1.3 cm (image 82, series 3) and previously measured 6.7 x 2.6 cm..BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Interval decrease in retroperitoneal fluid collection.2. Necrotic pancreatic body and tail without evidence of fluid reaccumulation.3. Hydronephrosis again noted. |
Generate impression based on findings. | Female 67 years old; Reason: Assess ascites, r/o liver pathology, r/o bowel obstruction History: abdominal distention, decreased caliber of BM CHEST:LUNGS AND PLEURA: Small right loculated or organizing pleural effusion extending into thefissures. Ground glass opacities in the right posterior lung likely represent acombination of atelectasis and edema.MEDIASTINUM AND HILA: Severe 4-chamber cardiomegaly. Single lead ICD device terminates inthe right ventricle. Prosthetic mitral valve is also noted.Hypoattenuating lesions in the thyroid, completely characterized given lack of IV contrast. No adenopathy is detected.CHEST WALL: Sternotomy wires noted and appear intactABDOMEN: The absence of intravenous contrast limits evaluation of the solid organs and of the bowels. Given these limitations, the following observations were made:LIVER, BILIARY TRACT: The liver surface is nodular, with widened fissures suggesting cirrhotic morphology. No definite lesion detected although limited given lack of IV contrast. Cholelithiasis without cholecystitis. No intra or extrahepatic biliary dilation noted. No ascites.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: The aorta is tortuous with moderate atherosclerotic calcifications 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.Cirrhotic morphology without discrete mass although limited given lack of IV contrast. No biliary pathology or ascites detected.2. Cholelithiasis without cholecystitis. |
Generate impression based on findings. | 71 year old female with possible Crohn's flare ABDOMEN:LUNG BASES: Bilateral lower lobe pulmonary arterial filling defect suspicious for pulmonary emboli.LIVER, BILIARY TRACT: Cholelithiasis without evidence of cholecystitis. Small right hepatic cyst is unchanged. Clips are again noted adjacent to the gallbladder.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: No wall thickening, fat stranding or free or loculated fluid collection. The bowel is normal in caliber. Fibrofatty proliferation of the mesentery.BONES, SOFT TISSUES: Anterior abdominal surgical mesh.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No bowel wall thickening, fat stranding or loculated fluid collections. Fibrofatty proliferation of the mesentery.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Filling defects in bilateral lower lobe pulmonary arteries suspicious for pulmonary emboli. This finding was discussed with Dr. Glick (pager 7730) at 9 a.m.2. No acute intra-abdominal or pelvic abnormality.3. Cholelithiasis without evidence of cholecystitis. |
Generate impression based on findings. | Nasopharyngeal cancer with lung, liver mets and retroperitoneal lymph nodes. The examination is limited by lack of intravenous contrast administration. Within these limitations, there is a right nasopharyngeal mass that measures approximately 13 AP x 15 RL x 15 SI mm with mild narrowing of the nasopharyngeal airway. The skull base appears to be intact and the intracranial structures appear grossly unremarkable. There is no definite evidence of significant cervical lymphadenopathy. There are partially imaged multiple bilateral infiltrative upper lung and mediastinal nodules and masses. There is a left internal jugular venous catheter in position. There is mild degenerative cervical spondylosis without lytic or blastic lesions. There is fluid with bubbly secretions within the right sphenoid sinus. The mastoid air cells are clear. | 1. The examination is limited by lack of intravenous contrast administration. Within these limitations the right nasopharyngeal carcinoma measures approximately 15 mm. No definite evidence of significant cervical lymphadenopathy or skull base invasion. 2. Partially imaged multiple bilateral infiltrative upper lung and mediastinal nodules and masses. Refer to the separate chest CT report for additional details.3. Fluid with bubbly secretions within the right sphenoid sinus may indicate acute sinusitis in the appropriate clinical setting. |
Generate impression based on findings. | Fall. There is normal alignment. The vertebral body and intervertebral disc heights maintained. There is no fracture or dislocation and the odontoid is normal. There is no prevertebral soft tissue swelling. There is incomplete fusion of the posterior arch of C1, which is a normal variant. There is also enlargement of the bilateral transverse processes with suggestion of a rudimentary rib at C7. The imaged portions of the lungs are clear. | No evidence of fracture or dislocation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | trisomy 21, fever, and abdominal pain. Evaluate for appendicitis. ABDOMEN:LUNG BASES: Minimal atelectasis left lower lobe.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Bowel is normal in caliber without evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No free air or free fluid in the abdomen.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: The urinary bladder is distended.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: The appendix is normal in appearance.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No free air or free fluid in the pelvis. | Normal-appearing appendix. |
Generate impression based on findings. | Reason: 59 yo F history of non-hodgkins lymphoma with shortness of breath, ? hemoptysis, interstitial opacities on CXR, eval infection versus hemorrhage History: shortness of breath, ? hemoptysis LUNGS AND PLEURA: There appears to be an interval decrease in number of bilateral ground glass pulmonary nodules although there is interval increase in number of reticulonodular opacities; the overall lung involvement is about the same, however.New moderate right sided pleural effusion.MEDIASTINUM AND HILA: Mild mediastinal lymphadenopathy unchanged. Heart size is normal. No pericardial effusions.CHEST WALL: Reference left retropectoral lymph node (series 4, image 16) measures 11 x 8 mm. Degenerative changes to the thoracic spine unchanged.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. There is gastric banding. Hypodense lesion in the right lobe of the liver is too small to further characterize. Mild mesenteric lymphadenopathy. | 1.Extensive pulmonary opacities, now more reticulonodular than ground-glass, but still consistent with lymphoma.2.New right-sided moderate sized pleural effusion. |
Generate impression based on findings. | Head injury. Rule out intracranial bleed or facial fracture. The images are somewhat degraded by motion.Head CT: There is no intracranial hemorrhage, hydrocephalus, or mass effect. There is no depressed skull fracture. The orbits and mastoid air cells are unremarkable.Maxillofacial CT: There is prominent swelling and emphysema within the soft tissues at the floor of the mouth associated with a displaced and comminuted right mandibular body fracture. Notably, there is a dominant mandibular body fracture fragment measuring up to 20 mm that is posteriorly displaced by approximately 10 mm. There is another comminuted and mildly displaced fracture of the right mandibular angle that extends from the alveolar process of the right second molar inferoposteriorly through the mandibular angle. There is associated periodontal lucency and slight displacement of ADA #32, suggesting traumatic loosening. There is also a carious ADA #3 and periodontal lucency at ADA#8. The temporomandibular joints are intact. There is a minimally displaced fracture of the right nasal bone. There is a 5 mm diameter spheroid metallic foreign body in the subcutaneous tissues overlying the posterior left zygomatic arch, which is otherwise intact. There is packing material within the anterior oral cavity. The paranasal sinuses are clear. | 1.Displaced and comminuted mandibular fractures involving the right mandibular body and angle with a 10 mm posteriorly displaced mandibular body fragment and associated extensive regional soft tissue injury and apparent loosening of ADA#32.2.Minimally displaced right nasal bone fracture of indeterminate age.3.A metallic foreign body within subcutaneous tissues overlying the zygomatic arch is compatible with a bi-bi or bullet.4.Carious ADA #3 and periodontal lucency at ADA#8. 5.No evidence of intracranial hemorrhage. |
Generate impression based on findings. | New diagnosis of RLL adenocarcinoma needs staging imaging. Head: There is a 5 mm wide partially calcified extra-axial lesion in the left frontal convexity that may represent a meningioma. Otherwise, there is no evidence of abnormal intraparenchymal enhancement. There is no evidence of intracranial hemorrhage or cerebral edema. The ventricles are normal in size and configuration. There is no midline shift or herniation. The mastoid air cells are clear. There is a small air-fluid level within the right sphenoid sinus.Neck: There is a somewhat ill-defined lobulated mass within the isthmus and left thyroid lobe that measures approximately 20 AP x 35 RL x 25 SI mm, which demonstrated marked hypermetabolism on the prior PET and may invade the overlying strap muscles. There is a hypoattenuating nodule within the right thyroid lobe that measures 5 mm in diameter. There is on significant cervical lymphadenopathy. There is a hyperattenuating mass with remodelling of the right nasoantral wall that demonstrates corresponding moderate hypermetabolism on the prior PET within the right nasal cavity that measures 33 AP x 16 RL x 21 SI mm. There is moderate opacification of the right maxillary sinus with bubbly secretions. The major cervical vessels are patent. There is extensive emphysema in the imaged portions of the lungs. Refer to the separate chest CT report for additional details. | 1. An ill-defined lobulated mass within the isthmus and left thyroid lobe that measures up to approximately 35 mm with corresponding marked hypermetabolism on the prior PET and possible invasion of the overlying strap muscles may represent a primary thyroid malignancy or metastases.2. A right nasal mass that measures up to 33 mm may represent a primary sinonasal neoplasm or a metastasis.3. No evidence of intracranial metastases.4. No significant cervical lymphadenopathy.5. Secretions with air fluid levels in the paranasal sinuses may represent acute sinusitis in the appropriate clinical setting. |
Generate impression based on findings. | Reason: SOB, hypoxia r/o PE History: SOB, hypoxia PULMONARY ARTERIES: Diagnostic quality exam. No evidence of pulmonary embolism.LUNGS AND PLEURA: Bilateral apical scarring unchanged. Moderate, apical predominant centrilobular emphysema. There is bronchial wall thickening. There has been interval partial resolution of left lower lobe atelectasis/consolidation since prior exam. There is still partial collapse of the lower lobe with leftward mediastinal shift. There has been interval resolution of left lower lobe bronchus obstruction as noted on prior exam.MEDIASTINUM AND HILA: Heart size is normal. Mild atherosclerotic calcification of the aortic arch and coronary arteries. No pericardial effusions.CHEST WALL: Left mild left axillary lymphadenopathy.UPPER ABDOMEN: Absence of enteric contrast material and acquisition of images in an early phase markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.No evidence of pulmonary embolism.2.Interval partial resolution of the lower lobe atelectasis/consolidation. |
Generate impression based on findings. | 66 years old. Acute mental status change. There are postoperative changes related to the recent left hemicraniectomy and hematoma evacuation. There is no significant interval change in the residual evolving subdural hematoma along the left tentorium and left parafalcine regions. There is persistent associated mild mass effect and partial effacement of left lateral ventricle, and 7 mm of midline shift to the right. There is apparent poor gray white differentiation in the anterior temporal lobe, which is unchanged and may be artifactual or related to edema. The left facial/periorbital swelling has decreased. | Stable postoperative changes related to left hemicraniectomy without significant change in the residual left hemispheric subdural hematoma and associated mass effect and midline shift.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | ALL with altered mental status and dilated right pupil. There is a large intraparenchymal hematoma that measures up to approximately 7 cm with extensive surrounding edema centered in the right temporal lobe with associated subarachnoid and possibly intraventricular extension. There are also several subcentimeter hemorrhagic foci in the bilateral parieto-occipital lobes situated at the grey-white matter junctions. There is a background of bilateral parieto-occipital predominant cerebral edema. There is approximately 14 mm of midline shift to the left as well as subfalcine and uncal herniation. There is partial effacement of the third and lateral ventricles and mild dilatation of the left lateral ventricle. There basal cisterns are also effaced. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. | Bilateral parieto-occipital predominant vasogenic cerebral edema with multifocal intracerebral hemorrhages, including a dominant hemorrhagic focus centered in the right temporal lobe with associated 14 mm of midline shift, uncal and subfalcine herniation, and probable early entrapment of the left lateral ventricle. The differential diagnosis includes atypical posterior reversible encephalopathy syndrome, hemorrhagic emboli, and less likely neoplasm, given the rapid development of this condition.Discussed with Dr. Siruguppa at 9:55 AM on 11/1/13. |
Generate impression based on findings. | Reason: Lung cancer re-staging. Thanks History: Lung cancer CHEST:LUNGS AND PLEURA: Large, heterogeneously enhancing right lung mass measuring 8.8 x 6.0 x 8.4 cm (AP x TV x CC) which cannot be identified as separate from the pleura (series 1201, image 65 and series 1202, image 40). There is no adjacent bony destruction. There are few ipsilateral smaller nodules likely representing metastasis. There is no pleural effusion. There is, right greater than left, dependent basilar atelectasis.There is mild to moderate, an apical predominance, paraseptal emphysema.MEDIASTINUM AND HILA: Mild mediastinal shift to the right. Mild cardiomegaly. No pericardial effusion. Subcarinal mass splaying the two main bronchi and measures 4.7 x 5.7 cm (series 1202, image 41). There is contralateral hilar adenopathy is present.Mild anterior mediastinal lymphadenopathy. A prevascular lymph node measures 15 x 9 mm (series 1201, image 37).CHEST WALL: Few hypodense lesions in the thyroid, largest measuring 22 x 19 mm (series 1201, image 16). Mild lower cervical lymphadenopathy. ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Two hypodense lesions in the left lobe of the liver with the fluid attenuation likely represent benign hepatic cysts.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Moderate 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: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Large heterogeneously enhancing right lung mass highly suspicious for primary malignancy. Bilateral hilar and multiple ipsilateral pulmonary nodules are consistent for metastatic disease.2.Few hyperdense lesions in the thyroid. Dedicated sonographic examination is recommended for characterization. |
Generate impression based on findings. | 57 year-old female evaluate for CVA, altered mental status. There are postsurgical findings related to left frontoparietal craniotomy with underlying encephalomalacia, which is unchanged. There is no definite evidence of tumor recurrence, although assessment is limited with intravenous contrast. Otherwise, there is minimal scattered nonspecific cerebral white matter hypoattenuation. There is no evidence of acute intracranial hemorrhage. The ventricles are stable in size and configuration. There is no midline shift. The imaged portions of the paranasal sinuses and mastoid air cells are clear. The extracranial soft tissues are unremarkable. | No evidence of acute intracranial hemorrhage, mass, or cerebral edema. Please note CT is insensitive for the detection of ischemia. |
Generate impression based on findings. | Headache. History of clip and coils. CT: There are postoperative findings related to left frontal burr hole with underlying encephalomalacia likely from prior ventriculostomy and pterional craniotomy approach for left paraclinoid ICA aneurysm clipping. The aneurysm clip produces considerable streak artifact, which limits assessment of surrounding structures. There is no intracranial mass or hemorrhage. There is mild disproportionate prominence of the ventricular system. The imaged portions of the paranasal sinuses and mastoid air cells are clear.CTA: The aneurysm clip is located in the region of the left paraclinoid ICA. Within the limitations of the streak artifact, there is no definite residual aneurysm. There is no definite steno-occlusive of the major cerebral vessels. | 1. Sequela of left paraclinoid ICA aneurysm clipping without definite residual or new aneurysm, although assessment is limited due to streak artifact. 2. No intracranial hemorrhage, but mild disproportionate prominence of the ventricular system, which may represent residual hydrocephalus. |
Generate impression based on findings. | Female 52 years old; Reason: 52 yr old female with recurrent stage IIIC ovarian ca, 1/12 TAH/BSO, 5 cycles Taxol/Carbo, 4/4/13 secondary debulking, currently s/p 8 cycles Bevacizumab. Measure para-aortic LN, R hemipelvic LN. Compare with previous scans.i History: Occ low back pain and L hip pain CHEST:LUNGS AND PLEURA: Thickening along the fissure in the lingula with associated confluent density most consistent with rounded atelectasis, unchanged. No new masses, infiltrates, nodules or effusions seen. MEDIASTINUM AND HILA: No adenopathy. Slight pericardial thickening posterolaterally on the left is less prominent on today's examination.CHEST WALL: Right anterior chest wall Port-A-Cath with tip of the catheter in the proximal right atrium. Bilateral breast implants, unchanged.ABDOMEN:LIVER, BILIARY TRACT: Diffuse fatty infiltration in the liver again seen. Segment two, benign cyst, unchanged. No other significant lesion seen in the liver. Gallstones noted without cholecystitis. No intrahepatic or extrahepatic biliary duct dilatation 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: Prior referenced left para-aortic lymph node (series 3, image 114) is unchanged to slightly smaller in size and measures 0.9 x 0.8, compared with previous cm1.0 x 0 .9 cm. Other scattered subcentimeter snob periaortic low-density lymph nodes are unchanged.BOWEL, MESENTERY: Postoperative omentectomy without evidence of recurrent masses or nodules in the, mesentery or omentum. No mesenteric fluid is seen.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Prior hysterectomy and salpingo-oophorectomy without evidence of recurrent abnormalities.BLADDER: No significant abnormality noted.LYMPH NODES: No enlarged lymph nodes are seen in current examination -- the, lymph nodes all appear stable when compared with scans from 7/8/2013. In the region of the conglomerate enlarged lymph nodes described on 4/28/2013 in the right external iliac chain, the largest lymph node measures 1.0 x 0.7 cm, stable.BOWEL, MESENTERY: No significant abnormality noted. No nodules, masses or free fluid.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. No evidence of metastatic disease in the chest. 2. Stable retroperitoneal and pelvic lymph nodes. |
Generate impression based on findings. | Reason: Evaluate for septic emboli History: staph bacteremia and septic joints CHEST:LUNGS AND PLEURA: New bilateral lower lobe groundglass opacities with septal thickening and linear consolidation main edema and atelectasis. No specific evidence of septic emboli. No pleural effusions.MEDIASTINUM AND HILA: Mild mediastinal lymphadenopathy. Heart size is normal without pericardial effusion.CHEST WALL: Large left axillary lymph node measuring 3.7 x 3.0 cm (series 3, image 30) previously measuring 2.1 x 2.4 cm. Mass in the left breast measures 3.3 x 4.0 cm (series 3, image 19) previously measuring 2.7 x 2.3 cm. There is mild subpectoral lymphadenopathy bilaterally.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: There is mild pericholecystic fluid in the fundus of the gallbladder without CT evidence of gallbladder wall thickening or cholelithiasis. No intrahepatic or extrahepatic biliary ductal dilatation. No focal hepatic lesions.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Few new hypodense lesions in the upper and lower pole of the right kidney extending to and causing mild retraction of the cortex suggestive of infarction. Hypodense lesion in the left kidney may also represent an infarction.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: A portion of the previously identified large exophytic calcified fibroid is visualized. | 1.Interval increase in size of left breast mass and left axillary lymphadenopathy.2.New bilateral lower lobe atelectasis. No evidence of septic emboli.3.New hyperdense lesions in bilateral kidneys may represent infarction from septic emboli. |
Generate impression based on findings. | Reason: CT PE protocol - rule out PE History: Sinus tachycardia, Motion decreased the quality of the exam.PULMONARY ARTERIES: Technically adequate examination. No evidence of pulmonary embolism. Pulmonary artery caliber is normal. No evidence of right heart strain.LUNGS AND PLEURA: There is mild bronchial wall thickening. There is a solid nodule measuring 8 x 9 mm in the right lower lobe of the lung (series 7, image 99) may represent atypical infection. There is nonspecific septal thickening at the left lung base.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusions. Prominent right hilar lymphoid tissue likely reactive.CHEST WALL: Hypodense lesion in the isthmus of the thyroid. Mild axillary lymphadenopathy.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Scattered nonspecific mesenteric lymph nodes. Left kidney with hypoattenuating and thinned cortex suggestive of prior insult. Patchy hypoattenuation of bilateral kidneys is again demonstrated. | 1.No evidence of pulmonary embolism.2.New right lower lobe nodule. Follow-up CT examination in 3 months is recommended.3.Hypodense lesion in the isthmus of thyroid. |
Generate impression based on findings. | Reason: concern for PE History: tachycardia, new o2 requirement PULMONARY ARTERIES: Technically adequate study, without evidence of pulmonary embolism or right heart strain. The pulmonary artery caliber is near upper normal. LUNGS AND PLEURA: Left hemithorax volume loss likely is secondary to chronic-appearing left hemidiaphragm elevation.Focal consolidation in the right lung base costophrenic angle region could be aspiration or infection.MEDIASTINUM AND HILA: Marked attenuation of the right subclavian vein at the thoracic inlet level results in collateral blood flow throughout the right upper chest.There is no significant mediastinal or hilar lymphadenopathy.CHEST WALL: Left chest wall surgery with internal fixation of the ribs.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Surgical clips are present in the left upper quadrant region.A large radiolucent gallstone is seen in the fundus of the gallbladder. | 1. No evidence of pulmonary embolism.2. Right lower lobe consolidation suggestive of aspiration or pneumonia. |
Generate impression based on findings. | 88 year-old male assess for mass, intracerebral hemorrhage, first-time seizure. The bilateral subdural collections are stable in size and unchanged in density characteristics without interval new hemorrhage. There is no midline shift. There is unchanged patchy cerebral white matter hypoattenuation suggestive of age indeterminate small vessel ischemic disease. There is no evidence of mass lesions. The imaged portions of the paranasal sinuses and mastoid air cells are clear. The imaged portions of the orbits are unremarkable. | The bilateral subdural collections have not significantly changed in size and attenuation characteristics. |
Generate impression based on findings. | 77-year-old male with altered mental status, unwitnessed fall, evaluate for hemorrhage. There is patchy hypoattenuation in the periventricular and subcortical white matter most like represents small vessel ischemic disease of indeterminate age. There is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is partial opacification of the left ethmoid air cells, The imaged portions of the mastoid air cells are clear. There is linear soft tissue attenuation in the left occipital scalp, which likely represents scar. | No evidence of intracranial hemorrhage, mass, or cerebral edema.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 72-year-old patient. Evaluation for dementia. There is mild diffuse cerebral and cerebellar vermian volume loss, In particular the mamillary bodies appear small. There is no intracranial mass, hemorrhage, hydrocephalus or midline shift. There is atherosclerotic calcification of vertebral and internal carotid arteries bilaterally. There is partial opacification of ethmoid sinuses. The remaining paranasal sinuses are clear. The mastoid air cells are clear. | Mild diffuse cerebral and cerebellar vermian volume loss that is most pronounced in the mamillary bodies, which may be related to alcohol abuse.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Metastatic breast cancer. There is overall interval increase in size of cervical metastatic lymphadenopathy. For example, a right level 1 lymph node measures 8 x 10 mm (image 36, series 9), previously 5 x 7 mm, a right level 2 lymph node measures 12 x 16 mm (image 29, series 9), previously 9 x 12 mm, a right level 3 lymph node measures 14 x 16 mm (image 34, series 9), previously 12 x 14 mm, and a partially necrotic right level 4 lymph node measures 11 x 17 mm (imaged 43, series 9), previously 8 x 11 mm, and indents the internal jugular vein, as do other jugulodigastric lymph nodes with possible invasion of the vessel. There are unchanged prominent bilateral occipital lymph nodes. The metastatic lesion in the right clavicular head appear more sclerotic with commensurate decreased conspicuity of the associated pathological fracture. There is a large associated right upper chest wall soft tissue mass with extension to the skin is not significantly changed. There has been interval increase in size of the lytic metastatic lesion in the posterior elements of the C3 vertebral body without spinal canal narrowing. In addition, there are new lytic lesions within the posterior elements of C2 and C4. There is a partially imaged mixed sclerotic and lytic mass arising from the occipital bone with soft tissue components that extend into the intracranial compartment and into the scalp. The airways are patent. The thyroid gland is unremarkable. There is a left internal jugular venous catheter. The cervical carotid arteries are patent. The imaged portions of the lungs are clear. | 1. Overall interval increase in size of cervical metastatic lymphadenopathy and C3 vertebral metastasis along with new metastatic involvement of the C2 and C4 posterior elements. 2. Interval increased sclerosis of the right clavicular head metastatic lesion with decreased conspicuity of the pathological fracture, but no significant change in size of the overlying soft tissue may that extends to the skin.3. Partially imaged mixed sclerotic and lytic metastases in the occipital bone with soft tissue components that extend into the intracranial compartment and into the scalp. |
Generate impression based on findings. | 36-year-old male with stage IV melanoma status post left occipital lesion resection and ipilimumab/IDOi phase I trial. The limited intracranial images are unremarkable. There is mild mucosal thickening of the left ethmoid air cells, otherwise the imaged paranasal sinuses are clear. The imaged mastoid air cells are clear. The soft tissue density at the site of the resected left occipital lesion compatible with graft placement is again demonstrated. Accounting for differences in scan angulation, the dimensions have not significantly changed. This measures approximately 5.8 x 1.0 cm (series 7 image 10), previously measured 5.6 x 1.1 cm. The deep margins are again inseparable from underlying trapezius and paraspinal musculature. Multiple asymmetrically prominent lymph nodes are again identified along the left side of the neck. A reference left level 2 lymph node measures 6 x 5 mm (series 7 image 21), previously measured 8 x 7 mm. Additional level 2 reference lymph node measures 6 x 5 mm, previously measured 7 x 7 mm. The index retropharyngeal node on the left measures approximately 6 x 5 mm (series 7 image 16), previously measured 7 x 6 mm. There is no pathological lymphadenopathy by CT size criteria. There are no exophytic masses or mucosal lesions are present in the aerodigestive tract. The cervical vasculature is patent. There is minimal atherosclerotic calcification at the left carotid bifurcation. The thyroid gland, submandibular glands and parotid glands are unremarkable. There are no suspicious osseous lesions. The imaged lung apices are clear. | 1. Stable to slightly decreased non-pathologically enlarged reference cervical lymph nodes. 2. No definite locoregional tumor recurrence at the left occipital skin graft site. |
Generate impression based on findings. | SDH. There has been interval removal of the right subdural collection drainage catheter. The heterogeneous right cerebral convexity subdural collection is slightly small, now measuring up to 10 mm in width, previously 12 mm. Likewise, there has been continued slight interval decrease in the degree of midline shift to the left, now 3 mm, previously 4 mm. There is no evidence of hydrocephalus. There is unchanged mild nonspecific cerebral white matter hypoattenuation that likely represents microangiopathy. The extracranial structures are unchanged. | Slight interval decrease in size of the heterogenous right cerebral convexity subdural hematoma and associated midline shift. |
Generate impression based on findings. | 60 year old patient with history of metastatic lung CA and CVA. CT: There is subtle hypoattenuation within the right paracentral lobule corresponding to the area of restricted diffusion on the recent MRI. There is otherwise unchanged encephalomalacia within the right posterior temporal lobe and superior frontal lobe. There is no other discernable abnormality at the remaining sites of restricted diffusion on the prior MRI. There are punctate foci of enchantment within the left superior and middle frontal gyri, as well as a calcified 5 mm focus within the left hippocampus. There is no intracranial hemorrhage or hydrocephalus. There is partial opacification of the right maxillary sinus.CTA: There is a 3 vessel arch. There is normal course and morphology of carotid and vertebral arteries in the neck. There is a punctate focus of atherosclerotic calcification at the right carotid bifurcation without significant stenosis by NASCET criteria bilaterally. There are no significant steno-occlusive lesions in the neck. Intracranially, there is atherosclerotic calcification without significant stenosis in the cavernous/supraclinoid segments of the ICAs bilaterally. There is also minimal irregularity of the M2-3 segments of the right MCA, but no significant steno-occlusive lesions. There is an extracranial origin of the right PICA and calcification within the left vertebral. There is no evidence of aneurysm. | 1.Evolving small right paracentral lobule infarct.2.Chronic right MCA watershed infarcts.3.Minimal vascular calcification without aneurysm, stenosis or vessel occlusion within the head neck vasculature. 4.Small intracranial metastases, which are more conspicuous on the recent brain MRI.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Reason: PE? History: SOB, desats PULMONARY ARTERIES: No evidence of PE.LUNGS AND PLEURA: Necrotic left upper lobe mass extending into the superior aspect of the left lobe abutting the left pulmonary artery stable to marginally increased in the short interval. Basilar edema and atelectasis. Severe emphysema. Aspirated debris in central airways.MEDIASTINUM AND HILA: Atherosclerotic calcification of the aorta and its branches. Scattered small mediastinal nodes unchanged. Coronary calcification.Left hilar adenopathy, some is confluent with the mass; there is also calcification related to remote healed granulomatous disease.CHEST WALL: Degenerative change involving the spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Atherosclerotic desiccation the aorta with some mural plaque in the right lateral upper abdominal aorta incompletely evaluated. Please see recent abdominal CT for further details. Punctate calcification in liver. | 1. No evidence of PE.2. Left upper lobe cavitary mass highly suggestive of neoplasm. Necrotizing/cavitary infection is considered less likely. |
Generate impression based on findings. | Asthma and allergic rhinitis presenting with prolonged congestion. There is mild mucosal thickening within the bilateral maxillary and ethmoid sinuses. There is opacification of the right infundibulum. The frontal and sphenoid sinuses are clear. The left ethmoid roof is slightly lower than the left. The carotid grooves and optic canals are covered by bone. There are bilateral conchae bullosa. There is mild nasal septal deviation. The nasal cavity is clear. The mastoid air cells are clear. The imaged intracranial structures are grossly unremarkable. | Mild paranasal sinus opacification in a sporadic distribution. |
Generate impression based on findings. | Altered mental status. There is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. There is unchanged deformity of the right lamina papyracea, likely related to a remote fracture. The skull and extracranial soft tissues are otherwise unremarkable. | No evidence of intracranial hemorrhage, mass, or cerebral edema. |
Generate impression based on findings. | 16 year female with headache, evaluate for hemorrhage status post craniotomy There are interval postsurgical findings from right frontotemporoparietal craniotomy with interval decrease in midline shift now measuring approximately 9 mm, previously measured 15 mm and interval decrease in the size of intraparenchymal hematoma with extensive surrounding edema centered in the right temporal lobe with associated subarachnoid extension. However, there has been interval development of intraparenchymal hemorrhage in the superior vermis and medial cerebellar hemispheres with partial effacement of the superior fourth ventricle. Otherwise, several subcentimeter hemorrhagic foci in the bilateral parieto-occipital lobes situated at the gray-white matter junctions are not significantly changed. There is a persistent background of bilateral parieto-occipital prominent cerebral edema. However, there is interval development of hypoattenuating foci in the bilateral thalami and right thalamocapsular junction. Partial effacement of the third and lateral ventricles with mild dilatation of the left lateral ventricle persists. The basal cisterns remain effaced. | Interval right frontotemporoparietal craniotomy for evacuation of the right temporal hematoma with resultant interval decrease in midline shift, now measuring approximately 9 mm, previously measured 15 mm, but interval development of remote cerebellar hemorrhage and acute infarcts in the bilateral thalamic perforator territories, likely related to prior mass effect. There remains uncal and subfalcine herniation and unchanged appearance of the supratentorial ventricular system unchanged in appearance. Discussed with Dr. Tholster at 3PM on 11/2/13.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 18 year-old female with metastatic lung cancer, supraclavicular lymphadenopathy, reevaluate There are partially imaged postsurgical findings from right pneumonectomy and supraclavicular lymph node dissection. There is no significant cervical lymphadenopathy. For example, a right supraclavicular lymph node that 6 x 7 mm and a right level 2 lymph node measures 7 x 9 mm. The thyroid gland, parotid glands and submandibular glands are unremarkable. There is no focal effacement or mucosal lesions of the aerodigestive tract. There are no soft tissue masses in the neck. The cervical vasculature is patent. There are no suspicious osseous lesions are identified. The limited intracranial are grossly unremarkable, as from a left anterior temporal convexity arachnoid cyst. The imaged paranasal sinuses are clear. There is partial opacification of the bilateral mastoid air cells. | Partially imaged postoperative findings related to right pneumonectomy and supraclavicular lymph node dissection without evidence significant cervical lymphadenopathy. Please refer to the dedicated chest report for further details. |
Generate impression based on findings. | Metastatic medullary thyroid carcinoma (RET germline mutation negative) involving the lung and liver and neck nodes. Head: There is no evidence of intracranial metastases. There is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. Neck: There are postoperative findings related to left hemithyroidectomy. There are multiple enlarged necrotic cervical lymph nodes, left more than right, extending into the supraclavicular regions and superior mediastinum. Reference lymph nodes include the following:* A conglomerate of left level 4 lymph nodes measures 2.8 x 2.5 cm (previously 2.8 x 2.8 cm).* A left level 5 node measures 1.6 x 1.9 cm (previously 1.7 x 1.8 cm).* A conglomerate of left level 3 node measures 2.0 x 2.8 cm (previously 2.0 x 2.9 cm).* A right supraclavicular lymph node measures 3.1 x 2.3 (previously 3.2 x 2.2 cm).There is narrowing and possible invasion of the bilateral internal carotid arteries by the adjacent cervical lymph nodes, many of which display irregular margins suggestive of extracapsular extension. The carotid arteries are patent. There is a chronic comminuted left clavicular fracture. A 4 mm sclerotic focus within the inferior C2 vertebral body is unchanged and may represent an enostosis. The airways are patent. The imaged portions of the lungs are clear. | 1. No significant interval change in the extensive cervical lymph node metastases 2. No evidence of osseous or intracranial metastatic disease. Refer to the separate chest CT report regarding the mediastinal lymphadenopathy. |
Generate impression based on findings. | Status post surgery and radiotherapy for left carotid cancer (carcinoma ex pleomorphic adenoma with perineural invasion). There are posttreatment changes related to the left parotidectomy and radiotherapy. There are no new soft tissue masses in this region suggestive of residual/recurrent disease. There is no associated adenopathy which is significant by size criteria (a previously described index lymph node near the resection bed measures 4 x 4 mm today - previously 4 x 5 mm). The nasopharynx, oropharynx, hypopharynx, and larynx are unremarkable. There is a stable subcentimeter hypoattenuating nodule within the right thyroid lobe. The major cervical vessel are patent. There is hardware from anterior C4-6 fusion with stable degenerative spondylosis of the cervical spine and no new or aggressive osseous lesion is demonstrated. | Stable post-treatment findings related to left parotidectomy and radiation with no evidence of locoregional tumor recurrence of significant cervical lymphadenopathy.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Assessment of left MCA aneurysm. CT: There is no intracranial hemorrhage, hydrocephalus, cerebral edema, or midline shift. The ventricles and basal cisterns are normal in size and configuration. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. CTA: This exam confirms the presence of the 3 x 3 mm aneurysm with a wide neck at the insular bifurcation of the right MCA within the sylvian fissure. There are no other cerebral aneurysms. There are no significant steno-occlusive lesions demonstrated. | Wide neck 3 mm right MCA insular bifurcation saccular aneurysm. No other aneurysms or significant steno-occlusive lesions are identified. |
Generate impression based on findings. | Metastatic renal cancer on axitinib. The heterogeneous left thyroid mass measures approximately 45 x 51 x 72 mm, previously 38 x 48 x 62 mm. The mass appears to invade the left strap and sternocleidomastoid muscles and left lateral wall of the upper trachea and is indistinct from the esophageal wall. The mass also encases the left common carotid artery by approximately 180 degree without significant narrowing of the vessel. An adjacent dominant heterogeneous left level 3 lymph node measures 16 x 21 mm, previously 15 x 20 mm. There has also been interval enlargement of numerous other hyperattenuating spheroid-shaped cervical lymph nodes, even those that are not necessarily enlarged by size criteria. For example a left supraclavicular lymph node measures 12 x 15 mm, previously 8 x 10 mm, a right level 5 lymph node measures 7x 13 mm, previously 8 x 6 mm, a right parotid lymph node measures 6 x 7 mm, previously 4 x 5 mm, and a left level 1A lymph node measures 6 x 7 mm, previously 4 x 4 mm. A lesion in the apex of the right pleural space measures 18 x 22 x 21 mm, previously 16 x 17 x 20 mm. A right chest subcutaneous lymph node has also enlarged, now measuring 5 mm in diameter, previously 3 mm. A left upper lung nodule has increased in size, now measuring 10 x 10 mm, previously 7 x 9 mm. There also appear to be new right upper lung nodules that measuring up to 6 mm. There is a partially imaged expansile lytic metastatic lesion in the spinous process of T3 and a partially imaged large destructive left scapular mass. There is left vocal cord augmentation for paralysis. There is a small left maxillary sinus retention cyst. The mastoid air cells are clear. The imaged portions of the intracranial structures and orbits are unremarkable. | 1. Interval increase in size of the left thyroid mass with apparent invasion of the lateral wall of the trachea, surrounding musculature and perhaps the esophageal wall, as well as encasement of the left common carotid artery without significant narrowing of the vessel.2. Interval increase in size of extensive metastatic cervical lymphadenopathy, even among lymph nodes that are not particularly enlarged by size criteria, although these displays abnormal attenuation and morphology.3. Interval increase in size of the right pleural apex metastasis and left upper lung nodule and apparently new right upper lung nodules. Refer to the separate chest CT report for additional details.4. Partially imaged expansile lytic metastatic lesion in the spinous process of T3 and a partially imaged large destructive left scapular mass. Refer to the separate chest CT report for additional details. |
Generate impression based on findings. | Stroke. CT: There is patchy hypoattenuation in the left corona radiata corresponding to the recent infarct without evidence of hemorrhagic transformation. Otherwise, there are scattered areas of cerebral white matter hypoattenuation that likely represent microangiopathy. The ventricles and basal cisterns are stable in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. There is a carious ADA 10. The skull and extracranial soft tissues are otherwise unremarkable. CTA: There is absent opacification throughout left internal carotid artery beyond its origin secondary to predominantly low attenuation plaque at the carotid bulb. There is reconstruction of flow at the terminal segment of the left internal carotid artery via the circle or Willis. There is mild mixed attenuation plaque at the right carotid bulb. There is mild bilateral carotid siphon plaque. There is mild to moderate atherosclerotic plaque in the V4 segments of the bilateral vertebral arteries and mild narrowing of the origins of the bilateral vertebral arteries. No aneurysms are identified. The neck soft tissues, osseous structures, and imaged lung apices are grossly unremarkable. | 1. Recent left corona radiata infarct without evidence of hemorrhagic transformation or midline shift.2. Absent opacification throughout left internal carotid artery beyond its origin secondary to predominantly low attenuation plaque at the carotid bulb suggest occlusive disease. A Doppler ultrasound exam may be useful for confirmation. |
Generate impression based on findings. | Altered mental status. There is moderate nonspecific cerebral white matter hypoattenuation. There is no evidence of intracranial hemorrhage or mass. The ventricles and sulci are mildly prominent, indicating brain parenchymal volume loss. There is no midline shift or herniation. The mastoid air cells are clear. There is a right glaucoma shunt devices in position. There are bubbly secretions and air-fluid levels in the bilateral maxillary sinuses. The skull and extracranial soft tissues are otherwise unremarkable. | 1. Moderate nonspecific cerebral white matter hypoattenuation may represent small vessels ischemic disease, but no evidence of acute intracranial hemorrhage or mass. However, noncontrast head CT is not sensitive for acute nonhemorrhagic infarct and MRI should be considered for further evaluation assuming there are no contraindications.2. Bubbly secretions and air-fluid levels in the bilateral maxillary sinuses may indicate acute sinusitis in the appropriate clinical setting. |
Generate impression based on findings. | Trauma. There is no evidence of acute fracture. There is mild inferior bowing of the right orbital wall. The orbital contents are unremarkable. There is mild scattered paranasal sinus mucosal thickening without air-fluid levels. There are multiple carious teeth. The facial soft tissues are unremarkable. The imaged intracranial structures are grossly unremarkable. | 1. No evidence of acute maxillofacial fracture.2. Multiple carious teeth. |
Generate impression based on findings. | Confused speech. There are postoperative findings related to left temporal convexity meningioma resection. There is interval increase in the amount of intraparenchymal hemorrhage along the margins of the resection cavity and within the resection cavity. There is also more pronounced edema surrounding the resection cavity, including within the inferior frontal gyrus in the region of the operculum, as well as in Heschl's gyrus. The ventricles are stable in size and configuration. There is unchanged mild midline shift to the right. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. | Interval increase in the amount of intraparenchymal hemorrhage along the margins of the resection cavity and within the resection cavity as well as more pronounced edema surrounding the resection cavity, including within the inferior frontal gyrus and Heschl's gyrus. |
Generate impression based on findings. | AMS. There is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. | No evidence of intracranial hemorrhage, mass, or cerebral edema. |
Generate impression based on findings. | Male 74 years old; Reason: 74 yo M with hx of known Gtube leak, concern for infectious fluid collection, and hypoxia, tachycardia, hypoxia History: hypoxia, tachycardia, hypoxia CHEST:LUNGS AND PLEURA: Stable bilateral moderate pleural effusions. Associated compressive atelectasis appears similar to previous exams.MEDIASTINUM AND HILA: Extensive necrotic adenopathy is identified, with reference subcarinal lesion measuring 2.3 x 2.4 cm (series 3 image 49). The main pulmonary arteries are attenuated by mass effect from the nodes.Hilar adenopathy is also identified, measuring 2.1 x 1.7 cm (series 3 image 53).CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Stable mild biliary dilation and too small to characterize hypoattenuating lesions. The gallbladder is normal.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral hypodense renal lesions, likely representing cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: G-tube extends into the stomach. Interval placement of total 3 pigtail catheters. Previously identified left upper abdominal fluid collection has markedly decreased in size with residual measuring 3.7 x 1.9 Cm (series 3 image 114, previously 5.8 x 1.9 cm. The reference right lower abdominal fluid collection containing a percutaneous drain measures 5.7 x 2.8 cm (series 3 image 178) smaller from previously measured 2.9 x 6.7 cm .BONES, SOFT TISSUES: Lytic lesions involving the vertebral bodies, right ilium, are unchanged. Ventral abdominal wall defect is again identified. OTHER: Interval decrease in abdominal ascites.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Catheter noted in the bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Multiple fluid collections in the pelvis appear smaller than on the prior study. The reference right lower abdominal fluid collection containing a percutaneous drain measures 2.2 x 0.1 cm (series 3 image 188) previously 2.9 x 9.6 cm.BONES, SOFT TISSUES: Lytic lesions involving the vertebral bodies, right ilium, are unchanged. OTHER: Interval decrease in ascites. | 1. Multiple lower abdominal fluid collections are decreased in size. 2. Interval insertion of a pigtail catheter in the left upper quadrant, with decrease in size of the previously noted abscess collection. |
Generate impression based on findings. | Male 26 years old; Reason: ileus, obstrution, colitis History: pain, generalized 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: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Patient status post left femoral rod and screws.OTHER: No significant abnormality noted. | 1.No acute intra-abdominal pathology detected. |
Generate impression based on findings. | Male 36 years old; Reason: re evaluate disease status following additional systemic therapy, please provide bidimensional measurements for adrenal mass, as it is being followed, and compare to previous History: stage IV metastatic melanoma CHEST:LUNGS AND PLEURA: Previously noted subcentimeter nodules are stable. No new nodule or mass detected.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: 1 cm left adrenal nodule is unchanged.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Stable bilateral lung nodules. 2. Left adrenal nodule is unchanged. |
Generate impression based on findings. | Female 69 years old; Reason: r/o recurrent ovarian cancer History: pleural effusions, LE edema CHEST:LUNGS AND PLEURA: Biapical scarring unchanged. Nodular septal thickening has progressed in bilateral midlung zones, non specific. No evidence of pleural effusions. No new nodules or masses detected.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Right Port-A-Cath is in stable position with its tip in the cavoatrial junction.ABDOMEN:LIVER, BILIARY TRACT: No suspicious nodule. Mild periportal edema with suggestion of gallbladder wall edema, nonspecific. No cholelithiasis or biliary ductal dilation. The right upper quadrant inflammatory change to suggest cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Status post lymph node dissection without pathologically enlarged adenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Surgically absent with postsurgical changes in the pelvis. Small nodular densities abutting the sigmoid colon, best seen on image number 177, series number 3 may is stable since 2006, suggesting benign etiology. Stable fluid layering in the pelvic cul-de-sac.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: Interval resolution of the left sided lymphocele. | 1. Interval resolution of the left sided pelvic lymphocele.2. No evident metastatic disease in the chest, abdomen or pelvis. 3. Gallbladder wall edema and periportal edema, nonspecific. |
Generate impression based on findings. | Female 62 years old; Reason: History metastatic renal cancer, on therapy, assess for progression History: none CHEST:LUNGS AND PLEURA: There is increase in the size of the numerous nodules throughout the lung fields, for instance, a reference nodule measuring 1.8 cm in the left lower lobe (series 7 image 58), previously 1.4cm.There is increase in size and conspicuity of the other non referenced nodules throughout the lung.MEDIASTINUM AND HILA: Heterogeneous, enhancing left thyroid mass is stable and measures 3.8 X 4.8 cm image number 6, series number 5.CHEST WALL: Left scapula/glenoid metastases, partially imaged.ABDOMEN:LIVER, BILIARY TRACT: Liver dome lesion has progressed in size and now measures 2 x 2 cm (image number 73, series number 5), previously 1.5 x 1.5 cm . Cholelithiasis, unchanged.SPLEEN: Hypodense lesion in the inferior pole of the spleen is unchanged measuring 1.3-cm in diameter image number 94, series number 5.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Status post right colectomy. Left adrenal nodule is again seen measuring 2.1 x 1.7cm previously 1.6-cm by 1.5-cm (image number 93 of series number 5).KIDNEYS, URETERS: Status post right nephrectomy. Small hypodense lesions involving the left kidney are slightly larger. Some are too small to accurately characterize, however inferior pole lesion has grown and previously measured 1 cm, currently 1.2 cm (series 5 image 121). Close follow-up of the lesion in midpole left kidney (series 5 image 105) is also advised.Small nodule lateral to the left kidney is also stable. RETROPERITONEUM, LYMPH NODES: Small lymph nodes are unchanged.BOWEL, MESENTERY: Stable ventral hernia containing loops of bowel, no obstruction.BONES, SOFT TISSUES: Right body wall metastases is unchanged measuring 3 .3 by 3.5-cm image number 120. T10 vertebral body metastatic disease unchanged.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: Left sacral metastatic disease, stable.OTHER: No significant abnormality noted. | 1.slight interval increase in size of the lung nodules and renal lesions. Close follow-up is recommended.2. Stable thyroid lesion and bone metastatic disease. |
Generate impression based on findings. | Male 28 years old; Reason: eval for recurrence History: hx testicular cancer ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No focal hepatic lesions or biliary ductal dilatation. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No pathologic lymphadenopathy. BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No pelvic lymphadenopathy. BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Status post right orchiectomy. | No CT evidence of metastatic disease in the abdomen or pelvis. |
Generate impression based on findings. | Female 31 years old; Reason: assess for intra-abd process, abscess History: abd pain, 3 months s/p c-section 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: Right renal hypoattenuating lesion is too small to characterize, but most likely represents cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Interval resolution of the hypoattenuating fluid collection in the anterior abdominal wall.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Interval decrease in the size of the postpartum uterus, with resolution of the previously noted debris and gas. Interval decrease in the loculated, mixed gas and fluid collection in the pelvis. Trace pelvic free fluid is likely physiologic. No residual abscess or infection the abdomen suggested.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Interval decrease in size of the postpartum uterus with resolution of the previously noted pelvic abscess and anterior abdominal fluid collection. |
Generate impression based on findings. | Female 34 years old; Reason: stone? hydronephrosis? History: L flank pain, hysterectomy, recurrent pyelo 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 significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No renal or ureteral stone is detected. No hydronephrosis, perinephric fluid collections or fat stranding is seen. Scarring of the left kidney is identified with a lobular/nodular contour.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes in the small bowel and terminal ileum without evidence of obstruction.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.No renal/ureteral calculi, hydronephrosis or perinephric fluid collections identified.2.Post surgical changes in the small bowel without obstruction. |
Generate impression based on findings. | History of OHT, patient with multiple skin abscesses concerning for possible systemic infection. Please assess for possible fungal/acute infectious emboli source. LUNGS AND PLEURA: There is a subcentimeter subpleural nodular opacity in the left lower lobe (image 68, series 4), which is grossly unchanged in appearance compared to the study from 4/12/2010 and may represent a lymph node. Other smaller punctate micronodules are also likely postinflammatory.There is no consolidation or pleural effusion.MEDIASTINUM AND HILA: There are post-surgical changes from a heart transplant. Scattered small subcentimeter nodes. There is a left jugular central venous catheter with tip in the right atrium. There is atherosclerotic calcification of the aorta and its branches.CHEST WALL: Flowing osteophytes in the thoracic spine raises the possibility of dish. Small subcutaneous nodule in left back is unchanged (image 61/106).UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Cholecystectomy clips. | No specific evidence of infection. |
Generate impression based on findings. | Female 69 years old; Reason: eval acute intraabd process History: persistent n/v, constipation, low bp, transjugular liver bx 3 days ago ABDOMEN:LUNGS BASES: No significant abnormality noted. Bibasilar atelectasis identified.LIVER, BILIARY TRACT: The liver is normal in morphology. No fluid collection, mass, or lesion detected. No hemorrhage from recent liver biopsy identified. No perihepatic ascites. Nonspecific fluid noted in the porta hepatis.Patient is status post cholecystectomy.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 obstruction seen.Contrast is seen in the stomach, antrum, duodenal bulb, duodenal sweep and descending duodenum, with no evidence of contrast extravasation or ulcer.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 hemorrhage, or complication from transjugular liver biopsy detected.2.Nonspecific fluid in the porta hepatis, correlate clinically., |
Generate impression based on findings. | Fall. Head: There is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The mastoid air cells are clear. There is a small right maxillary sinus retention cyst. There is no evidence of calvarial fracture. There is a 10 mm thick apical scalp hematoma.Cervical Spine: There is apparent mild rotatory scoliotic curvature, which may be in part positional. The vertebral body heights and disc spaces are preserved. There is no evidence of fracture or spondylolysis. There are no lytic or blastic lesions. There is no significant spinal canal stenosis. The paraspinal soft tissues are unremarkable. A pacer device is partially depicted. The imaged lung apices are clear. | 1. Small apical scalp hematoma, but no evidence of acute intracranial hemorrhage or calvarial fracture.2. No evidence of fracture or spondylolysis. |
Generate impression based on findings. | Questionable PE seen on CT of the abdomen. Question of PE. PULMONARY ARTERIES: There is a saddle pulmonary embolus extending into bilateral lobar and segmental artery branches. The pulmonary artery diameter is within normal limits.LUNGS AND PLEURA: There is a 8 mm nodular opacity within the right middle lobe which was presnt on 3/10/2006 abdomen pelvis CT and is presumably benign. Ill defined subcentimeter nodule in right upper lobe (image 87/302) is nonspecific.There is bibasilar dependent atelectasis. Azygous fissure, normal variant. MEDIASTINUM AND HILA: There is mild straightening of the interventricular septum which may suggest right heart strain. There is moderate coronary artery calcifications.CHEST WALL: There is a large heterogeneous soft tissue mass extending from the thyroid into the mediastinum. Degenerative changes affect the thoracic spine. UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Please refer CT abdomen and pelvis report from 11/1/2013 for findings. | 1. Saddle pulmonary embolus with mild interventricular septal straightening.2. Large soft tissue mass extending from the thyroid to the mediastinum; this is poorly evaluated with PE protocol CT. Consider clinical correlation for history of goiter, further evaluation with ultrasound may be considered. 3. Ill defined subcentimeter nodule in right upper lobe (image 87/302) is nonspecific. Recommend follow up CT of the chest in 6 months to monitor stability/change to exclude malignancy. |
Generate impression based on findings. | Status post fall. Thoracic compression deformity. There is diffuse osteopenia and degenerative spondylosis and mild apex right kyphoscoliosis. The degenerative change is most prominent within the partially visualized lower cervical spine, including disc-osteophytes posteriorly at C5-T2 and 4 mm anterolisthesis of T1 on T2. There are also multilevel anterior osteophytes in the thoracic spine with vacuum disc phenomena. Uncovertebral and facet joint arthropathy result in bilateral neural foraminal stenosis at C5-6 and C6-7. There is no significant canal or neural foraminal stenosis within the thoracic spine. There is no evidence of fracture. There is a right sided chest tube with subcutaneous emphysema and a very small amount of residual pneumothorax anteriorly. There is right lower lobe atelectasis and a small pleural effusion. There is also left subsegmental atelectasis, more so in the lower than upper lobe. There is calcification of the thoracic aorta and extensive coronary artery calcification with cardiomegaly. If clinically warranted, designated imaging of the chest could further delineate these findings. | 1. Diffuse osteopenia and degenerative change without evidence of vertebral fracture.2. Small amount of residual pneumothorax. There is right lower lobe atelectasis and a small pleural effusion and left subsegmental atelectasis, more so in the lower than upper lobe. If clinically warranted, designated imaging of the chest could further delineate these findings.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Female 67 years old; Reason: cause of LLQ and RLQ abdominal pain and n/v? History: LLQ and RLQ abdominal pain and n/v. known diverticulosis, pt has liver tx 2000 without rejection, still has appendix. 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: There is a small left pleural effusion. Scattered bilateral groundglass opacities are seen, likely representing edema, however nonspecific infectious etiology can appear similarly, correlate clinically.LIVER, BILIARY TRACT: Liver morphology is normal without focal lesion. The gallbladder is not visualized.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Numerous bilateral renal cysts are seen, some of which have high attenuation. These are largely unchanged compared to previous however, a the left upper lobe cyst is mildly enlarged. These remain incompletely evaluated given lack of IV contrast.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No Evidence of bowel obstruction. There is marked bowel wall thickening in the distal small bowel, ileum, and multiple prominent mesenteric lymph nodes are noted (series 3 image 96). No intramural emphysema, or free air detected.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Moderately enlarged, heterogeneous uterus appear similar to prior.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: There is a large left inguinal region incompletely evaluated on this examination, but appears grossly stable since exams of 2007. | 1.Distal small bowel/ileal wall thickening, which could be related to enteritis versus ischemia. Correlate clinically.2.Numerous renal lesions incompletely characterized given the single noncontrast examination. Dedicated renal CT examination or MRI advised.3.Large left inguinal region incompletely characterized on this examination. |
Generate impression based on findings. | Seizure and fall. Head: There is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. Cervical Spine: The vertebral body heights and disc spaces are preserved. There is no evidence of fracture or spondylolysis. There are degenerative changes at C5-C7 with small anterior osteophytes, mild endplate sclerosis, and Schmorl node formation. There is no significant osseous spinal canal stenosis. The paraspinal soft tissues are unremarkable. The imaged lung apices are clear. | 1. No evidence of acute intracranial hemorrhage or fracture. Non-contrast CT is relatively insensitive for detection of seizure foci and MRI is recommended if clinically warranted.2. Degenerative spondylosis at C5-C7 without evidence of cervical spine fracture or spondylolysis. |
Generate impression based on findings. | Worsening pulmonary fluid with frothy pink fluid and requiring reintubation LUNGS AND PLEURA: There is bibasilar consolidation/atelectasis but improved when compared to the prior study. The patchy areas of groundglass opacities are noted within the aerated portions of both lungs which are nonspecific but likely representing areas of multifocal pulmonary hemorrhage given the clinical history of blood per endotracheal tube. Other differential considerations for this appearance include atypical edema and drug reaction which are considered less likely. An underlying superimposed infection cannot be excluded. Bilateral small pleural effusions have improved.MEDIASTINUM AND HILA: An endotracheal tube is in place below thoracic inlet and above the carina. A left central venous catheter is noted with its tip at the SVC/RA junction. Cardiothymic silhouette normal. Multiple subcentimeter lymph nodes in the hilar regions bilaterally.CHEST WALL: No significant abnormality notedUPPER ABDOMEN: Mild hepatosplenomegaly. Multiple surgical clips in the left upper quadrant. | Multifocal bilateral ground glass opacities improved in the interval which are nonspecific but likely representing areas of pulmonary hemorrhage. An underlying superimposed infection cannot be excluded. Bilateral small pleural effusions have improved. |
Generate impression based on findings. | Motor vehicle collision. There is encephalomalacia in the right middle frontal gyrus, likely related to a chronic infarct. There is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is calcification of the intradural vertebral arteries and carotid siphons. There are no depressed skull fractures. The paranasal sinuses and mastoid air cells are clear. | 1. No evidence of intracranial hemorrhage, mass, or cerebral edema. 2. Encephalomalacia in the right middle frontal gyrus, likely related to a chronic infarct. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 50 year-old female with syncope, tachycardia and new oxygen requirement. Question of PE. PULMONARY ARTERIES: Technically adequate study without evidence of acute pulmonary embolus. The main pulmonary artery is enlarged compatible with pulmonary hypertension. Small foci of air in main PA from power injection.LUNGS AND PLEURA: There is subsegmental atelectasis involving the right middle lobe. There is no pleural effusion or pneumothorax.Diffuse bronchial wall thickening with areas of mucus plugging consistent with bronchiolitis.MEDIASTINUM AND HILA: There is no evidence of right heart strain. There is no mediastinal lymphadenopathy.CHEST WALL: There is no axillary lymphadenopathy. Degenerative changes affect the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. There is a 1.5 x 1.7 left adrenal nodule which is incompletely characterized on this study though was present on 6/28/2013 study. Small hyperdense foci in stomach may represent pill fragments or be related to recent meal. | 1. No evidence of acute pulmonary embolus.2. Diffuse bronchial wall thickening with areas of mucus plugging consistent with bronchiolitis.3. Left adrenal nodule is incompletely characterized on this study but may represent a benign adrenal adenoma. |
Generate impression based on findings. | Male 68 years old; Reason: please evaluate etiology of fever History: 38.3C fever in spite of broad spectrum abx. s/p cystectomy and ileal conduit 2 weeks ago. ABDOMEN:LUNGS BASES: Dense calcifications in the dome of the liver probably granulomatous. Two punctate hypodensity scattered in the liver are nonspecific and unchanged.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral nephroureterostomy stents. No evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: Atherosclerotic changes. No evidence of aneurysm. Shotty retroperitoneal nodes.BOWEL, MESENTERY: Diverting ileostomy. Nephroureterostomy stents extending out the ileostomy in the right lower quadrant. Generalized small bowel dilatation consistent with postsurgical ileus without evidence of mechanical obstruction.Multiple moderately mature loculated fluid collections are seen the throughout the mesenteric particularly in the mid abdomen and right mid and lower abdomen. These may interconnect. One of the fluid collections is slightly high density may represent organizing hematoma in the right lower quadrant seen on series 3 image 62/117 measures baseline purposes as 5.3 x 6.8 cm.BONES, SOFT TISSUES: Surgical changes anterior abdominal wall. Degenerative changes lumbar spine. No lytic or blastic disease.OTHER: The fluid collections somewhat attenuated caliber of the right external iliac vein however there is no evidence of thrombus.PELVIS:PROSTATE/SEMINAL VESICLES: Surgically absent. See soft tissue paragraph, below.BLADDER: No significant abnormality noted.LYMPH NODES: Small groin nodes. Small iliac nodes.BOWEL, MESENTERY: Postsurgical changes as detailed above. Loculated fluid collections seen in the leaves of the mesentery may interconnect. There may be a connection between the mesenteric fluid collections and the air or fluid collection described below in the pelvis.The descending colon is displaced medially out of the paracolic gutter with dilated small bowel loops seen in the left paracolic gutter.BONES, SOFT TISSUES: Postsurgical changes anterior abdominal wall. Moderate-sized fluid collections seen in the distribution of the right and left lateral pelvis are fluid density without significant enhancing wall and may represent lymphocele, seroma hematoma. Infection in the fluid collection cannot be excluded. Additionally there is extensive bubbly gas and fluid with an enhancing rim along some of its portions seen in the distribution of the surgical bed extending from the level of the base of the penis and prostate distribution cephalad and to the pelvic side walls and extending cephalad on the right the level of series 3 image 79. This could be related to the recent surgery. Infected fluid collection cannot be excluded. For baseline purposes this is measured on series 10 image 92, 8.1-cm transverse by 4.3-cm AP. Also see sagittal reconstructions.OTHER: Atherosclerotic changes iliac and femoral arteries. | 1.Multiple fluid collections as detailed above some concerning for abscess particularly air fluid collection extending from the surgical bed. 2.Mesenteric fluid collections consistent with seroma hematoma or less likely abscess. 3.Bilateral iliac distribution fluid collections most likely lymphoceles or seromas. 4.Bilateral nephroureterostomy stent in place. 5.Nonspecific hypodensities liver.6.Discussed with Dr. Charlie Nottingham, pager 3923, 11/3/13, 9:25am. |
Generate impression based on findings. | MVA. There is no evidence of fracture or spondylolisthesis. There is 3 mm anterolisthesis of C4 on 5 and 3 mm retrolisthesis of C5 on 6, as a result of multilevel spondylosis. There are disk osteophyte complexes at C4-5 through C6-7 and uncovertebral/facet joint arthropathy bilaterally at C3 through T1 resulting in multilevel neural foraminal stenosis. This is worst at the left C3-4, bilateral C4-5 and bilateral C5-6 levels. There is atherosclerotic calcification within the the common carotid arteries and dense calcification at the carotid bifurcations. The paraspinal soft tissues are otherwise unremarkable. | 1. No evidence of fracture or spondylolisthesis.2. Multilevel degenerative spondylosis resulting in multilevel neural foraminal and canal stenosis. These findings could be better delineated with MRI if clnically warranted. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Reason: assess aortic disection anf flow throug peripheral vessels. History: aortic dissection VESSELS: Ascending thoracic aortic dissection beginning at the supravalvular descending aorta. The dissection propagates into the right brachial cephalic artery, and right subclavian artery. In addition, the dissection extends into the distal left subclavian artery. Coronary arteries are relatively spared. The carotid arteries are also spared, and arise from the true lumen.The dissection also extends in to the abdominal aorta. The celiac axis appears to arise from the false lumen. The dissection propagates into the superior mesenteric artery. The right renal artery arises from the true lumen. The left renal artery appears to arise from the false lumen, however the dissection also propagates a short distance into the left renal artery.The dissection propagates until the proximal left common femoral artery. On the right there is a filling defect in the right iliac, that likely represents a thrombus. The dissection appears to propagate into the proximal right internal iliac artery. The right external iliac artery has decreased opacification distal to the internal/external iliac bifurcation. This is then reconstituted at the level of the common femoral artery. At the level of the mid thigh, there is asymmetric opacification of the profunda femoris vessels with decreased perfusion on the left relative to the right.CHEST:LUNGS AND PLEURA: Centrilobular emphysema noted. Bilateral wedge-shaped dense opacification in the lower lobes with air bronchograms noted. Small bilateral pleural effusion seen.Very small bilateral pneumothoraces.MEDIASTINUM AND HILA: Postoperative changes of median thoracotomy with subcutaneous emphysema noted. Two mediastinal drains are identified. CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted although limited given the single phase of contrast.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Decreased contrast enhancement of the left kidney relative to the right, nonspecific, although worrisome for ischemia related to perfusional abnormality.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Marked degenerative disease of the spine and right hip.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: Marked degenerative disease of the spine and right hip.OTHER: No significant abnormality noted. | 1.Type A dissection as described above with decreased perfusion to the left kidney relative to the right. Correlate for ischemic perfusional state. |
Generate impression based on findings. | Abnormal involuntary movement/tremor. There is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. | No evidence of intracranial hemorrhage, mass, or cerebral edema.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Altered mental status. There is stable moderate patchy periventricular and subcortical white matter hypoattenuation most likely due to sequela of chronic small vessel ischemic disease. There are also unchanged subcentimeter hypodensities in the bilateral thalami, which are compatible with chronic lacunar infarcts. There is calcification within bilateral vertebral and paraclinoid internal carotid arteries. There is no evidence of intracranial hemorrhage, mass, or cerebral edema. There is minimal mucosal thickening within ethmoid sinuses. The remaining paranasal sinuses are clear. There is unchanged partial opacification of scattered mastoid air cells. | Stable white matter hypoattenuation most likely representing sequela of chronic small vessel ischemic disease and chronic bilateral thalamic lacunar infarcts. No evidence of intracranial hemorrhage, mass, or cerebral edema. However, non-contrast CT is not sensitive for acute non-hemorrhagic infarct.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Female 37 years old; Reason: neoplasm History: altered mental status 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: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: IVC filter is tilted, with strut perforation through the IVC.BOWEL, MESENTERY: NG tube projects in stomach. No evidence of obstruction, free air, or perforation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No evidence of infection or abscess detected.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Air in the bladder is likely iatrogenic from Foley insertion.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Dilated rectum with asymmetric wall thickening in presacral space edema, correlate for stercoral colitisBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Dilated rectum with asymmetric wall thickening in presacral space edema, correlate for stercoral colitis |
Generate impression based on findings. | Altered mental status. There is left temporal and parietal lobes representing encephalomalacia related to prior infarct with ex-vacuo dilatation of the left lateral ventricle. There is also extensive diffuse periventricular and subcortical white matter hypoattenuation, which likely represents sequela of chronic small vessel ischemic disease with more focal areas of hypoattenuation within the bilateral basal ganglia and thalami, as well as in the right pons. There is no intracranial mass, hemorrhage, or hydrocephalus. There is mild diffuse cerebral volume loss. There is vascular calcification within the vertebral arteries and carotid siphons bilaterally. There are multiple dental caries. There is mild scattered paranasal sinus mucosal thickening. | 1. Chronic left MCA territory infarct and bilateral basal ganglia, thalamus, and right pontine lacunar infarcts of indeterminate age. However, CT is insensitive in the detection of acute nonhemorrhagic stroke and MRI is recommended for further evaluation.2. Multiple dental caries. |
Generate impression based on findings. | Male 28 years old; Reason: Evaluate for resolution of fluid collection and if drain can be removed, 28 y/o s/p ileoanal pouch procedure, loop ileostomy, drain in for pelvic abscess History: drain in see last CT of drain placement ABDOMEN:LUNG BASES: Basilar 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: Status post proctocolectomy with ileoanal anastomosis and right lower quadrant diverting loop ileostomy. Interval resolution of the dilated proximal small bowel loops.Interval resolution of the pneumoperitoneum. Few mesenteric nodes not pathologically enlarged and stable from previous exam.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Removal of the Enteric tube.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Moderate free fluid in the pelvis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Interval insertion of a catheter in the cul-de-sac with trace residual free fluid, markedly decreased from previous exam. | 1.Interval resolution of the bowel obstruction, pneumoperitoneum and trace residual pelvic free fluid. |
Generate impression based on findings. | Headache. CT: There is no evidence of acute intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. CTA: There is mild smooth long-segment narrowing of the M1 segment of the right MCA. There is an extracranial origin of the left PICA, which is a normal variant. There are hypoplastic bilateral P1 segments of the PCAs and prominent PCOMs and associated infundibula, which is a normal variant. There is no evidence of aneurysm or significant steno-occlusive lesion otherwise. | 1. No evidence of evidence of acute intracranial hemorrhage, mass, or cerebral edema.2. Mild smooth long-segment narrowing of the M1 segment of the right MCA, which may represent developmental dysplasia, residual or new vasospasm, or a mild manifestation of reversible cerebral vasoconstriction syndrome. No evidence of cerebral aneurysm. |
Generate impression based on findings. | Anaplastic carcinoma of the thyroid status post thyroidectomy and neck dissection. There are postoperative findings related to recent thyroidectomy and bilateral neck dissection with drainage tubing remaining within the surgical bed and an enteric tube within the esophagus. There is stranding of the regional fat planes, but no discrete fluid collection. There is also mucosal edema within the left supraglottic region with associated effacement of the piriform sinus. There is no definite evidence of residual tumor or cervical lymphadenopathy. The submandibular glands appear hyperemic, likely in response to treatment. The major cervical flow voids appear to be patent, with the termination of the left internal jugular vein as part of the vertebral vein superiorly. There are no lytic or blastic lesions. The imaged intracranial structures and orbits are grossly unremarkable. The imaged paranasal sinuses and mastoid air cells are clear. The imaged portions of the lungs are also clear. | Expected postoperative findings related to recent thyroidectomy and bilateral neck dissection without definite evidence of residual tumor or cervical lymphadenopathy. |
Generate impression based on findings. | Intracranial hemorrhage and altered mental status. There are recent postoperative findings related to right hemicraniotomy for evacuation of a large right temporal lobe hematoma with minimal extra-axial fluid deep to the craniotomy. There is residual hemorrhage within the right temporal lobe within and along the margins of the surgical cavity, which is not significantly changed accounting for differences in technique. The smaller hemorrhagic foci within the bilateral cerebral hemisphere associated with predominantly parieto-occipital white matter and cortical edema are also not significantly changed. Likewise, the superior cerebellar hemorrhage is unchanged. The hypoattenuation within the right thalamus and thalamocapsular junction is slightly better defined. There is edema within the bilateral cerebral peduncles and midbrain, which display a distorted configuration. There is effacement of the third ventricle and mild dilatation of the lateral ventricles, which is not significantly changed. There is approximately 10 m of midline shift to the left, right uncal herniation and subfalcine herniation, which are not significantly changed. There is fluid within the bilateral mastoid air cells. The extracranial structures are unchanged. | 1. Slight interval evolution of the acute infarct in the right thalamus and thalamocapsular junction in a thalamoperforator artery distribution.2. No significant interval change in the multifocal cerebral hemisphere intraparenchymal hematomas, including the partially evacuated large right temporal lobe hematoma, superimposed upon a background of posterior predominant cerebral edema, suggest underlying posterior reversible encephalopathy syndrome and superimposed effects of coagulopathy. No enhancing intracranial mass lesions are identified. 3. Unchanged remote cerebellar hemorrhage with partial effacement of the upper fourth ventricle and unchanged 10 mm of midline shift and third ventricular effacement with mild dilatation of the lateral ventricle, suggesting entrapment. |
Generate impression based on findings. | Intracranial hemorrhage and altered mental status. There are recent postoperative findings related to right hemicraniotomy for evacuation of a large right temporal lobe hematoma with minimal extra-axial fluid deep to the craniotomy. There is residual hemorrhage within the right temporal lobe within and along the margins of the surgical cavity, which is not significantly changed accounting for differences in technique. The smaller hemorrhagic foci within the bilateral cerebral hemisphere associated with predominantly parieto-occipital white matter and cortical edema are also not significantly changed. Likewise, the superior cerebellar hemorrhage is unchanged. The swelling within the right thalamus and thalamocapsular junction has slightly increased swelling with resultant increased effacement of the third ventricle and increase in dilatation of the lateral ventricles. There is edema within the bilateral cerebral peduncles and midbrain, which display a distorted configuration. There is approximately 10 m of midline shift to the left, previously 9 mm. The right uncal herniation and subfalcine herniation are not significantly changed. There is mild fluid within the bilateral mastoid air cells. There is slightly increased subgaleal fluid or swelling overlying the craniotomy site. | 1. Interval evolution of the acute infarct in the right thalamus and thalamocapsular junction in a thalamoperforator artery distribution without hemorrhagic transformation, but increased swelling with resultant increased effacement of the third ventricle and increase in dilatation of the lateral ventricles and 10 mm of midline shift to the left.2. No significant interval change in the multifocal cerebral hemisphere intraparenchymal hematomas, including the partially evacuated large right temporal lobe hematoma, superimposed upon a background of posterior predominant cerebral edema, suggest underlying posterior reversible encephalopathy syndrome and superimposed effects of coagulopathy. 3. Unchanged remote cerebellar hemorrhage with partial effacement of the upper fourth ventricle. |
Generate impression based on findings. | Base of tongue adenocarcinoma s/p resection and chemoradiation in 2009. Head: There is no evidence of abnormal intracranial enhancement. There is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. Neck: There are stable postoperative findings related to left partial glossectomy, left submandibular gland resection, and selective dissection of the left neck nodal chain with pectoralis flap reconstruction. There is no evidence of mass lesions to suggest locoregional tumor recurrence. There is no significant cervical lymphadenopathy. The major salivary glands and thyroids are unremarkable. The major vascular structures of the neck are unchanged. The osseous structures are unremarkable. The imaged intracranial structures and orbits are unremarkable. The imaged paranasal sinuses and mastoid air cells are clear. The airways are patent and the imaged portions of the lungs are clear. | 1. No evidence of locoregional tumor recurrence or significant cervical lymphadenopathy. 2. No evidence of intracranial metastases. |
Generate impression based on findings. | Neck stiffness, HA. There is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull appears unremarkable. There is a metallic density in the subcutaneous tissue overlying the left lateral supraorbital rim, which likely represents a bi-bi or bullet. | No evidence of intracranial hemorrhage, mass, or cerebral edema. |
Generate impression based on findings. | Goiter. There is a partially imaged diffusely and massively enlarged thyroid gland, inc which the left lobe extends superiorly to the level of the angle of the mandible and the right lobe extends superiorly nearly to the level of the hyoid bone. Inferiorly there is incompletely depicted retrosternal extension. The thyroid gland is diffusely heterogeneous with multiple nodular components. There is severe narrowing of the trachea at the level of the thyroid, measuring 4 mm in traverse width. There is also a course calcification in the right thyroid that measures up to 8 mm. There is no significant cervical lymphadenopathy. The major salivary glands are unremarkable. The major cervical vessels are patent. There are carious ADA 5 and 12. The paranasal sinuses and mastoid air cells are clear. The osseous structures are unremarkable. The imaged intracranial structures and orbits are unremarkable. The imaged portions of the lungs are clear. | 1. Partially imaged massive thyroid goiter with multiple nodular components and with severe narrowing of the trachea at the level of the thyroid, measuring 4 mm in traverse width. 2. Dental caries in ADA 5 and 12. |
Generate impression based on findings. | Postop. There are postoperative findings including transpedicular screws at L3 and L4 with a fixation rod and bone grafting at this level and there is partial bony fusion. There has been interval recent intervertebral spacer device insertion at L1-2, L2-3, L3-4 and L4-5 with associated foci of air and fat stranding within the right retroperitoneum. At the L4-5 level, a portion of the cage extends anterolaterally into left paraspinal soft tissues. The physiologic lumbar lordosis is diminished. There is mild inferior endplate depression at L3. Otherwise, the vertebral body heights are maintained. There is loss of intervertebral space at L3-4 and L4-5. There is multilevel spondylosis with disc bulges and facet osteophytes and ligament flavum hypertrophy resulting in spinal stenosis that is most pronounced L4-5 and and neural foraminal stenosis at L3 and L4-5. There are no vertebral fractures. There is significant atherosclerotic calcification of the abdominal aorta. The bladder appears to be distended. | Postoperative findings including partial right L3-4 fusion and interval spacer insertion within intervertebral spaces of L1-2 through L4-5. The cage at L4-5 is positioned anterolaterally, extending partially into the adjacent paraspinal soft tissues. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Left T3N0 tonsil cancer status post tonsillectomy and chemo RT in September 2009. Head: There is no abnormal intracranial enhancement. There is no evidence of intracranial hemorrhage, mass, or cerebral edema. Thre is an unchanged punctate hypodensity in the left basal ganglia, which may represent a chronic lacunar infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There are small left maxillary sinus retention cysts. The mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. Neck: There are unchanged treatment effects in the oropharynx, including volume loss in the left tonsillar fossa and persistent edema in the uvula. There is no evidence of mass lesions to suggest tumor recurrence. There is no significant lymphadenopathy by size criteria. In particular, the level 1A lymph nodes are no significantly changed, measuring up to 8 mm. The major salivary glands appear unchanged, including atrophy of the submandibular glands. The tyroid gland is unremarkable. The airways are patent. There is unchanged multilevel degenerative spondylosis. There is mild to moderate narrowing of the carotid bifurcations bilaterally. The imaged lung apices are clear. | 1. No evidence of locoregional tumor recurrence or significant cervical lymphadenopathy. 2. No evidence of intracranial metastases. |
Generate impression based on findings. | 84 year-old female with intracranial hemorrhage. There has been no significant change in the size of a left temporal lobe parenchymal hematoma, however there has been a decrease in density consistent with aging. Previously demonstrated subarachnoid extension involving the sylvian fissure and the sulci of the left frontal and left occipitotemporal regions as well as right sylvian fissure also demonstrates a decrease in density. There is no interval new hemorrhage.Edema and mass effect associated with the left temporal lobe parenchymal hematoma has not substantially changed. The ventricular system remains patent and stable in size with only mild effacement of the left ventricular atrium.When compared to the head CT obtained in 2011, there appear to be bilateral CSF density extra fluid collections consistent with hygromas. When measured on coronal imaging to the third ventricle at the same location, the depth on the right is 6 mm, and on the left 3 mm, both unchanged and without underlying mass effect.Bilateral facial/periorbital soft tissue hematomas are redemonstrated. | 1. No significant interval change in size of a left temporal parenchymal hematoma or of the scattered subarachnoid blood product, although there has been a decrease in density.2. No evidence of new intracranial hemorrhage is seen.3.Small bilateral subdural hygromas without associated mass effect. |
Generate impression based on findings. | Female 28 years old; Reason: pulmonary hemorrhage? History: persistent RML RLL infiltrate despite therapy for CAP and HCAP. LUNGS AND PLEURA: Bilateral patchy and ground glass opacities some of which are confluent, especially in the right middle lobe. The patchy opacity in the right middle lobe also contains air bronchograms. These opacities do not appear to be in the dependent portion of the lung but more in the middle and upper lobes and there are areas where they are more nodular. Bilateral pleural effusions. Right pleural effusion is moderate and the left is small. There is peribronchial thickening especially centrally consistent with bronchitis.MEDIASTINUM AND HILA: Severe cardiomegaly and small pericardial effusion. Multiple subcentimeter size lymph nodes in the mediastinum. Reference lymph node in the right paratracheal distribution measures 0.9 cm (series 3, image 31). Left-sided central venous catheter terminates in the distal SVC.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.Bilateral nodular, patchy and ground glass opacities upper and mid lung predominant distribution, especially the right middle lobe. Differential considerations are hemorrage, atypical edema or atypical infection.2.Cardiomegaly with pericardial effusion. |
Generate impression based on findings. | Malignant neoplasm of thyroid gland. Examination of participant in clinical trial. Baseline prior to starting new systemic therapy; please give bi-dimensional measurements. Hx of head and neck cancer CT neck:The patient is s/p thyroidectomy. Surgical clips are present along the thyroid bed. There is soft tissue thickening present within the visceral space. There is infiltration of fat planes along the retropharyngeal space and surrounding the visceral space as well as along the carotid space, right more than left, extending all the way up into the suprahyoid neck.Within the suprahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated. Within the infrahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated.The airway appears patent.The parotid and the submandibular glands appear intact.The visualized lung apices demonstrate a calcified nodule along the left upper lobe measuring 10 mm in diameterThe carotid and vertebral vasculature visualized on this exam appears intact.The cervical vertebral bodies in general are intact with no evidence for canal stenosis. At C5-6 there is loss of disk space height , endplate and uncovertebral osteophytes with mild narrowing of the neural foramina.CT head:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No acute intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.No evidence for neck lymphadenopathy on the basis of CT size criteria for lymphadenopathy2.the patient is status endarterectomy which is associated infiltration within the soft tissues of the neck. Please correlate with timing of recent surgery and clinical exam findings. Differential considerations include post surgical change as well as infection.3.No evidence for brain metastases.4.Calcified nodule in the left upper lung field is incompletely visualized on this exam. Typically calcified nodules are related to calcified granulomas |
Generate impression based on findings. | 35-year-old female with presence of cerebrospinal fluid drainage device -- rule-out pseudocyst at the distal shunt catheter. Patient has abdominal pain. Within the limits of a non-IV contrast enhanced examination which limits evaluation of solid parenchymal organs and vascular structures, the following observations can be made:ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality noted in liver parenchyma, although lack of IV contrast markedly limits evaluation. Patient status post cholecystectomy. No intrahepatic or extrahepatic biliary duct dilatation is seen.SPLEEN: 5.9 x 5.7 cm well-defined near water density lesion in the spleen likely representing benign cysts, unchanged when compared with prior chest CT examination. No other abnormalities.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilaterally small kidneys, without focal mass identified -- lack of IV contrast markedly limits ability to evaluate the kidneys. No perinephric fluid collections. RETROPERITONEUM, LYMPH NODES: Inferior vena cava filter in position just past the confluence of the iliac veins. No adenopathy, masses, or other fluid collection seen.BOWEL, MESENTERY: Orally administered contrast reveals normal stomach with rapid progression of contrast through normal-appearing small bowel to the normal. Colon.CSF shunt catheter enters the peritoneal space in the right abdomen, and traverses inferiorly with tip of catheter in the lying just above the bladder. Small amounts of fluid are seen about the distal course of the catheter, but without date loculation or rounded collection to suggest pseudocyst. No significant free intraperitoneal fluid is seen elsewhere in the abdomen/pelvis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality noted in the bowel. A a paucity of free mesenteric fluid is seen.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Vascular stent in the pelvis, but appears to be in the right external venous stent, but without contrast administration exact determination whether this is arterial or venous is difficult. Patency cannot be ascertained without IV contrast. No abnormal fluid collections about the pelvis are seen. | 1. CSF shunt catheter coursing through the abdomen without discontinuity seen. 2. No evidence of pseudocyst about catheter tip. |
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