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Generate impression based on findings. | 36 year old female with a history of distal tibial shaft fracture status post ORIF. Evaluate for fracture union. Patient presents with persistent pain. Metal streak artifact somewhat limits evaluation. Note is made of a surgical side plate and screw device affixing the previously described comminuted fracture of the distal tibial metadiaphysis in near anatomic alignment without evidence of hardware complication. Note is made of a nondisplaced fragment along the medial aspect of the distal tibial diaphysis, which may be related to prior surgical screw placement. There is slight callus formation in the surrounding area, appearing similar to the prior radiographs dated 10/28/2013 when allowing for differences in technique. There is no definite bony bridging identified.Again seen is a surgical sideplate and screw device affixing a distal fibular fracture in near-anatomic alignment without evidence of hardware complication. The fracture line remains distinct and there is no definite bony bridging identified. Again seen is a posterior malleolar fracture. The fracture line appears similar to the prior study.The tibiotalar and subtalar articulations appear anatomic. There is no abnormal widening of the distal tibiofibular syndesmosis. The bones appear diffusely demineralized, presumably secondary to disuse. The visualized musculotendinous structures are grossly intact, within the limitations inherent to CT. | Orthopedic fixation of distal tibial and fibular fractures as above. |
Generate impression based on findings. | Female, 40 years old, syncope, right ear pain for two weeks. Evaluate for mass, acoustic neuroma, bleed. The cerebral and cerebellar hemispheres and brainstem are normal in attenuation and morphology. No pathologic parenchymal or extra-axial enhancement is detected. Please note that this examination is not tailored for evaluation of the internal auditory canals.No large intracranial hemorrhage is detected, though the presence of contrast may obscure subtle hemorrhage. No abnormal extra-axial fluid collection is seen. There is no evidence of mass effect or midline shift. The ventricles and basal cisterns are patent and normal in size. The paranasal sinuses and mastoid air cells are normally pneumatized. A mild degree of soft tissue debris is present in the right external auditory canal.The bones of the calvarium and skull base are intact. | No definite or significant abnormalities are detected within the limitations discussed above. |
Generate impression based on findings. | Reason: rule out PE History: respiratory insufficiency with known lung cancer PULMONARY ARTERIES: Technically adequate examination. No evidence of pulmonary embolism.LUNGS AND PLEURA: Entire right lung is atelectatic. Interval increase in narrowing of the right mainstem bronchus compared to prior exam. The lobar bronchi are not seen distally due to extrinsic compression and/or luminal occlusion by tumor. Right diaphragm graft is unchanged. Interval increase in size and number of pulmonary nodules in the left lung, primarily lower lobe. Assessment of interval change of the right lung is limited due to complete right lung atelectasis. Interval increase in intralobular septal thickening consistent with progressive lymphangitic spread versus edema.MEDIASTINUM AND HILA: Severe and extensive mediastinal lymphadenopathy, increased from prior exam. Reference prevascular lymph node measures 26 mm in short axis compared to 23 mm previously (series 11, image 94). The distal trachea and mainstem bronchi are encased by lymphadenopathy. Reference right hilar lymph nodes are difficult to measure secondary to surrounding lung atelectasis. Right mainstem bronchus stent is patent proximally but is occluded distally.Heart size is normal. No pericardial effusions. CHEST WALL: Right chest port with catheter extending to the right atrium. Low cervical lymphadenopathy bilaterally appear not significantly changed from prior exam. Previously noted right intercostal lymphadenopathy (series 11, image one 25) at the level of the pulmonary artery bifurcation appears unchanged from prior exam. Infiltration of the right paravertebral fat by tumor is again noted. UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Porcelain gallbladder unchanged. Slight interval increase in nodularity of left adrenal gland. Enlarged gastrohepatic, periaortic, and aortocaval lymph nodes are similar to prior exam. | 1.No evidence of pulmonary embolism.2.Interval increase of extensive pleural, lung parenchymal, and mediastinal disease compatible with mesothelioma.3.Complete atelectasis of right lung due to either extrinsic compression or luminal occlusion by tumor. |
Generate impression based on findings. | Pain and swelling to upper mandible post fall. Head: There is a stable region of encephalomalacia spanning the left posterior frontal and anterior parietal lobes underlying the craniotomy. There is ex vacuo dilatation of the underlying left lateral ventricle. There is no intracranial mass, acute hemorrhage, hydrocephalus. Maxillofacial: There are radio-opaque foreign bodies within soft tissues of the right upper lip with associated soft tissue thickening and density. There is chronic-appearing partial opacification of the sphenoid sinus with sclerosis of the sinus walls. The other paranasal sinuses and mastoid air cells are clear. There is irregularity of the right nasomaxillary suture with no associated swelling, which could be congenital or related to a fracture of indeterminate age. There is extensive dental disease including lucencies associated with mandibular and maxillary molars and multiple caries. | 1. Foreign bodies within the right upper lip associated with significant soft tissue swelling. 2. Unchanged encephalomalacia in the left hemisphere, but no evidence of acute intracranial hemorrhage.3. Extensive dental disease. |
Generate impression based on findings. | Female, 69 years old, seizure altered mental status. The cerebral and cerebellar hemispheres and brainstem are normal in attenuation and morphology. At most, there may be minimal periventricular hypoattenuation compatible with age indeterminate small vessel ischemic disease.No intracranial hemorrhage or abnormal extra-axial fluid collection is seen. There is no evidence of mass effect or midline shift. The ventricles and basal cisterns are patent and normal in size. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.The bones of the calvarium and skull base are intact. | No acute intracranial abnormality. |
Generate impression based on findings. | 26 year old female with known pancreatitis, evaluate for severity ABDOMEN:LUNG BASES: Left pleural effusion. Basilar atelectasis.LIVER, BILIARY TRACT: Diffuse hepatic steatosis. SPLEEN: No significant abnormality notedPANCREAS: Diffuse pancreatic enlargement and peripancreatic fluid with stranding of the surrounding fat consistent with pancreatitis. The pancreas enhances homogeneously, without evidence of necrosis. Infiltration of the fat fluid extends within the mesentery and along the left psoas muscle, increased in extent from the prior study. The SMV, splenic vein, and portal vein are patent. No evidence of pseudoaneurysm. No loculated fluid collection/pseudocyst.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Moderate ascites.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Distended and otherwise, unremarkable.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Mild ascites. | Findings consistent with acute pancreatitis without evidence of necrosis or loculated fluid collection. Peripancreatic and abdominal free fluid and fat infiltration is increased in extent compared to the prior study as detailed above. |
Generate impression based on findings. | Male, 35 years old, altered mental status Image quality is slightly degraded by motion artifact. Within this limitation, the following observations are made.The cerebral and cerebellar hemispheres and brainstem are normal in attenuation and morphology. No intracranial hemorrhage or abnormal extra-axial fluid collection is seen. There is no evidence of mass effect or midline shift. The ventricles and basal cisterns are patent and normal in size. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.The bones of the calvarium and skull base are intact. | No acute intracranial abnormality. |
Generate impression based on findings. | Reason: parathyroid carcinoma History: disease progression? CHEST:LUNGS AND PLEURA: Reference right middle lobe nodule slightly increased to 23 x 15 mm on image 60/102 (20 x 10 mm on previous). The degree of surrounding consolidation and atelectasis has increased. Previously a measurement in craniocaudal dimension of 16 mm was given. Currently this is 17 mm on image 79/125. Linear scarring or atelectasis on the left is unchanged. No new pulmonary nodules.MEDIASTINUM AND HILA: Widespread intrathoracic lymphadenopathy. The previously referenced low right paratracheal lymph node has slightly increased to 23 x 20 mm on image 36/151 (19 x 18 mm on previous). Post op change involving the thyroid. Please see dedicated neck CT report for further details.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Multiple new hypodense lesions are noted involving the liver, especially the right lobe (image 113/151). Previously noted hyperdense lesions, the largest of which are in the right lobe (images 80 and 91/151) are unchanged. Other hypodense lesions such as the left lobe lesion, previously noted (image 92/151) may represent cysts. There is some differential perfusion involving the right posterior segment of uncertain significance.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: Retroperitoneal lymphadenopathy is unchanged. BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Intrathoracic lymphadenopathy is stable to marginally in increased.2. Reference right middle lobe pulmonary nodule has slightly increased.3. Multiple new hepatic lesions which are nonspecific. Some of the conspicuity of these lesions may be due to phase of contrast enhancement though review of CTs back to 12/6/2011 reveals that these are definitively new. An MR may provide better characterization though the lesions are suggestive of metastases.4. Stable retroperitoneal lymphadenopathy. |
Generate impression based on findings. | 42-year-old male evaluate for known intra-abdominal abscess deep to cecum ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Subcentimeter hypodense hepatic lesions, too small to accurately characterize.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Cecal, and terminal ileal wall thickening with adjacent 2.3 x 1.8 cm loculated fluid collection, likely representing early abscess (image 118, series 4). There is extensive infiltration of adjacent fat. The appendix is not visualized and may be absent or involved in this process. Fibrofatty proliferation of the mesentery, as well as multiple prominent lymph nodes, measuring 5 to 10 mm indicate chronic inflammation.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: Cecal, and terminal ileal wall thickening with adjacent 2.3 x 1.8 cm loculated fluid collection, likely representing early abscess (image 118, series 4). There is extensive infiltration of adjacent fat. The appendix is not visualized and may be absent or involved in this process. Fibrofatty proliferation of the mesentery, as well as multiple prominent lymph nodes, measuring 5 to 10 mm indicate chronic inflammation.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Extensive cecal and terminal ileal wall thickening and surrounding fat infiltration with small 2.3-cm loculated fluid collection, likely representing early abscess formation. The appendix is not visualized and may be absent or involved in this process. These findings are consistent with the provided history of inflammatory bowel disease. |
Generate impression based on findings. | T1N1M0 scca BOT with two primary lesions s/p CRT completed treatment in 2008 follow by resection. Head: There is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is mild left maxillary sinus mucosal thickening. The mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. Neck: There are stable post-treatment findings in the base of tongue region without evidence of locoregional tumor recurrence. There is no significant cervical lymphadenopathy. The airways are patent. The thyroid gland is mildly atrophy. The major salivary glands are unremarkable. There is an aberrant right subclavian artery. The osseous structures are unremarkable, aside from mild degenerative spondylosis. The imaged portions of the lungs are clear. | 1. No evidence of locoregional tumor recurrence of significant cervical lymphadenopathy.2. No evidence of intracranial metastases. |
Generate impression based on findings. | Female 24 years old; Reason: concern for PE History: tachypnea, DVT. PULMONARY ARTERIES: Subsegmental pulmonary emboli in both lower lobes. The main pulmonary artery is normal in caliber.LUNGS AND PLEURA: Small lung volumes. Bilateral patchy and ground glass opacities especially in the dependent portions of the lung with a few areas of nodular opacities in the anterior left upper lobe. There are bilateral pleural effusions greater on the right than the left with overlying consolidation and fluid within the fissures. These finding are more likely to represent pulmonary edema and compression atelectasis than infection.MEDIASTINUM AND HILA: Subcentimeter mediastinal lymph nodes are noted especially in the right paratracheal region right reference node measures 1.1 cm (series 5, image 83). Normal size heart without pericardial effusion. Left subclavian catheter tip at the superior cavoatrial junction.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.Bilateral lower lobe segmental pulmonary emboli.2.Bilateral patchy and ground glass opacities are seen in the dependent regions with development of septal thickening, bilateral pleural effusions and fluid in the fissures. These findings most likely represent edema.3.Mediastinal adenopathy, likely reactive to the edema. |
Generate impression based on findings. | 34-year-old male with dropping hemoglobin -- rule-out retroperitoneal bleed. Within the limits of a non-IV contrast-enhanced examination which limits the ability to evaluate solid organ parenchyma and vascular structures, the following observations can be made:ABDOMEN: Extensive free intraperitoneal air persists, subjectively unchanged when compared with previous.LUNG BASES: Bibasilar atelectasis.LIVER, BILIARY TRACT: No significant abnormality noted in liver parenchyma. New since prior examination is an 11.0 x 3.7 by 2.4-cm intraperitoneal collection (series 4, image 40) of near water density with an air-fluid level immediately adjacent to the left lobe of the liver, anterior and, superiorly and causing mass effect on the left lobe of the liver. There is no evidence of high density material to suggest acute hemorrhage and this has more appearance of a seroma or other fluid collection. This is just above the left. Gastrostomy tube and may represent complications or leakage from the gastrostomy tube.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted - no adenopathy, masses or abnormal fluid collections. No evidence of retroperitoneal hematoma..BOWEL, MESENTERY: Gastrostomy tube is seen in the same position as prior examination. In the anterior stomach with free are seen about the stomach immediately adjacent to the catheter -- this may be a site of leakage for the intraperitoneal air. As mentioned above, there is a, air fluid collection loculated just superior to the gastrostomy tube abutting the liver. Residual contrast is seen in the colon from prior oral administration from CT examination 10/29/13. Small and large bowel shows no diagnostic abnormalities.CSF shunt catheter seen entering the anterior midabdomen, and a catheter traverses through the, mesentery without complication with tip of the catheter in the left pelvis. No significant free mesenteric fluid is identified.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Foley catheter in bladder -- small amount of air in bladder most likely relates to Foley catheter. No other abnormalities.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Extensive pneumoperitoneum persists, unchanged. In addition, new air fluid level is seen anterior to left lobe of liver and appears to be close to the percutaneous gastrostomy site. 3. No other significant changes or other abnormalities seen. |
Generate impression based on findings. | Female, 73 years old, confusion. Status post fall. The cerebral sulci are prominent, more so in the frontal regions, compatible with volume loss. The supratentorial ventricular system is also prominent but in proportion to the sulci.Periventricular hypoattenuation is seen, a nonspecific finding which probably reflects age indeterminate small vessel ischemic disease. No CT evidence of acute territorial ischemia is demonstrated.No mass effect is seen. No intracranial hemorrhage or abnormal extra-axial fluid collection is detected.No calvarial fracture is seen. There is an area of opacified left ethmoid air cells. Otherwise, the visualized paranasal sinuses are well pneumatized. | 1. Parenchymal volume loss with a frontal lobe predominance.2. Age indeterminate small vessel ischemic disease.3. No definite evidence of an acute intracranial abnormality. |
Generate impression based on findings. | 84-year-old female with abdominal pain and vomiting, rule obstruction versus ileus. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Several subcentimeter hypodensities, too small to characterize.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Subcentimeter hypodensities too small to characterize.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Circumferential narrowing and wall thickening at the junction of the descending and sigmoid colon (image 50 series 80224) with associated high-grade bowel obstruction. No loculated or free fluid or free air. The cecum measures 8.6 cm in diameter. Multiple dilated loops of fluid-filled small bowel measure up to 4.2 cm.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Circumferential narrowing and wall thickening at the junction of the descending and sigmoid colon (image 50 series 80224) with associated high-grade bowel obstruction. No loculated or free fluid or free air. The cecum measures 8.6 cm in diameter. Multiple dilated loops of fluid-filled small bowel measure up to 4.2 cm.BONES, SOFT TISSUES: Hardware extends within the L4 and L5 vertebral bodies. Severe degenerative changes of the lumbar spine.OTHER: No significant abnormality noted | High-grade bowel obstruction due to circumferential sigmoid colon wall thickening and narrowing. Annular adenocarcinoma is the diagnosis of exclusion. No evidence of metastatic disease. |
Generate impression based on findings. | Reason: Further definine left pleural effusion vs. collapse History: Further definine left pleural effusion vs. collapse Limited examination due to difficulty in patient positioning and patient motion.LUNGS AND PLEURA: There is complete obstruction of the left mainstem bronchus approximately 2 cm from its origin. There is minimal aeration identified in the left upper lobe with marked shift of the mediastinum from right to left..Bilateral pleural effusions left greater than right.Centrilobular emphysema identified in the right lung.Right basilar atelectasis.Mild septal thickening and and groundglass opacities the right lung are compatible with edema. MEDIASTINUM AND HILA: Endotracheal tube with its tip 1.As noted above there is marked shift of the mediastinum from right to left cm above the carina.There is severe cardiac enlargement and small pericardial effusion. Pacemaker leads are identified in the expected positions.CHEST WALL: Diffuse anasarca.Severe degenerative joint disease involving the right glenohumeral joint.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. Ascites. | 1.There is complete obstruction of the right mainstem bronchus approximately 2 cm from its origin. This may represent endobronchial obstruction by mucous plugging. However , an obstructing mass cannot be excluded.2.Bilateral pleural effusions left greater than right with the mild amount of edema within the right lung.3.Severe cardiac enlargement small pericardial effusion.4.Generalized anasarca with ascites.5.Moderate to marked centrilobular emphysema within the visualized right lung. |
Generate impression based on findings. | Female, 56 years old, dizziness. The cerebral and cerebellar hemispheres and brainstem are normal in attenuation and morphology. No intracranial hemorrhage or abnormal extra-axial fluid collection is seen. There is no evidence of mass effect or midline shift. The ventricles and basal cisterns are patent and normal in size. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.The bones of the calvarium and skull base are intact. | No acute intracranial abnormality. |
Generate impression based on findings. | Reason: evaluate for cause of hypoxemia and RML collapse History: hypoxemia LUNGS AND PLEURA: No evidence of right middle lobe collapse as clinically queried. There is a moderate right pleural effusion with compressive right lower lobe atelectasis. Scarlike opacity in the left lower lobe (image 59/89) is unchanged. 6-mm in nodule in left lower lobe (image 54/89) has been stable to 11/18/2010 abdomen pelvis CT. Nonspecific 5-mm nodular opacity in the left upper lobe (image 27/89) more likely postinflammatory though continued follow-up is recommended. Similar clustered nodules are noted in the perifissural right upper lobe (image 38/89). Trace left pleural effusion.MEDIASTINUM AND HILA: Atherosclerotic calcification of the aorta and its branches. Multinodular thyroid. Coronary calcification. Cardiomegaly. Status post mitral valve replacement. CHEST WALL: Degenerative change involving the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Granulomas in the liver and spleen. Left adrenal nodule incompletely visualized though was described as an adenoma on prior abdomen pelvis CTs. Hyperdense left renal nodule is incompletely visualized (image 89/89) but may represent a hemorrhagic cyst. | 1. No evidence of right middle lobe collapse.2. Moderate right pleural effusion with compressive right lower lobe atelectasis.3. Scattered small subcentimeter pulmonary nodules which are likely inflammatory/infectious though follow up CT in 12 months is recommended to confirm stability as some are new versus 2009 CT.4. Other findings as above. |
Generate impression based on findings. | Female; 53 years old. Reason: SCC of nasal cavity s/p surgery and induction chemo. Please assess for any other disease. History: Facial and neck pain. CHEST:LUNGS AND PLEURA: Centrilobular emphysema.MEDIASTINUM AND HILA: Coronary calcifications. Normal sized precarinal lymph node.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: 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: Uterus is absent.BLADDER: No significant abnormality noted.LYMPH NODES: Surgical clips in the right femoral region.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative disk disease at T11/12 and L5/S1.OTHER: No significant abnormality noted. | No evidence of metastatic disease in the chest, abdomen, or pelvis. Please see separate report for CT of the neck performed on the same day. |
Generate impression based on findings. | Female, 53 years old, history of nasal squamous cell carcinoma status post surgical resection and induction chemotherapy. Extensive postsurgical changes are demonstrated in the face including resection of the left globe, partial left maxillectomy with resection of the nasal bones and soft tissue flap reconstruction. A bulky, heterogeneously enhancing tumor is redemonstrated measuring 6.8 x 4.2 cm in maximal transaxial dimension (image 6 series 7), previously 6.4 x 3.9 cm. As before, the tumor spans from the midline forehead, inferiorly and laterally to involve the ethmoid region, filling the exenterated left orbit, and extending down to the level of the partially resected left maxilla and maxillary sinus. This increase in size results in a greater degree of incursion into the left ethmoid region and left nasal cavity. At the superior margin of the tumor, there is progressive erosion through the left orbital roof with tumor incursion into the anterior cranial fossa. Tumor contacts and probably exerts mass effect upon the inferior left frontal lobe. Parenchymal invasion cannot be assessed on this study.At the inferior margin of the tumor, there seems to have been some improvement in the volume of enhancing tissue situated along the left anterior maxilla at the level of the junction of the nose and the flap construct. When similar slices are compared, enhancing tissue at this level measures 2.4 x 1.4 cm (image 19 series 7), previously 3.6 x 3.2 cm. The underlying maxilla remains eroded at this location, similar to prior. Posterior to this region, the residual left maxillary sinus remains opacified with relatively nonenhancing material which probably reflects trapped secretions or mucosal thickening.Bulky heterogeneously enhancing adenopathy is redemonstrated in the left neck. Overall, these lesions have decreased in size. A reference left parotid space lesion measures 2.6 x 2.2 cm (image 16 series 7), previously 2.6 x 2.5 cm. More inferiorly in the left parotid space, there is a lesion which measures 2.2 x 2.1 cm (image 28 series 7), previously 2.8 x 2.6 cm. A submental reference node measures 1.1 x 0.7 cm (image 40 series 7), previously 1.0 x 0.6 cm.A few additional minimally prominent left level 2 nodes are seen, not significantly changed from prior. No definite new adenopathy is seen elsewhere in the neck.The left parotid gland is encompassed nearly entirely by adenopathy. The right parotid gland and submandibular glands are unremarkable. The thyroid is free of focal lesions. Cervical vasculature remains patent. Mild emphysema is redemonstrated in lung apices. Except as above, the osseous structures of the neck are intact. | Since the prior examination, there has been a mild increase in size of the patient's large heterogeneously enhancing left facial tumor. This change results in subtle increased tumor incursion into the left ethmoid and nasal cavity regions.More significantly, however, is progressive tumor erosion through the left bony orbital roof with tumor now present within the left anterior cranial fossa. This likely produces some degree of mass effect upon the inferior frontal lobe. Parenchymal invasion would be better assessed on MRI.At the inferior margin of the tumor, there has been some reduction in the bulkiness of enhancing tissue seen previously at the level of the left anterior maxilla. Left parotid space adenopathy has also improved. |
Generate impression based on findings. | 70 year-old male with dissection of aorta treated at outside institution, with continued sepsis despite antibiotic coverage CHEST:LUNGS AND PLEURA: Extensive anterior pneumothorax across right and left anterior thorax loculated and not being served by the right posterior chest tube. Resultant loss of volume in both right and left lungs with atelectasis, greatest at the right lung base. Air space consolidation in both lung bases may be from the atelectasis, although coexisting infection cannot be excluded. In the right lung. The scattered ground glass infiltrate.Bilateral posterior loculated pleural effusions.MEDIASTINUM AND HILA: Postsurgical changes about the aorta are seen with presumed internal. Graft placed and removal of the internal stent seen on 2/2/13 examination at the level of the aortic arch and descending aorta. Small amount of non-loculated fluid is seen about the aorta and graft and moderately extensive pneumomediastinum is present -- this most likely relates to the extensive pneumothorax and may relate to timing of surgery.Coronary artery calcification seen. Central venous line with tip of catheter in the right atrium.Endotracheal tube in expectedCHEST WALL: Chest wall changes with sutures persisting from surgery that are new since 10/2/13 examination. Extensive subcutaneous emphysema seen, presumably relating to recent procedure. Right lateral posterior chest tube into the right dependent posterior pleural space.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Orally administered contrast shows no abnormalities in the stomach, small bowel, with rapid transit through to the ileum. Unopacified colon appears unremarkable. Extensive ascites is present without loculation.BONES, SOFT TISSUES: Diffuse anasarca without other abnormality.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Orally administered contrast shows no abnormalities in the stomach, small bowel, with rapid transit through to the ileum. Unopacified colon appears unremarkable with rectal balloon in position. Extensive ascites is present without loculation.BONES, SOFT TISSUES: Diffuse anasarca without other abnormality.OTHER: No significant abnormality noted | 1. Extensive postoperative changes about the aorta and mediastinum from interval surgery since 10/2/13 examination. 2. Extensive anterior pneumothorax and pneumomediastinum -- the right dorsal chest tube in position but not believing pneumothorax. 3. Diffuse ascites and subcutaneous anasarca without a loculated collection to suggest focal abscess. |
Generate impression based on findings. | 77-year-old male with history of all colitis status post total abdominal proctocolectomy with diffuse abdominal pain. ABDOMEN:LUNG BASES: Mild basilar scarring/atelectasis.LIVER, BILIARY TRACT: Unchanged left hepatic cyst and right subcentimeter hypodensity.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Moderate atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: Mildly distended small bowel with several angulated loops suggesting low-grade adhesions. No evidence of obstruction, loculated or free fluid or free air. Status post total abdominal colectomy with right lower quadrant ileostomy.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: Mildly distended small bowel with several angulated loops suggesting low-grade adhesions. No evidence of obstruction, loculated or free fluid or free air. Status post total abdominal colectomy with right lower quadrant ileostomy.BONES, SOFT TISSUES: Moderate degenerative changes of the lumbar spine.OTHER: Note is made of a penile prosthesis with reservoir adjacent to the bladder. | Several angulated loops of small bowel indicating low-grade adhesions without evidence of frank obstruction or acute intra-abdominal abnormality. |
Generate impression based on findings. | Neoplasm of unspecified nature of endocrine glands and other parts of nervous system. Eval for fusion Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The patient is status post laminectomies at L3, L2 and L1 and posterior fusion with pedicle screws and interconnecting rods with pedicle screws at the T12 L1 L3 and L4There are heterogeneous sclerotic changes redemonstrated at L2 and posterior elements of S1. Since the prior exam 2 days ago spinous processes of L1, L2 and L3 have been removed where there were prior mixed sclerotic / lytic lesions and soft tissue mass in the spinal canal.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a mild disk bulge present at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a mild disk bulge present at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. Imaging at this level is partially obscured by metal artifact. There is postsurgical change present at this level with a couple air bubbles in the spinal canal peripherally and within the perivertebral tissues at the surgical site.At L2-3 there is no significant compromise to spinal canal or neural foramina. Imaging at this level is partially obscured by metal artifact. There is postsurgical change present at this level with air bubbles in the spinal canal peripherally and within the perivertebral tissues at the surgical site.At L1-2 there is no significant compromise to spinal canal or neural foramina. Imaging at this level is partially obscured by metal artifact. There is postsurgical change present at this level with air bubbles in the spinal canal peripherally and within the perivertebral tissues at the surgical site. | 1.Status post recent spinal surgery with removal of mass within the spinal canal and posterior element pathology with attendant postsurgical changes.2.Sclerotic change at L1-2 and S1 posterior elements is suspected to be related to metastatic disease.3.Cholelithiasis , retroperitoneal adenopathy and prior gastric surgery. Please refer to recent CT abdomen for further comments |
Generate impression based on findings. | Reason: mets lung cancer. S/p chemo and pleurectomy and proton beam RT, now with recurrence disease. Pls compare w/ outside August PET/CT . History: mets lung ca CHEST:LUNGS AND PLEURA: Postop change from right pneumonectomy and pleurectomy with minimal residual thickening along the chest wall which correlates with the increased activity on PET. For continued reference, thickening along the lateral aspect measures 8 mm on image 76/148. Along the medial aspect the thickening measures 6 mm on image 44/148.Punctate perifissural nodule on the left (image 48/103) which is likely post inflammatory and was present on prior studies.MEDIASTINUM AND HILA: Postop change in left supraclavicular area. Scattered left supraclavicular lymph nodes are present and correlate with the increased activity on PET. For continued reference the short axis of a left supraclavicular node measures 6 mm on image 12/148.CHEST WALL: Postop change involving the lateral right ribs. Small subcentimeter axillary lymph nodes are stable.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: New heterogeneous cortical hypodensity involving the posterior medial aspect of the right kidney is new from prior study though is more likely due to infarct or scarring than metastatic disease. Continued follow-up is recommended.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Scattered small retroperitoneal lymph nodes are stable.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. The areas of increased activity on 8/27/2013 PET CT correlate with supraclavicular nodes and soft tissue thickening along the medial and lateral aspects of the right hemithorax, suspicious for residual disease. There is no significant change in size, however, and no new sites of disease are seen.2. New heterogeneous cortical hypodensity involving the posterior medial aspect of the right kidney is new from prior study though is more likely due to infarct or scarring than metastatic disease. Continued follow-up is recommended. |
Generate impression based on findings. | Reason: evaluate for infection History: fever, tachycardia Motion limits sensitivity.LUNGS AND PLEURA: Significant interval increase in bilateral lower lobe and dependent multifocal areas of consolidation/atelectasis compatible with aspiration pneumonia.Increasing nodular and tree in bud opacities bilaterally with bronchial/bronchiolar wall thickening. No significant pleural effusions. MEDIASTINUM AND HILA: Mild nonspecific prominent mediastinal lymph nodes similar appearance the prior exam.Cardiac enlargement without evidence of a pericardial effusion.Severe coronary artery calcification.Enlargement of the main pulmonary artery compatible with pulmonary arterial hypertension.Tracheostomy tube unchanged.Central venous catheter with its tip in the SVC.CHEST WALL: Anasarca. Degenerative changes throughout the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Significant interval development of multifocal areas of consolidation/atelectasis with nodular and tree in bud opacities associated with bronchial/bronchiolar wall thickening compatible with recurrent infection and aspiration. |
Generate impression based on findings. | 42 year-old female with abdominal pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Wall thickening and pericolonic stranding along the sigmoid colon with multiple extraluminal foci of gas indicating microperforation. Fat infiltration extends to the appendiceal and obliterates the normal fat plane between the sigmoid colon and bladder. No evidence of free intraperitoneal air.BONES, SOFT TISSUES: Mild degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Absent.BLADDER: Loss of the normal flat plane between bladder and sigmoid colon without evidence of intravesicular gas.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Wall thickening and pericolonic stranding along the sigmoid colon with multiple extraluminal foci of gas indicating microperforation. Fat infiltration extends to the appendiceal and obliterates the normal fat plane between the sigmoid colon and bladder. No evidence of free intraperitoneal air.BONES, SOFT TISSUES: Mild degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality noted | Severe sigmoid diverticulitis with walled off microperforation. No mature abscess or free intraperitoneal air. Loss of the fat plane between the sigmoid and bladder, correlate for symptoms of enterovesicular fistula. |
Generate impression based on findings. | 21-year-old male with septicemia -- evaluate pyelo versus osteo- ABDOMEN:LUNG BASES: Bibasilar atelectasis, left greater than right.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral, nonobstructing calyceal calculi, in mid polar regions. Kidneys show normal size and morphology without evidence of renal mass. No hydronephrosis. No perinephric fluid collections.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Foley catheter in the urethra with balloon inflated in the urethra proximally. Air in the bladder without other abnormality relating to recent instrumentation.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Bilateral, nonobstructing renal calculi -- no CT evidence for findings to suggest pyelonephritis or perinephric abscess. 2. Foley catheter balloon in proximal urethra. |
Generate impression based on findings. | Fall. There is straightening of the cervical spine alignment in the sagittal plane, which is most likely related to muscle spasm and/or neck brace. There are multilevel degenerative changes, including posterior and uncovertebral joint osteophytes at C3-4, C4-5 and C5-6. There is no evidence of fracture or loss of vertebral body height. There is loss of intervertebral disc space loss at C5-6. The prevertebral soft tissues are unremarkable. | Multilevel degenerative changes most prominent at C3-4 through C5-6 without fracture or spondylolisthesis. |
Generate impression based on findings. | Reason: h/o parotid cancer History: r/o chest mets LUNGS AND PLEURA: No pulmonary or pleural metastases.Dependent atelectasis and residual scarlike opacities in the right middle lobe are present.MEDIASTINUM AND HILA: Scattered thyroid cysts.Stable 12-mm right hilar lymph node image 35 series 3.No other evidence of mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Retained T-tack, abdomen otherwise unremarkable. | No sign of metastases, or other significant abnormality. |
Generate impression based on findings. | 16-year-old female with intracranial hemorrhage and altered mental status, placement of ICP device There has been interval placement of a right frontal intracranial pressure monitoring device with a small amount of associated subarachnoid hemorrhage underlying the insertion site. Redemonstrated are postoperative findings related to right hemicraniotomy for evacuation of a right temporal lobe hematoma with minimal extra-axial mixed density fluid deep which is unchanged. As before, there is residual hemorrhage within the right temporal lobe within and along the margins of the surgical cavity, smaller hemorrhagic foci within the bilateral cerebral hemisphere associated with predominantly parieto-occipital white matter cortical edema, and superior cerebellar hemorrhage, which is unchanged. There remains edema within the bilateral cerebral peduncles and midbrain. Effacement of the third ventricle with mild dilatation of the lateral ventricles, stable. There is approximately 12 mm of midline shift to the left (previously 10 mm), right uncal herniation and subfalcine herniation, which are not significantly changed. There is fluid within the bilateral mastoid air cells. | 1.There has been interval placement of a right frontal intracranial pressure monitoring device with a small amount of associated subarachnoid hemorrhage underlying the insertion site. 2.Midline shift now measuring 12 mm, previously 10 mm 3.Remaining abnormalities including hemorrhage, edema, and herniation are stable. |
Generate impression based on findings. | Reason: evaluate for metastatic cancer History: s/p thyroidectomy for poorly differentiated thyroid cancer LUNGS AND PLEURA: Basilar atelectasis.Interval increase in size of subpleural nodule in right lower lobe now measuring 10 mm on image 66/94 (8 mm on prior). No new pulmonary nodules. Scattered punctate micronodules are stable and presumably post inflammatory.MEDIASTINUM AND HILA: Extensive postop change involving neck with surgical drains present. Please see neck CT report for further details.No pathologically enlarged intrathoracic lymph nodes.CHEST WALL: Degenerative change involving the spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Feeding tube courses through the stomach. | Slight increase in size of right lower lobe nodule suspicious for metastatic disease. |
Generate impression based on findings. | 20 year-old male status post firearm accident, abdominal pain, rule out anastomotic leak. 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: Metallic fragments adjacent to the right ureter, correlate for ureteral injury.RETROPERITONEUM, LYMPH NODES: Fluid collection adjacent to the right psoas muscle containing gas, measures 5.7 x 3.1 cm (image 83, series 3), possibly representing a hematoma, although abscess cannot be excluded. Small adjacent bullet fragments, several which may be intraperitoneal. Several fragments are adjacent to the ureter, correlate for ureteral injury.BOWEL, MESENTERY: The small bowel anastomosis is patent, without evidence of disruption.BONES, SOFT TISSUES: Metallic fragments in the right flank with a tract extending through a defect in the right iliac bone into the psoas muscle. A bullet is lodged within the left rectus abdominis muscle.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: The small bowel anastomosis is patent, without evidence of disruption.BONES, SOFT TISSUES: Metallic fragments in the right flank with a tract extending through a defect in the right iliac bone into the psoas muscle. A bullet is lodged within the left rectus abdominis muscle.OTHER: No significant abnormality noted | 1. Bullet wound with multiple associated fragments entering the right flank and fracturing the right iliac bone with a large fragment lodged within the left rectus abdominis muscle. 2. Fluid collection adjacent to the right psoas muscle may represent hematoma or abscess. The small bowel anastomosis is intact. 3. Metallic fragments adjacent to the right ureter, correlate for ureteral injury. |
Generate impression based on findings. | Reason: h/o of both breast and ovarian cancer now with pneumonia that is not resolving. R/o mass/obstruction History: h/o of both breast and ovarian cancer now with pneumonia that is not resolving. R/o mass/obstruction LUNGS AND PLEURA: Large right perihilar mass measuring approximately 6 cm by 3.6 cm (image 67 series 4).Smaller left upper lobe mass (measuring 2.3 cm by tube .1 cm (image 50 series 6).Multiple smaller nodules also noted throughout the right lung.Interlobular septal thickening and ground glass opacities in the right lung. Small right pleural effusion.Left basilar scarring similar in appearance to the prior exam.MEDIASTINUM AND HILA: No mediastinal lymphadenopathy. Large right hilar lymph node.Cardiac size is normal without evidence of pericardial effusion.Right chest Port-A-Cath with its tip in the SVC.CHEST WALL: Sclerotic foci in in multiple cervical, thoracic, and lumbar vertebrae compatible with osseous metastases .Diffuse degenerative changes with kyphosis of the thoracic spine.Severe degenerative joint disease involving the right glenohumeral joint.Status post left mastectomyUPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Multiple hepatic hypodensities within the liver compatible with metastatic foci. These were not present on the prior outside exam. | 1.Development of multiple necrotic appearing primarily central nodules and masses within the right upper, middle, and lower lobes compatible with metastatic disease.2.New small right pleural effusion.3.Interval development of multiple hepatic hypodense lesions compatible with metastatic disease.4.Multiple vertebral sclerotic foci compatible osseous metastases similar in appearance to prior exam. |
Generate impression based on findings. | Reason: TXN2B salivary adenocarcinoma (tongue) s/p resection 9/30/09 F/B TFHX completed 12/16/09. please re-eval for recurrence History: as above CHEST:LUNGS AND PLEURA: Multifocal pulmonary nodules, some of which are calcified, are unchanged and presumably postinflammatory. Focal left lower lobe bronchiectasis is unchanged. No new pulmonary nodules.MEDIASTINUM AND HILA: Coronary calcification. Stable calcified nodes consistent with healed granulomatous disease.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Punctate hepatic hypodensities are too small to characterize but stable and likely benign.SPLEEN: Calcified granuloma.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Degenerative change involving spine, worst at L3 -- 4.OTHER: No significant abnormality noted. | Stable CT with no evidence of measurable metastatic disease. |
Generate impression based on findings. | 72-year-old female exhibiting new onset delusions The ventricles and sulci are normal in size. There are no masses, mass effect or midline shift. There is no evidence for intracranial hemorrhage or acute cerebral or cerebellar cortical infarction. There are no extraaxial fluid collections or subdural hematomas. The visualized portions of the paranasal sinuses and mastoid air cells are clear. | Negative nonenhanced head CT. |
Generate impression based on findings. | Male; 75 years. Reason: eval for rectal cancer, interval exam, also please perform CT without contrast to eval for kidney stone, possible stone distal right ureter on prev History: bladder spasm; pain, urinary symptoms CHEST:LUNGS AND PLEURA: 4-mm nodule in the left upper lobe, near the major fissure (series 7, image 184) is not significantly changed.Left apical pleural thickening/scarring. Moderate centrilobular emphysema.MEDIASTINUM AND HILA: Coronary calcifications and stent. Borderline large mediastinal and hilar lymph nodes are unchanged.Index precarinal lymph node (series 8, image 38) measures 2x 1 cm (previously 1.9x 1.1 cm). Ectasia of the ascending aorta to 4.3 cm.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: 3-mm stone at the left uretero vesicular junction with mild dilatation of the left ureter, unchanged. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Vascular calcifications of the abdominal aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate with some coarse calcifications.BLADDER: Bladder wall appears mildly diffusely thickened, which may be exaggerated by under distention.LYMPH NODES: No significant abnormality noted. A subcentimeter hyperdense focus in the left perinephric space is unchanged from prior, may represent a lymph node or be postsurgical in etiology.BOWEL, MESENTERY: A few small bowel loops and fluid occupying the perirectal space. Ostomy in the left mid abdomen.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. No interval change or conclusive evidence of malignancy. Small bowel loops and fluid occupy the rectal space without conclusive evidence of local recurrence2. 3 mm stone at the left uretero vesicular junction causing mild hydroureter, unchanged. 3. Dilatation of the ascending thoracic aorta, follow-up is suggested. |
Generate impression based on findings. | Reason: Pt with hx of Tonsil cancer completed FHX 8/2009. please re-eval for recurrence of dz History: as above CHEST:LUNGS AND PLEURA: Scattered, calcified and noncalcified pulmonary nodules are again noted throughout the lungs, unchanged. Mild peripheral reticulation in the subpleural lung bases, likely dependent edema though a chronic interstitial abnormality cannot be excluded.No new suspicious pulmonary nodules or masses. MEDIASTINUM AND HILA: Dense coronary calcification. Atherosclerotic calcification of the aorta and its branches. Scattered small subcentimeter lymph nodes are unchanged.CHEST WALL: Multi-level degenerative disk disease.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable presumed bilateral renal cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Colonic diverticulosis.BONES, SOFT TISSUES: Small hiatal hernia. Degenerative change involving thoracic and lumbar spine, but no evidence of metastatic disease.OTHER: No significant abnormality noted. | No evidence of metastatic disease. |
Generate impression based on findings. | 33-year-old male with metastatic melanoma on treatment -- assess response to therapy. CHEST:LUNGS AND PLEURA: Left upper lobe, lateral, subpleural micronodule, unchanged dating back to 6/14/12. A more inferior 4-mm nodule in the left lower lobe (series 4, image 47) is unchanged from most recent several CT examinations, but is new when compared with 6/14/12 and cannot be excluded as a metastatic nodule. No new nodules are seen elsewhere in the lung parenchyma. No confluent airspace consolidation or effusion seen..MEDIASTINUM AND HILA: Prior report referenced an enlarging pre-tracheal lymph node, which now measures 1.4 x 0.6 cm (series 3, image 36). This lymph node appears to be fluctuating in size and may be due to image slice sampling as it appeared similar in size on 5/23/13 as well and may not not be due to metastatic disease as an mildly prominent node has been present in this area over the course of this patient's series of examinations..CHEST WALL: No significant abnormality noted -- no axillary adenopathy or other masses.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Prior noted. Left posterior body wall soft tissue nodule, measuring 9 x 5 mm on 9/26/13 cannot definitely be seen on today's examination.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No enlarged lymph nodes seen -- surgical clips in the right external iliac chain. Again seen.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Soft tissue nodule posterior to the left gluteal muscles has continued to increase in size and now measures 3.5 x 3 .0 cm, (series 3, image 165) compared with 3.2 x 2.1 cm previously. Surgical clips and soft tissue scarring in the right inguinal region remains unchanged.OTHER: No significant abnormality noted | 1. Stable chest examination since 9/26/13 with several micronodules. Left lower lobe nodule while stable over last several examinations it is new since June/2012, and is, therefore still worrisome for metastatic lesion. 2. Stable appearance to mediastinum, which does not definitely show evidence of metastatic disease. 3. Increasing size of left subcutaneous pelvic nodule adjacent to gluteal muscle. 4. Small subcentimeter left posterior subcutaneous nodule, not definitely seen on today's examination. 5. No new foci of disease seen. |
Generate impression based on findings. | Afib and slurred speech. There is no evidence of acute intracranial hemorrhage or mass. There is unchanged mild nonspecific cerebral white matter hypoattenuation that likely represents 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. The skull and extracranial soft tissues are unremarkable. | No evidence of acute intracranial hemorrhage or mass. However, non-contrast CT is not sensitive for acute non-hemorrhagic stroke and MRI should be considered for further evaluation if there are no contraindications. |
Generate impression based on findings. | History rectal cancer. LUNGS AND PLEURA: Emphysema. Bronchial wall thickening, nonspecific but most likely seen with asthma or bronchitis. There is aspirated debris noted in the central airways. Linear scar or atelectasis at the lung bases.Punctate micronodule in lingula (image 62/116) unchanged. Other scattered punctate micronodules are also stable.MEDIASTINUM AND HILA: Scattered borderline mediastinal nodes are unchanged. Coronary calcification. Atherosclerotic calcification of the aorta and its branches.CHEST WALL: Small centimeter axillary lymph nodes unchanged.UPPER ABDOMEN: The abdomen will be reported separately. | No definitive evidence of metastatic disease. Stable borderline mediastinal lymph nodes which are more likely inflammatory than metastatic. A few small punctate pulmonary micronodules are also stable and most likely post inflammatory. Continued CT follow is recommended. |
Generate impression based on findings. | 68-year-old female with history of breast and renal cell cancer, assess for disease progression. CHEST:LUNGS AND PLEURA: Left apical paramediastinal mass invading the mediastinum measures 4.8 x 2.7 cm (image 13, series 4) and previously measured 3.3 x 2.0 cm, increased in size and now closer to the trachea and compressing the esophagus. Left subpleural apical mass measures 1.6 x 1.7 cm and previously measured 1.1 x 1.5 cm (image 18, series 6). Left upper lobe subpleural nodule is unchanged. Subcentimeter right lower lobe nodule is unchanged.MEDIASTINUM AND HILA: Fluid within the superior pericardial recess is unchanged. No mediastinal or hilar adenopathy.CHEST WALL: Right axillary surgical clips and skin thickening. Degenerative changes of the thoracic spine.ABDOMEN:LIVER, BILIARY TRACT: Hepatic cysts, the largest measuring 1.6 x 1.4 cm (image 82, series 4), are unchanged. Fatty lesion in the right hepatic lobe is also unchanged. Extensive cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple renal cysts some of which are exophytic are unchanged. Left renal AML is unchanged, measuring 3.8 cm in maximal diameter (image 113, series 4). Status post right nephrectomy.RETROPERITONEUM, LYMPH NODES: Retroperitoneal lymph node dissection. No new adenopathy.BOWEL, MESENTERY: Hiatal hernia. Ventral hernia containing mesenteric fat.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Ventral hernia containing mesenteric fat.BONES, SOFT TISSUES: Degenerative changes of the lumbosacral spine and pelvis.OTHER: No significant abnormality noted. | 1. Increase in size of left apical mass invading the mediastinum mediastinum.2. Unchanged hepatic and left renal angiomyolipomas. |
Generate impression based on findings. | Reason: baseline prior to starting new systemic therapy; please give bi-dimensional measurements History: hx of metastatic head and neck cancer CHEST:LUNGS AND PLEURA: Densely calcified pulmonary nodule in the left upper lobe is presumably a healed granuloma. Punctate micronodules in the periphery of the right middle lobe (images 50 and 57/93) are most likely post inflammatory but continued follow-up is recommended.MEDIASTINUM AND HILA: Postop change in the neck. Please see dedicated neck CT report for further details.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: 1 cm hypodensity in periphery of spleen (image 70/142) too small to characterize. Splenule.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.G-tube tip in stomach.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No definitive evidence of metastatic disease to the chest or upper abdomen. |
Generate impression based on findings. | Reason: hx of pulm mets, sp resection of LLL pls eval for growth. Please compare to may and feb 2013 films for measurments - only chest and abd, recent HN scans are stable. History: none CHEST:LUNGS AND PLEURA: There is minimal resection of this patient's previously noted left upper lobe nodule. Post surgical changes are identified at the resection site.Right lower lobe nodule (image 52 series 6) demonstrates interval increase in size now measuring 9 mm x 6 mm previously measured 7 mm x 6 mm.Right middle lobe nodule (image 81 series 6) is also increased in size now measuring 9 mm x 8 mm previously measuring 7 mm x 6 mm.Left basilar nodule (image 64 series 6) has also increased in size.MEDIASTINUM AND HILA: Debris within the trachea identified just below the thoracic inlet.Mediastinal lymphadenopathy is stable to slightly decreased with reference AP window lymph node (image 40 series 4) now measuring 12 mm previously measuring 14 mm. The remaining enlarged mediastinal lymph nodes demonstrate no significant interval change.Cardiac size is normal without evidence of a pericardial effusion.CHEST WALL: Postsurgical changes from prior laryngectomy and neck dissection.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Interval resection of a left lower lobe metastasis.2.Interval increase in size of scattered pulmonary nodules.3.Stable to slight decrease in mediastinal lymphadenopathy.4.No new sites of disease identified. |
Generate impression based on findings. | Reason: evaluate for bronchiectasis - History: Immunoglobulin deficiency and productive cough LUNGS AND PLEURA: Mild cylindrical right middle and bilateral lower lobe bronchiectasis with mild bronchial wall thickening.Multiple pulmonary nodules are present and were described in detail on 10/30/2013 study.MEDIASTINUM AND HILA: Coronary calcification. Scattered small mediastinal nodes are unchanged.CHEST WALL: T12 compression fracture.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Status post cholecystectomy. | 1. Mild cylindrical right middle and bilateral lower lobe bronchiectasis with mild bronchial wall thickening.2. Multiple pulmonary nodules are present and were described in detail on 10/30/2013 study. The right lower lobe nodule has increased size and neoplasm cannot be excluded. Follow up with PET/CT should be considered. |
Generate impression based on findings. | Reason: Pt with hx of Recur HNC 1020 s/p CRT; Please re-eval and compare to prior exams History: as above CHEST:LUNGS AND PLEURA: Right upper lobe groundglass nodules are new, unlikely to represent tumor most likely a site of aspiration. Otherwise, lungs are unremarkable.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Prior resection of the cecum possible appendectomy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No sign of metastases, or other significant abnormality. |
Generate impression based on findings. | T4 N1 oral tongue cancer treated with carbo-taxol induction chemotherapy then 5/5 cycles of TFHX chemoradiotherapy completed in 7/16/2010, as well as a history of a T1 oral tongue tumor that was previously excised. There are unchanged post-treatment findings with persistent supraglottic edema. There is no evidence of tumor or significant cervical lymphadenopathy. There are secretions within the lower trachea. The remaining major salivary glands are unremarkable. The thyroid is also unremarkable. There are multiple periodontal lucencies. There are otherwise no lytic or blastic lesions. The major cervical vessels are patent. There is mild paranasal sinus mucosal thickening. The imaged intracranial structures are grossly unremarkable. The imaged portions of the lungs are clear. | 1. No evidence of locoregional tumor recurrence or significant cervical lymphadenopathy. 2. Secretions within the lower trachea. 3. Multiple periodontal lucencies. |
Generate impression based on findings. | Male 49 years old; Reason: Patient with History of Semi-solid nodules History: cough. LUNGS AND PLEURA: Interval resolution of the multiple mixed groundglass and semi-solid attenuation nodules as well as previously seen tree in bud opacities. No focal opacities or pleural effusions.MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. No cardiomegaly or pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Small hepatic hypodensity in the right lobe of the liver too small to characterize but statistically most likely benign hepatic cyst. | Interval resolution of the previously described pulmonary opacities. |
Generate impression based on findings. | 39-year-old male status post right radical nephrectomy and adrenalectomy for clear cell carcinoma with invasion into the renal sinus adipose tissue and right adrenal gland. CHEST:LUNGS AND PLEURA: Scattered micronodules some of which are calcified consistent with prior granulomatous disease. Nodular opacity adjacent to the left major fissure may be postinflammatory or infectiousMEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter right hypoattenuating hepatic lesion which fills in on delayed imaging consistent with a hemangioma.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: The right adrenal gland is surgically absent.KIDNEYS, URETERS: No focal renal lesions. The collecting system and ureter fill normally on delayed images. Status post right nephrectomy.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Mild degenerative changes of the lumbar spine.OTHER: No significant abnormality noted | 1. Status post right nephrectomy without evidence of recurrent or metastatic disease. |
Generate impression based on findings. | Male 58 years old; Reason: Pt with hx of tonuge ca. s/p CRT; please re-eval and compare History: as above. CHEST:LUNGS AND PLEURA: Micronodules compatible with previous infection and intrapulmonary lymph nodes, unchanged.Mild mosaic attenuation in the lower lobes, possibly secondary to small airways disease, also unchanged.MEDIASTINUM AND HILA: Aberrant right subclavian artery. No cardiomegaly or pericardial effusion. No significant mediastinal or hilar lymphadenopathy.CHEST WALL: Multilevel degenerative changes again seen with loss of height of several midthoracic vertebrae.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Degenerative disease in the spine. | No evidence of metastases. |
Generate impression based on findings. | Malignant neoplasm of other specified sites of pleura. localized new back pain w/ hx of bone mets Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. There is a heterogeneous lesion present in the right anterolateral aspect of the L1 vertebral body with mixed sclerotic and lytic components measuring approximately 23 by 18 mm axial dimensions. This was not identified on the prior CT of the abdomenA lytic lesion is present within the right iliac bone measuring approximately 7 mm in diameter. This was not identified on the prior CT of the abdomenAt L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a disk bulge present at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is disk bulge present at this level associated with some partially effaced but that he lateral recesses creating mild to moderate degree of spinal stenosisAt L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is retroperitoneal adenopathy present which was also present on a recent abdomen CT . Measurement of lymphadenopathy at the right half of retroperitoneum at the level of the L3 vertebral body currently is 17 x 33 mm and previously was 37 x 27 mm.Atherosclerotic effusions are present in the aorta and some of its branches with some mild enlargement of the infrarenal abdominal aorta to 2 cm .The wall of the gallbladder appears calcified.Contrast is present the expected locations of the ureters bilaterally which is likely related to recent contrast enhanced CT of the chest. | 1.There is a new mixed sclerotic lytic lesion present at the L1 suspicious for metastatic disease 2.there is a new right iliac bone lytic lesion suspicious for metastatic disease .3.The there degenerative changes present in the lumbar spine worse at L3-4 with a disk bulge resulting in a mild to moderate degree of spinal stenosis.4.Regression of retroperitoneal lymphadenopathy since the prior exam5.please refer to chest CT same day for further comments. A number of nodules identified in the left lower lung field and there is no disease in the right lung6.calcified porcelain gallbladder |
Generate impression based on findings. | T4AN2BM0 oral tongue SCC --> TPF --> TFHX 5/10/13. Betel nut exposure. There are stable posttreatment findings in the region of the oral tongue with mild heterogeneous patchy enhancement in the right oral tongue and persistent hyperemia of the base of tongue and submandibular glands, but no evidence of recurrent tumor in the right oral tongue. There is no significant cervical lymphadenopathy. The airways are patent. The thyroid gland is unremarkable. An enteric tube in position. There is a right internal jugular venous cathter. The major cervical vessels are otherwise patent. The osseous structures are unremarkable. There is mild left maxillary sinus mucosal thickening. The imaged portions of the intracranial structures and orbits are grossly unremarkable. The imaged portions of the lungs are clear. | Stable post-treatment findings without evidence of locoregional oral tongue squamous cell carcinoma recurrence or significant cervical lymphadenopathy. |
Generate impression based on findings. | Reason: Patient with history RUL consoldation/mass- interval follow up History: Shortness of breath LUNGS AND PLEURA: Continued increase in size and density of focal consolidation in the right upper lobe now with extension into the right third rib (image 22/113) with cortical destruction. New 7-mm nodule in right upper lobe on image 44/113 suggestive of metastatic disease.Previously identified right lower lobe slightly spiculated pulmonary nodule, again measures 9 mm (image 62/113) is unchanged in size. Additional scattered pulmonary micronodules and scarring appear similar to prior exam.MEDIASTINUM AND HILA: Small, nonspecific mediastinal lymph nodes are unchanged. No mediastinal or hilar lymphadenopathy.Severe coronary artery calcifications. Cardiac size is normal without pericardial effusion.CHEST WALL: Degenerative changes the spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Dense right hepatic lobe calcification is unchanged. Right renal hypoattenuation is unchanged. | Continued increase in size and density of right upper lobe mass/consolidatoin now with extension into the right third rib consistent with malignancy. New 7-mm nodule in right upper lobe suggestive of metastatic disease. |
Generate impression based on findings. | RE-OP parathyroidectomy Please help to localize There are several nodules present in the soft tissues of the lower neck . Their locations and serial Hounsfield units on dynamic CT or listed below along with some density units of normal structures:Houndsfield units through nodules (0seconds, 25 seconds, 55 seconds, 85 seconds):Right thyroid (image#241-246): 47.96HU, 154.29HU, 187.21HU, 187.25 HURight Carotid artery (image#241-246): 45.18HU, 407.86HU, 210.5HU, 179.45HURight Jugular vein (image#242-247): 47.48HU, 297.14HU, 209.86HU, 204.67HURight submandibular gland (image # 148): 34.15HU, 107.54HU, 146.38HU, 138.6HURight sternocleidomastoid muscle: (image # 241): 47.42HU, 51.87HU, 65.42HU, 66.88HULymph node (image # 247-249): 39.67HU, 56.25HU, 66.17HU, 85.75HU2.5 x 3.5 mm nodule behind and immediately above the left clavicle (image # 325 ): 51.75HU, 145.0HU, 141.5HU, 140.75HU3x3x5mm nodule anterior to the left thyroid gland (image#254): 63.75HU, 162.0HU, 123.5HU, 119.00HU2mm right intrathyroidal lesion (Image# 242): 54HU, 226HU, 180HU, 144HUCT 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.Within the visceral space the patient is status post thyroid surgery.The airway appears patent.The visualized intracranial structures which include the posterior fossa are intact. The visualized portions of the paranasal sinuses are intact with some mucosal thickening. The mastoid air cells are clear. There is mucosal thickening in the right maxillary sinus. The ethmoid air cells and frontal sinuses and the upper parts of the maxillary sinuses are not included on this exam.The parotid and the submandibular glands appear intact.The visualized lung apices appear clear.The carotid and vertebral vasculature visualized on this exam appears intact.The cervical vertebral bodies in general are intact with no evidence for canal stenosis. There degenerative changes present with endplate and uncovertebral osteophytes at the C3-4 where there is a narrowing of the neural foramen bilaterally. There is loss of disk space height, endplate and uncal vertebral osteophytes present at C5-6 and C6-7 with some mild narrowing of the neural foramen bilaterally.Parathyroid sampling:Intraprocedural images demonstrate the location of venous sampling.Reported PTH, Intact values (REF 15-75 pg/mL):FEMORAL VEIN: 131SUPERIOR VENA CAVA: 216INNOMINATE VEIN JUNCTION: 168LEFT INNOMINATE VEIN: 128LEFT INTERNAL JUGULAR VEIN, LOWER: 130LEFT INTERNAL JUGULAR VEIN,MID: 125LEFT INTERNAL JUGULAR VEIN, UPPER: 118RIGHT INTERNAL JUGULAR VEIN, LOWER: 161RIGHT INTERNAL JUGULAR VEIN, MID: 463RIGHT INTERNAL JUGULAR VEIN, UPPER: 123 | 1.There is a tiny nodule present just above and behind the left clavicle which is suspicious for parathyroid adenoma.2.There is a tiny nodule anterior to the left thyroid gland which is suspicious for parathyroid adenoma.3.There is a tiny right intrathyroidal lesions suspicious for parathyroid adenoma. |
Generate impression based on findings. | Reason: lung cancer, s/p 6 cycles of chemo. please evaluate for disease and copmare with previous scans using the same target lesions History: lung cancer CHEST:LUNGS AND PLEURA: Unchanged architectural distortion of the left upper lobe with fibrosis and bronchiectasis. Small left pleural effusion stable. Multiple pulmonary nodules are again noted with reference measurements as below:-- right lower lobe nodule (series 5, image 67) unchanged, again measuring 4 mm. -- right lower lobe nodule (series 5, image 77) unchanged, again measuring 4 mm. -- left upper lobe nodule (series 5, image 49) unchanged, again measuring 6 mm. No new or suspicious nodules. Faint patchy ground glass opacities in the right upper lobe are likely postinflammatory.MEDIASTINUM AND HILA: Scattered small subcentimeter nodes are unchanged. Port tip at RA/SVC junction.CHEST WALL: Right chest wall port. Widespread sclerotic metastases are not significantly changed.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Widespread hepatic metastases are stable. The reference lesion or the subcapsular inferior right lower lobe again measures 13 x 12 mm (image 113/164).SPLEEN: Chronic splenic vein thrombosis.ADRENAL GLANDS: Right adrenal nodule stable 18 x 10 mm in image 107/164.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: The pancreas is atrophic with stable dilation of the pancreatic duct.RETROPERITONEUM, LYMPH NODES: Retroperitoneal lymphadenopathy is stable with no change in reference management of 14 mm (image 102/164) just posterior to the pancreatic body.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Widespread sclerotic metastases are stable. | Stable metastases. No new sites of disease. |
Generate impression based on findings. | 56-year-old male with metastatic medullary thyroid cancer. CHEST:LUNGS AND PLEURA: Radiation change. Again seen at both apices. The prior noted. New lesion along the superior major fissure has now dramatically increased in size (series 5, image 30), and measures 5.1 x 4.2 cm. It is characterized by predominantly central necrosis and there was only a rim of thick soft tissue density margin. This is not the appearance of metastatic thyroid cancer -- lower primary lung cancers, particularly squamous, can have this appearance, but the rapid development of this over 4 months makes that less likely. Considerations for atypical infection such as fungus or tuberculosis would be recommended, although radiographs of primary tumor cannot be excluded.MEDIASTINUM AND HILA: Small mediastinal lymph nodes are again seen. The referenced, AP window lymph node (series 3, image 42) and now measures 0.5 cm in short axis dimension compared with 0.7 cm previously. The referenced right hilar lymph node (series 3, image 47) is also slightly smaller, measuring 0.5 cm in short axis dimension. Reference, subcarinal lymph node (series 3, image 50, 1) is unchanged, measuring 0.7-mm compared to 0.8-cm previously.CHEST WALL: Radiation change to the sternum, sternoclavicular joints, unchanged. Predominately sclerotic changes seen in the right lateral scapula and in the upper cervical vertebral bodies are unchanged consistent with known metastases.. No other abnormalities is seen and no new lesion seen to suggest metastasis.ABDOMEN:LIVER, BILIARY TRACT: Liver parenchyma enhances homogeneously with with scattered small hypodense lesions seen near water density consistent with small cysts and one hyper enhancing lesion in the right lobe (series 3, image 108), with peripheral nodular enhancement seen on older CT that shows homogeneous delay enhancement typical of hemangioma. These lesions are unchanged through the series of examinations, and not representing metastatic disease.Marked intrahepatic and extrahepatic biliary duct dilatation again seen with changes consistent with obstruction of the distal bile duct as it approaches the ampulla.SPLEEN: No significant abnormality notedPANCREAS: Dilated pancreatic duct again seen to tail and body region to the head of the pancreas with abrupt termination as it approaches the distal common bile duct. Pancreatic parenchyma enhances homogeneously and no mass can be seen on this examination, however, the rapid tapering is certainly indicative of high-grade stricture or mass lesion. The coronal images show that the pancreatic duct and distal bile duct obstructed at different levels within more normal appearing distal pancreatic duct moving towards the ampulla where the common bile duct seems to be obstructed. ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No change bilateral, nonobstructing renal calculus, left greater than right. No renal masses. No hydronephrosis. RETROPERITONEUM, LYMPH NODES: Slightly prominent periaortic lymph nodes are again seen predominantly, unchanged. The prior referenced left para-aortic lymph node (series 3, image 115) measures 1.1 x 0.9 cm compare with 1.0 x 1.0 cm previously. No new areas of lymph node enlargement are seen. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Marked increase in size of right necrotic lung mass -- the rapid progression would suggest atypical fungal infection or TB, however, aggressive primary lung cancer cannot be excluded. 2. No change in the biliary and pancreatic duct dilatation extending to head of pancreas, but obstructing at different levels, making pancreatic primary cancer unlikely and most likely metastatic disease. 3. No change in reference lymph nodes. 4. Presumed radiation changes to the sternum. No change in the appearance of skeletal metastases to the right lateral scapula and upper cervical vertebral bodies. |
Generate impression based on findings. | Sensorineural hearing loss status post right cochlear implantation and bilateral T-tube insertion. Right temporal bone: There right cochlear implant in position with at least 360 degree turns formed within the cochlea. There is also a T-tube spanning the tympanic membrane. The external auditory canal and auricle are unremarkable. The middle ear and mastoid bowl and air cells are clear. The ossicular chain is intact. The facial nerve describes a normal course. The semicircular canals, vestibular aqueduct and vestibular are intact. Left temporal bone: There are postoperative findings related to canal wall up mastoidectomy with unchanged fluid, soft tissue and attenuation material, and calcification within the superolateral mastoid bowl. There is a T-tube spanning the tympanic membrane. The middle ear is clear. The ossicular chain is intact. The facial nerve describes a normal course. The inner ear structures are unremarkable. The auricle appears unremarkable. There is trace soft tissue attenuation within external auditory canal, which likely represents cerumen. | Unremarkable right cochlear implant and bilateral T-tubes with clear middle ear cavities. Stable left canal wall up mastoidectomy with unchanged non-specific partial opacification. |
Generate impression based on findings. | 48-year-old female with ampullary cancer, restaging. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: The previous identified hypoattenuating hepatic lesions are not visualized. The lesions were much more conspicuous on MRI. No new lesions identified. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Status post Whipple procedure. The SMV, splenic, and portal veins are patent.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small ventral hernia containing mesenteric fat.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Fibroid uterus.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. | Previously noted low-attenuation liver metastases are not visualized on the current CT but were much better visualized on the prior MRI. No new metastatic lesions. If evaluation of the hepatic metastases is required, MRI is recommended. |
Generate impression based on findings. | Female, 68 years old, history of aneurysm, now confused. Non-angiographic findings:Periventricular and patchy subcortical hypoattenuation is a non-specific finding which most commonly represents age-indeterminate small vessel ischemic disease.No intracranial hemorrhage or abnormal extra-axial fluid collection is seen. There is no evidence of mass effect or midline shift. The ventricles and basal cisterns are patent and normal in size. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. The bones of the calvarium and skull base are intact. No concerning soft tissue lesions are seen in the neck. There is a coarse calcification within the right thyroid lobe, stable. Emphysema is redemonstrated in the lung apices.Angiographic findings:Mild atherosclerotic calcification is seen at the origins of great vessels. Aortic branching is conventional. Origins of the great vessels are patent. The origin of the right common carotid artery is tortuous and folds back upon itself which gives the impression of a stenotic narrowing but this is probably mostly artifactual. There is an approximate 50% stenosis of the proximal left subclavian artery composed of calcified and noncalcified plaque, not significantly changed.Mild atherosclerotic disease is seen in the common carotid arteries. No significant focal stenosis. Mild atherosclerotic disease is evident at the carotid bifurcations but again there is no significant focal stenosis. The ICAs demonstrate normal caliber and morphology throughout the neck. Likewise, mild atherosclerotic disease affects the cervical vertebral arteries without significant focal stenosis.Atherosclerotic calcification affects the cavernous ICAs but without a significant focal stenosis. The remaining intracranial vessels are likewise free of significant focal stenosis or occlusion.An aneurysm is redemonstrated at the M2 segment of the right MCA. The aneurysm measures approximately 4.2 mm in the AP dimension and approximately 3.8 mm in the TV dimension and has not significantly changed in size. The size of the neck is difficult to assess as it involves the branch point of at least two vessels but at approximately 3 to 4 mm, it does not seem to have changed.There is an apparent 1 mm outpouching arising from the right M1 segment of the MCA at the branch point of the vessel, directed inferiorly, which may represent a small aneurysm or possibly an infundibulum (see image 285 of series 80868). This finding is unchanged.Also unchanged is a 1 mm outpouching arising from the communicating segment of the left ICA, appearing similar to the prior exam. Again, this could represent a small aneurysm or infundibulum, though no discrete PCOM artery is present on this side. The right PCOM artery is unremarkable. The ACOM artery is unremarkable as well. Extradural origin of the PICAs is noted. A right AICA is not discretely seen. The posterior circulation is free of significant abnormality. | 1. A 4-mm aneurysm of the right M2 segment is unchanged in size.2. Questionable small aneurysms versus infundibula are also unchanged as discussed above.3. Mild atherosclerotic disease affects the vessels of the neck. |
Generate impression based on findings. | Reason: Pt with oral tongue ca; s/p CRT in 6/2013. please re eval to scans and PET History: as above CHEST:LUNGS AND PLEURA: Scattered punctate micronodules are stable and presumably postinflammatory.MEDIASTINUM AND HILA: Port tip at RA/SVC junction. Minimal debris in central airways consistent with aspiration.CHEST WALL: Right chest wall port.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.G-tube tip in stomach. NG tube tip in duodenum.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No evidence of metastatic disease. |
Generate impression based on findings. | Reason: h/o HNC, compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: No sign of pulmonary or pleural metastases.Groundglass opacities adjacent to the minor fissure hand in the left lung base most likely is from chronic aspiration.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Degenerative abnormalities affect the thoracic spine.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Degenerative abnormalities affect the lumbar spine.OTHER: No significant abnormality noted. | No sign of metastases. Patchy ground glass opacities are suggestive of chronic aspiration. |
Generate impression based on findings. | 74-year-old female with history of abdominal aortic aneurysm status post EVAR, evaluate for endoleak. ABDOMEN:LUNG BASES: Small opacity along the right minor fissure is only partially visualized, but likely represents an intrapulmonary lymph node. Coronary arterial calcification. Basilar scarring/atelectasis.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: An intact abdominal aortobiiliac endograft is again noted without evidence of endoleak. The thrombosed infrarenal abdominal aortic aneurysm is decreased in size and measures 3.7 x 4.5 cm and previously measured 4.4 x 4.9 cm (image 92, series 9). Extensive atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: Degenerative changes of the thoracolumbar spine.BONES, SOFT TISSUES: Small fat containing umbilical herniaOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality noted | 1. Intact abdominal aortobiiliac endograft without evidence of leak or complication. Mild interval decrease in size of thrombosed infrarenal abdominal aortic aneurysm. |
Generate impression based on findings. | Metastatic medullary thyroid cancer with brain mets s/p WBRT who progressed on sunitinib, on cabozantinib since 02/13. There are post-treatment findings relate to total thyroidectomy and neck dissection. There is no evidence of recurrence tumor in the thyroidectomy bed. There is an unchanged inferior right tracheoesophageal groove lymph node that measures 6 x 4 mm. There is no significant cervical lymphadenopathy. The major salivary glands re unremarkable. The airways are patent. There is an unchanged diffusely heterogeneous appearance of the osseous structures without evidence of pathological fracture. The are major cervical arteries are patent. The left internal jugular vein is not identified, which is unchanged. There is a left maxillary sinus retention cyst and mild right maxillary sinus mucosal thickening. The small imaged portion of the intracranial structures are unremarkable. There is a partially imaged cavitary right lung mass, which has increased in size, and biapical scarring. Refer to the separate chest CT report for additional details. | 1. Stable post-treatment findings in the neck without evidence of locoregional tumor recurrence or significant cervical lymphadenopathy.2. Unchanged diffuse heterogeneity of the osseous structures, which likely represents metastatic involvement.3. The partially imaged cavitary right lung mass has increased in size. Refer to the separate chest CT report for additional details. |
Generate impression based on findings. | Reason: evaluate for metastasis. History: ewing sarcoma. LUNGS AND PLEURA: Post op change. No new pulmonary nodules.MEDIASTINUM AND HILA: Port tip at RA/SVC junction.CHEST WALL: Extensive postop change on the left with residual pleural and chest wall thickening (image 39/109). This is presumably postoperative scarring and fibrosis and it appears stable though close attention to this area is necessary on follow up to exclude residual disease.Right chest wall port.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. No evidence of pulmonary metastases.2. Extensive postop change on the left with residual pleural/chest wall thickening. This is presumably postoperative scarring and fibrosis and it appears stable though close attention to this area is necessary on follow up to exclude residual disease. A PET/CT may also provide better differentiation of scarring/fibrosis versus residual disease. |
Generate impression based on findings. | Female 27 years old; Reason: To r/o PE. Patient w/ recent h/o OCP's History: SOB PULMONARY ARTERIES: At the evaluation of the pulmonary arteries. No pulmonary emboli. Normal caliber of the main pulmonary artery.LUNGS AND PLEURA: Multiple non-solid opacities in a centrilobular distribution in the left upper lobe likely represents bronchiolitis, aspiration or an early infectious process. No pleural effusions. Small scattered micronodules which are nonspecific.MEDIASTINUM AND HILA: Scattered subcentimeter mediastinal lymph nodes. No hilar lymphadenopathy. No cardiomegaly or pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. High density material in the dependent portion of the gallbladder likely is a small nonobstructive stones. | 1.No pulmonary emboli.2.Multiple non-solid opacities in a centrilobular distribution in the left upper lobe likely represents bronchiolitis, aspiration or an early infectious process. |
Generate impression based on findings. | Reason: baseline prior to starting new systemic therapy History: hx of metastatic head and neck cancer CHEST:LUNGS AND PLEURA: Subsegmental atelectasis or scarring in the left lower lobe. Linear scarring and atelectasis at the right base. Scattered punctate calcifications. No suspicious nodules.MEDIASTINUM AND HILA: Port tip at RA/SVC junction. Coronary calcification. Atherosclerotic calcification of the aorta.CHEST WALL: Right chest wall port. Degenerative change involving the spine. Post op change left anterior chest.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral hypodense lesions are presumably cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications the aorta. Scattered small subcentimeter nodes.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Postop change involving the colon.BONES, SOFT TISSUES: Degenerative involving the spine.OTHER: No significant abnormality noted. | No evidence of metastatic disease. |
Generate impression based on findings. | History of fall x 2 on coumadin. There is a left frontal scalp hematoma that measures 4 mm in width, without underlying calvarial fracture. There is no evidence of intracranial hemorrhage, mass, or cerebral edema. There is mild patchy cerebral white matter hypoattenuation that may represent microangiopathy. 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 left sphenoid sinus retention cyst. | Small left frontal scalp hematoma, but no evidence of acute intracranial hemorrhage or calvarial fracture. |
Generate impression based on findings. | Right lung mass follow up. LUNGS AND PLEURA: 28 x 16mm nodular opacity in the medial right lower lobe abutting the spine and left atrium (image 53/90). Scattered right-sided pulmonary nodules measuring up to 6 mm (image 18/90 in the right upper lobe). Emphysema.MEDIASTINUM AND HILA: Scattered small subcentimeter nodes. CHEST WALL: Borderline axillary lymph nodes bilaterally. Minimal degenerative change involving thoracic spine. Cervical spinal fusion hardware partially visualized.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Roughly 3 cm nodular opacity in medial right lower lobe suspicious for malignancy. Additional scattered pulmonary nodules measure up to 6 mm but are nonspecific. |
Generate impression based on findings. | 65-year-old female with right upper ache -- history of gallstone pancreatitis. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Liver enhances homogeneously and shows normal vasculature. Gallbladder is normal in appearance with no evidence of gallstones. CT fails to detect approximately 25% of gallstones. No gallbladder wall thickening is seen. No intrahepatic or extrahepatic biliary duct dilatation is seen to suggest obstruction.SPLEEN: No significant abnormality notedPANCREAS: Normal enhancement pattern of pancreatic parenchyma. Pancreatic duct is slightly prominent throughout but without characteristic abnormality to suggest underlying pathology. No peripancreatic fluid collections are seen.ADRENAL GLANDS: Right adrenal gland appears normal. Left adrenal gland is diffusely thickened, but without focal mass.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Enlarged lymph nodes seen in the gastrohepatic ligament in the peridiaphragmatic region (series 4, image 26) measuring 3.1 x 1.4 cm. as an isolated finding. This is of uncertain significance.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Normal uterus. Bilateral ovaries approximately 3 cm in size are slightly prominent when compared to most postmenopausal women, but without diagnostic abnormality.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. No evidence for pancreatitis. 2. No gallstones seen with normal-appearing gallbladder (should be noted, CT fails to detect approximately 25% of gallstones.). 3. No evidence of biliary tract obstruction. 4. Enlarged gastrohepatic ligament lymph node of uncertain significance. |
Generate impression based on findings. | Male 33 years old; Reason: r/o abscess vs obstruction History: abd pain, epigastric. Crohn's dx with ileostomy ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver contour is normal. No focal hepatic lesions are evident. Hepatic and portal veins are patent. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small areas of cortical parenchymal scarring in the right kidney. Subcentimeter calcification near the upper pole of the left kidney. No hydronephrosis in either kidney.RETROPERITONEUM, LYMPH NODES: Nonspecific small lymph nodes.BOWEL, MESENTERY: Status post colectomy and left lower abdominal ostomy. Mild mucosal hyperenhancement of the tunneled portion of the ostomy. The small bowel is suboptimally evaluated due to poor distention with enteric contrast. No bowel obstruction.No mesenteric fluid collections.BONES, SOFT TISSUES: Left lower abdominal ostomy. No parastomal hernia or fluid collections. 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: Status post colectomy.BONES, SOFT TISSUES: Post operative changes in the pelvis and pelvic floor.OTHER: No significant abnormality noted. | 1.Post operative changes from colectomy and left lower abdominal ileostomy without bowel obstruction. Mild hyperenhancement of the tunneled portion of small bowel , suboptimally evaluated due to poor bowel distention.2.Nonobstructive left renal calcification. |
Generate impression based on findings. | Unknown primary, s/p CRT, last treatment 2010, and tonsillectomy/adenoidectomy. There is persistent supraglottic mucosal edema and hyperemia of the submandibular glands, which is likely treatment related. There is no evidence of tumor or significant cervical lymphadenopathy. The major salivary glands are unchanged. The thyroid gland is somewhat atrophic. The major cervical vessels are patent. There are bilateral lens implants and there is an unchanged linear structure along the left orbital floor that is likely related to orbital floor fracture repair. There is a periapical lucency and cyst involving the lingual root of ADA#14. The partially imaged intracranial structures are grossly unremarkable. There is mild scattered paranasal sinus opacification. The imaged portions of the lungs are clear. | Stable post-treatment findings without evidence of tumor recurrence or significant cervical lymphadenopathy. |
Generate impression based on findings. | Female 88 years old; Reason: 88 yo female ESRD, AV fistula, pls evaluate for abdominal aortic aneurysm History: hypotension, tachycardia, abdominal pain ABDOMEN:LUNGS BASES: Minimal subsegmental atelectasis in the lung bases. Nodularity with subpleural reticulations involving the lingula, suboptimally evaluated.Heart size is enlarged.Main pulmonary artery is dilated measuring 3.8-cm. Catheter terminates at right atrium.LIVER, BILIARY TRACT: Hypodense hepatic lesions, suboptimally evaluated with the phase of contrast. Gallbladder is distended with pericholecystic fluid and stones. There is a small amount of perihepatic ascites.SPLEEN: Spleen is normal in size. Small amount of peri-splenic fluid.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal gland is nodular.KIDNEYS, URETERS: Nonobstructive small right renal calculi. Large calculus in the left renal pelvis in a staghorn configuration.RETROPERITONEUM, LYMPH NODES: Abdominal aorta is normal in caliber. Calcific arteriosclerotic disease affects the aorta. No dissection or aneurysm is evident. Calcific arteriosclerotic disease affects the ostia of the major branch vessels.The celiac, SMA, renal arteries and IMA are patent.BOWEL, MESENTERY: Small bowel is normal in caliber. It is suboptimally evaluated without oral contrast. Extensive colonic diverticula. There is inflammation of the mesentery adjacent to the hepatic flexure and upper abdomen. Scattered mesentery ascites and extensive free intraperitoneal air.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Multiple uterine calcifications possibly fibroids and mass adjacent to the left adnexa with peripheral calcifications, suboptimally evaluated by CT.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis involves the sigmoid colon.BONES, SOFT TISSUES: Severe bone demineralization.Severe degenerative changes affect the lumbar spine.OTHER: Trace pelvic ascites. | 1.Extensive free intraperitoneal air with inflammation adjacent to the hepatic flexure and right upper abdomen. Differential considerations include perforated hollow viscus with the colon at the hepatic flexure or the stomach / duodenal bulb. Cholecystitis is a possibility but considered less likely given the extensive free intraperitoneal air.2.No aortic dissection is clinically questioned.3.Bilateral renal calculi, the left kidney has calculi and a staghorn callus configuration.4.Enlarged main pulmonary artery from pulmonary hypertension.5.Findings discussed with Dr. James Ahn at 12:20 p.m. via telephone |
Generate impression based on findings. | Multiple, recurrent SCC of skin and CLL. Head: There is no 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 appears unremarkable. There is a 2 mm wide focus of left temporal scalp skin thickening.Neck: There are postoperative findings related to left parotidectomy and neck dissection with pectoralis flap reconstruction. There is an ill-defined lesion in the left supraclavicular region deep to the inferior portion of the pectoralis flap that likely corresponds to the treated tumor recurrence. There is also ill-defined diffuse heterogeneous enhancement with blurring of the fat planes along the left paravertebral muscles. Otherwise, there is no significant cervical lymphadenopathy. The remaining major salivary glands are unremarkable. The thyroid gland is unremarkable. The left internal jugular vein appears to have been sacrificed. The other major cervical vessels are otherwise patent, with a right internal jugular venous catheter in position. There is a carious ADA#2 with periodontal lucency. The osseous structures are otherwise unremarkable. The imaged portions of the lungs are clear. There is a 6 mm diameter focus in the subcutaneous tissues of the right face at the level of the mandibular angle, which may represent a sebaceous cyst. | 1. Postoperative findings related to left parotidectomy and neck dissection with flap reconstruction with an ill-defined lesion in the left supraclavicular lesion that likely corresponds to the treated tumor recurrence. Ill-defined diffuse heterogeneous enhancement with blurring of the fat planes along the left paravertebral muscles is likely related to treatment effects, although additional underlying tumor cannot be entirely excluded. 2. No evidence of intracranial metastases.3. A 2 mm wide focus of left temporal scalp skin thickening is non-specific and may represent a second skin neoplasm.4. Carious ADA#2. |
Generate impression based on findings. | Reason: assess atelectasis History: sob LUNGS AND PLEURA: Left chest tube unchanged in position. Stable to marginally increased small left pleural effusion with basilar atelectasis. Left ground glass opacity has improved.Right chest tube directed towards postero-medial lung apex. Trace right pneumothorax and pleural fluidNew near complete atelectasis of right upper and lower lobes with extensive debris in the right mainstem bronchus, presumably mucus plugging due to the rapid onset.MEDIASTINUM AND HILA: Heterogeneous multi-nodular thyroid. Coronary calcification. CHEST WALL: Degenerative change involving the thoracic spine. Subcutaneous emphysema on the right nearly completely resolved.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Multiple hypodense hepatic lesions are presumably cysts but inadequately evaluated. NG tube tip in stomach. | New near complete atelectasis of right upper and lower lobes with extensive debris in the right mainstem bronchus, presumably mucus plugging due to the rapid onset. |
Generate impression based on findings. | Reason: Patient s/p cardiac arrest. Evaluate for anomalous coronary arteries. History: s/p cardiac arrest Coronary arteries: LM: The left main coronary artery arises normally from the left sinus of Valsalva and bifurcates into the left anterior descending and left circumflex coronary arteries. There are no significant stenoses present in the left main.LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove, supplying the diagonal and septal branches. The ostium is nonstenotic. The first 4 cm well-visualized and are unremarkable; however, beyond this level, the vessel is blurred from respiratory artifact and cannot be further assessed.LCx: The left circumflex coronary artery is non-dominant. It courses normally in the left atrioventricular groove but is blurred beyond the first 4 cm and cannot be assessed beyond this point. The ostium and first 4 cm are nonstenotic.RCA: The right coronary artery arises from the right coronary cusp. Only the first centimeter is well visualized. The ostium is nonstenotic. The remaining course of the right coronary is blurred from motion artifact. The posterior descending artery does arise from the distal right coronary artery; this is a right dominant system. Left Ventricle: The left ventricular late diastolic volume is normal.Right Ventricle: Visually the right ventricular late diastolic volume is within normal limits.Left Atrium: Visually, the left atrial volume appears to be normal in size. There are four distinct pulmonary veins which drain normally into the left atrium. There is no evidence of left atrial appendage thrombus.Right atrium, vena cavae, and coronary sinus: The right atrial volume is normal in size. The superior and inferior vena cavae are unremarkable. The coronary sinus is normal in size. Valves: There is no calcification on the aortic or mitral valves.Great vessels: The visualized portions of the thoracic aorta demonstrate no evidence of dissection or aneurysm. The aortic arch is not visualized. The main pulmonary artery is normal in size.Pericardium: The pericardium is normal in thickness. There is no pericardial effusion.LUNGS AND PLEURA: Visualization of the lung parenchyma is limited by the field of view and length of scan which excludes a substantial amount of the lungs. Bilateral lower lobe subsegmental atelectasis is present. There is respiratory motion artifact.MEDIASTINUM AND HILA: No significant abnormality noted in the extracardiovascular portions of the mediastinum.CHEST WALL: No rib fractures identified. UPPER ABDOMEN: A portion of the hepatic parenchyma is visualized. Although this is a postcontrast phase, it has a heterogeneous appearance which raises the question of steatosis. No evidence of cirrhosis in the limited views of the superior liver. | 1. Normal origins of the coronary arteries.2. Limited visualization beyond the proximal coronary arteries, secondary to respiratory motion artifact. No significant stenoses of the entire left main, proximal first centimeter of the right, proximal 4 cm of the LAD, proximal 4 cm of the circumflex coronary arteries. |
Generate impression based on findings. | Female 49 years old; Reason: metastatic breast cancer - evaluate response to treatment, compare with previous History: known mets - left hip pain CHEST:LUNGS AND PLEURA: Right upper lobe pulmonary nodule measures 0.8 cm (image 42/series 5) previously, 0.4 cm. Paramediastinal fibrotic changes persist.Soft tissue masses now extends into the left pleural surface from the left rib.MEDIASTINUM AND HILA: Heart size is normal. The anterior mediastinal mass has significantly increased in size now measuring 9.3 x 4.9 cm (image 46/series 3) previously, 4.8 x 2.1 cm.The lesion compresses the free wall of the right ventricle. Extension into the pericardium is possible. Trace pericardial effusion.CHEST WALL: Destruction of the sternum and the left third rib. Bilateral breast prosthesis. Sclerotic thoracic vertebral body metastases.ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. New segment 8 lesion measures 2.6 x 2.5 cm (image 84/series 3). Diffuse hypoattenuation of the liver to suggest hepatic steatosis.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: Sclerotic L3 vertebral body metastases.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: Soft tissue mass in the left iliac fossa and adjacent to the left gluteus minimus muscle that extends from the large metastatic burden involving the left ilium.Extensive sclerotic metastases involving the ileum and sacrum. Pathologic fracture involving the right iliac wing image 144/series 3 it extends to the superior right acetabulum with mild displacement. Pathologic fracture through the right sacrum.Sclerotic metastases involving the proximal femora.OTHER: No pelvic ascites. | 1.Increase in the size of the reference lesions with new liver lesion.2.Pathologic fractures through the right ilium and right sacrum. |
Generate impression based on findings. | Reason: pt withHNC. PLEASE RE EVAL ndcompare to prior scans History: as above CHEST:LUNGS AND PLEURA: Emphysema. No new pulmonary nodules. Minimal right base scarring or atelectasis.MEDIASTINUM AND HILA: Coronary calcification. Trace pericardial fluid unchanged. Scattered small mediastinal lymph nodes unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Extensive degenerative change involving the spine. | No evidence of metastatic disease. |
Generate impression based on findings. | Reason: staging for hysterctomy for endometrial sarcoma History: sarcoma found incidentally on D and C LUNGS AND PLEURA: Scattered nonspecific micronodules are identified in both lungs.A well -defined 6 mm nodule is noted in the right upper lobe (image 37 series 4). Left upper lobe 5-mm nodule is also noted (image 37 series 4).No evidence of pleural effusions.Minimal bronchial wall thickening.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Small residual amount of thymic tissue in the intermediastinum.Cardiac size is normal without evidence of a pericardial effusion.CHEST WALL: No evidence of axillary lymphadenopathy.Mild degenerative changes in the thoracic spine with minimal anterior wedging of several lower thoracic vertebrae.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Demonstration of bilateral solitary upper lobe well-defined pulmonary nodules that are nonspecific. These may be inflammatory in origin, however metastatic disease cannot be excluded. Follow-up examination in 6 to 12 weeks is recommended . |
Generate impression based on findings. | Locally recurrent head and neck squamous cell carcinoma originating in the nasopharyngeal area with poorly differentiated squamous cell histology. Started treatment on MK3475. There is a partially imaged heterogenously enhancing mass centered within the clivus, extending into the sella, planum sphenoidal, sphenoid sinuses, right posterior ethmoid sinuses, bilateral cavernous sinuses, left orbital apex, left anterior clinoid process, left pterygoid plate, and left petrous apex. There are underlying postoperative findings in the sinonasal cavities with diffuse moderate right maxillary sinus mucosal thickening with suggestion of an air fluid level. There is also mild partial opacification of the ethmoid air cells, right greater than left. There is minimal opacification of the left mastoid air cells. The right mastoid air cells are clear. There is an incomplete posterior C1 arch, which is a normal variant. There is no significant cervical lymphadenopathy. The major salivary glands and thyroid gland are unremarkable. The airways are patent. There is a common origin of the of the brachiocephalic and left common carotid arteries. There is mild atherosclerotic plaque at the bilateral carotid bifurcations. There is mild multilevel cervical degenerative spondylosis. The imaged portions of the lungs are clear. | Partially imaged recurrent tumor centered within the clivus, extending into the sella, planum sphenoidal, sphenoid sinuses, right posterior ethmoid sinuses, bilateral cavernous sinuses, left orbital apex, left anterior clinoid process, left pterygoid plate, and left petrous apex. No evidence of significant cervical lymphadenopathy. |
Generate impression based on findings. | Nine month old male with history of plagiocephaly and developmental delay, evaluate for craniosynostosis and underlying brain abnormalities There is mild flattening of the left parieto-occipital skull as compared to right. However, there are no findings of craniosynostosis. Specifically, there is no early closing of the sutures or abnormal signal ridging. Expected closing of the metopic suture is identified. There is mild prominence of the anterior subarachnoid spaces which is CSF density without underlying gyral mass effect. The ventricles and sulci are normal in size. There are no masses, mass effect or midline shift. There is no evidence for intracranial hemorrhage or acute cerebral or cerebellar cortical infarction. The mastoid air cells are clear. | 1.There is mild flattening of the left parieto-occipital skull as compared to right. However, there are no CT findings of craniosynostosis.2.Mild benign enlargement of the subarachnoid spaces of infancy, which usually resolves by two years of age. |
Generate impression based on findings. | Right middle ear s/p stapedotomy 10/2012. Right: There are postoperative findings related to stapedectomy with stapes prosthesis insertion. The tip of the prosthesis is appropriately seated at the footplate, without protrusion into the vestibule. The head of the prothesis appropriately attaches to the lenticular process of the incus. There is a focus of fenestral otospongiosis that appears to extend to the anterior aspect of the stapes footplate, which appear slightly thickened. The remainder of the ossicular chain is intact. The middle ear and mastoid air cells are clear. The facial nerve describes a normal course, although it may be dehiscent along the tympanic segment. The otic capsule and semicircular canals are intact. Left: There is a 2 mm diameter lucent focus in the region of the fissula ante fenestram, compatible with otospongiosis. There is no definite encroachment upon the oval window niche. The otic capsule is intact. The facial nerve describes a normal course, but appears dehiscent along the tympanic segment. The ossicular chain is intact. The middle ear and mastoid air cells are clear. The external auditory canal is patent. The auricle is unremarkable. | 1. The right stapes prosthesis is in satisfactory position. However, the focus of fenestral otospongiosis appears to encroach upon the anterior aspect of the footplate.2. Left fenestral otospongiosis. |
Generate impression based on findings. | Reason: ro sarcoid History: pulmonary nodules LUNGS AND PLEURA: Bilateral upper lobe predominant ground glass and interstitial abnormality with some areas of traction bronchiectasis and architectural distortion. Patchy density nodular opacities are present but difficult to evaluate at due to respiratory motion. They appear to be part of the underlying pulmonary process. Paraseptal emphysemaMEDIASTINUM AND HILA: Punctate focus of air in the main pulmonary artery presumably related to an existing IV and medication administration. Dilated esophagus. No significant lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Ascites. Enteric tube courses through the stomach. | 1. Severe multifocal pulmonary opacities. No significant lymphadenopathy. While there is a suggestion of chronicity to some of the findings much of the opacity is likely new versus 10/21/2013 chest radiograph. While sarcoidosis is a consideration, it is less likely that this degree of opacity would develop so rapidly entirely due to sarcoid. Consider ARDS/edema or infection as well.2. Paraseptal emphysema.3. Ascites. |
Generate impression based on findings. | Cerebral aneurysm, nonruptured Brain CTA: There is opacification of the distal internal carotid arteries, the distal vertebral arteries and the proximal anterior middle and posterior cerebral arteries. No aneurysms or intracranial stenosis is appreciated.The anterior communicating artery and the posterior communicating arteries are identified and are intact. The posterior communicating arteries are small. The anterior communicating artery is medium size There is redemonstration of a 2-mm left anterior communicating artery aneurysm directed medially and superiorly. The left A1 segment is larger than the right A1 segment.CT head:There is hyperdense opacification involving the right posterior and middle ethmoid air cells which has mildly progressed since the prior exam and is associated with mild degree of expansion.There is opacification of the frontal sinuses as well as the left ethmoid air cells which is less dense than that in the right ethmoid air cells. There is slight hyperdensity within the left frontal sinus. Since the prior exam the hyperdensity in the right frontal sinus is less denseThere is redemonstration of status post paranasal sinus surgeryAs hyperdensity present within the right maxillary sinus. The walls of the maxillary sinuses are thickened.There is redemonstration of diploic space expansion involving the right parietal temporal bones associated with the ground glass appearance centrally consistent with fibrous dysplasia.There is redemonstration of groundglass appearance involving the sphenoid bone, clivus and the much left occipital bone at the skull base including the left occipital condyle.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.Hyperdense opacification of the right ethmoid air cells, right maxillary sinus and left frontal sinus which has progressed since the prior exam is suggestive of progression of the patient's known allergic fungal sinusitis. There is change in character of opacification of the right frontal sinus which is nonspecific.2.The patient is status post sphenoid sinus surgery, left-sided posterior ethmoidal surgery and transphenoidal surgery, for prior allergic fungal sinusitis with residual erosion of the clivus and other parts of the sphenoid bone.3.Stable 2-mm left A1/A2 junction of the anterior communicating artery aneurysm.4.The patient is status post left maxillary sinus antrectomy. 5.There is focal ground glass appearance to portions of the right to the sphenoid bone, inferior clivus, portions of the occipital bone at the skull base and focal thickening of the right parietal bone, and temporal bone possibly related to fibrous dysplasia. This is stable since prior exams. Differential considerations include a giant cell tumor and ossifying fibroma |
Generate impression based on findings. | Reason: History of metastatic high-grade myxofibrosarcoma on treatment. Evaluate for response and extent of disease. History: History of metastatic high-grade myxofibrosarcoma on treatment. Evaluate for response and extent of disease. LUNGS AND PLEURA: Interval right upper lobectomy. New right moderate pleural effusion. Large mass in right upper chest measuring 8.9 x 5.8 cm on image 31/99 abutting the hilum and mediastinum with loss of multiple fat planes suggesting invasion.Right medial lower chest mass measuring 7.7 x 5.3 cm on image 48/99 which in some locations appears to be contiguous with the above noted mass and also shows extension into the subcarinal space and mediastinum near the azygoesophageal groove.Large mass in right anterior lower chest measuring 11 x 9.2 cm (image 60/99) with extension to the chest wall. This also abuts the mediastinum with suggestion of invasion.MEDIASTINUM AND HILA: Ports at RA/SVC junction.CHEST WALL: Right chest wall port. Small axillary lymph nodes.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Left adrenal adenoma. | Multiple right sided masses which are new and increased versus 8/26/2013 PET/CT consistent with metastases. |
Generate impression based on findings. | Male 62 years old; Reason: Esophageal cancer, r/o invasion of adjacent structures History: esophageal cancer. CHEST:LUNGS AND PLEURA: No focal opacities or pleural effusions. Scattered punctate micronodules are presumably postinflammatory.MEDIASTINUM AND HILA: There is asymmetric thickening of the distal esophagus corresponding with abnormally high activity on the recent CT PET exam consistent with the patient's diagnosis of esophageal cancer. There does not appear to be invasion of surrounding structures since there is a plane of fat surrounding the distal esophagus. No cardiomegaly or pericardial effusion.10 mm paraesophageal/high right paratracheal lymph node (image 15/158) which showed increased activity on recent PET.CHEST WALL: Multilevel degenerative changes are noted about the thoracic spine.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: There are multiple hypodensities within the liver that are fluid attenuation and not hot on PET CT which favors a benign etiology. Multiple nonobstructive calcified gallstones.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple hypodensities are seen within the kidneys bilaterally which were seen previously and are grossly unchanged. These likely represent benign renal cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Subcentimeter lymph nodes are seen in the retroperitoneal region.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Single periportal lymph node measures 1.0 cm (series 3, image 106).BONES, SOFT TISSUES: Multilevel degenerative changes are noted throughout the lumbar spine.OTHER: No significant abnormality noted. | 1.Asymmetric thickening of the distal esophagus consistent with the patient's diagnosis of esophageal cancer. There does not appear to be CT evidence of invasion of adjacent structures.2.Borderline enlarged paraesophageal/high right paratracheal lymph node which showed increased activity on recent PET |
Generate impression based on findings. | 56-year-old female with pain and a history of distal radius fracture. Presents for surgical planning. Note is made of comminuted and diffusely impacted distal radius fracture with distinct intra-articular extension. There is 3 mm of depression of the distal fracture fragment (32 :series 80353) adjacent to the ulnar aspect and adjacent to the DRUJ. The fracture edges are indistinct, consistent with a subacute timing. There is also a nondisplaced ulnar styloid fracture in near anatomic alignment. There is a well corticated ossicle along the dorsal aspect of the hamate may represent prior remote trauma. Moderate degenerative changes affect the basilar joint. | Intraarticular comminuted distal radius and ulnar styloid fractures. |
Generate impression based on findings. | 70 year-old male with history of pancreatic cancer, with nausea, vomiting, and leukocytosis. ABDOMEN: Evaluation of solid or pathology and vasculature is limited due to lack of IV contrast.LUNG BASES: Basilar tree in bud opacities and consolidation may relate to aspiration/infection.LIVER, BILIARY TRACT: Expected pneumobilia. No biliary ductal dilatation. Status post cholecystectomy. Evaluation of hepatic parenchyma is limited due to lack of contrast.SPLEEN: No significant abnormality notedPANCREAS: Status post partial pancreatectomy and duodenectomy. New soft tissue masses are identified adjacent to the SMV measuring 2.6 x 2.5 cm (image 40, series 4) and abutting the stomach at the gastric anastomosis along the proximal margin of the residual pancreas measuring 2.8 x 2.3 cm (image 29, series 4), both with previously seen surgical clips now encased by soft tissue not present on prior exam. A third soft tissue mass is present within the mesentery adjacent to the gastric anastomosis (image 28, series 4). The lack of iv contrast makes it difficult to separate these out from adjacent vascular structures, in particular the SMV which abuts this mass, not seen previously. The previously noted fluid collections have resolved.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The stomach is markedly dilated compatible with obstruction at level of the gastric and anastomosis. There is marked free reflux of contrast within the esophagus. Caliber change of the proximal jejunum as it courses near the anastomosis and surgical clips may indicate a second site of adhesion or partial obstruction. The distal small bowel is collapsed and contains minimal contrast.BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: The distal small bowel is collapsed. The colon is normal in diameter.BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality noted | Marked gastric dilatation indicating obstruction at the level of the gastric anastomosis. New soft tissue lesions abutting the SMV and gastric anastomosis suspicious for recurrent tumor, likely causing the obstruction. |
Generate impression based on findings. | 65-year-old male with history of type B aortic dissection presenting with back pain. VESSELS:Variant aortic arch anatomy with the left common carotid arising from the proximal brachiocephalic artery. Type B aortic dissection flap arises from the descending thoracic aorta distal to the origin of the left subclavian artery. The dissection continues until just proximal to the origin of the celiac axis. Compared to prior there is increased thrombus within the false lumen and the true lumen has enlarged. There is a fenestrated communication between the two lumens (series 8 image 322) The descending thoracic aorta has enlarged and now measures 4.3 x 4.4 centimeters (series 8 image 322), previously 3.4 x 3.6 cm. Additional measurements of the thoracic and abdominal aorta are listed below.The celiac axis is widely patent and arises from the true lumen. Multifocal atherosclerotic calcification affects the renal arteries. Mild atherosclerotic disease affects the aorta and iliac arteries. The abdominal aorta is normal in size with a small focus of intramural thrombus in the infrarenal aorta.SINUS OF VALSALVA: 3.5 X 4.0 x 3.7 cmSINOTUBULAR JUNCTION: 3.5 X 3.6 cmASCENDING THORACIC AORTA AT LEVEL OF MAIN PULMONARY ARTERY: 3.6 X 3.5 cmASCENDING THORACIC AORTA IMMEDIATELY PROXIMAL TO THE INNOMINATE ARTERY: 3.4 X 3.4 cmPROXIMAL DESCENDING THORACIC AORTA IMMEDIATELY DISTAL TO THE LEFT SUBCLAVIAN ARTERY: 2.5 X 2.6 cmSUPRARENAL ABDOMINAL AORTA: 2.6 X 2.4 cm RIGHT COMMON ILIAC ARTERY: 12 X 13 mmRIGHT EXTERNAL ILIAC ARTERY: 9 X 9 mmRIGHT COMMON FEMORAL ARTERY: 7 X 7 mmLEFT COMMON ILIAC ARTERY: 9 X 11 mmLEFT EXTERNAL ILIAC ARTERY: 9 X 10 mmLEFT COMMON FEMORAL ARTERY: 7X 8 mmCHEST:LUNGS AND PLEURA: Moderate apical predominant intralobular and paraseptal emphysema with associated apical scarring. Calcified pulmonary granulomas consistent with prior granulomatous infection.MEDIASTINUM AND HILA: Heterogeneous thyroid nodule extending from the isthmus into the superior mediastinum and measures 1.6 x 1.6 cm in the axial plane (series 12 image 79). This is not significantly changed compared to prior, but further evaluation with ultrasound is recommended.Prominent enlargement proximal pulmonary arteries, left greater than right, suggestive of pulmonary hypertension.Unchanged prominent right hilar lymph node. Calcified subcarinal lymph nodes compatible with prior granulomatous infection. The heart is of normal in size. No pericardial effusion. Moderate coronary atherosclerotic calcification affects the proximal left anterior descending and circumflex arteries.CHEST WALL: Minimal degenerative changes affect the thoracic spine.ABDOMEN:The lack of oral contrast limits evaluation of the bowel. The phase of intravenous contrast limits evaluation of the abdominal solid organs; exams is protocoled for the evaluation of the arterial system.LIVER, BILIARY TRACT: Scattered hepatic granulomas. No intra-extrahepatic biliary ductal dilatation. Cholelithiasis without CT evidence of cholecystitis.SPLEEN: Scattered splenic calcifications compatible with prior granulomatous infection.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left inferior pole renal cyst with adjacent subcentimeter hypodensity that is statistically also most likely a renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Diastases rectus and a small fat-containing ventral hernia.OTHER: No significant abnormality noted.PELVIS:PROSTATE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes from partial colectomy with completion reanastomosis. Uncomplicated sigmoid diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Type B aortic dissection extending from the origin of the left subclavian to the level of the celiac axis. There is interval enlargement of both the true lumen and overall diameter of the descending thoracic aorta. There has been no additional propagation of the dissection flap.2.Large heterogeneous nodule arising from the thyroid isthmus. Further evaluation with ultrasound is recommended. |
Generate impression based on findings. | 60 year-old female with microscopic hematuria -- rule-out upper urinary tract lesions and stones. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Liver is diffusely of low attenuation indicative of hepatic steatosis. No focal parenchymal lesions are seen on any phase of imaging. Hepatic vasculature appears normal. Gallbladder and biliary tract appears normal.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right kidney: Punctate calcification in renal parenchyma -- no collecting system calculus seen. Postcontrast images show normal morphology and enhancement to the kidney without mass lesions. Excretory phase shows prompt excretion into normal appearing pyelocalyceal system. Right ureter is opacified throughout the entire length and no evidence of urothelial lesion is seen in pelvis, or ureter.Left kidney: Punctate lower pole calcification is seen inferiorly, which may represent vascular calcification or a represent a punctate calculus in the lower pole nonobstructed calix. No other calcifications are seen. Enhancement of the kidneys shows no evidence of abnormal masses with normal morphology. No hydronephrosis. No perinephric fluid collections. Delayed excretory phase imaging shows prompt excretion into a normal pyelo- calyceal system with excellent opacification of nearly the entire ureter with no evidence of any urothelial lesion.RETROPERITONEUM, 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 bladder wall thickening is seen. There is, however, at the very base of the bladder dorsally (series 8, image 126 with wide windows) a 4-mm apparent capillary projection into the bladder lumen. While this may be artifactual, if no other source for hematuria. Scout, this could represent a small mucosal bladder lesion..LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Punctate calcification in the left lower pole kidney -- vascular calcification versus punctate calyceal calculus without obstruction. 2. Three to 4-mm potential bladder polypoid lesion in the posterior inferior bladder. 3. Diffuse hepatic steatosis. |
Generate impression based on findings. | Reason: smoker greater 30 pack year History: none LUNGS AND PLEURA: Scattered nonspecific micronodules.Pleural-based 9 mm x 4 mm nodule medially and posteriorly in the right lower lobe (image 52 series 5) may be postinflammatory in origin.No suspicious pulmonary nodules or masses.Mild upper lobe predominant centrilobular emphysema.Small Bochdalek hernia on the left.No pleural effusionsMEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of a pericardial effusion.CHEST WALL: Left breast prosthesis.Surgical clips in the left axilla.Significant degenerative changes within the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.Scattered nonspecific micronodules. Small right-sided pleural-based nodules which may be postinflammatory in origin. Follow-up examination in one year is recommended.2.No suspicious pulmonary nodules or masses. |
Generate impression based on findings. | Male 89 years old; Reason: 89yo M BPH, COPD and 40 pk year history with multiple nodules increasing in size. History: hypoxia, SOB. LUNGS AND PLEURA: Diffuse severe emphysema is again seen in the centrilobular and paraseptal distribution. The previously seen scattered peribronchial vascular nodules in the right lung have nearly completely resolved. Other punctate micronodules are stable.However, a new single non-solid opacity measuring 1.2 x 1.4 cm (series 5, image 61) is seen in the right middle lobe, which could represent a focus of infection. It less likely represents AAH given rapid onset.Calcified and noncalcified pleural plaques suggestive of prior asbestos exposure.MEDIASTINUM AND HILA: Again seen is a heterogeneous right thyroid with a large nodule containing calcifications that extends to the manubrium of the sternum and measures 2.6 x 3.2 cm (series 3, image 11), previously measuring 2.8 x 3.4 cm. The thyroid nodule is hypoattenuating which represent either fluid or necrosis. Enlarged main pulmonary artery which measures 3.2 cm.Large paraesophageal hernia. There is mediastinal and hilar lymphadenopathy. Reference right paratracheal lymph node measures 1.2 cm (series 3, image 66), previously measured 1.1-cm. Reference right hilar lymph node stable to marginally increased.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Sludge/stones in the gallbladder. Previously seen hypoattenuating lesion in the liver is not significantly changed (image 111/125). Right adrenal nodule unchanged. Focal calcification in the left neural foramen of T12/L1 unchanged. | 1.Severe emphysema.2.Stable to marginally increased borderline enlarged intrathoracic lymph nodes. 3.Interval resolution of the previously described scattered peribronchial and prevascular nodules likely due to prior infection. 4.New single non-solid opacity measuring slightly larger than 1 cm in the right middle lobe, which could represent a focus of infection or scarring. It less likely represents AAH given rapid onset, though continued follow up is recommended. |
Generate impression based on findings. | 71 year-old female with a history of metastatic breast cancer. Status post chemoradiation therapy. Evaluate for healing or new fracture. UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Note is made of a 12-mm nodule in the soft tissues along the midline of the pelvis (197; series 3) which is suspicious for metastatic disease.Again seen is a large mixed lytic/sclerotic lesion in the right iliac bone extending inferiorly to involve the superior and medial aspect of the right acetabulum and right superior pubic ramus. Additional lytic lesions are identified within the right femoral head, right lesser trochanter, sacrum, left inferior pubic ramus, and left iliac bone. Note is made of cortical breakthrough involving the lesion of the left inferior pubic ramus raising the question of an early pathologic fracture. The previously described pathologic fracture of the femoral head seen on recent MRI scan is not definitely visualized on this exam.OTHER: Vascular calcifications of the aorta and its branches. | Findings consistent with multiple osseous metastases as described above. |
Generate impression based on findings. | Reason: lung nodule History: none LUNGS AND PLEURA: Stable lingular scar like opacity.Small right micronodule in the right upper lobe (image 46 series 5) smaller than prior exams and most likely postinflammatory.Scattered nonspecific micronodules similar appearance the prior exam.No suspicious pulmonary nodules or masses. No pleural effusionsMEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of a pericardial effusion.CHEST WALL: Kyphosis of the cervical thoracic junction with accompanying degenerative changes.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.Stable scarlike opacity in the lingula and benign right upper lobe micronodule.2.No suspicious pulmonary nodules or masses. |
Generate impression based on findings. | 74-year-old female with mantle cell lymphoma -- restaging. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Reference mediastinal, pretracheal lymph node (series 4, image 36) measures 1.4 x 0 .9 cm, previously 1.4 x 0.6 cm. reference right hilar lymph node (series 4, image 42) measures 1.3 x 0.9 cm, previously 1.2 x 0.9 cm.. No new foci of lymph node enlargement is seen. No other significant abnormalities are noted.CHEST WALL: No significant abnormality noted -. No significant axillary adenopathy seen. No change in the prior noted thyroid nodules..ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No iliac or internal pelvic lymphadenopathy is seen. Prior noted. Reference left inguinal lymph node (series 4, image 169) measures 1.3 x 1 .7 cm, previously 1.1 x 1.7 cm.BOWEL, MESENTERY: Scattered, diffuse diverticular changes throughout colon without change or complication. No other abnormality seen. No free mesenteric fluid. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No significant change in scattered mildly prominent lymph nodes in the chest, abdomen, and pelvis. No new foci of lymph node enlargement. |
Generate impression based on findings. | 80 year-old female with abdominal pain and diarrhea ABDOMEN:LUNG BASES: Right basilar consolidation and extensive cardiophrenic and posterior mediastinal lymphadenopathy only partially visualized on this study. Diffuse pleural thickening and nodularity, inseparable from the diaphragm. Right pleural effusion. The possibility of a more proximal obstructing mass cannot be excluded.LIVER, BILIARY TRACT: Hypoattenuating hepatic lesions in both lobes some too small to characterize. Prominence of the common bile duct. Status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple hypoattenuating renal lesions some too small to characterize, but likely representing cysts. One high density right renal lesion likely represents a complex cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine and SI joints.OTHER: No significant abnormality noted | Right basilar consolidation and pleural effusion with extensive cardiophrenic and posterior mediastinal lymphadenopathy and diffuse thickening and nodularity of the pleura only partially visualized on this abdominal CT. The possibility of a proximal obstructing mass cannot be excluded. No acute abnormality in the upper abdomen. |
Generate impression based on findings. | Chronic sinusitis. There is minimal mucosal thickening within the bilateral maxillary sinuses. There is mild scattered opacification of the ethmoid air cells. The frontal and sphenoid sinuses are clear. There are bubbly secretions and air-fluid levels within the bilateral conchae bullosa. There is mucosal thickening along the floor of the nasal cavity and mild prominence of the inferior turbinate mucosa. There is minimal nasal septal deviation. The ethmoid roofs appear to be intact and nearly symmetric. The imaged mastoid air cells are clear. The imaged intracranial structures and orbits are unremarkable. | Findings suggestive of acute rhinitis. |
Generate impression based on findings. | 70 year-old male with left renal mass, assess and characterize. ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Extensive hypovascular soft tissue infiltrating the renal hila and extending along the ureters with very minimal hydronephrosis. Separate from this and with different imaging characteristics is an enhancing left mid pole exophytic lesion measures 2.0 x 3.4 cm (image 82, series 6) worrisome for a renal carcinoma.RETROPERITONEUM, LYMPH NODES: Extensive soft tissue infiltration encasing but not invading or obstructing the aorta, IVC, SMA, celiac axis, renal veins, and left renal artery.BOWEL, MESENTERY: Misty mesentery with diffuse soft tissue infiltration extending along the mesenteric veins without evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Enhancing left renal mass consistent with renal cell carcinoma.2. Extensive soft tissue infiltrating the renal hila and encasing the aorta, IVC, celiac axis, SMA, left renal artery, renal veins and extending along the mesenteric vessels and within the mesentery of unclear etiology, but consider lymphoma given the lack of obstruction. The differing imaging characteristics suggest this is a different process from the isolated renal mass. |
Generate impression based on findings. | 36 year-old female with melanoma -- status post 4 cycles of treatment -- assess response to therapy CHEST:LUNGS AND PLEURA: Enlarging and multiple new nodules throughout both lungs. The prior reference left peri-fissural nodule (series 10, image 50) has markedly increased in size and now measures 5.0 by 4.0 cm, compared with 2.3 x 1.8 cm previously.MEDIASTINUM AND HILA: Referenced right paratracheal mass has increased in size (series 8, image 29) now measuring 3.4 x 2 .7 cm, previously 3.0 x 2.3 cm. Multiple new foci of enlarged lymph nodes are seen in the anterior mediastinum, subcarinal region, bilateral hilar regions. Small pericardial effusion persists.CHEST WALL: Left chest wall surgical changes again seen -- no evidence of mass lesions identified. No skeletal metastatic lesionsABDOMEN:LIVER, BILIARY TRACT: Innumerable new masses throughout the liver, consistent with marked progression of metastatic disease. The prior noted Segment 6 reference lesion is markedly increased in size (series 8, image 116) now measuring 3.6 x 3 .9 cm, previously 1.1 x 1.2 cm.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Marked increase in pulmonary, parenchymal metastases and increased mediastinal lymphadenopathy. 2. Marked increase in diffuse liver metastatic lesions. |
Generate impression based on findings. | Reason: 69yo female with history of multiple malignancies and recent hospitalization presenting with acute onset shortness of breath. History: shortness of breath PULMONARY ARTERIES: Motion limits sensitivity. No evidence of pulmonary embolism. Mild main pulmonary artery dilation suggestive of pulmonary hypertension. No evidence of right heart strain.LUNGS AND PLEURA: There is interval placement of right pleural drain with interval decrease in right pleural effusion . No left pleural effusion. Mild left pleural thickening.Severe upper lobe predominant emphysema with right apical scarring and bullous formation. Stable right paramediastinal radiation changes. Reference sub-pleural and pleural nodules cannot be accurately measured due to motion. No obvious new masses or nodules are identified.MEDIASTINUM AND HILA: Reference lymphadenopathy cannot be accurately delineated due to phase of the contrast and unopacified central venous structures . Central venous structures are not opacified due to contrast injection through central line.Severe calcifications of the coronary arteries and aorta. Heart size is normal. No pericardial effusions.A right subclavian venous catheter with tip terminating in the right atrium.CHEST WALL: Patchy sclerosis and lucency in the T5 vertebral body is unchanged. No axillary lymphadenopathy. In thickening and nodularity of the left breast incompletely imaged.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.No evidence of pulmonary embolism.2.Interval placement of a right pleural catheter with subsequent decrease of right pleural effusion. |
Generate impression based on findings. | Male 66 years old; Evaluate right upper lung nodule seen on OSH radiograph in September 2013. LUNGS AND PLEURA: Diffuse centrilobular emphysema. Single round well defined hyperattenuating nodule in the right upper lobe lung measures 7 mm (series 4, image 26). No pleural effusions.MEDIASTINUM AND HILA: Borderline cardiomegaly without pericardial effusion. The main pulmonary artery measures 2.3 cm in diameter which can be seen with pulmonary artery hypertension. Multiple subcentimeter sized lymph nodes are seen the mediastinum and right hilar region.CHEST WALL: Mild degenerative changes are noted in the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Multiple hypodensities in the liver too small to characterize but most likely represent benign hepatic cysts. Fluid attenuating simple cystic appearing lesion in the left kidney likely represents a renal cyst. Small punctate sclerotic focus in T5 is likely degenerative in nature. | 7 mm nodule in right upper lobe is nonspecific; malignancy cannot be excluded, especially in a high risk patient. Typically nodules of this size are followed at 3-6 months with CT to confirm stability. The nodule may be too small for reliable PET/CT though this is an alternative consideration. |
Generate impression based on findings. | Clinical question: aneurysm? sah? mass? vertebral insufficiency?Signs and Symptoms: headache, neuro findings, DM/HTN/HLD/smoking. HeadacheChest pain, unspecified Neck CTA: There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.Atherosclerotic calcifications are present at the carotid bifurcations.There are multilevel degenerative changes present in the cervical spine worst at C3-4 and C5-6 and to a lesser degree C6-7 where there are endplate and uncovertebral osteophytes narrowing the spinal canal and neural foramina .Brain CTA: There is opacification of the distal internal carotid arteries, the distal vertebral arteries and the proximal anterior middle and posterior cerebral arteries. No aneurysms or intracranial stenosis is appreciated. There is fenestration of the anterior communicating artery. The A2 segment is partially azygos .The right vertebral artery is larger than the left vertebral artery appeared there is extracranial origin of the posterior inferior cerebellar arteries.The posterior communicating arteries are identified and are intact.CT head:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are opacified and associated with thickening of the walls of the maxillary sinuses The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.No evidence for intracranial aneurysm.2.No evidence for cervicocerebral occlusive disease.3.Multilevel degenerative changes are present in the cervical spine.4.Opacification of the paranasal sinuses. Findings are suspicious for chronic sinusitis5.multiple periapical lucencies along left maxillary dentition are suspicious for the possibility of periportal abscess |
Generate impression based on findings. | Hearing loss. Right: There is a diplastic, severely deficient auricle. The external auditory canal is absent, obliterated by a predominantly osseous atresia plate, and there is no distinct tympanic membrane. The malleus and incus are dysmorphic and form an malleus-incus complex with fixation to the atresia plate. The incudostapedial joint appears to be disrupted, but the stapes appears to be grossly intact. The middle ear is hypoplastic, measuring up to 5 mm transversely. There is also mild hypoplasia hypoplasia of the mastoid portion of the temporal bone. The facial nerve describes a more anterior and inferior course than normal and appears to be dehiscent along the anomalous tympanic segment. The oval window is patent. However, there appears to be mild cochlear and modiolar deficiency. In addition, the semicircular canal bone island is asymmetrically small in size. There is a lateralized internal carotid artery. Left: The external auditory canal is patent and the auricle is unremarkable. The middle ear and mastoid air cells are well-pneumatized and clear. The ossicular chain is intact. The facial nerve describes a normal course. There is a lateralized internal carotid artery. The inner ear structures are unremarkable. | 1. Right congenital aural atresia with the constellation of associated anomalies described in the findings section, including inner ear abnormalities.2. Bilateral lateralized internal carotid arteries. |
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