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Generate impression based on findings. | T4a N2C M0 Larynx SCC s/p carbo/taxol induction f/b TFHX 11/19/10 f/b adjuvant everolimus study (placebo vs everolimus) completed 3/12. There is persistent diffuse oropharyngeal, hypopharyngeal, and laryngeal mucosal edema with mild narrowing of the corresponding airway. There is persistent ill-defined soft tissue in the preepiglottic space and deformity of the epiglottis. The laryngeal cartilages are diffusely sclerotic, but otherwise appear intact. There is no significant cervical lymphoadenopathy. There is apparent hyperemia of the soft palate, which may represent mucositis. The major salivary glands are unchanged. The thyroid gland is atrophic. There is unchanged mild to moderate atherosclerotic plaque of the bilateral common and internal carotids diffusely. There is a small right maxillary sinus retention cyst. The osseous structures are unremarkable. The imaged portions of the intracranial structures and orbits are unremarkable. There is moderate pulmonary emphysema that is partially imaged. | Persistent ill-defined soft tissue in the preepiglottic space, but no definite evidence of laryngeal tumor progression or significant cervical lymphadenopathy. |
Generate impression based on findings. | Reason: SCLC - restaging History: none CHEST:LUNGS AND PLEURA: Scattered punctate micronodules are unchanged. Emphysema.MEDIASTINUM AND HILA: Extensive intrathoracic lymphadenopathy, markedly progressed. For continued reference a low right paratracheal mass measures 43 x 32 mm on image 33/145. A prevascular node measures 22 mm in short axis on image 25/145. Port tip in high right atrium.CHEST WALL: Right chest wall port. Small axillary lymph nodes bilaterally, unchanged. Scattered punctate sclerotic foci are unchanged and presumably metastases.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Splenule.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate renal hypodensities are too small to characterize but stable and presumably benign.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: Heterogeneous sclerosis involving the left ilium incompletely evaluated presumably metastatic. Sclerotic focus in sacrum also incompletely evaluated (image 145/145). Degenerative change elsewhere. Other punctate areas of sclerosis in the vertebral bodies are also presumably metastases.OTHER: No significant abnormality noted. | 1. Significant interval increase in intrathoracic lymphadenopathy/masses.2. Osseous metastases. |
Generate impression based on findings. | Reason: Evaluate for infection History: Leukocytosis. WBC 42. LUNGS AND PLEURA: Stable scattered calcified and noncalcified micronodules.Small bilateral pleural effusions with a basilar subsegmental atelectasis and scarring.No suspicious nodules or masses.No specific evidence of acute infection.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Pulmonary artery is markedly enlarged compatible with pulmonary arterial hypertension.Cardiac size is normal without evidence of a pericardial effusion.Calcifications and heterogeneity of the thyroid gland compatible with a goiterCHEST WALL: Degenerative changes throughout the thoracic spine with scattered nonspecific lucencies within the vertebral bodies..UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Normal development of perihepatic and perisplenic ascites not present on the recent CT exam of the abdomen dated 10/27/13 | 1.Small pleural effusions and developing ascites.2.No specific evidence of acute infection.3.Enlarged pulmonary artery compatible with pulmonary arterial hypertension. |
Generate impression based on findings. | Type II or unspecified type diabetes mellitus without mention of complication, not stated as uncontrolled 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.Incidental note is made of hyperostosis frontalis interna. | 1.No evidence for acute intracranial hemorrhage mass effect or edema.2.CT is insensitive for the early detection of nonhemorrhagic CVA |
Generate impression based on findings. | HeadacheDisturbance of skin sensationOther specified visual disturbancesIntracranial injury of other and unsEvaluate for evidence of intracranial bleed in patient s/p head on car collisionSigns and Symptoms: worsening headache, right facial numbness , right blurred vision and pecified nature, without mention of open intracranial wound, unspecified state of consciousness. 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.No evidence for acute intracranial hemorrhage mass effect or edema. |
Generate impression based on findings. | Reason: T4a N2C M0 Site Larynx Histology SCC s/p carbo/taxol induction f/b TFHX 11/19/10 f/b adjuvant everolimus study (placebo vs everolimus) completed 3/12. History: Please monitor for recurrence CHEST:LUNGS AND PLEURA: Stable scattered calcified and noncalcified micronodules.Nodular ground glass opacities with bronchiectasis in the right middle lobe unchanged.Stable left basilar scarring.Moderate upper lobe predominant centrilobular emphysema.No suspicious pulmonary nodules or masses.No pleural effusions.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Reference high right paratracheal lymph node (image 31 series 3) is unchanged measuring 6 mm.Reference subcarinal lymph node (image 46 series 3 is unchanged measuring 7 mm.Cardiac size is normal without evidence of a pericardial effusion.Moderate coronary artery calcifications.CHEST WALL: Degenerative changes in the thoracic spine.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Splenic calcification compatible with prior granulomatous disease .ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Nonobstructing left renal calculi unchanged.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No evidence of metastatic disease. |
Generate impression based on findings. | Female 57 years old; Reason: Metastatic breast cancer to bones. On continuing systemic therapy. Restaging. History: No new symptoms CHEST:LUNGS AND PLEURA: Left apical posterior pulmonary nodule measures 5-mm (image 17/series 6), unchanged. No new suspicious lesions. The pleural spaces are clear.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion.CHEST WALL: Right chest wall port terminates at the cavoatrial junction. Post operative changes from left mastectomy.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: Hyperdense nodule in the anterior fundal aspect of the uterus may represent a leiomyoma.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evident corresponding abnormality for the cecal area of uptake on the PET portion of the exam.BONES, SOFT TISSUES: Increase in the size of the sclerotic lesion involving the right posterior acetabulum. Sclerotic lesions involving the left femoral neck and right intertrochanteric region also suspicious for metastatic disease.OTHER: No significant abnormality noted. | 1.Osseous metastatic disease to the right posterior acetabulum, left femoral neck and right intertrochanteric region.2.No definite new sites of disease. |
Generate impression based on findings. | 67-year-old male with abdominal pain, leukocytosis, and cloudy urine output. ABDOMEN:LUNG BASES: Basilar atelectasis. Emphysematous changes of the lung bases.LIVER, BILIARY TRACT: Status post cholecystectomy with fluid and nondependent gas in the gallbladder fossa which measures 12.6 x 6.3 cm (image 49, series 3).SPLEEN: No significant abnormality notedPANCREAS: Status post partial pancreatectomy with a collection of fluid and nondependent gas in the surgical bed of the pancreatic head, which measures 5.8 x 7.5 cm (image 69, series 3). This collection is contiguous with a collection of fluid and gas in the gallbladder fossa and exerts mass effect on the adjacent duodenum.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Atrophic kidneys with multiple bilateral hypoattenuating lesions. One complex left renal cyst and an enhancing small right lower pole lesion are again noted.RETROPERITONEUM, LYMPH NODES: Periportal lymph node measures 2.2 x 2.4 cm and previously measured 1.8 x 1.0 cm (image 53, series 3).BOWEL, MESENTERY: Status post gastrojejunostomy. No evidence of bowel obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: The small bowel and colon are normal in caliber.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Trace fluid. | Status post Whipple procedure with communicating postoperative fluid collections in the gallbladder and pancreatic fossas containing gas as detailed above, suspicious for early infection. 2.4-cm periportal lymph node is also noted. |
Generate impression based on findings. | Post TPA. There is edema in the superior division of the left MCA territory with regional mild mass effect but no significant midline shift. A left dense MCA sign is less conspicuous. Thre is mild patchy cerebral white matter hypoattenuation elsewhere, which is nonspecific, but likely related to microangiopathy. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is a small right maxillary sinus retention cyst. The imaged mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. | Acute left MCA territory infarct without hemorrhagic transformation or significant midline shift. Neurovascular imaging is recommended.Discussed with Dr. Ardelt at 4:30 PM on 11/4/13. |
Generate impression based on findings. | Female 52 years old; Reason: 52 y/o with lesion in pancreas, recommend dedicated CT pancreas protocol History: pancreatic lesion ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver has a smooth contour. No suspicious hepatic lesions. Hepatic and portal veins are patent. Noncalcified gallstones layer at the fundus.SPLEEN: Scattered splenic granulomata.PANCREAS: Pancreas is normal in morphology without atrophy. The duct is mildly prominent but no focal ductal dilatation. Small subcentimeter hypodense foci along the anterior aspect of the pancreas (image 48 and image 44) may represent small side branch type IPMNs.The splenic vein and portal vein 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: Degenerative changes affect the lower lumbar spine the degenerative disk disease centered at L5-S1 disk space.OTHER: No significant abnormality noted. | 1.Two nonspecific hypodense areas in the pancreas may represent subcentimeter side branch type IPMNs. Follow imaging - M.R.C.P. in 12 months is suggested.2.Cholelithiasis. |
Generate impression based on findings. | Female 63 years old; Reason: evaluate for recurrent abdominal hernias History: abdominal pain,ventral wall hernias on exam Exam is not sensitive for detecting lesions in the solid organs of vasculature. Due to lack of IV contrast. Given those limitations, the following observations medicalABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver is enlarged to about 23 cm as seen on coronal image 53. This excludes the suprahepatic. Chronic collection. The dorsal component of the perihepatic collection is increased in size as measured on series 2 image 27, 6.3 x 3.4 cm. Previously measured more caudally on the 2/28/12 exam series 2 image 34 as 3.3 x 1 .8 cm.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Previously seen scattered capsular high densities around both kidneys are nearly completely resolved. Correlate clinically as to the possible etiology.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Redemonstration of right lower quadrant colostomy, gastric and jejunal anastomoses. No evidence of free or loculated intraperitoneal fluid. No evidence of intra-abdominal hernias in the upper abdomen. See pelvis.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: Broad based central herniation. Nonobstructive.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Broad-based, nonobstructive ventral hernia in the pelvis. 2.Increased perihepatic near fluid density collection.3.Near complete resolution of perirenal high density foci thought to be calcifications on prior exam.4. Other findings unchanged from prior exam. |
Generate impression based on findings. | Male 38 years old; Reason: CT Abdomen, IV contrast only, evaluate portal vein s/p liver transplant History: CT Abdomen, IV contrast only, evaluate portal vein s/p liver transplant ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Status post liver transplant. The hepatic and portal veins are patent. No biliary ductal dilatation.Scattered hepatic hypodensities are too small to fully characterize.Faint contrast is noted within the hepatic artery about the hepatic hilum suboptimal imaged without an arterial phase.Small amount of fluid adjacent to the liver.SPLEEN: Splenic vein is patent. Spleen is mildly enlarged.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: Mild dilatation of the small bowel, likely an ileus.BONES, SOFT TISSUES: Left abdominal catheter with its inferior portion not imaged. Anterior abdominal staples.OTHER: No significant abnormality noted. | 1.Stable postoperative appearance of the liver with patent portal vein and hepatic veins.2.Faint enhancement of the hepatic artery in the hilum suggests patency. The enhancement is likely due to the phase of imaging.3.Findings discussed with Dr. Rentz at the time of dictation. |
Generate impression based on findings. | Female 77 years old; Reason: pt is s/p 3 cycles eribulin/herceptin - please assess disease status and compare to previous imaging History: MBC CHEST:LUNGS AND PLEURA: Mild upper lobe emphysema. Few scattered pulmonary nodules including few micronodules along the fissures.Right lung base pleural thickening and areas of loculated effusion. Slight decrease in the pleural thickening at the right lung base.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. Stable to slight decrease in the size of the cardiophrenic nodes.Right subcarinal lymphadenopathy and right hilar lymphadenopathy.CHEST WALL: Decrease in the size of the right axilla lymphadenopathy. The superior right axilla lymph node measures 1.5 x 0.9 cm (image 39/series 401) previously, 1.5 x 1.0 cm.The inferior right axillary node/body wall node measures 0.9 x 0.6 cm (image 47/series 401) previously, 1.0 x 0.6 cm.The right anterior chest wall/breast mass measures 3.8 x 1.4 cm (image 63/series 401) previously, 4.9 x 1.4 cm.Left chest wall port terminates at the caval atrial junction.ABDOMEN:LIVER, BILIARY TRACT: Stable hepatic hypodensities. No new suspicious hepatic lesions. The hepatic and portal veins are patent.Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis in either kidney. Probable bilateral vascular calcifications.RETROPERITONEUM, LYMPH NODES: Calcific arteriosclerotic disease of the aorta.Reference left para-aortic lymph node measures 1.2 x 1.0 cm (image 110/series 401) previously, 1.2 x 0.9 cm.There is disease adjacent to the right cruse of the diaphragm.BOWEL, MESENTERY: Post operative changes at the cecum.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Absent or atrophic.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.Decrease in the size of the reference lesions. |
Generate impression based on findings. | Reason: Patient with acute pancreatitis, now with tachypnea and tachycardia; please evaluate for PE. History: Tachycardia, tachypnea PULMONARY ARTERIES: No evidence of PE.LUNGS AND PLEURA: Small - moderate left pleural effusion with left lower lobe atelectasis and consolidation. Minimal right basilar atelectasis.MEDIASTINUM AND HILA: Venous catheter tip at RA/SVC junction.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Upper abdominal fat stranding consistent with pancreatitis. Please see recent abdomen CT report for further details. | 1. No evidence of PE.2. Small - moderate left pleural effusion with nonspecific left lower lobe atelectasis and consolidation. |
Generate impression based on findings. | Male 57 years old; Reason: pt with esophageal ca s/p neo-adjuvant chemo and rt ended 9/27/13 History: doing well now needs disease evaluation piror to resection CHEST:LUNGS AND PLEURA: Mild diffuse ground-glass parenchymal changes in the lung. The ground-glass changes centered adjacent to the paramediastinal borders most likely from post radiation pneumonitis. There are scattered ground glass pulmonary parenchymal nodules. The pleural spaces are clear.MEDIASTINUM AND HILA: Heart size is normal no pericardial effusion. The paraesophageal nodes have resolved.Distal esophagus thickening has decreased measuring 2.1 x 2.2 cm (image 78/series 701) previously, 4.3 x 4.0 cm.CHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Small exophytic left renal cysts. Mild bilateral renal cortical atrophy.RETROPERITONEUM, LYMPH NODES: Lymph node in the gastrohepatic ligament has decreased in size now measuring 0.6 x 0.6 cm (image 87/series 701) previously, 1.6 x 1.3 cm.BOWEL, MESENTERY: No bowel obstruction. Small duodenal diverticulum.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.Decrease in the size of the distal esophagus mass.2.Resolution of the left paraesophageal lymph node and decrease in the size of the gastrohepatic lymph node.3.Pulmonary ground-glass opacities some of which are likely due to radiation. The peripheral ground-glass nodules may be infectious or post treatment related. |
Generate impression based on findings. | Unspecified cerebral artery occlusion with cerebral infarction 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 50% stenosis at the origin of the left ICA. On the basis of NASCET criteria there is no significant stenosis at the right carotid bifurcation. The common carotid arteries are very tortuousThere is a high-grade stenosis present at the origin of the right vertebral artery. The right vertebral artery has a tortuous proximal andThere is no significant stenosis along the course of the left vertebral artery. Atherosclerotic calcifications are present at the carotid bifurcations.The multilevel degenerative changes present in the cervical spine with endplate and uncovertebral osteophytes at C4-5, C5-6, C6-7 associated with loss of disk space height and narrowing of the neural foramina bilaterally.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 a 50% stenosis present along the distal portion of the right vertebral artery near the vertebrobasilar junction. Additional 50% stenosis is present at the right vertebral artery as it enters the posterior fossa.The anterior communicating artery and the posterior communicating arteries are identified and are intact. There is fetal origin of the right posterior cerebral artery with a hypoplastic right P1 segment. The left posterior communicating artery is small. The right A1 segment is larger than the left A1 segment The anterior communicating artery is fenestratedAtherosclerotic calcifications are present along the distal internal carotid arteries.Atherosclerotic calcifications are present along the distal vertebral arteries.There multiple foci of narrowing of the pericallosal arteries left more than rightCT head:There is encephalomalacia present along the left temporal lobe and the left parietal lobe. There is associated executive effect on the left lateral ventricle.There is a focus of encephalomalacia present along the left precuneusPunctate hypodense foci are present in the right mid brain and in the right thalamus as well as in the basal ganglia bilaterally.Periventricular and subcortical white matter hypodensities of a moderate degree are present.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. | 1.50% stenosis at the origin of the left internal carotid artery.2.High-grade stenosis at the origin of the right vertebral artery with tandem intracranial RVA stenoses.3.There is encephalomalacia present along the left middle cerebral artery territory involving left temporal lobe and the left parietal lobe as well as a watershed territory between the left to middle and posterior cerebral arteries.4.Punctate lesions in the brain stem, thalami and basal ganglia are suspected to represent lacunar infarcts5.Periventricular and subcortical white matter hypodensities of a moderate degree are present. At this age these are most likely vascular related6.distal atherosclerotic changes are present especially along the left pericallosal artery |
Generate impression based on findings. | Male 72 years old; Reason: evaluate for scrotal/pelvic abscess s/p complex inguinal hernia repair 9/2013 History: persistent scrotal swelling and pain PELVIS:PROSTATE/SEMINAL VESICLES: Coarse calcifications in the prostate.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Post operative changes adjacent to the cecum. No bowel obstruction.Colonic diverticulosis.BONES, SOFT TISSUES: Post operative changes in the left inguinal canal.OTHER: Enhancing hydrocele in the left scrotum. Extensive soft tissue thickening and edema involving the scrotum with inflammation extending into the left inguinal canal and to the lower pelvis. | 1.Extensive inflammation involving the left scrotum and soft tissues with intrapelvic extension of inflammation. No intrapelvic drainable fluid collections. |
Generate impression based on findings. | Female 38 years old; Reason: immunocompromised w abd pain and leukocytosis History: see above ABDOMEN:LUNGS BASES: Post operative changes of median sternotomy.LIVER, BILIARY TRACT: Liver contour is smooth. No suspicious hepatic lesions. Hepatic and portal veins are patent. No intra-or extrahepatic biliary ductal dilatation.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: Small bowel is normal in caliber. No bowel distention. No mesenteric fluid collections. Appendix located retrocecally is normal in caliber.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Left adnexal cyst.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.No bowel obstruction or intra-abdominal fluid collections.2.Left adnexal cyst. Clinical correlation and if needed, pelvic sonography is suggested. |
Generate impression based on findings. | Clinical question: One out bleed or other intracranial process. Signs and symptoms: alteration of mental status x 1 week. History of encephalopathy and hepatocellular carcinoma. Nonenhanced head CT:No evidence of acute intracranial process CT however is insensitive for detection of acute nonhemorrhagic ischemic strokes.There are nonspecific patchy low attenuation of white matter in the subcortical and periventricular region which could represent age indeterminate to small vessel ischemic strokes. There are no prior exams for comparison. If such studies are available and submitted to the radiology department an addendum to this report was be provided after comparison.Unremarkable cerebral cortex, cortical sulci and ventricular system.Unremarkable calvarium, paranasal sinuses, orbits, mastoid air cells and middle ear cavities. | Nonspecific mild subcortical and periventricular low attenuation of white matter as detailed. |
Generate impression based on findings. | Unspecified cerebral artery occlusion with cerebral infarctionUnspecified cerebral artery occlusion with cerebral infarction The patient is status-post right-sided craniotomy. A small focus of encephalomalacia is present along the right middle frontal gyrus underneath the craniotomy site predated the craniotomy based on an MRI from 12/9/11.A focus of encephalomalacia is present along the right occipital lobe at the inferior aspect of the kidney as compared to another focus of encephalomalacia is present along the right middle temporal gyrus and right superior temporal gyrus and one more is present along the left occipital lobe involving calcarine territory.Since the prior exam a right-sided epidural hyperdense collection is decreased in thickness and is currently barely perceptible measuring approximately 3 mm in thickness.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.Incidental note is made of hyperostosis frontalis interna. | 1.No evidence for acute intracranial hemorrhage mass effect or edema.2.Since the prior examination the patient's right-sided dural hematoma has decreased in thickness and visibility3.multiple foci of encephalomalacia are present in the occipital lobes, and right temporal lobe and right frontal lobe compatible with prior infarctions. |
Generate impression based on findings. | 43 year-old female patient with abdominal pain. Evaluate for obstruction. Note that the lack of intravenous contrast limits evaluation of vasculature, lymph nodes and solid organs.ABDOMEN:LUNG BASES: Trace bilateral dependent atelectasis.LIVER, BILIARY TRACT: Liver parenchyma less dense than expected and is suggestive of steatosis. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Bowel normal in caliber without evidence of obstruction. No intramural air, free air or free fluid. Postsurgical changes at the cecum. Collapsed rectum and sigmoid colon with possible mild wall thickening, which can simulate colitis.BONES, SOFT TISSUES: Minimal multilevel degenerative changes of the thoracic and lumbar spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Surgical clips in the pelvis. | 1.Bowel normal in caliber without evidence of obstruction.2.Collapsed rectum and sigmoid colon with possible wall thickening. Findings may be secondary to adherent stool, however cannot rule out colitis. Recommend correlation with patient's symptoms.3.Hypoattenuating liver parenchyma suggestive of steatosis. |
Generate impression based on findings. | Male 55 years old; Reason: r/o PE History: cp, sob. PULMONARY ARTERIES: Significant pulmonary emboli burden including the distal right main pulmonary artery with pulmonary emboli extending into the interlobar descending pulmonary artery and involving multiple segmental and subsegmental branches on the right. No pulmonary emboli seen on the left.LUNGS AND PLEURA: Small right pleural effusion with overlying atelectasis which could represent pulmonary infarction. Left basilar subsegmental atelectasis.MEDIASTINUM AND HILA: No specific evidence of right heart strain. No cardiomegaly. No pericardial effusion. No significant mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.Multiple pulmonary emboli within the right main pulmonary artery and its distal branches.2.Small right sided pleural effusion with overlying consolidation which can also be seen in pulmonary infarct. |
Generate impression based on findings. | Reason: evaluate for PE History: chest pain, SOB PULMONARY ARTERIES: Technically adequate examination. No evidence of pulmonary embolism. Main pulmonary artery caliber is within normal limits. No evidence of right heart strain.LUNGS AND PLEURA: Small micronodule along the minor fissure is smaller compared to prior exam and likely represents a lymph node (series 8, image 71). Focal area of scarring with traction bronchiectasis in the right lower lobe posterior basal segment appears similar to prior exam (series 8, image 98). No pleural effusions or pneumothorax.MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. Heart size is normal. No pericardial effusions.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Diffuse hepatic hypoattenuation suggestive of hepatic steatosis. | 1.No evidence of pulmonary embolism.2.No other acute cardiopulmonary abnormality. |
Generate impression based on findings. | Female, 53 years old, headache. 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. | 70 year-old female with nausea, vomiting, and lower abdominal pain, assess for change in left ovarian mass, abscess, or SBO ABDOMEN:LUNG BASES: Severe emphysematous changes of the lung bases. Right basilar subpleural nodularity/scarring.LIVER, BILIARY TRACT: Diffuse hepatic steatosis. Unchanged hepatic cysts.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: Normal caliber bowel without evidence of obstruction.BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Interval decrease in size of unilocular left adnexal cyst which now measures 3.3 x 2.7 cm and previously measured 3.7 x 3.2 cm.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Normal caliber bowel without evidence of obstruction.BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality noted | 1. No acute abdominal or pelvic abnormality. 2. Interval decrease in size of a unilocular left adnexal cyst, most likely benign in etiology.3. Diffuse hepatic steatosis. |
Generate impression based on findings. | encephalopathy, unresponsiveness The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of a small skin lesion measuring 10 x 6 mm sagittal dimensions with Hounsfield units approximate 118 which was also identified on the prior exam and is not substantially changed extending upwards from the high calvarium just behind the level of the coronal suture. It is not well visualized on recent MRIs were disassociated with artifact.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Periventricular and subcortical white matter hypodensities of a marked degree are present. This was also present on the previous exam and is unchangedThe visualized portions of the paranasal sinuses are partially opacified. The visualized portions of the mastoid air cells are partially opacified. The visualized portions of the orbits are intact.Atherosclerotic calcifications are present along the distal internal carotid arteries. | 1.Periventricular and subcortical white matter changes of a mild degree are nonspecific. Differential considerations include vascular related lesions as well as neurodegenerative or related to prior treatment.2.CT is insensitive for the early detection of nonhemorrhagic CVA.3.There is a scalp lesion present along the midline just behind the level of the coronal suture. This is unchanged since the prior exam. Please correlate with physical findings on clinical exam. It does not appear to be associated with any calvarial erosion . |
Generate impression based on findings. | Female, 55 years old, C-spine tenderness after MVC. Alignment is anatomic. Vertebral body heights are preserved. No fracture or acute dislocation is demonstrated.At C3-4, there is right-sided uncovertebral hypertrophy which narrows the right neural foramen.At C5-6, there is a posterior disk osteophyte complex which indents the thecal sac and may cause some degree of canal stenosis. The neural foramina are moderately narrowed at this level.Mildly prominent upper mediastinal lymph nodes are nonspecific. | No fracture or acute dislocation. |
Generate impression based on findings. | 78 year old female with hypotension, tachycardia, evaluate for retroperitoneal bleeding. ABDOMEN:LUNG BASES: Basilar pleural effusions and atelectasis. Calcified granuloma in the right lung base.LIVER, BILIARY TRACT: Few scattered hepatic calcifications. Dilatation of hepatic veins, IVC and periportal cuffing indicating volume overload.SPLEEN: Splenic granulomata. PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Renal atrophy.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of abdominal aorta and its branches. No evidence of hematoma.BOWEL, MESENTERY: Right lower quadrant ostomy. Fluid tracks within the mesentery.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Increased ascites.PELVIS:UTERUS, ADNEXA: Calcifications are noted within the uterus.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Right lower quadrant ostomy.BONES, SOFT TISSUES: Body wall collaterals are again noted. Degenerative changes of the thoracolumbar spine and pelvis and deformity of the femurs noted on the scout film.OTHER: Left femoral catheter terminates within the IVC. Anasarca and increased ascites. | No evidence of hematoma. Interval increase in anasarca and ascites with persistent pleural effusions, indicating volume overload. |
Generate impression based on findings. | 62-year-old female patient with abdominal pain and back pain. Evaluate for aortic dissection. CHEST:LUNGS AND PLEURA: Spiculated lung nodule in the right lower lobe (series 8 image 42), measuring 0.7 x 1.2 cm. Scarring versus atelectasis in the right lung base.MEDIASTINUM AND HILA: There is redemonstration of a type B aortic dissection, stable compared to outside study on 11/2/2013.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Wedge-shaped hypoattenuating lesion in the spleen consistent with prior infarct.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Hypoattenuating mass in the superior pole of the right kidney measures 2.7 x 2.4 cm (series 81065, image 86).RETROPERITONEUM, LYMPH NODES: Aortic dissection stable compared to prior examination. Renal arteries, celiac artery and superior mesenteric artery are supplied by the true lumen.BOWEL, MESENTERY: Colonic diverticulosis without CT evidence of diverticulitis.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumbar spine. Lytic lesion in the posterior T12 vertebral body measures fat density and is most likely to be benign.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: Multilevel degenerative changes in the thoracic and lumbar spine. Lytic lesion in the posterior T12 vertebral body measures fat density and is most likely to be benign.OTHER: No significant abnormality noted. | 1.Stable type B aortic dissection.2.Right renal mass suspicious for renal cell carcinoma.3.Right lower lobe spiculated nodule.4.Hypoattenuating lesion in the spleen consistent with prior infarct.Findings of renal mass and lung nodule communicated to Dr. Kim via telephone at 9:56 AM on 11/5/2013 by Dr. Stephanie McCann. |
Generate impression based on findings. | Male 38 years old; Reason: further characterize the patchy infiltrates seen on CXR History: cough, night sweats, fever. LUNGS AND PLEURA: Diffuse bilateral patchy semi-solid and groundglass opacities with sparing of the lung bases. No bronchiectasis or honeycombing is noted. Scattered bilateral lucencies may represent cystic changes and/or emphysema. Micronodules are also visualized scattered throughout the lungs. No pleural effusions.MEDIASTINUM AND HILA: Very mild mediastinal lymphadenopathy. Borderline normal sized axillary lymph nodes. 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. No significant abnormality noted. | 1.Diffuse bilateral patchy and groundglass opacities which spare the lung bases. The pattern is highly consistent with pneumocystic pneumonia, but other differential considerations include other atypical infection including fungal or viral etiologies as well as hypersensitivity pneumonitis, pulmonary hemorrhage or drug reaction. |
Generate impression based on findings. | s/p meningioma resection. There are postoperative findings related to left temporal convexity meningioma resection. There is no significant interval change in the amount of intraparenchymal hemorrhage along the margins of the resection cavity and within the resection cavity. The associated edema surrounding the resection cavity, including within the inferior frontal gyrus in the region of the operculum, as well as in Heschl's gyrus are better defined and appears to extend slightly farther superiorly into the frontal and parietal lobes. Elsewhere, there is mild periventricular white mater hypoattenuation that is unchanged and likely represents microangiopathy. The ventricles are stable in size and configuration. There is unchanged mild midline shift to the right. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unchanged. | No significant interval change in the amount of intraparenchymal hemorrhage along the margins of the resection cavity and within the resection cavity, although the associated edema appears better defined and appears to extend slightly farther superiorly into the frontal and parietal lobes. However, MRI is more sensitive for the detection of acute infarction. |
Generate impression based on findings. | Painless hematuria 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 noted. Specifically, no worrisome mass, stone, or hydronephrosis. Unremarkable collecting systems bilaterally. Incidental note made of bilateral benign renal sinus cysts.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: No significant abnormality notedOTHER: No significant abnormality noted | Negative for acute, inflammatory, or neoplastic process. Specifically, unremarkable kidneys and collecting system, without evidence for neoplasm, stone, or obstruction. |
Generate impression based on findings. | 29 year-old female with nausea, vomiting, abdominal pain and Crohn's disease. 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, narrowing and hyperenhancement of the mucosa of the terminal ileum extending 5-6 cm from the IC valve. Approximately 4 to 5 cm proximal to this there is a 3 to 4 cm segment of narrowed distal ileum with wall thickening and mucosal hyperenhancement. No evidence of free or loculated fluid collection, fistula or obstruction. Lack of normal haustral folds and mild wall thickening of the entire ascending and transverse colon. Within the mid transverse colon is a segment of more marked narrowing and wall thickening with proximal fecal distention. The distal colon appears unremarkable. Fibrofatty proliferation of the mesentery is noted. Multiple large mesenteric lymph nodesBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Wall thickening, narrowing and hyperenhancement of the mucosa of the terminal ileum extends 5-6 cm from the IC valve. Approximately 4 to 5 cm proximal to this there is a 3 to 4-cm segment of narrowed distal ileum with wall thickening and mucosal hyperenhancement. No evidence of free or loculated fluid collection, fistula or obstruction. Lack of normal haustral folds and mild wall thickening of the entire ascending and transverse colon. Within the mid transverse colon is a segment of more marked narrowing and wall thickening with proximal fecal distention. The distal colon appears unremarkable. Fibrofatty proliferation of the mesentery is noted. Multiple large mesenteric lymph nodes.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Distal and terminal ileal inflammatory skip lesions and inflammation of the entire ascending and transverse colon with more focal narrowing and wall thickening at the mid transverse colon causing proximal fecal distention, as detailed above. No evidence of abscess or fistula. |
Generate impression based on findings. | 55-year-old female with abdominal tenderness after motor vehicle collision. 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: Redemonstration of very large anterior ventral wall hernia containing stomach, small bowel, and colon. Size of the hernia is unchanged compared to the 2011 examination. No evidence of bowel obstruction is seen. No free mesenteric fluid is noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Redemonstration of very large anterior ventral wall hernia containing stomach, small bowel, and colon. Size of the hernia is unchanged compared to the 2011 examination. No evidence of bowel obstruction is seen. No free mesenteric fluid is noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Large anterior wall ventral hernia with stomach, small bowel, and colon, unchanged and without obstruction. 2. No evidence of acute traumatic abnormality. |
Generate impression based on findings. | 47-year-old female with history of vesicovaginal fistula repair, please perform CT cystogram. ABDOMEN: Evaluation of solid organ pathology and vasculature is limited due to lack of IV contrast.LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Status post cholecystectomy. The liver appears unremarkable on this noncontrast study.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: A catheter extends within the bladder. The bladder is distended with contrast and contrast is noted within the proximal vagina. Postvoid images demonstrate persistent contrast within the vagina.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Postsurgical change and scarring of the lower anterior abdominal and pelvic wall. Degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality noted | Findings consistent with persistent vesicovaginal fistula. |
Generate impression based on findings. | Reason: widely metastatic non small cell lung cancer acute tachycardia with relative hypoxia rule out PE History: tachycardia, relative hypoxia PULMONARY ARTERIES: Technically adequate examination. No evidence of pulmonary embolism.LUNGS AND PLEURA: Interval development of near complete collapse of the right upper lobe secondary to secretions/tumoral invasion of the right upper lobe bronchus. Right perihilar mass effaces the right upper lobe pulmonary artery without obstruction.Scattered bilateral regions of ground glass opacities. Bilateral reference masses are difficult to measure due to surrounding lung atelectasis. No pneumothorax. Pleural thickening and nodularity without pleural effusion.MEDIASTINUM AND HILA: There is esophageal debris. Mediastinal adenopathy and invasion by tumor similar to prior exam. Heart size is normal. No pericardial effusion.CHEST WALL: Large mass measuring 5.5 cm (series 8, image 10) in the right lower cervical neck likely an enlarged lymph node.Hypodense thyroid nodule in the left lobe.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Multiple hypodense lesions in the liver compatible with hepatic metastases, . Left adrenal nodule. Ascites surrounding the liver and spleen. | 1.No evidence of pulmonary embolism.2.Interval development of near complete collapse of the right upper lobe secondary to occlusion of right upper lobe bronchus secondary to secretions and/or tumoral invasion.3.Redemonstration of bilateral lung metastases, mediastinal adenopathy, and supraclavicular lymphadenopathy.These findings were discussed with the resident on call at 1930 on 11/4/2013 by Dr. Hansford. |
Generate impression based on findings. | 3-year-old female with increased oxygen requirements, neutropenia. Evaluate for fungal or anaerobic infection. Respiratory motion artifact limits evaluation. LUNGS AND PLEURA: No focal air space opacities or pleural effusions are present.There is a small wedge-shaped area of low-attenuation in the right apex (coronal series, image 32), which may represent a small focal area of mosaic perfusion, air trapping, or a small bulla or pneumatocele.Debris is noted in the proximal trachea along the superior margin of the study.MEDIASTINUM AND HILA: A large amount of debris is noted in the esophagus. No mediastinal or hilar lymphadenopathy is present. A right central venous catheter is present with its tip at the junction of the right innominate vein and SVC.The heart size is normal. No pericardial effusion is present. CHEST WALL: No osseous lesions are identified.UPPER ABDOMEN: The visualized liver, superior kidneys, and spleen appear within normal limits. | 1. No evidence of infection as clinically questioned.2. Large amount of debris in the esophagus and proximal trachea suggestive of aspiration.3. Small wedge-shaped area of low-attenuation in the right apex which may represent mosaic perfusion, air trapping, or a small bulla or pneumatocele, and is not felt to be of current clinical significance. |
Generate impression based on findings. | Obstructive hydrocephalus. preop planning 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 demonstrate bilateral prosthetic globesBurr holes are present in the frontal calvarium bilaterally associated with ventriculostomy tracts.Atherosclerotic calcifications are present along the distal internal carotid arteries. | 1.No evidence for acute intracranial hemorrhage mass effect or edema.2.The lateral ventricles appear similar in size when compared to prior exam and nondilated. |
Generate impression based on findings. | 46 year old female with right-sided abdominal pain/flank pain with 3+ blood on urinalysis. Within the limits of a non-IV contrast-enhanced examination which limits ability to evaluate solid parenchymal organs and vascular structures the following observations can be made:ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality noted in liver parenchymal although the lack of IV contrast limits ability to evaluate for masses. Patient is status post cholecystectomy with no inter or extrahepatic biliary duct dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Normal size kidneys, with minimal focal cortical scarring in the left kidney. Left lobe. Punctate, nonobstructing calyceal calculus seen. No other calcifications seen. No hydronephrosis and no perinephric fluid collections are seen. Ureters are nondilated with no evidence of ureteral calculus.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small anterior wall ventral paraumbilical hernia containing only mesenteric fat, unchanged.PELVIS:UTERUS, ADNEXA: Enlarged uterus, which, on prior contrast, CT shown to have multiple fibroid tumors. No other abnormalities.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. Punctate, nonobstructing left lower pole calyceal kidney calculus. 2. No evidence of urinary tract obstruction. 3. Fibroid uterus, unchanged. |
Generate impression based on findings. | Male 67 years old; Reason: evaluate for progression. History: kaposi's sarcoma. CHEST:LUNGS AND PLEURA: Slight increase in the moderate left pleural effusion which obscures evaluation of the left lower lobe. Left basilar consolidation/atelectasis. Narrowed appearance of left lower lobe bronchus is questioned. Interval resolution of the right lower lobe groundglass opacity.MEDIASTINUM AND HILA: Mediastinal (right paratracheal and subcarinal) lymphadenopathy. Reference right paratracheal lymph node is stable in size and measures1.6 x 1.9 cm (series 7 image 41) previously 1.8 cm x 1.7 cm. Mildly enlarged posterior mediastinal lymph node adjacent to descending thoracic aorta, paraesophageal lymph nodes, and borderline-enlarged left retrocrural lymph nodes are all stable to slightly increased.Small to moderate sized pericardial effusion is also slightly larger since previous. Normal heart size.CHEST WALL: Borderline enlarged and mildly enlarged bilateral subpectoral and axillary lymph nodes, left greater than right. For baseline purposes, left axillary lymph node (series 3 image 26) measures 1.5 cm x 1.1 cm. Other: Previously seen neck base and submental lymph nodes are not included on this examinationABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Mildly enlarged spleen (craniocaudal length 13.4 cm)PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Simple cyst interpolar left kidney. Likely extrarenal left pelvis. No new lesions detected.RETROPERITONEUM, LYMPH NODES: Retroperitoneal fluid and soft tissue without evident measurable enlarged lymph nodes.BOWEL, MESENTERY: Minimal haziness of the mesenteric fat. Surgical clips in the left upper abdomen. Mesenteric lymph nodes and mesenteric nodularity particularly adjacent to the descending colon. For baseline purposes, left upper abdominal nodule (series 3 image 124) measures 1.3 cm x 0.9 cm.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Bilateral mildly enlarged external iliac lymph nodes. Stable, right external iliac lymph node (series 7 image 196) measures 2.3 x 1 .0 cm, previously 2.2 cm x 1.2 cm. Borderline enlarged bilateral internal iliac lymph nodes. Bilateral inguinal lymph nodes not enlarged by size criteria.BOWEL, MESENTERY: Sigmoid colonic sutures. Multiple surgical clips along the serosal margin of the sigmoid and descending colon. Mesenteric and omental nodularity as described above.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Slight increase in the moderate left pleural effusion. Left basilar consolidation/atelectasis remains however underlying neoplasm/infectious etiology cannot entirely be ruled out.2. Stable thoracic and pelvic lymphadenopathy.3. Retroperitoneal fluid/soft tissue without measurable lymphadenopathy4. Mesenteric nodularity, particularly adjacent to the descending colon, of indeterminate etiology. Mesenteric and sigmoid colonic postsurgical changes |
Generate impression based on findings. | Chronic sinusitis. There are postoperative findings related to left uncinectomy and partial left internal ethmoidectomy. There is mild opacification of the posterior left maxillary sinus with bubbly secretions. In addition, there is lateralization of the left middle turbinate, which partially obstructs the left neo-infundibulum. There is minimal mucosal thickening within the right maxillary sinus. There is minimal mucosal thickening within the operated left ethmoid air cells, but there is mild buckling of the lamina papyracea medially into the ethmoid sinus space. There is also mild neo-osteogenesis in the left ethmoid sinuses. The right ethmoid air cells are clear. However, there appears to be dehiscence of the bilateral fovea ethmoidalis. The ethmoid roofs are otherwise nearly symmetric. The right frontal sinus is not pneumatized and the left frontal sinus is clear. The sphenoid sinuses are clear. The optic nerve canals are covered by bone. However, the right carotid groove may be dehiscent. The imaged portions of the intracranial structures and orbits are unremarkable. | 1. Postoperative findings related to left uncinectomy and partial left internal ethmoidectomy with mild opacification of the posterior left maxillary sinus, lateralization of the left middle turbinate, which partially obstructs the left neo-infundibulum, and mild opacification and neo-osteogenesis in the left ethmoid sinuses. 2. Apparent dehiscence of the bilateral fovea ethmoidalis. |
Generate impression based on findings. | 19 year-old male with Crohn's disease on mercaptopurine, presenting with abdominal pain and obstipation, rule out intestinal etiology. 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: Mesenteric lymphadenopathy likely related to the history of inflammatory bowel disease.BOWEL, MESENTERY: The jejunum and proximal ileum are poorly distended. The mid to distal ileum is better distended and visualized. No small bowel dilatation, wall thickening, fistula, free or loculated fluid. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Mesenteric lymphadenopathy likely related to the history of inflammatory bowel disease.BOWEL, MESENTERY: Fibrofatty proliferation of the mesentery most prominent about the rectosigmoid colon, which contains submucosal deposition suggesting a history of inflammation. No small bowel dilatation, wall thickening, fistula, free or loculated fluid. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No evidence of active inflammation, fistula or loculated fluid collection. Fibrofatty proliferation of the mesentery and submucosal fat deposition within the rectosigmoid colon consistent with the stated history of inflammatory bowel disease. |
Generate impression based on findings. | 46-year-old male with abdominal pain, elevated white blood cell count and elevated lipase. History of ulcerative colitis; abdominal pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Parenchyma enhances normally without focal abnormality or evidence of fluid accumulation. No dilatation of pancreatic duct is seen. No abnormal calcifications.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Orally administered contrast passes rapidly through normal-appearing stomach and small bowel to the colon. Mild circumferential thickening of the cecal wall most likely relates to adherent fecal debris without pericecal inflammatory changes and normal haustral fold patterns. Ascending and transverse colon show no diagnostic abnormalities. Descending colon and sigmoid colon show relative loss of haustral pattern, but without wall thickening or peri-colonic inflammatory changes. No rectal abnormalities are seen. No free mesenteric fluid.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: Orally administered contrast passes rapidly through normal-appearing stomach and small bowel to the colon. Mild circumferential thickening of the cecal wall most likely relates to adherent fecal debris without pericecal inflammatory changes and normal haustral fold patterns. Ascending and transverse colon show no diagnostic abnormalities. Descending colon and sigmoid colon show relative loss of haustral pattern, but without wall thickening or peri-colonic inflammatory changes. No rectal abnormalities are seen. No free mesenteric fluid.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. No CT evidence of pancreatic abnormality. 2. Changes in descending/sigmoid colon, compatible with history of ulcerative colitis, but without evidence of acute inflammatory disease. |
Generate impression based on findings. | Altered mental status. eval sdh, prior to anticoagulation The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post burr holes along the right frontal and parietal calvarium.There is redemonstration of an extra-axial collection adjacent to the right hemisphere which is heterogeneous density currently it measures up to 10 mm in thickness and previously measured approximately the same. This collection crosses sutures.The septum pellucidum is shifted approximately 3 mm the left of midline is stable when compared to prior examNo abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.Stable right-sided subacute subdural hematoma associated with midline shift |
Generate impression based on findings. | Reason: History of metastatic breast cancer on treatment. Evaluate for response and extent of disease. History: History of metastatic breast cancer on treatment. Evaluate for response and extent of disease. CHEST:LUNGS AND PLEURA: Interval appearance of a left apical nodule measuring 8 x 11 mm (series 4 image 7). Progressive left anterior pleural thickening with increasing nodular focus at the level of the lingula measuring 7 x 15 mm (series 4 image 41). In retrospect, this focus was barely perceptible, approximately 4 x 13 mm.Persistent ground glass occupies the right upper lobe. There is new bronchial wall thickening with tree in bud opacities in the anterior right upper lobe (series 4 image 28) that appear postinflammatory. Bilateral anterior subpleural reticulation is again identified, consistent with prior radiation exposure.No interval pleural effusion.MEDIASTINUM AND HILA: Increasing mediastinal and left hilar lymphadenopathy. Representative AP window lymph node measures 11 mm (series 3 image 30). This was barely perceptible on prior study. Left hilar lymph node measures 11 mm (series 3 image 33) as compared to 5 mm at the same level on the prior study.The heart size is normal. No interval pericardial effusion.CHEST WALL: The port catheter terminates at the superior caval atrial junction. Postsurgical changes from prior bilateral mastectomies.Left supraclavicular lymph node is stable at 9 mm.Within the left axillary region, there is slightly larger fluid collection with mild peripheral enhancement measuring 2.5 x 6.4 cm (series 3 image 55). This previously measured 1.7 x 6.3 centimeters. In addition, immediately superior to this in the axilla, soft tissue nodularity consistent with lymphadenopathy is also increasing in size. It measures 1.8 x 2.1 cm (series 3 image 40), as compared to 1.3 by 1.8 cm. Small seroma at the right chest wall is stable.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: 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: Previously noted punctate cortical sclerosis of the left ileum is not included in this field of view. Stable punctate sclerotic focus within the right posterior element of T9.OTHER: No significant abnormality noted. | Progressive disease with a new pulmonary nodule at the left apex. New aortopulmonary window and enlarging left hilar and axillary lymphadenopathy. Left anterior pleural nodular thickening suspicious for metastasis. |
Generate impression based on findings. | 24-year-old female patient with fevers. CHEST:LUNGS AND PLEURA: Right lung base scarring versus atelectasis. Interval resolution of right-sided pleural effusion. Moderate left-sided pleural effusion with associated atelectasis and volume loss, decreased compared to prior examination.MEDIASTINUM AND HILA: Multiple large superior mediastinal, thoracic inlet and supraclavicular lymph nodes, stable. Paratracheal lymph node measures 1.1 by 0.8 cm (series 3 image 19), previously 1.2 x 1.1 cm.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left pelvic kidney without hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Redemonstrated is right lower quadrant ileostomy. Status post subtotal colectomy with rectum and sigmoid Hartmann's pouch. Redemonstrated is a large amount of abdominal ascites and interloop fluid collections with enhancement of the peritoneum, stable. Free fluid tracks along the mesentery. Continued peritoneal thickening and enhancement.Interval placement of pigtail drain in right pericolic gutter. Trace amount of free air noted in the right lower quadrant (series 3 image 148).Multiple scattered loops of small bowel with thickened walls, which may suggest an element of inflammation versus infection.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumbar spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Redemonstrated is right lower quadrant ileostomy. Status post subtotal colectomy with recto-sigmoid Hartmann's pouch. Redemonstrated is a large amount of abdominal ascites and interloop fluid collections with enhancement of the peritoneum, stable. Free fluid tracks along the mesentery. Continued peritoneal thickening and enhancement.Interval placement of pigtail drain in right pericolic gutter. Trace amount of free air noted in the right lower quadrant (series 3 image 148).Multiple, scattered loops of small bowel with thickened walls, which may suggest an element of inflammation versus infection.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumbar spine.OTHER: No significant abnormality noted. | 1.Stable ascites and peritoneal enhancement in the abdomen and pelvis with interval placement of pigtail drain in right hemiabdomen.2.Multiple scattered loops of small bowel with wall thickening suggests possible inflammation versus infection. |
Generate impression based on findings. | Abdominal pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Uterus atrophic or absentBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Cholelithiasis without acute inflammation or ductal dilatation. Otherwise, negative examination. |
Generate impression based on findings. | Female 82 years old; Reason: 82 year old female with AML and fungal infection on chemotnic antifungal therapy. Please evaluate status of fungal disease. History: asymptomatic LUNGS AND PLEURA: No focal opacities in the lungs. Scant dependent atelectasis in the left lung base. The previously described left upper lobe patchy ground glass opacities are not visualized on today's exam indicating near complete resolution the previous fungal infection. Scattered pulmonary micronodules which are nonspecific.MEDIASTINUM AND HILA: Scattered subcentimeter mediastinal lymph nodes especially in the right paratracheal and subcarinal distribution. Mild cardiomegaly and mild coronary artery calcifications. No pericardial effusion. Left central venous catheter terminates in the distal SVC.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Status post cholecystectomy. Atherosclerotic calcifications are noted of the abdominal aorta. | Interval near complete resolution of the previous left upper lobe opacities, presumably representing fungal infection. |
Generate impression based on findings. | new AM headache rule out mass 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 demonstrate old left medial wall out fracture identified on prior MRI from 2008. | No evidence for acute intracranial hemorrhage mass effect or edema. |
Generate impression based on findings. | Female 63 years old; Reason: 63yo F with SLE presenting with hypoxia, respiratory distress, recurrent pneumonias, eval for etiology History: hypoxia. LUNGS AND PLEURA: There is pronounced predominantly basilar tree in bud opacities bilaterally, greater in the left lung base consistent with aspiration bronchiolitis. Within the lungs bilaterally there are a few scattered patchy/groundglass opacities in the periphery. There is no septal thickening. No focal consolidation or pleural effusions.MEDIASTINUM AND HILA: Scattered subsegmental lymph nodes in the mediastinum. No cardiomegaly or pericardial effusion. Modeate sized hiatal hernia.CHEST WALL: Severe thoracic scoliosis.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Subcentimeter hypodensity in the right lobe of the liver too small to characterize but likely represents a hepatic cyst.. | 1.Pronounced tree in bud opacities in the lung bases bilaterally greater on the left. Findings are consistent with aspiration bronchiolitis. The peripheral patchy ground glass opacities may be pneumonitis related to the patient's SLE. |
Generate impression based on findings. | Male, 68 years old, history of Parkinson's disease, presurgical planning for deep brain stimulator placement. Imaging is performed with a stereotactic frame in place. The ventricles and sulci are prominent compatible with generalized parenchymal volume loss. No mass effect, acute intracranial hemorrhage or abnormal fluid collections are detected.Mucosal thickening/secretions are present in the left maxillary sinus and scattered through the ethmoid air cells. The visualized bony structures are unremarkable. | Presurgical planning CT for deep brain stimulator placement. |
Generate impression based on findings. | Reason: Etiology/nature of mass in R-lung space History: SOB LUNGS AND PLEURA: Demonstration of moderate sized bilateral pleural effusions, right greater than left, with basilar atelectasis.There is narrowing of the right lower lobe bronchus at the segmental level with subsequent atelectasis.However, no definite mass lesion can be identified.No significant pulmonary edema.MEDIASTINUM AND HILA: Marked cardiac enlargement with a small pericardial effusion.Moderate coronary artery and aortic calcifications.Enlargement of the pulmonary artery compatible pulmonary arterial hypertension.Hypoattenuating blood pool compatible with anemia.No hilar or mediastinal lymphadenopathy.CHEST WALL: Severe anasarca. Marked degenerative changes throughout the spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Hypodense right renal 4-cm mass most likely represents a cyst. Splenic calcification. Atherosclerotic changes of the aorta and its branches. | 1.Severe cardiomegaly with small pericardial effusion and enlargement of the pulmonary artery.2.Bilateral pleural effusions with mild interstitial edema.3.Basilar atelectasis with some narrowing of the right lower lobe bronchus at the segmental level. No definite mass lesion identified.4.Severe anasarca.5.Hypoattenuating right renal mass most likely represents a cyst. |
Generate impression based on findings. | T4aN2c SCC left retromolar trigone s/p EPIC trial cis/cetuximab/RT, completed in June 2009. Head CT: There is minimal residual hypoattenuation within the anterior left temporal lobe and no residual abnormal enhancement, suggests evolution of radiation necrosis. There is no evidence of additional intracranial lesions. The ventricles are stable in size and configuration. The osseous structures are unremarkable. There is a now an air-fluid level within the left maxillary sinus, while the right maxillary sinus opacification has cleared. There is minimal opacification of the bilateral mastoid air cells.Neck CT: Extensive streak artifact related to dental amalgam obscures much of the oral cavity structures. There are stable posttreatment findings in the left retromolar trigone region. The left parapharyngeal space remains effaced. There are no significantly enlarged lymph nodes by size criteria. The major salivary glands appear unchanged, including atrophy and hyperemia of the submandibular glands. The thyroid gland is perhaps mildly atrophic. The airways are patent. The major cervical vessels are patent. There is unchanged degenerative spondylosis in the cervical spine, particularly at the C4-5 to C6-C7 level, where there is spinal canal and neuroforaminal narrowing. There is mild emphysema in the lung apices. | 1. Stable posttreatment change in the left retromolar trigone region with no definite evidence of locoregional tumor recurrence or significant cervical lymphadenopathy, although evaluation is limited by artifact related to dental amalgam.2. Evolution of mild radiation necrosis in the left anterior temporal lobe without evidence intracranial metastases.3. Acute left maxillary sinusitis. |
Generate impression based on findings. | Male 85 years old; Reason: Pt with hs of Thyroid Ca. Please re-eval and compare History: as above. CHEST:LUNGS AND PLEURA: Multiple micro-nodules, some of which are calcified, compatible with previous infection. Apical scarring and calcification, unchanged. No suspicious nodules.MEDIASTINUM AND HILA: Postsurgical changes from a previous thyroid surgery. No significant mediastinal or hilar lymphadenopathy. Pacemaker device with leads in the area of the right atrial appendage and right ventricular apex. Mild coronary artery calcification.CHEST WALL: Degenerative changes of the spine. Pacemaker generator in left anterior chest wall.ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Unchanged right renal hypodensity.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Aortobiiliac atherosclerotic calcifications.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Mild degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality noted. | No evidence of metastatic disease and no significant change. |
Generate impression based on findings. | Reason: 58M, immunosuppressed, multifocal opacities on CXR, please further characterize History: productive cough LUNGS AND PLEURA: Development of a multiple cavitating nodules and masses in both lungs with surrounding groundglass. The largest of these lesions are noted in the right upper lobe (image 45 series 5) measuring 3.5 cm x 4.8 cm and in the superior segment of the left lower lobe (image 58 series 5) measuring 5.8 cm x 5.8 cm.Numerous other smaller nodules, some with cavitation are identified.There is significant bronchial wall thickening particularly in the lower lobes.No pleural effusions.MEDIASTINUM AND HILA: Enlarged mediastinal lymph nodes with low left paratracheal lymph node measuring 18 mm (image 45 series 3).Subcarinal lymph node (image 54 series 3) measures 12 mm.Right hilar lymph node (image 50 series 3) measures 14 mm.Cardiac size is normal without evidence of a pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Evidence of mucosal edema involving the proximal small bowel. | Interval development of multiple cavitating nodules with surrounding ground glass throughout both lungs compatible with opportunistic infections including fungal and atypical etiologies. |
Generate impression based on findings. | Female 56 years old; Reason: Pt with hx of HNC s/p EPic trial in 2009 and CRT 1/12. please re-eval for recurrence History: as above. CHEST:LUNGS AND PLEURA: Postradiation fibrosis in the lung apex. Apical predominant mild centrilobular emphysema. Interval resolution of the previous right upper lobe opacity which was just above the minor fissure. However, there are a few areas of bronchial wall thickening and groundglass opacities as well as mucus plugging in the left lower lobe, consistent with aspiration. No evidence of pulmonary or pleural metastases.MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. No cardiomegaly or pericardial effusion.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Phrygian cap gallbladder common normal variant, containing a gallstone unchanged since 4/10/2009.SPLEEN: Tiny hypodensity in the spleen too small to characterize, but likely benign.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal stone is unchanged.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.High-density structures anterior to the gastric wall in the area of the prior percutaneous gastrostomy tube 2009 seen in left upper abdomen.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.No evidence of metastases. 2.Interval resolution of the previous right upper lobe opacity.3.Interval new development of mild left lower lobe aspiration. |
Generate impression based on findings. | 47-year-old female with metastatic melanoma, evaluate for progression. CHEST:LUNGS AND PLEURA: Unchanged micronodule and subpleural nodular opacity.MEDIASTINUM AND HILA: Central venous catheter extends to the right SVC. Reference mediastinal lymph node measures 1.7 x 0.9 cm (image 32 series 3) and previously measured 1.5 x 1.1 cm. Additional mediastinal adenopathy is unchanged.CHEST WALL: Chest wall port catheter.ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. No focal hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Interval placement of left nephroureterostomy catheter with tip extending from the left renal pelvis to the urinary bladder. Prominence of the left renal collecting system.RETROPERITONEUM, LYMPH NODES: Retroperitoneal adenopathy and soft tissue mass is again noted. Reference left para-aortic lymph node measures 2.4 x 2.0 cm (image 108, series 3) and previous measured 2.4 x 1 .7 cm, mildly increased in size. Additional retroperitoneal lymph nodes are also mildly enlarged. Infiltrating soft tissue encasing the iliac vessels and ureter on the left, extending along the psoas muscles is also mildly increased in extent. There is Atherosclerotic calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Ventral hernia containing colon without evidence of obstruction.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Reference left obturator lymph node measures 1.7 x 1.2 cm and previously measured 1.6 x 1.3 cm (image 166, series 3). BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Status post bilateral inguinal lymph node dissection.OTHER: No significant abnormality noted. | 1. Mildly increased abdominal lymphadenopathy and soft tissue encasing the left ureter and extending along the psoas muscle. |
Generate impression based on findings. | Male 50 years old; Reason: GI Malignancy please compare to previous scan and provide index lesion measurements for RECIST History: As above CHEST:LUNGS AND PLEURA: Scattered micronodules are stable. Mild bibasilar dependent atelectasis.MEDIASTINUM AND HILA: Decreasing size of the mediastinal lymph nodes including a reference subcarinal lymph node measuring 1.3 x 1 .0 cm, previously 1.1 x 1.7 cm subcarinal node (series 3, image 48). The reference left para-aortic lymph node measures 1.1 x 1.3 cm (series 3 image 56) previously 1.6 x 1.3 cm.CHEST WALL: Right chest wall port terminates at the cavoatrial junction. ABDOMEN:LIVER, BILIARY TRACT: 1.4 x 1.0 cm right hepatic lobe lesion (series 3, image 108) is stable. Stable Irregular enhancing soft tissue in gallbladder wall, likely represents a benign etiology given its stable nature (series 3, image 109). No biliary ductal dilatation. Patent hepatic vasculature. Portal vein is mildly attenuated by porta hepatis lymphadenopathy but remains patent. SPLEEN: No significant abnormality notedPANCREAS: No focal pancreatic lesion. ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Extensive retrocrural, peripancreatic, porta hepatis, and retroperitoneal lymphadenopathy. The reference peripancreatic lymph node measures 2.5 x 2.2 cm (series 3 image 104) previously 2.2 x 2.8 cm. The reference aortocaval lymph node measures 1.3 x 1.7cm (series 3, image 143) previously 1.8 x 2.1 cm . BOWEL, MESENTERY: Previously non-referenced mesenteric lymphadenopathy and congestion is now more prominent, and larger since the previous examination.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Infrerenal IVC filter noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Multiple mildly enlarged pelvic lymph nodes, including the 1.2 x 1.6 cm right internal iliac chain node (series 3, image 172) previously 1 x 1.3 cm. While this lesion is smaller, and numerous non-referenced pelvic lymphadenopathy including a left external iliac node (series 3 image 188) is markedly increased, and measures 1.4 x 2 .5 cm, previously 1.9 x 0.7 cm. BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Stable gallbladder enhancing focus of unclear etiology. Given its stable nature, this likely represents benign etiology.2. Mixed response of the adenopathy. While reference retroperitoneal paraaortic lesions have slightly decreased in size, numerous non-referenced mesenteric, and pelvic lymph nodes have markedly increased in size. |
Generate impression based on findings. | 57-year-old female with bladder cancer -- restaging status post 6 cycles of chemotherapy. CHEST:LUNGS AND PLEURA: Scattered micronodules unchanged. No new nodules, infiltrates or effusions.MEDIASTINUM AND HILA: No, adenopathy or masses.CHEST WALL: Stable appearance to the scattered small nonspecific sclerotic foci in the vertebral bodies. No evidence for metastatic disease.ABDOMEN:LIVER, BILIARY TRACT: No change in the scattered subcentimeter hypodense lesions most likely cysts. Enhancing lesion in segment 4 periphery (series 3, image 91) is unchanged and most likely represents a flash filling hemangioma. No evidence for metastatic disease. Gallbladder and biliary tract appear normal. 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 enlarged lymph nodes identified. No other masses.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: Enlarged right external iliac lymph node again seen (series 3, image 174) measures 2.6 x 1 .3 cm, previously 2.7 x 1.6 cm. The prior referenced right femoral reference lymph node is more difficult to compare due to different slice sampling of the node. It currently measures 1.9 x 1.3 cm (series 3, image 174) , previously 2.5 x 0.8 cm. BOWEL, MESENTERY: No significant abnormality noted..BONES, SOFT TISSUES: Scattered, subcentimeter sclerotic foci throughout in left iliac bone and right acetabulum, unchanged.OTHER: No significant abnormality noted.. | 1. Stable right external iliac/femoral lymph nodes with reference measurements above. No other foci of enlarged lymph nodes identified. 2. Stable nonspecific pulmonary, parenchymal micro-lung nodules. 3. Stable scattered nonspecific small sclerotic foci in the skeletal system. |
Generate impression based on findings. | 76-year-old male history of prostate cancer status post 3 cycles of chemotherapy, evaluate for progression. CHEST:LUNGS AND PLEURA: Scattered micronodules are unchanged.MEDIASTINUM AND HILA: Reference benign-appearing paratracheal lymph node measures 1.2 x 1.1 cm and previously measured 1.6 x 1.4 cm (image 33 series 3).CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT:Unchanged peripheral right hepatic cysts. The gallbladder appears unremarkable.SPLEEN: No significant abnormality notedPANCREAS: Fatty atrophy of the pancreas, appropriate for age.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Unchanged hypoattenuating centimeter right renal lesion.RETROPERITONEUM, LYMPH NODES: Infrarenal abdominal aortic aneurysm measuring 3.1 cm previously measured 3.1 cm (image 130, series 3). Small retroperitoneal lymph nodes are unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multifocal osseous metastatic disease is unchanged.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Multifocal osseous metastatic disease is unchanged.OTHER: No significant abnormality noted | No new lesions or significant interval change from the prior study. Metastatic disease appears limited to skeletal system. |
Generate impression based on findings. | 73-year-old male patient with renal cancer. Assess for disease progression. CHEST:LUNGS AND PLEURA: Right lower lobe micronodule along the fissure is stable compared to prior examination (series 6 image 262).MEDIASTINUM AND HILA: Redemonstration of hypoattenuating right lesion, stable. Enlarged subcarinal lymph node measures 2.0 x 1.4 cm (series 4 image 64), previously 1.7 x 1.2 cm.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Hyperattenuating focus in the spleen stable compared to prior examination and may represent a hemangioma.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Status post right adrenalectomy.KIDNEYS, URETERS: Status post right nephrectomy. Hypoattenuating left renal lesions are stable compared to prior examination and most likely represent cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumbar spine.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate with TURP defect.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumbar spine.OTHER: No significant abnormality noted | 1.Minimally enlarged mediastinal lymph node.2.Status post right nephrectomy without evidence of local recurrence.3.Stable right lower lobe micronodule. |
Generate impression based on findings. | Male 63 years old; Reason: mets lung cancer. s/p 2 cycles of Irinotecan, pls c/w previous study to evaluate tx response, Pls comment on the left supraclavicular/retroclavicular LAD as well. History: lung ca CHEST:LUNGS AND PLEURA: Paramediastinal fibrotic changes from radiation. Left pleural effusion appears decreased compared to prior exam. Persistent decreased vascularity to the right upper lobe compared with right lower lobe and left lung presumably due to radiation scarring affecting vascular perfusion. Ground glass opacities in the left lung and lower right lung are slightly improved compared to prior exam but some persist in left lower lobe. Anterior right lower lobe shows centribobular small nodularity and scattered ground glass opacities seen in both lower lobes with bronchiolar wall thickening -- the pattern raises the question of aspiration bronchiolitis. MEDIASTINUM AND HILA: Reference left retroclavicular lymph node measures 0.8 x 0.9 cm, previously 0.8 x 1.3 cm as seen on image 12 of series 4 the. Reference right paratracheal lymph node measures 1.6 x 1 .6 cm, previously 2.1 x 2.1 cm as seen on image 27 of series 4..CHEST WALL: No significant abnormality noteddABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noteddSPLEEN: No significant abnormality noteddPANCREAS: No significant abnormality noteddADRENAL GLANDS: No significant abnormality noteddKIDNEYS, URETERS: Round, exophytic stable right renal cyst..RETROPERITONEUM, LYMPH NODES: Reference retroperitoneal lymph node measures 1.4 x 2 .3 cm, previously 1.6 x 2.8 cm as seen on image 117 of series 3.. This is decreased in size.A non-reference left para-aortic lymph node measures 1.9 x 2.6 cm (series 4 image 7), which has markedly increased in size from the previous of 1.8 x 1.4 cm.Left-sided IVC noted. Atherosclerotic abdominal aorta.BOWEL, MESENTERY: There is a hiatal hernia..BONES, SOFT TISSUES: No significant abnormality noteddOTHER: No significant abnormality noteddPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noteddBLADDER: No significant abnormality noteddLYMPH NODES: No significant abnormality noteddBOWEL, MESENTERY: No significant abnormality noteddBONES, SOFT TISSUES: No significant abnormality noteddOTHER: No significant abnormality notedd | 1. Mixed response of the reference a non-reference adenopathy. While the reference nodes have decreased in size, non-reference retroperitoneal adenopathy has increased in size as referenced above. 2. Bilateral pulmonary ground glass opacities of and right lobe centrilobular micronodule changes unclear - while nonspecific this raises the question of aspiration bronchiolitis. |
Generate impression based on findings. | History of neuroblastoma status post chemotherapy, surgery, radiation. CHEST: LUNGS AND PLEURA: Unchanged 3-mm right upper lobe nodule (series 4, image 21). No new nodules identified. MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Normal sized heart without pericardial effusion. CHEST WALL: No axillary lymphadenopathy. The right internal jugular vein is enlarged, similar to prior.ABDOMEN:LIVER, BILIARY TRACT: Normal enhancement of the liver, without focal lesions seen. No intrahepatic or extrahepatic biliary ductal dilatation. Normal appearing gallbladder.SPLEEN: Normal in appearance.PANCREAS: Normal in appearance.ADRENAL GLANDS: Normal in appearance.KIDNEYS, URETERS: Thinned cortex of the superior pole of the left kidney, similar to the prior exam. RETROPERITONEUM, LYMPH NODES: The left retroperitoneal soft tissue, presumably representing a conglomerate of lymph nodes, measures 1.6 x 0.4 cm (series 3, image 56), previously 1.7 x 0.5 cm.BOWEL, MESENTERY: Normal appearing loops of bowel.BONES, SOFT TISSUES: No soft tissue or osseous lesion seen. Surgical changes from prior bilateral iliac biopsies.OTHER: No ascites.PELVIS:PROSTATE, SEMINAL VESICLES: Normal in appearance.BLADDER: Distended.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: Normal appearing loops of bowel.BONES, SOFT TISSUES: No soft tissue or osseous lesion seen.OTHER: No ascites. | Unchanged appearance of the right upper lobe micronodule and left-sided retroperitoneal soft tissue. |
Generate impression based on findings. | 59-year-old male patient with pancreatic cancer. Evaluate for disease progression. CHEST:LUNGS AND PLEURA: Right lower lobe pulmonary micronodule (series 4 image 106), new since CT chest 6/11/2013.MEDIASTINUM AND HILA: Right chest port with catheter tip at the cavoatrial junction.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Redemonstrated is common bile duct stent with expected pneumobilia. No focal hepatic lesion identified. Patent hepatic vasculature.SPLEEN: Splenomegaly, stable.PANCREAS: Redemonstration of pancreatic head, neck and proximal body mass. Mass measures 9.1 x 3.5 cm (series 3 image 116), previously 7.8 x 3.1 cm.Again noted is involvement and attenuation of the celiac axis, superior mesenteric artery and portal splenic confluence.Extensive mesenteric, perigastric and perisplenic collaterals are again noted.ADRENAL GLANDS: Stable bilateral adrenal nodules, previously characterized as adenomas on MR.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Prominent peripancreatic lymph nodes and retroperitoneal lymph nodes, stable.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumber spine.OTHER: Small amount of abdominal ascites.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumber spine.OTHER: Interval increase in free pelvic fluid. | 1.Interval increase in the size of the pancreatic mass.2.Stable vascular involvement and attenuation by pancreatic tumor. |
Generate impression based on findings. | 57-year-old male with history of testis cancer, status post retroperitoneal lymph node dissection. CHEST:LUNGS AND PLEURA: No new nodules, infiltrates or effusions. Left lower lobe micro-nodule previously referenced (series 5, image 77) is ill-defined and barely visible on today's examination.MEDIASTINUM AND HILA: No masses or other abnormality. CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No change in the dilatation intrahepatic and extrahepatic bile ducts, dating back to 2006. Gallbladder is normal in appearance. Liver parenchyma shows no mass lesions. Vascular structures appear normal.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Scattered surgical clips from prior surgery. No evidence of recurrent lymphadenopathy.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 change in the appearance of the small scattered subcentimeter left external iliac and femoral lymph nodes. No evidence of lymphadenopathy is seen.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Stable examination with no evidence for recurrent cancer. |
Generate impression based on findings. | Obesity with recurrent ventral hernia ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Subcentimeter left renal cystsRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: At least 6 ventral hernias are identified best identified on coronal projection image 77. While 4 of these ventral hernias contain only mesenteric fat, two of the inferior ventral hernias include small bowel loops within the hernia sac without evidence for bowel, edema or bowel obstruction.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Moderately severe sigmoid diverticulosis with evidence of chronic inflammation.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | At least 6 ventral hernias. Two of the inferior ventral hernias contain small bowel loops within the hernia sac without evidence for bowel wall edema or bowel obstruction. |
Generate impression based on findings. | Patient with ampullary cancer and pancreatitis with necrosis of the ERCP. Status post IR drainage. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: There is a metallic stent in the common bile duct. Pneumobilia is present. Pancreatic duct is dilated. Collection near the tail of the pancreas has resolved within the internal. Patient's known ampullary cancer not well seen on today's study. There is fat stranding around the pancreas indicating evidence of inflammation. Chronic thrombosis of the splenic vein with associated with collaterals, unchanged.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral small hypodense lesions are unchanged.RETROPERITONEUM, LYMPH NODES: Borderline enlarged retroperitoneal lymph nodes, unchanged.BOWEL, MESENTERY: There are diffuse peritoneal soft tissue density lesions. These may represent peritoneal carcinomatosis. Alternatively they may represent residual/resolving inflammatory changes.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 | Interval resolution of the fluid collections near the tail and body of the pancreas.Peritoneal soft tissue densities, prick carcinomatosis cannot be excluded. |
Generate impression based on findings. | Reason: History of mesothelioma - restaging CT History: History of mesothelioma - restaging CT CHEST:LUNGS AND PLEURA: Surgical changes at the right lung base with a mesh graft is unchanged. Increased right medial lower lobe atelectasis. Diffuse, nodular right hemithorax pleural thickening mildly improved compared to prior exam.Reference measurements are as follows:1.At the level of the right pulmonary artery at the 9 o'clock position (series 3, image 44), pleural thickening measures 7 mm, previously 13 mm.2.At the level of the heart base at the 4 o'clock position (series 3, image 69), right crural soft tissue nodule measures 1.6 x 4.2 cm, previously measuring 1.8 x 3.8 cm.3.Abutting the right ventricle at the 12 o'clock position (series 3, image 15), pericardial soft tissue nodule measures 1.9 x 4.2 cm, previously measuring 1.8 x 4.2 cm.Innumerable left lung pulmonary nodules which are not significantly changed compared to prior exam. The reference left upper lobe nodule measures 6 mm, previously measuring 6 mm (series 4, image 38).MEDIASTINUM AND HILA: Mild interval increase in mediastinal lymphadenopathy. Left upper paratracheal lymph node now measures 15 mm in short axis (series 3, image 21), previously 12 mm. In addition a left upper paratracheal lymph node now measures 14 mm in short axis (series 3, image 28), previously 12 mm.Reference right lower paratracheal lymph node now measures 24 mm in short axis (series 3, image 36), previously 24 mm.Heart size is normal. No significant pericardial effusion.CHEST WALL: Multiple confluent enhancing soft tissue mass in the right lateral chest wall a interval decrease in size. The reference right axillary lymph node measures 14 mm in short axis (series 3, image 30) previously 14 mm. Right axillary lymphadenopathy is not significantly changed compared to prior exam.Degenerative changes thoracic spine are unchanged.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Stable aortocaval lymphadenopathy. The reference aortocaval lymph node measures 14 mm (series 3, image 91) previously 15 mm.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. | Overall stable exam with mixed response demonstrating interval decrease in the right lung hemithorax pleural disease and minimal interval increase in mediastinal lymphadenopathy. Left lung nodules are not significantly changed. |
Generate impression based on findings. | History of renal cell carcinoma, status post left partial nephrectomy ABDOMEN:LUNG BASES: Pleural-based nodular densities in the lung bases bilaterally are stable.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal nodule measuring 1.4 x 1 cm image number 39, series number 5, new from previous study. MRI of the adrenal glands and helpful for further evaluation.KIDNEYS, URETERS: Interval resection of patient's known left lower pole enhancing mass. Postsurgical changes around the lower pole of the left kidney. Right kidney is unremarkable except for a simple appearing cyst in the lower pole.RETROPERITONEUM, LYMPH NODES: Incidentally noted is left-sided inferior vena cava. Small retroperitoneal lymph nodes are unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate gland.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 | Interval resection of patient's known left lower pole renal mass. New, left adrenal nodule. Further evaluation with adrenal MRI may be helpful. |
Generate impression based on findings. | AMS r/o acute changes. There is an apparent subtle area of hypoattenuation in the right medial temporal lobe without associated mass effect. There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. | No evidence of intracranial hemorrhage. An apparent subtle area of hypoattenuation in the medial temporal lobe without associated mass effect may be artifactual or represent an ischemic process, among other possibilities. Further characterization via MRI is recommended if there are no contraindications. |
Generate impression based on findings. | Reason: eval for metastaic disease. h/o recurretn basal and scc History: none LUNGS AND PLEURA: Stable scattered nonspecific micronodules.No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of a pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Fatty infiltration of the liver. | No evidence of metastatic disease. |
Generate impression based on findings. | Male 63 years old; Reason: please evaluate for recurrence of bladder cancer History: bladder cancer s/p cystectomy and orthotopic neobladder. ABDOMEN: The absence of intravenous and oral contrast limits evaluation of the solid organs and of the bowels. Given these limitations, the following observations were made:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Fatty infiltration of the liver is seen. No focal lesion is identified although limited given lack of IV contrast. The gallbladder is normal without any intrahepatic or extra hepatic biliary ductal dilation.SPLEEN: No significant abnormality noted.PANCREAS: Diffuse calcifications are noted the pancreatic head most often associated with chronic pancreatitis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No focal lesion detected. No hydronephrosis or perinephric fluid collections.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:BLADDER: Patient status post cystoprostatectomy with neo bladder formation. LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.No evident metastatic or recurrent disease although limited given lack of IV contrast. For full characterization of the ureters, CT urography is recommended.2.Numerous calcifications in the pancreatic head, most often associated with chronic pancreatitis.3. Diffuse hepatic steatosis. |
Generate impression based on findings. | 63 year-old male with history of tonsil cancer and status post CRT. The orbits are unremarkable. The mastoid air cells are clear. Limited view of the intracranial structure is unremarkable. Posttreatment findings, including loss of normal fat planes in the right parapharyngeal and perivascular space, are again noted. No new enhancing mass or focal effacement of the aerodigestive tract is noted. No lymphadenopathy is noted.The oral cavity, oro/nasopharynx, hypopharynx, larynx and subglottic airways are patent. The epiglottis, vallecula, piriform sinuses, and vocal cords are normal. The parotid, submandibular, and thyroid glands are unremarkable. The carotid arteries and jugular veins are patent.Postsurgical findings are noted from prior sinus surgery. Minimal mucosal thickening is noted in the right maxillary sinus. Mild degenerative disease is noted at C5-6. Nonunion of the C1 posterior arch. The osseous structures are otherwise unremarkable.Please see chest CT for additional findings. | Stable posttreatment findings, with no evidence of recurrent/residual disease or cervical lymphadenopathy. |
Generate impression based on findings. | Metastatic thyroid cancer and squamous cell carcinoma of larynx. There are extensive post-treatment findings related to thyroidectomy, pharyngolaryngectomy with flap reconstruction, tracheostomy and voice prosthesis insertion, neck dissection, and radiation therapy. No recurrent mass is identified. There is no evidence of significant cervical lymphadenopathy. There is no interval change in a heterogeneous soft tissue nodule presumed to represent residual left thyroid tissue that measures 14 x 8 mm. The reconstructed airway is patent. There are secretions within the neopharynx. The stent right carotid artery remains patent. The left internal jugular vein has been ligated. There is unchanged sclerosis of C3 through C6 vertebral bodies with kyphotic angulation. The orbits and imaged intracranial structures are unremarkable. There is centrilobular emphysema and micronodules in the right lung. Refer to the separate chest CT report for additional details. | Interval evolution of extensive post-treatment findings without definite evidence of locoregional tumor recurrence of significant cervical lymphadenopathy. |
Generate impression based on findings. | Male, 57 years old, history of left neck squamous cell carcinoma status post CRT. Postsurgical findings are redemonstrated in the left neck compatible with a resection of the parotid gland, left neck dissection and soft tissue flap reconstruction. The appearance of these findings is not significantly changed. Within this very distorted background, no evidence of recurrent disease is demonstrated.No pathologic adenopathy is identified within the neck by size criteria. Right parotid gland and the submandibular glands are unremarkable. The thyroid is free of focal lesions.Supraglottic mucosal edema is again seen appearing similar to the prior exam and likely reflecting posttherapy change. The aerodigestive tract is otherwise unremarkable.The left internal jugular vein is absent, a stable finding. The remaining vessels are unremarkable.Cystic change is redemonstrated in the right upper lung and there is stable reticulation in the left upper lung.No concerning osseous lesions are demonstrated. | Post surgical and post treatment findings are redemonstrated with no evidence of recurrent disease or pathologic adenopathy. |
Generate impression based on findings. | 78-year-old male with history of urothelial cancer CHEST:LUNGS AND PLEURA: Paraseptal emphysema and basilar predominant reticular interstitial opacities, similar to the prior study. Scattered micronodules are unchanged. Calcified left pleural plaque is unchanged.MEDIASTINUM AND HILA: Interval increase in the size of the mediastinal lymph nodes. Index prevascular lymph node measures 2.1 x 1.4 cm image number 32, series number 4. This lymph node was measuring 1.2 by 0.7-cm image number 35, series number 3. Esophagus is again dilated.CHEST WALL: Interval increase in the size of the right axillary lymph nodes. Index right axillary node now measures 1.8 by 1.2-cm image number 25, series number 4. This lymph node was measuring 1 x 0.6 cm on image number 18, series number 3.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: New left adrenal nodule measures two by 1.9-cm image number 88, series number 4. Right adrenal gland is unremarkable.KIDNEYS, URETERS: Interval placement of double-J stent into the left renal collecting system and interval resolution of left-sided hydronephrosis.RETROPERITONEUM, LYMPH NODES: Significant interval increase in the size and number of retroperitoneal and mesenteric adenopathy suspicious for metastatic disease. Index left paraortic lymph node measures 2 x 1.5 cm image number 122, series number 4. This lymph node was measuring 1.1 x 0.7 cm on image number 123, series number 3.BOWEL, MESENTERY: Interval development of multiple mesenteric adenopathy and mesenteric fat stranding.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy.BLADDER: Status post cystectomy.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Interval development of right axillary, mediastinal, retroperitoneal and mesenteric adenopathy. |
Generate impression based on findings. | HPT PLEASE DO A 4D CT SCAN Re-op parathyroid Recurrence Sesta scan U of C s/o inferior pole of the leftt Please look for parathyroid adenomas 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 # 289 ):: 83.38HU, 218.57HU, 178.03HU, 174.29Right Carotid artery (image # 270 ):: 47.98HU, 336.26HU, 155.77HU, 141.18HURight Jugular vein (image # 244 ):: 34.61HU, 232.72HU, 164.46HU,153.15HURight submandibular gland (image # 148 ): 37.96hu, 71.74hu, 95.96hu, 100.38HURight sternocleidomastoid muscle: (image # 222 ): 57.99HU, 86.91HU, 86.76HU, 92.80HULymph node (image # 247-252 ): 47.05HU, 84.73 HU, 90.75HU, 82.70HU, 12x6mm nodule inferior to the left lobe of the thyroid (image # 366-373): 4.82HU, 122HU, 64.73HU, 60.43 HUplease note that a draining vein from this lesion extends into the distal left innominate vein11x7mm nodule left of jugular vein (image#314): 61.79HU, 49.08HU, 55.08HU, 51.63HUCT 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 thyroid gland contains a multiple hypodense foci. Surgical clips are present along the inferior aspect of the right thyroid bed.The airway appears patent.The visualized intracranial structures which include the posterior fossa are intact. The visualized portions of the orbits and paranasal sinuses are intact. 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 in the cervical spine with endplate and uncovertebral osteophytes present at see 45, C5-6 with some mild narrowing of the foramina at these levelsParathyroid sampling:Intraprocedural images demonstrate the location of venous sampling.Reported PTH, Intact values (REF 15-75 pg/mL):FEMORAL VEIN: 65SUPERIOR VENA CAVA: 115INNOMINATE VEIN JUNCTION: 94LEFT INNOMINATE VEIN: 72LEFT INTERNAL JUGULAR VEIN, LOWER: 69LEFT INTERNAL JUGULAR VEIN,MID: 72LEFT INTERNAL JUGULAR VEIN, UPPER: 67RIGHT INTERNAL JUGULAR VEIN, LOWER: 95RIGHT INTERNAL JUGULAR VEIN, MID: 72RIGHT INTERNAL JUGULAR VEIN, UPPER: 70 | 1.There is a small nodule inferior to the left thyroid gland which is suspicious for parathyroid adenoma2.multiple lesions in the thyroid gland are non-specific. Please refer to ultrasound study for further comments. |
Generate impression based on findings. | 83-year-old male with a thoracic aneurysm repaired in past. CHEST:LUNGS AND PLEURA: Diffuse emphysematous changes are again seen with scattered micronodules similar in appearance. No new nodules, masses, infiltrates or effusions seen. MEDIASTINUM AND HILA: Atherosclerotic calcification again seen diffusely in the aorta and coronary arteries. Descending aorta, aortic arch are unchanged and otherwise, unremarkable. The saccular aneurysm off the descending thoracic aorta is again seen, unchanged in its appearance. On sagittal view (image 84). It extends over a 3.2-cm length and creates a cross-sectional maximal diameter of 4.4-cm, unchanged. Prior reported to measure the diameter is 1.5 cm, which seem to represent the margin of the aneurysm to the expected location of the anterior wall and this too appears unchanged.CHEST WALL: No significant abnormality notedABDOMEN: Within the limits of non-IV contrast enhanced examination limiting evaluation of solid organ parenchyma and vascular structures to following observations can be made:LIVER, BILIARY TRACT: Liver parenchyma appears homogeneous. Multiple gallstones again seen without other complication. No intrahepatic or extra hepatic biliary duct dilatation is seen.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Lack of IV contrast limits ability evaluate renal parenchyma, however, the left lower pole water density lesion appears unchanged in size. It is stable since 2011 examination and most likely represents a benign cyst. No other significant lesions are seen in the kidneys. No abnormal calcifications or hydronephrosis is seen.RETROPERITONEUM, LYMPH NODES: Status post aortic aneurysm stent graft extending to the iliac bifurcation unchanged in appearance. The maximum diameter of the overlying sac measures 4.2-cm (coronal series image 65). No other changes abnormalities or masses. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Diffuse skeletal degenerative change without focal abnormality seen.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate, unchanged.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Diffuse degenerative disease seen without significant focal abnormality. Left inguinal hernia containing mesenteric fat, unchanged.OTHER: Penile prosthesis and reservoir pump unchanged. | 1. No change descending thoracic saccular aneurysm as measured and described above. 2. Abdominal aortic aneurysm with graft and aneurysm sac unchanged. 3. Gallstones unchanged without complication. 4. Left inguinal hernia containing only mesenteric fat. |
Generate impression based on findings. | Pre-kidney transplant evaluation ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right kidney is not visualized. There is a large amorphous calcification in the right renal bed measuring 2.6 x 1.3 cm. The etiology of this calcification is unknown. Atrophic left kidney with extensive vascular calcifications.RETROPERITONEUM, LYMPH NODES: Extensive atherosclerotic disease with calcifications along the aorta and its major branches and bilateral common iliac artery.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Limited study to the lack of IV contrast. Extensive atherosclerotic changes. Cholelithiasis. Right kidney is not visualized. |
Generate impression based on findings. | Unresectable carcinoid tumor CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Index pretracheal lymph node measures 1.4 x 1.3 cm image number 43, series number 7 , not significantly changed from previous study.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Index aortocaval lymph node measures one by 0.8-cm image number 115, series number 7.BOWEL, MESENTERY: Patient's known ill defined soft tissue mass in the mesentery is grossly stable and measures 3.1 by 1.8-cm image number 120, series number 7. Index mesenteric lymph node measures 1 cm in diameter image number 132, series number 7, not significantly changed from previous study.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate, unchanged.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No significant change from previous study. |
Generate impression based on findings. | Right sided headache, hx of craniotomy. There is a left suboccipital post craniotomy with underlying encephalomalacia. There is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are stable in size and configuration. Linear calcifications within the left lateral ventricle are unchanged and are likely related to the prior ventricular shunt. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. There is apparent mild subluxation of the bilateral mandibular condyles, likely related to open mouth position. The extracranial soft tissues are unremarkable. | No evidence of acute intracranial hemorrhage, mass, or cerebral edema. However, CT is insensitive for the early detection of nonhemorrhagic stroke, |
Generate impression based on findings. | 47-year-old male with history of renal skull carcinoma CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Diffuse fatty infiltration of the liver.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable postsurgical changes of partial nephrectomy involving the lower pole of the left kidney. Bilateral small hypodense lesions are stable. No evidence of recurrent or metastatic disease.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: No significant abnormality notedOTHER: No significant abnormality noted | No evidence of recurrent or metastatic disease. |
Generate impression based on findings. | Peripheral T-cell lymphoma s/p autologous stem cell transplant (4/29/2013). There has been continued marked interval decrease in the bilateral cervical lymphadenopathy. For example, a right level 5 lymph node now measures 6 x 5 mm, previously 10 x 8 mm. Likewise, a left level 2 lymph node now measures 7 x 3 mm, previously 16 x 9 mm. The nasopharynx and other aerodigestive track structures are unremarkable. There is a hypoattenuating right thyroid nodule that measures up to 8 mm, which is unchanged. The major salivary glands are unremarkable. There is a right internal jugular venous catheter in position. The major cervical vessels are otherwise patent. The osseous structures are unremarkable. The imaged intracranial structures and orbits are unremarkable. There is a partially imaged right pleural effusion and extensive bilateral ground-glass opacities. Refer to the recent prior chest CT report for additional details. | 1. Continued marked interval decrease in the bilateral cervical lymphadenopathy related to lymphoma, indicating treatment response. 2. Partially imaged extensive pulmonary opacities related to lymphoma. |
Generate impression based on findings. | Female 44 years old; Reason: 44 yr old patient with ovarian cancer s/p18 cycles of Avastin. eval disease process compare to 8-16-13 scan History: none CHEST:LUNGS AND PLEURA: Unchanged micronodules.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: A right chest wall Port-A-Cath terminates in the right atrium.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: Scattered subcentimeter foci of decreased attenuation within the right kidney and are unchanged from prior study. Mild right pelvocaliectasis. The left kidney is normal in appearance.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No ascites or adenopathy. The bowel is unremarkable.BONES, SOFT TISSUES: There are postsurgical changes of the anterior abdominal wall. Again seen, is a wide-mouthed fat-containing supraumbilical midline ventral hernia.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Postsurgical changes compatible with hysterectomy. The prior right adnexal cyst and anterior midline cyst are no longer visualized. A left adnexal cyst measures 2.4 x 2.4 cm previously 2.2 x 2.4 Cm in diameter (series 3; image 159), similar in appearance to the prior study.BLADDER: The bladder is nondistended, limiting evaluation.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. Stable left adnexal cyst and interval resolution of previous midline pelvic and right adnexal cysts.2. Stable mild right pelvocaliectasis. |
Generate impression based on findings. | 58 year old female with history of urothelial cancer CHEST:LUNGS AND PLEURA: Right lower lobe micronodules unchanged.MEDIASTINUM AND HILA: Small mediastinal lymph nodes are unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Patient's No hypodense lesion in the liver is unchanged measuring 1 x 1 cm image number 91, series number 6.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy. No evidence of recurrence. Left renal cyst is stable. Left nephrolithiasis is unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Previous described lytic lesions in the pelvic bones and sacrum are stable.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: Please see discussion aboveOTHER: No significant abnormality noted. | No significant change from previous study. |
Generate impression based on findings. | Reason: 36 yo female, morbidly obese, tachycardia, tachypneic History: tachycardia, tachypnea, sob PULMONARY ARTERIES: Extremely limited technique secondary to body habitus and imaging noise. Due to poor opacification of the segmental and subsegmental branches, this examination is diagnostic to the lobar level. No filling defect to this level to suggest pulmonary embolus is identified. The caliber of the main pulmonary artery is normal. There are low density foci in the segmental and subsegmental branches which may be underfilling and artifact related to noise. If there is high clinical suspicion for pulmonary embolus, consider pulmonary arterial angiography.LUNGS AND PLEURA: Subsegmental atelectasis involves the lingula.MEDIASTINUM AND HILA: The heart size is normal. The right ventricle is within limits of normal size. The left ventricle is larger than that of the right; the interventricular septum is unremarkable. No pericardial effusion is present.CHEST WALL: Multilevel osteophytes involving the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Previously reference extrahepatic nodule adjacent to the caudate lobe is slightly larger, 19 x 27 mm (series 12 image 244), as compared to 20 x 24 millimeters on prior exam. | 1. limited examination secondary to body habitus and image noise. No pulmonary embolus is detected to the lobar level.2. Extrahepatic nodule adjacent to caudate lobe is slightly larger, 19 x 27 mm. Considerations include lymphadenopathy or exophytic nodule emanating from the liver. |
Generate impression based on findings. | Male, 69 years old, history of tonsil cancer status post CRT. No mass effect, focal edema or suspicious enhancement is seen to suggest brain parenchymal metastatic disease. The bones of the calvarium and skull base are intact. The lateral axillary sinus mucus retention cysts are again seen.Mild treatement related findings are redemonstrated in the neck including thickening of the platysma, fascial place stranding, and supraglottic mucosal thickening. There has been no significant change. No evidence of recurrent tumor or pathologic adenopathy is detected.The salivary glands and thyroid are unremarkable. The cervical vessels remain patent with evidence of atherosclerotic calcification of the carotid bifurcations. Lung apices are unremarkable. No concerning osseous lesions are detected. | 1. No evidence of disease recurrence in the neck.2. No intracranial metastatic disease. |
Generate impression based on findings. | Kidney cancer status post nephrectomy --? Metastatic disease. CHEST:LUNGS AND PLEURA: No masses, nodules, airspace consolidation or effusion seen.MEDIASTINUM AND HILA: No lymphadenopathy. Arterial calcifications seen in the aorta and coronary arteries.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted in liver parenchyma. Patient is status post cholecystectomy. No other biliary tract abnormality seen..SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Normal right adrenal gland. Absent left adrenal gland.KIDNEYS, URETERS: Left nephrectomy since prior CT examination of 8/8/13. No evidence of residual or recurrent tumor is seen in the surgical bed.RETROPERITONEUM, LYMPH NODES: No enlarged lymph nodes seen. No other abnormal masses.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes in the skeletal system without focal abnormality.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: Pelvic small and large bowel shows no intrinsic abnormalities other than diffuse diverticulosis without complication.BONES, SOFT TISSUES: Degenerative bony changes without evidence for metastatic disease.OTHER: No significant abnormality noted. | 1. Interval left nephrectomy without evidence of residual, recurrent or metastatic tumor seen. |
Generate impression based on findings. | 61-year-old male with history of left MCA stroke. No evidence of hemorrhagic transformation of the patient's known left MCA distribution infarct. No evidence of midline shift or herniation. The ventricles are stable in size and configuration. Partial opacification of the right maxillary sinus, otherwise the visualized portions of the paranasal sinuses are clear. The mastoid air cells are clear. The visualized orbits are intact. Congenital non-union of C1. | No evidence of hemorrhagic transformation of the patient's known left MCA distribution infarct. No significant interval change. |
Generate impression based on findings. | Reason: h/o HNC, s/p induction, compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: Mild apical centrilobular and paraseptal emphysema. Scattered small 1-2 mm micronodules in the lung periphery, nonspecific. Interval near complete resolution of previously described ground glass and tree-in-bud opacities in the right lower lobe, now also present in the lateral segment of the right middle lobe. Associated bronchial wall thickening to the segments. Constellation of findings suggestive of recurrent aspiration and ongoing bronchiolitis.No suspicious nodules, masses or pleural effusion. MEDIASTINUM AND HILA: Trace residual pericardial effsion. Heart size is normal. Moderate coronary artery calcifications.Several the previously referenced small mediastinal lymph nodes have decreased in size. Some of these lymph nodes contain calcifications.Fluid occupies the mid esophagus.CHEST WALL:Degenerative change of the spine with anterior osteophyte formation.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.Interval placement of a percutaneous gastrostomy tube.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Multifocal calcific plaques occupy the abdominal aorta and its branches. | 1.No evidence of pulmonary metastases.2.Although there is near complete resolution of the previous ground glass opacities within the right lower lobe, new tree in bud opacities are now noted in the right middle lobe with bronchial wall thickening. This is suggestive of recurrent aspiration and bronchiolitis.3.Decreased size of mediastinal lymph nodes. |
Generate impression based on findings. | Reason: 56Yrs male here for follow-up of Tx N3 HNSCC s/p TFHX chemoradiotherapy completed 9/2010; please re-eval for recurrence History: as above CHEST:LUNGS AND PLEURA: Scattered benign appearing micronodules are unchanged.There is no evidence of pulmonary or pleural metastases.MEDIASTINUM AND HILA: There is no mediastinal or hilar lymphadenopathy.Mild aortic root and coronary calcification is unchanged.CHEST WALL: Degenerative abnormalities of the thoracic spine.Postsurgical abnormalities are noted in the left side of the neck, unchanged.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small renal cysts cysts are present.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Vascular calcifications affect the aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Diverticulosis without diverticulitis.BONES, SOFT TISSUES: Degenerative abnormalities affect the lumbar spine as well as a Schmorl's node.OTHER: No significant abnormality noted. | No evidence of metastases, or other significant abnormality. |
Generate impression based on findings. | Male 49 years old; Reason: eval GT abscess History: erythema and induration ABDOMEN:LUNGS BASES: Stable bibasilar consolidation with air bronchograms left greater than right concerning for aspiration/pneumonia. There is also centrilobular nodules superior to the left basilar consolidation, consistent with bronchiolitis or aspiration.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Percutaneous gastrostomy catheter terminates in the gastric lumen. No bowel obstruction.BONES, SOFT TISSUES: Soft tissue hematoma in the left muscle extending to the left flank with edema of the soft tissues is essentially unchanged. There is gas in the left rectus muscle but no definite collection. No intra-abdominal bleed is evident.New large hematoma is noted within the right psoas muscle measuring 5.7 x 6.9 cm. OTHER: Apparent filling defect is noted within the IVC (series 3 image 101), with suggestion of thrombus within the right common femoral vein.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: As aboveOTHER: No significant abnormality noted. | 1.Unchanged left rectus hematoma and gas in the left rectus extending to the left body wall. This originates adjacent to the percutaneous gastrostomy catheter. Imaging features of hematoma and possible infection.2.New large right psoas hematoma which measures 5.7 x 6.9 cm. A3. apparent filling defect in the IVC, and right common femoral vein suggestive of thrombus.4.Dr. Mar was notified of the findings at 3 o'clock on 11/5/13. |
Generate impression based on findings. | 56 year-old female with vulvar cancer. Status post chemotherapy CHEST:LUNGS AND PLEURA: No parenchymal nodules or masses seen. No air space consolidation or effusions.MEDIASTINUM AND HILA: No adenopathy or other abnormalities. In the liver. Prior cholecystectomy without other biliary tract abnormality.CHEST WALL: Port-A-Cath system in the right anterior chest wall with tip of the catheter in the proximal right atrium.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 adenopathy. 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: Matted lymph nodes are seen with enlarged lymph nodes involving the left external iliac chain. Prior CT had shown an enlarged lymph node diameter of 2.8 x 1.9 cm on 3/6/13. Exact comparative measurement of difficult due to the aggregate confluent nature but maximal cross-sectional diameter now appears to measure 3.6 x 2.3 cm. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No identifiable vulvar soft tissue mass seen.OTHER: Presacral edema is seen, most likely relating to the recent surgical procedure. Similarly some subcutaneous edema seen, particularly on the left. About the left femoral vessels is are surgical clips in infiltrating soft tissue density unchanged from 3/6/13 and most likely represents post surgical changes. | 1. No significant abnormality seen in the chest. 2. Increasing size of lymph node in the left external lymph node chains as measured above. 3. Postoperative edema in the left pelvis and presacral space. |
Generate impression based on findings. | Reason: metastatic lung Ca, on chemo. followup. Can we compare to the CT component of the August PET? History: cough CHEST:LUNGS AND PLEURA: Redemonstration of a dense consolidated mass posteriorly in the left lower lobe slightly increased in size from the prior exam. Representative measurement (image 54 series 3) 2.6 cm x 5.1 cm , previously 2 cm x 4.9 cm.Multiple nodules increased in both lungs compared to CT chest dated 4/3/13. However, when compared to PET/CT of 8/26/13 there is an apparent interval decrease in size of the upper lobe nodules. This may reflect limited accuracy of the CT portion of the PET/CT and is not reliable.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Cardiac enlargement without evidence of pericardial effusion.Aortic valve prosthesis.Severe coronary calcification.CHEST WALL: Median sternotomy. Degenerative changes throughout the thoracic spine.ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Hypodense right renal masses most likely cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic changes of aorta and branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Degenerative changes throughout the spine with diffuse bony demineralization.OTHER: No significant abnormality noted. | 1.Mild interval increase in the left lower lobe mass compatible with primary neoplasm.2.Interval increase in number and size of multiple small pulmonary mixed solid and nonsolid pulmonary nodules compared to the previous dedicated CT dated 4/3/13. Accurate comparison to the PET/CT dated 8/26/13 cannot be made however, suspect interval decrease in several of the pulmonary nodules. |
Generate impression based on findings. | Poor dentition w/ facial swelling. There is a rim enhancing fluid collection that measures 8 AP x 12 RL x 14 SI mm adjacent to the left maxillary alveolus where there is dehiscence of the buccal cortex overlying ADA 12 and extensive overlying inflammatory changes that extend into the left lower eyelid. There are carious ADA 12 though 15 with extensive periodontal lucencies. There is complete opacification of the left maxillary sinus with low attenuation contents that extend into the nasal cavity, compatible with an antrochoanal polyp. There is also a right maxillary sinus retention cyst. The bilateral orbital contents are unremarkable. The mastoid air cells are clear. The imaged intracranial structure are grossly unremarkable. | 1. Left facial abscess measuring up to 14 mm adjacent to dehiscence of the buccal cortex overlying ADA 12 and associated with carious ADA 12 though 15. Associated cellulitis extends into the left lower eyelid without a post-septal component.2. Left antrochoanal polyp.Discussed with Dr. White at 2:10 PM on 11/5/13, |
Generate impression based on findings. | Male 53 years old; Reason: mets lung cancer, s/p chemo and RT, pls c/w previous study and evaluate dz status. History: lung ca. CHEST:LUNGS AND PLEURA: Centrilobular and paraseptal emphysema in the apices. Interval increase in the size of the dense left perihilar mass like opacity, especially anteriorly. The width of the lesion now measures 4.9 cm (series 4, image 34), previously 4.5 cm. distal to the mass is an area of consolidation, which likely represents atelectasis. Again seen is right perihilar and paramediastinal radiation reaction, unchanged. No pleural effusions.MEDIASTINUM AND HILA: No significant mediastinal lymphadenopathy. The previously measured right hilar lymph node is again not well seen on this exam without contrast. Small loculated fluid within the mediastinum unchanged and likely related to scarring. Moderate coronary artery calcification and right coronary stent again seen. Small pericardial effusion, unchanged. CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Surgical clips in the left perinephric region. Mild dilatation of the left renal pelvis or extrarenal pelvis.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Small gastrohepatic lymph nodes, 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. | Slight further increase in the size of the left suprahilar masslike opacity, which continues to be suspicious for local tumor recurrence. |
Generate impression based on findings. | Reason: PT with HNC s/p CRT +4.5 yr ago. please re-eval History: as above CHEST:LUNGS AND PLEURA: No evidence of pulmonary or pleural metastases.MEDIASTINUM AND HILA: Severe aortic and coronary artery calcifications are present.There is no significant mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Very small hepatic cyst like hypodensities.Cholelithiasis without cholecystitis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: NonePANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerosis affects 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: Degenerative abnormalities affect the lumbosacral region.OTHER: No significant abnormality noted. | No change, and no sign of metastases. |
Generate impression based on findings. | Reason: Pt with hx of Tonsil Ca. s/p CRT 2010. please re-eval for recurrence History: as above CHEST:LUNGS AND PLEURA: Postradiation fibrosis in the apices, right greater than left. Groundglass opacities in the anterior right upper lobe with architectural distortion and bronchiolectasis suggestive of scarring. There is debris in bilateral lower bronchi with associated bronchiectasis and bronchial wall thickening suggestive of bronchiolitis related to aspiration. Mucus impaction in bilateral upper lobes with bronchial wall thickening.Small pleural-based nodule in the right anterior upper lobe (series 5, image 54) with interval increase in size now measuring 5 mm, previously measuring 4 mm. Interval resolution of posterior right upper lobe groundglass opacities. Postsurgical changes in the right lower lobe is unchanged. MEDIASTINUM AND HILA: Slight interval increase in right paratracheal lymph node. Heart size is normal. No pericardial effusion.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Subcentimeter hypodensities unchanged. Status post cholecystectomy.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.No specific evidence of metastatic disease.2.Bronchiolitis related to aspiration. |
Generate impression based on findings. | 74-year-old male patient with chronic abdominal pain, weight loss and malignant neoplasm of the prostate. ABDOMEN:LUNG BASES: Trace bilateral dependent atelectasis.LIVER, BILIARY TRACT: Subcentimeter hypoattenuating liver lesion is stable compared to prior examination (series 5 image 14) and is too small to characterize.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right ureter with focal areas of dilatation throughout its course, stable compared to prior examination. No hydronephrosis. Cyst in the intrapolar region of the right kidney is again seen.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic changes in the abdominal aorta and iliac arteries.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumbar spine. Density in the L1 and L2 vertebral body indicative of post procedural spinoplasty.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Status post radical prostatectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Sigmoid diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumbar spine. Density in the L1 and L2 vertebral body indicative of post procedural spinoplasty.OTHER: Status post pelvic lymph node dissection. No pelvic lymphadenopathy identified. | 1.No evidence of recurrent metastatic disease.2.No abnormality seen to account for patient's symptomatology. |
Generate impression based on findings. | 34-year-old male with metastatic non-small cell lung cancer, worsening renal and liver function. ABDOMEN: Evaluation of solid organ pathology and vasculature is limited due to lack of IV contrast.LUNG BASES: Left pleural effusion and atelectasis/consolidation. Central venous catheter.LIVER, BILIARY TRACT: Innumerable hypoattenuating hepatic lesions consistent with metastases. A percutaneous right biliary drain is noted extending through a common bile duct stent into the duodenum. Evaluation of hepatic parenchyma is limited due to lack of IV contrast.SPLEEN: Peripheral hypoattenuating lesion may represent infarct.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Diffuse osseous metastatic lesions.OTHER: Marked abdominal and pelvic ascites.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Foley catheter extends to the bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Diffuse osseous metastatic lesions.OTHER: Marked abdominal and pelvic ascites. | Large amount of abdominal and pelvic ascites as well as extensive metastatic disease. No hydronephrosis. |
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