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Generate impression based on findings. | Reason: apical pulmonary nodule on CXR History: apical pulmonary nodule on CXR LUNGS AND PLEURA: Multiple calcified and noncalcified micronodules, none suspicious for tumor.Apical and left basilar scarring including left basilar bronchiectasis is present. MEDIASTINUM AND HILA: There is no mediastinal or hilar lymphadenopathy.Calcified mediastinal lymph nodes are the sequela of prior granulomatous disease.Moderate to severe coronary artery and valvular calcifications are present.Moderate to large size hiatal hernia possibly paraesophageal.CHEST WALL: Degenerative abnormalities affect the lower thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Cholelithiasis without cholecystitis. | 1. Prior granulomatous disease accounting for previously described pulmonary nodules.2. Large hiatal hernia possibly paraesophageal.3. Cholelithiasis without cholecystitis.4. Coronary artery calcifications. |
Generate impression based on findings. | 41 yo male with DM, HTN and acute onset right sided weakness/ numbness, pls evaluate for mass/ hemorrhage/ ischemia 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.2.CT is insensitive for the early detection of nonhemorrhagic CVA |
Generate impression based on findings. | Reason: metastatic head and neck ca, on therapy, eval for dz, compare to previous with measuremetns History: as above CHEST:LUNGS AND PLEURA: Stable moderate centrilobular emphysema.Scattered calcified micronodules. Noncalcified 5-mm nodule the right middle lobe unchanged and may reflect an intrapulmonary lymph node. Near complete resolution of the previously described groundglass opacity in the posterior lower lobes, left greater than right. MEDIASTINUM AND HILA: The superior esophagus is more distended when compared to prior study. A small posterior nodule is again identified, a measured approximately 2 mm (series 6 image 3).Stent in the right carotid artery. Phonation device is present. Soft tissuedensity of the cervical esophagus above the level of the vocal prosthesis unchanged. Postsurgical changes at the interface of neck, please refer to neck CT performed on the same day. No significantly enlarged lymph nodes. Heart size is mildly enlarged. Resolution of previous pericardial effusion. Severe coronary arterycalcifications. Small hiatal hernia. CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Unchanged subcentimeter hypoattenuating lesion in the posterior right hepatic lobe.SPLEEN: Poorly defined hypoattenuation in the anterolateral aspect of the spleen,unchanged.ADRENAL GLANDS: Stable 16 x 18 mm soft tissue nodule in the medial limb of the left adrenal gland. The lateral limb thickening is stable.KIDNEYS, URETERS: Large exophytic cyst left kidney. Smaller lesions are incompletelycharacterized.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: Stable lytic lesions within the pelvis and lucent lesions within the ribs.OTHER: No significant abnormality noted. | 1. Stable right middle lobe pulmonary nodule. No new suspicious pulmonary nodule or mass.2. The superior esophagus is more distended with the previously referenced posterior nodule measuring approximately 2 mm.3. Near complete resolution of the lower lobe groundglass opacities which may be related to aspiration.4. Skeletal abnormalities are stable. |
Generate impression based on findings. | 82-year-old female patient with history of bladder cancer. CT urogram for staging. ABDOMEN:LUNG BASES: Emphysematous changes bilaterally. Right lower lobe spiculated nodule measures 1.0 x 0.9 cm (series 5 image 18).LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Two cystic lesions are identified in the pancreatic tail. The distal, unilocular cystic lesion measures 1.3 x 0.9 cm (series 6 image 23) and does not have an appreciable solid component. The proximal lesion is a cystic mass with septations and calcifications that measures 2.3 x 1.5 cm (series 6 image 36). Between these two cystic lesions, there is a cluster of calculi/concretions impacted in the pancreatic duct. Distal pancreatic duct is dilated.The pancreatic head and proximal body are atrophic with a few punctate calcifications in the parenchyma.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic changes in the abdominal aorta and iliac arteries.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Enlarged inferior vena cava.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: There is a mass in the anterior wall of the urinary bladder with invasion anteriorly and superiorly, consistent with involvement of the urachal remnant. Mass measures 2.4 x 6.5 cm (series 8 image 107). Trace amount of free air in the bladder likely secondary to prior instrumentation.LYMPH NODES: No suspicious lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Bladder mass in the anterior wall involving the urachal remnant. Mass may be arising from the bladder versus urachal remnant adenocarcinoma.2.Uncommon abnormalities within the distal pancreas. Complex cystic mass may represent a cystadenoma versus cystadenocarcinoma. Pancreatic duct is dilated distal to this lesion. Distal unilocular cystic lesion may represent intraductal papillary mucinous neoplasm versus mucinous neoplasm. Intraductal concretions may be secondary to obstruction versus chronic pancreatitis.3.Right lower lobe lung lesion. |
Generate impression based on findings. | Male, 32 years old, chronic sinusitis. The right frontal sinus is hypoplastic. The left frontal sinus and frontoethmoidal recesses are completely opacified with soft tissue. The ethmoid air cells are nearly completely opacified. The left sphenoid sinuses completely opacified and the right sphenoid sinus is partially opacified with soft tissue material. The sphenoethmoidal recesses are obscured.Both maxillary sinuses demonstrate the presence of mucosal thickening and/or foamy debris which results in partial sinus opacification, worse on the left. Soft tissue obscures the bilateral maxillary outflow pathwaysThe nasal septum is intact with a leftward deviation. The nasal turbinates are unremarkable. There is mild soft tissue opacification of the upper nasal cavity.The mastoid air cells and middle ear cavities are normally pneumatized. | Pansinus mucosal inflammatory disease. |
Generate impression based on findings. | Male 77 years old; Reason: eval for hemothorax History: post op. LUNGS AND PLEURA: Interval resection of the lobulated left upper lobe nodule seen previously. There has been interval development of large mixed high and low fluid density accumulation with resultant collapse of the lung. A left chest tube is visualized within this fluid collection which is directed into the apex. There is also an element of pneumothorax. The high density fluid more superiorly in the left chest is more consistent with a hemothorax. Within the right upper lobe is a focal area of airspace opacity which could be due to infection. There is also a small right pleural effusion with overlying consolidation which may represent atelectasis.MEDIASTINUM AND HILA: Endotracheal tube is below the thoracic inlet above the carina. No evidence of pneumomediastinum or pneumopericardium. There is minimal amount of pericardial fluid. There is also fluid tracking within the anterior mediastinum which obscures the previously described anterior mediastinal lymph node but which appears grossly unchanged. CHEST WALL: Hardware is noted in the median chest wall consistent with recent surgery. Degenerative changes are noted about the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Fluid attenuating hypodensity in the posterior right lobe of the liver likely represents a hepatic cyst. Status post cholecystectomy. | 1.Postsurgical changes from resection of the left upper lobe nodule with interval development of a large left-sided pneumohemothorax and collapse of the lung. 2.Interval placement of a left-sided chest tube.3.Focal air space opacity in the right upper lobe, which could represent a focus of infection. |
Generate impression based on findings. | Reason: h/o clear cell cancer of palate; eval for mets History: none LUNGS AND PLEURA: Scattered nonspecific micronodules unchanged. No suspicious pulmonary nodules or masses.Moderate upper lobe predominant centrilobular emphysema.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of a pericardial effusion.Mild coronary calcification. Moderate atherosclerotic changes of aorta with considerable mural thrombus and possible ulcerated plaques.CHEST WALL: Degenerative changes in the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. Stable left adrenal nodule. | No evidence of metastatic disease. No significant interval change. |
Generate impression based on findings. | 91-year-old male with history of prostate cancer on therapy CHEST:LUNGS AND PLEURA: Subpleural nodularity and calcification is unchanged.MEDIASTINUM AND HILA: Coronary arterial calcifications. No mediastinal lymphadenopathyCHEST WALL: Extensive sclerotic osseous metastatic disease.ABDOMEN:LIVER, BILIARY TRACT: Unchanged hypodense lesions likely representing cysts, some of which may be peribiliary. Cholelithiasis.SPLEEN: Few scattered granulomataPANCREAS: Fatty atrophy of the pancreas.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS:Bilateral hypodense lesions some too small to characterize but likely representing cysts are unchanged.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Extensive osseous metastatic disease with superimposed degenerative changes and compression deformity of L1.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: Extensive osseous metastatic disease with superimposed degenerative changes and compression deformity of L1.OTHER: No significant abnormality noted | Extensive osseous metastatic disease, without significant interval change from the prior study. |
Generate impression based on findings. | Reason: H/o of cancer s/p RT. Please eval for recurrence History: None CHEST:LUNGS AND PLEURA: Right paramediastinal opacity with traction bronchiectasis, consistent with radiation fibrosis.Upper zone paraseptal emphysema.No suspicious nodules.MEDIASTINUM AND HILA: Reference right hilar lymph node measuring 8 mm in short axis, unchanged.Reference subcarinal lymph node measuring 7 mm in short axis, also unchanged.Moderately severe coronary artery calcification.CHEST WALL: Degenerative disease in the spine.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Extensive aortic atherosclerosis. | Stable disease. |
Generate impression based on findings. | Female 81 years old; Reason: Lung Ca, s/p radiation only. Followup of lung lesions. Also followup of aortic aneurysm. History: none. CHEST:LUNGS AND PLEURA: Severe centrilobular emphysema is visualized. Masslike consolidation posterior to the right bronchus intermedius within the right lower lobe is not significantly changed in size measuring 4.0 x 6.1 cm (series 80272, image 51), previously measured 3.7 x 6.0 cm. more distally is an area of consolidation which could represent postobstructive atelectasis.MEDIASTINUM AND HILA: Stable size of the high right paratracheal lymph nodes. No other significant mediastinal or hilar lymphadenopathy. Mildly enlarged heart unchanged from previous exam. No pericardial effusion. Dense mitral annular calcification. Moderate to severe native coronary artery calcification. A left-sided central venous catheter terminates in the SVC.CHEST WALL: Left anterior chest wall port unchanged in position.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Scattered hypodensities too small to characterize again identified.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Cystic lesion inferior pole right kidney stable in size.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: Multilevel degenerative changes the thoracolumbar spine.OTHER: The previously described abdominal aneurysm projecting somewhat posteriorly just inferior to the level of the hiatus is unchanged at 5 cm (series 3, image 90). The infrarenal abdominal aortic aneurysm is also stable measuring 4.3 cm in the transverse dimension (series 3, image 115). Again seen is eccentric mural thrombus unchanged. | 1.No significant change in the masslike consolidation posterior to the right bronchus intermedius within the right lower lobe.2.Stable size of the abdominal aortic aneurysms. |
Generate impression based on findings. | Status post resection of a clear cell carcinoma at the junction of the hard and soft palate. There are postoperative findings related to clear cell carcinoma resection and flap reconstruction at the junction of the hard and soft palate. There is relative deficiency of soft tissue along the left hard palate and a defect in the left soft palate that measures up to approximately 15 mm. There are focal defects in the hard palate. There is no definite mass lesion at the surgical site. The nasal cavity is clear and the palatine canals are not expanded. There is no significant cervical lymphadenopathy. The airways are patent. There is a heterogeneous right thyroid nodule that measure s 8 mm in diameter. The major salivary glands are unremarkable. The carotid arteries and jugular veins are patent. There is mild to moderate atherosclerotic plaque at the left carotid bifurcation. The major cervical vessels are otherwise patent. There is a canalis basalis medianus. There are left temporomandibular joint degenerative changes. There is a left maxillary sinus retention cyst. There is partial opacification of the left mastoid air cells. The imaged intracranial structures and orbits are unremarkable. There is mild pulmonary emphysema. | 1. Postoperative findings related to clear cell carcinoma resection and flap reconstruction at the junction of the hard and soft palate with soft tissue dehiscence and punctate defects in the hard palate, but no definite evidence of locoregional tumor recurrence or significant cervical lymphadenopathy. 2. No evidence of intracranial metastases. |
Generate impression based on findings. | 52 year-old female with metastatic melanoma CHEST:LUNGS AND PLEURA: No nodules or masses.MEDIASTINUM AND HILA: Bilateral hypodense thyroid lesions are nonspecific. No mediastinal or hilar adenopathy.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: A small right peripheral hypoattenuating lesion is too small to characterize, but likely represents a cyst.RETROPERITONEUM, LYMPH NODES: Scattered atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small ventral hernia containing mesenteric fat.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: Mild anterolisthesis of L4 on L5.OTHER: No significant abnormality noted. | No evidence of metastatic disease. Nonspecific hypodense thyroid lesions. |
Generate impression based on findings. | Malignant neoplasm of ethmoidal sinus. Pt is a 52 y/o female with met melanoma, s/p 4 cycles of ipilimumab, CT neck:The patient is status post partial removal of a right nasal cavity mass. There are now postsurgical changes in the paranasal sinuses and nasal cavity related to tumor resection, with resection of the nasal septum, the right ethmoid air cells, the anterior walls of the sphenoid sinuses, as well as the medial walls of the maxillary sinuses bilaterally, and the posterior aspect of the right maxillary sinus. Since the prior exam infiltration of the right pterygomaxillary fossa, and effacement of the fat planes in the right infraorbital fissure, the right cavernous sinus, the right foramen rotundum, the right pterygopalatine fossa, and the right sphenoid sinus have regressed. The right cavernous sinus the larger relative to the left but this is stable compared. There is mucosal thickening in the maxillary sinuses bilaterally. The frontal sinuses demonstrate minor mucosal thickening. The mastoid air cells are clear.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. Multiple lymph nodes in the soft tissue of the neck are stable.Within the visceral space the thyroid gland contains multiple hypointense foci the largest one in the right lobe measuring 15 x 13 mm axial dimension is stableThe airway appears patent.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 is a mild reversal of the normal cervical curvature compared there is mild loss of disk space height at C5-6 and C6-7 where there are endplate and uncovertebral osteophytes.CT head:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No acute intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.Since the prior examination there has been a no suggestion for recurrence of the patient's sinonasal neoplasm.2.No evidence for brain metastases. |
Generate impression based on findings. | Female 45 years old; Reason: rule out PE History: hypoxia, atrial fibrillation. PULMONARY ARTERIES: No evidence of pulmonary emboli.LUNGS AND PLEURA: Redemonstrated is upper lobe predominant architectural distortion honeycombing and traction bronchiectasis as well as scattered foci of peripheral consolidation. These findings are consistent with patient's known diagnosis of UIP. There is a slight increase in the size of compared to previous exam which may represent progression and/or acute exacerbation.Again seen is bilateral pleural thickening . Tiny right-sided pleural effusion. Postsurgical change are again seen in the left upper lobe.MEDIASTINUM AND HILA: Large main pulmonary artery again seen measuring 3.7 cm consistent with pulmonary artery hypertension. Stable cardiomegaly. Small amount of pericardial fluid is noted Centimeter sized supraclavicular and pretracheal lymph nodes are not significantly changed compared to previous exam.CHEST WALL: Mild scoliosis and degenerative changes of the thoracic spine. UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.No evidence of pulmonary emboli.2.Findings again compatible with known diagnosis of atypical UIP with slight increase in the size of several of the of the ground glass nodular opacities, which may represent progression and/or acute exacerbation. |
Generate impression based on findings. | Reason: f/u interval change in pulmonary nodules, lymphadenopathy; h/o probably sarcoidosis History: SOB, systemic malaise, obstructive lung disease LUNGS AND PLEURA: Multiple bilateral well defined pulmonary nodules ranging up to 11 mm in diameter, not significantly changed since 12/27/2009.Reticular interstitial opacity, predominantly in the subpleural regions and lung bases, increased since the previous scan and more obviously increased since 12/27/2009. The lungs are less inflated on the current inspiration scan than on the previous scans, and this contributes to the increased opacity.A focal area of interstitial opacity in the left upper lobe adjacent to the major fissure shows evidence of traction bronchiectasis, consistent with fibrosis.A mosaic perfusion pattern is present, most obviously in the upper lung zones, accentuated on the expiration, consistent with small airways disease.MEDIASTINUM AND HILA: Mediastinal and hilar lymphadenopathy is present, significantly decreased since the previous scan.Small right hilar lymph node calcifications.CHEST WALL: Collapse of a vertebral body at the level of T12, unchanged.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Mildly enlarged upper abdominal lymph nodes, decreased from previous.Surgical clips in the gallbladder bed. | 1. Multiple stable pulmonary nodules, consistent with a benign etiology such as sarcoidosis.2. Interval decrease in mediastinal and hilar lymphadenopathy but increase in interstitial lung disease, mainly at the lung bases, with evidence of fibrosis. Given the other findings this is most consistent with sarcoidosis, but the distribution is atypical, and alternative etiologies are possible. |
Generate impression based on findings. | Reason: pulmonary embolism History: shortness of breath PULMONARY ARTERIES: Technically adequate examination. No evidence of pulmonary embolism. Pulmonary artery is markedly dilated and measures 6.3 cm in diameter, previously measuring 6.7 cm. LUNGS AND PLEURA: New peripherally located nodule in the left lower lobe superior segment measuring 11 mm.A few bilateral micronodules along the fissures likely represent lymph nodes.Right lower lobe, posterior pleural based nodule remains unchanged (series 13, image 63).No pneumothorax or pleural effusions.MEDIASTINUM AND HILA: Right ventricle with marked dilation and hypertrabeculation. No pericardial effusions. 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. Hypodense lesion in the right kidney is too small to further characterize. Bilateral nephrolithiasis without evidence of obstruction. Thickening of bilateral adrenals is unchanged. Small hiatal hernia. | 1.No evidence of pulmonary embolism.2.New left lower lobe nodule. Follow-up CT scan in 3 months recommended.3.Marked dilation of the main pulmonary artery with slight interval decrease in caliber. Marked dilation of the right ventricle. |
Generate impression based on findings. | Refractory metastatic papillary thyroid cancer with lung metastases treated with cediranib. Head: There is no mass, cerebral edema, or abnormal intracranial enhancement. The ventricles, sulci, and cisterns are stable in size and configuration. The orbits are unremarkable. The mastoid air cells are clear. There is a left maxillary sinus retention cyst. The osseous structures are unremarkable.Neck: There are stable post-operative findings related to total thyroidectomy and neck dissection. There are no discrete mass lesions in the surgical bed to indicate tumor recurrence. There is no significant interval change in the lower cervical and partially imaged upper mediastinal lymphadenopathy. For example, a right paratracheal lymph node measures 12 x 8 mm (image 67, series 6), previously 12 x 8 mm. Likewise, a right supraclavicular lymph node measures 9 x 11 mm (image 61, series 6), previously 9 x 11 mm. In addition, a prevascular upper mediastinal lymph node measures 13 x 16 mm (image 78, series 6), previously 12 x 17 mm. The major salivary glands are unchanged, including mildly heterogenous enhancement of the bilateral submandibular glands, which can be related to radiation therapy. There is hyperdense material within the right vocal cord related to Radiesse injection medialization. The contents of the oral cavity, pharynx, and larynx are otherwise unremarkable. The carotid arteries and jugular veins are patent. There is unchanged multilevel degenerative spondylosis. There is a carious ADA 1. There is extensive pulmonary emphysema. Refer to the separate chest CT report for additional details. | 1. No definite evidence of locoregional tumor recurrence in the thyroidectomy bed.2. Unchanged lower cervical and partially imaged upper mediastinal lymphadenopathy. 3. No evidence of intracranial metastasis. |
Generate impression based on findings. | Reason: s/p bilateral lung transplant History: SOB PULMONARY ARTERIES: No evidence of PE to the subsegmental level.LUNGS AND PLEURA: Previously described soft tissue density in the right apex associated with surgical staples has reduced in size, approximately 8 x 16 mm (series 9 image 28), as compared to 16 x 16 mm.Within the medial segment of the right middle lobe and anterior aspects of the bilateral upper lobes, there is mild bronchial wall thickening, groundglass and several foci of mucoid impaction favoring inflammatory etiology.No pleural effusion is present. No suspicious pulmonary nodules or massesMEDIASTINUM AND HILA: The heart size is normal. No pericardial effusion.No mediastinal or hilar lymphadenopathy. There are multiple surgical clips in the subcarinal location..CHEST WALL: Mild dextroscoliosis, stable. Lower thoracic right lateral vertebral body body sclerosis unchanged when compared to 2007. UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Exophytic cysts arise from the superior poles of the partially imaged kidneys. | 1. No pulmonary embolus to the subsegmental level.2. Within the medial segment of the right middle lobe and anterior aspects of the bilateral upper lobes, there is mild bronchial wall thickening, groundglass and several foci of mucoid impaction favoring inflammatory etiology. |
Generate impression based on findings. | Recurrent sinus infections, h/o nasal polyps. There are postoperative findings related to bilateral uncinectomy and internal ethmoidectomy. There is diffuse sclerosis and thickening of the paranasal sinus walls. There is moderate mucosal thickening within the left maxillary sinus. There is a small air-fluid level within the right maxillary sinus. The bilateral neo-infundibula are patent. There is complete opacification of the remaining left ethmoid sinuses. There is mild neo-osteogenesis within the left ethmoid sinus. There is partial opacification of the frontal sinuses, left greater than right. There is also moderate opacification of the bilateral sphenoid sinuses with hyperdense material (~100 HU). There is mild medial buckling of the lamina papyracea. There appear to be punctate dehiscences of the left lamina papyracea. The ethmoid roofs are nearly symmetric and appear intact. There is a right conchae bullosa, which may have be partially opened surgically. The left middle turbinate is medialized. There is a pneumatized right anterior clinoid process and possibly associated dehiscence of the optic canal. The carotid grooves are covered by bone. The imaged intracranial structures are grossly unremarkable. There are bilateral lens implants. | Postoperative findings related to bilateral uncinectomy and internal ethmoidectomy with pansinus opacification compatible with chronic sinusitis and a small air-fluid level in the right maxillary sinus that may represent superimposed acute sinusitis. Mild medial buckling of the lamina papyracea with apparent punctate dehiscences of the left lamina papyracea. |
Generate impression based on findings. | 12-year-old male with history of right rib lesions, status post biopsy concerning for LCH. LUNGS AND PLEURA: A left lower lobe lung mass is again noted which is increased in size since the prior examination, now measuring 2.2 x 1.8 cm (series 4, image 62), this lesion abuts the medial pleural surface and now exhibits internal cavitation. Adjacent smaller clustered nodular opacities are also increased in size (series 4, images 58-60).MEDIASTINUM AND HILA: Evaluation is limited by the lack of intravenous contrast. There is no gross mediastinal or hilar lymphadenopathy. The heart size is normal. There is no pericardial effusion present.CHEST WALL: A right lateral expansile sixth rib lesion is again noted which displays increased callus formation compared with the prior examination compatible with healing following the clinical history of curettage. A new lytic right anterolateral rib lesion is present (series 3, image 73) which lies beneath a marker placed on the skin surface corresponding to the patient's pain.Lytic regions along the endplates of multiple vertebral bodies, most prominent along the anterior endplates of T7-T12 are unchanged and felt to most likely represents Schmorl's nodes.UPPER ABDOMEN: The visualized portions of the liver, kidneys, stomach, and spleen are within normal limits. | New lytic lesion in the anterolateral right seventh rib corresponding to the area of the patient's pain. Increasing size of left lower lobe mass which now demonstrates internal cavitation and is most compatible with a cavitary infection. Increased callus formation of previously identified expansile lytic lesion in the right sixth rib compatible with interval healing following curettage. |
Generate impression based on findings. | 56-year-old male with history of abdominal pain and history of metastatic colon cancer CHEST:LUNGS AND PLEURA: Bilateral scattered micronodules. Largest measures 8 mm on image number 42 causes number 5 in the right middle lobe.This nodule is new from outside chest CT dated 5/24/2013MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Status post liver resection. Subcentimeter hypodense lesions in the left lobe of the liver, too small to accurate characterize.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Interval development of left-sided hydronephrosis.RETROPERITONEUM, LYMPH NODES: There is ill-defined soft tissue in the left retroperitoneum adjacent to the left psoas muscle measuring 2.7 x 1.9 cm image number 156 on series number 3 causing obstruction of the left ureter. New left para-aortic adenopathy measuring 2.1 x 1.7 cm image number 130, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Sclerotic lesion in the left iliac wing, unchanged.OTHER: No significant abnormality noted | New subcentimeter lung nodule in the right middle lobe suspicious for metastatic disease.Interval development of left para-aortic adenopathy and left retroperitoneal mass causing left-sided hydronephrosis. |
Generate impression based on findings. | 73-year-old male with metastatic renal cell carcinoma, right arm weakness, known C7 metastasis Exam is limited in evaluation of solid organ pathology and vasculature due to the lack of IV contrast.CHEST:LUNGS AND PLEURA: Reference right upper lobe nodule measures 6 mm (image 34, series 4) and previously measured 10 mm (corrected measurement for image 29 series 5). Additional peripheral right upper lobe nodules and left lower lobe nodule are also decreased in size. No new nodules or masses. Unchanged calcified left basilar pleural nodule.MEDIASTINUM AND HILA: Unchanged ectasia of the ascending aorta measuring 4.3 cm. Severe atherosclerotic calcifications of the coronary arteries.CHEST WALL: Partially visualized fluid collection posterior to the upper thoracic spine measures 7.9 x 2.6 cm and previously measured 8.0 x 2.7 cm (image 4, series 3). Postsurgical changes of the lower cervical spine are only partially visualized.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The right kidney is not visualized.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Moderate degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Unchanged lytic left iliac osseous lesion. L4 vertebral body hemangioma. Moderate degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality noted | Limited study due to lack of IV contrast. Mild interval decrease in size of pulmonary nodules. Unchanged lytic metastasis to the left ilium. |
Generate impression based on findings. | Female 43 years old; Reason: 43yo female with stage IIC ovarian CA s/p ovarian CA. assess disease s/p surgery with colostomy and chemotherapy. assess disease status History: groin pain ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Patient status post lymph node dissection the evident metastatic nodes detected..BOWEL, MESENTERY: Left lower quadrant ostomy is seen without evidence of obstruction or free air.BONES, SOFT TISSUES: Right abdominal porta catheter is noted with its tip in the pelvis.OTHER: Loculated fluid collection along the spleen and left upper quadrant.PELVIS:UTERUS, ADNEXA: Status post hysterectomy and bilateral salpingo-oophorectomy. Thickening noted around the anastomotic site is seen, nonspecific.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: Free fluid in the pelvic cul-de-sac. | 1.No evidence of solid metastatic disease or recurrence detected. Loculated peritoneal abdominal collection in left abdomen. |
Generate impression based on findings. | 49-year-old female with history of HIV and rectal cancer now with partial small bowel obstruction -- please evaluate for masses. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Prior noted segment 2 left lobe liver lesion has increased in size (series 3, image 32) now measuring 1.7 x 0.9 cm compared with 1.0 x 0.8 cm previously. No new liver lesions are seen. Mild intrahepatic and extrahepatic biliary duct dilatation persists, unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral moderate hydronephrosis again seen with bilateral nephroureteral stents. Benign cysts in left kidney, unchanged. No other abnormalities.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Since the prior exam there has been progressive dilatation of the small bowel diffusely with fluid filled loops and a marked increase in ascites. There does appear to be some less dilated loops of small bowel in the left abdomen and lower midabdomen indicating probable obstruction, however, the marked ascites and paucity of fat makes it difficult to differentiate the tissues to see exact point of transition. There does appear to be increased density scattered throughout the mesentery at various separate locations (for example see series 3, image 101 anteriorly) that suggests mesenteric tumor metastases. The marked rectal wall diffuse tumor thickening is again seen with internal stent. The degree of thickening and surrounding tumor appears unchanged in the rectum, but there does appear to be new thickening of the more proximal sigmoid colon wall diffusely (see series 3, image 108). The more proximal colon again shows distention with extensive feces through proximal colon -- there is new marked edema in the cecum and proximal ascending colon that suggests edema/colitis. BONES, SOFT TISSUES: Diffuse subcutaneous anasarcaOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Absent uterus -- no other abnormalities.BLADDER: No significant abnormality notedLYMPH NODES: With loss of soft tissue contrast resolution. The stigmata reference left iliac lymph node cannot be identified. The reference left inguinal enlarged lymph node is again seen measuring 1.8 by 1.3 cm, previously 1.6 x 1.0 cm. No new areas of lymph node enlargement are seen.BOWEL, MESENTERY: Large, necrotic rectal mass with circumferential wall thickening and edema, and, intramural air again seen -- it is difficult to accurately measure, but appears similar in extent in the rectum, but to have increased thickening of the more proximal sigmoid suggesting extension. Extensive ascites is seen. Matted small bowel loops are seen in the region of the pelvis and rectosigmoid junction and may represent areas of mesenteric tumor extension causing small bowel obstruction. BONES, SOFT TISSUES: No significant abnormality noteddOTHER: No significant abnormality notedd | 1. Marked fluid-filled distention of small bowel loops and marked increase ascites and probable mesenteric tumor deposits causing small bowel obstruction. 2. Large necrotic rectal mass with probable more proximal extension of tumor along sigmoid colon. 3. Increased size of liver metastasis. |
Generate impression based on findings. | 29 year-old male with bilateral nasal congestion and recurrent sinusitis, and nasal polyp on the left side. The orbits are unremarkable. The mastoids are clear. Limited view of the intracranial structure is unremarkable. There is a retention cyst in the right maxillary sinus. The frontal sinuses, frontal-ethmoid recesses, anterior/posterior ethmoids, sphenoid sinuses, and left maxillary sinus are well developed and clear. The osteomeatal complexes are normal with intact uncinate processes and patent infundibuli. The intersphenoid septum is normal. The nasal turbinates and nasal septum are normal. The cribriform plate, fovea ethmoidalis and lamina papyraceae appear normal. The osseous structures are unremarkable. | Unremarkable CT paranasal sinus except for a right maxillary sinus retention cyst. |
Generate impression based on findings. | 63-year-old female patient with appendiceal cancer, off chemotherapy since March 2013. Evaluate for disease status. CHEST:LUNGS AND PLEURA: Pulmonary nodule in the left lower lobe adjacent to the left heart border is stable compared to prior examination.MEDIASTINUM AND HILA: Small mediastinal lymph nodes, stable.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Stable perihepatic scalloping from peritoneal disease. Right hepatic lobe lesions are stable compared to prior examination. No new hepatic lesions.SPLEEN: Again seen is scalloping of the spleen. Splenic lesions are stable compared to prior examination.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable bilateral hypoattenuating renal lesions, consistent with cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Redemonstrated is left lower abdominal wall hernia containing a loop of small bowel and ascites. No evidence of obstruction or wall edema of the involved bowel.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumbar spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Resected or atrophic.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Fluid and implants in the right inguinal canal measure 2.2 x 1.9 cm (series 4 image 172), previously 2.0 x 2.4 cm.Extensive pseudomyxoma peritonei.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumbar spine.OTHER: No significant abnormality noted. | Stable, extensive pseudomyxoma peritonei and metastatic disease. |
Generate impression based on findings. | Pancreas cancer, restaging CHEST:LUNGS AND PLEURA: Again noted numerous bilateral pulmonary nodules consistent with metastatic disease. Index left upper lobe nodule measures 7 mm, slightly increased in size compared to previous study. Other pulmonary nodules are also slightly increased in size. Bilateral small pleural effusions, unchanged.MEDIASTINUM AND HILA: Index aorticopulmonary lymph node measures two .0 x 0.9 cm on image number 25, series number 3, increased in size compared to previous study. Other mediastinal lymph nodes are also increased in size within the internal.CHEST WALL: Status involving the right sixth rib and small sclerotic foci in the T3 vertebral body, unchanged.ABDOMEN:LIVER, BILIARY TRACT: Multiple small hypodense lesions in the liver are unchanged and too small to accurately characterize. Cholelithiasis, unchanged.SPLEEN: No significant abnormality noted.PANCREAS: Large infiltrative pancreatic mass invading the retroperitoneal major vessels have further increased in size compared to previous study and now measures 5.8 x 5.6 cm image number 92, series number 3. Cystic lesion in the head of the pancreas and the tail of the pancreas are grossly stable.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Index para-aortic lymph node measures two by 2.1-cm image number 99, series number 3, increased in size compared to previous study. Other retroperitoneal lymph nodes are also slightly increased in sizeBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic lesion involving the right iliac bone, new from previous study. Metastatic disease cannot be excluded.OTHER: No significant abnormality noted. | Interval progression of disease with interval increase in the size of the lung nodules, pancreatic mass, retroperitoneal adenopathy. New sclerotic lesion involving the right iliac bone suspicious for metastatic disease. |
Generate impression based on findings. | Colon cancer restaging CHEST:LUNGS AND PLEURA: Scattered micronodules, unchanged.MEDIASTINUM AND HILA: Hiatal hernia, unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Multiple hypodense lesions in the liver, grossly unchanged. The lesion near the dome in the right lobe measures 1.8 x 2.1 cm in image number 81, series number 3. Other lesions are also grossly unchanged.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: Left adnexal cyst is unchanged.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. | No significant change from previous study. |
Generate impression based on findings. | Reason: Lung Cancer: restaging History: none CHEST:LUNGS AND PLEURA: Previously referenced pleural-based mass in the posterior basal segment left lower lobe favors the appearance of rounded atelectasis; however, increased the FDG activity on PET is compatible with tumor. It has slightly reduced in size, measuring 17 x 27 mm (series 4 image 64), as compared to 17 by 30 mm. it is associated with thickening and calcified pleural plaques related to prior asbestos exposure.Previously referenced pleural plaque at the level of the aortic arch is 5 mm (series 4 image 19), not significantly changed from prior at 6 mm. The referenced partially calcified pleural plaque at the mid lateral thorax has not significantly changed (image 26 series 80242).Soft tissue nodularity at the left posterior costophrenic angle has slightly increased, approximately 21 mm in AP dimension (series 80242 image 83), as compared to 17 mm on the prior study. This is contiguous with the main lower lobe mass with a small strand-like soft tissue component.The mild centrilobular emphysema remains stable.MEDIASTINUM AND HILA: The reference para-aortic lymph node measures 4 mm in the short axis (image 80242, series 23), previously 4 mm. The reference paraesophageal lymph node measures 5 mm (image 53, series 80242), previously 5 mm. The reference left cardiophrenic lymph node is unchanged and remains could be pericardial thickening.Incidental lipomatous hypertrophy of the interatrial septum. The heart size is normal. No interval pericardial effusion. Moderate aortic valve and coronary arterial calcification.CHEST WALL: Stable left lateral rib deformity.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Multiple hepatic hypoattenuating lesions are unchanged and likely represent benign hepatic cysts. SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Right adrenal nodule is unchanged and likely represents a benign adenoma.KIDNEYS, URETERS: Multiple hypoattenuating renal lesions are unchanged and likelyrepresent renal cysts.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. Slightly decreased size of left lower lobe mass.2. Soft tissue nodularity at the left posterior costophrenic angle has slightly increased, which is contiguous with the main lower lobe mass with a small strand-like soft tissue component. Continued short interval follow-up is recommended. |
Generate impression based on findings. | Reason: metastatic thyroid ca, on therapy,eval for dz progression with measurements History: as above CHEST:LUNGS AND PLEURA: Smoothly marginated the right lower lobe nodule, now 22 x 18 mm, not significantly changed when using comparable measurement parameters.Multiple smaller nodules, also unchanged.Diffuse emphysema and basilar scarring.MEDIASTINUM AND HILA: Moderately enlarged high right paratracheal lymph nodes, unchanged.Reference right hilar lymph node measuring 10 mm, minimally decreased from 12 mm previously.Mild coronary artery calcification.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Small nonspecific hypodensities, unchanged, most likely benign.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Mild thickening of the left adrenal gland, unchanged.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. | Stable disease. |
Generate impression based on findings. | 62 year old woman with cardiomyopathy treated with LVAD and percutaneous aortic valve closure. She is suspected of having thrombus in LVAD inflow canula.CPT: 75572 Left Atrium: The left atrium is severely dilated. There are four distinct pulmonary veins which drain normally into the left atrium. Right atrium, vena cavae, and coronary sinus: The right atrium is severely dilated. The superior and inferior vena cavae are grossly normal. The coronary sinus is normal in size. There is a pacemaker lead in the right atrial appendage and coronary sinus.Left Ventricle: The left ventricle is severely dilated. Epicardial pacemaker leads are noted. The inflow canula to the left ventricular assist device is noted in the LV apex. Image interpretation is limited by a significant amount of beam hardening artifact; however, there appears to be a hypodensity near the orifice of the inflow canula which may represent a thrombus. The abnormality is better visualized on the TTE. The canula does not appear to be obstructed and the interventricular septum bows into the RV. The outflow canula is anastomosed to the ascending aorta. It does not appear to have an obstruction in it, but the most proximal portion of the canula can not be assessed due to severe image artifact.Right Ventricle: Visually the right ventricle is severely dilated.Coronary arteries: Because heart rate management was not attempted and nitroglycerine was not administered, this exam was not performed to optimally visualize the coronary arteries. However within the limitations of the study the following observations are made:LM: The left main coronary artery arises normally from the left sinus of valsalva and bifurcates into the left anterior descending and left circumflex coronary arteries.LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove, supplying the diagonal and septal branches.LCx: The left circumflex coronary artery courses normally in the the left AV groove. It gives rise to the obuse marginal branches and a small AV circumflex branch.RCA: The right coronary artery arises normally from the right sinus of valsalva. Great vessels: The thoracic aorta demonstrates no evidence of dissection or aneurysm. The outflow canula of the left ventricular assist device is noted in the ascending aorta. The main and branch pulmonary arteries are mildly dilated.Valves: The aortic valve has evidence of being closed with a PFO-like amplatzer closure device. There is no mitral annular calcification. The tricuspid and pulmonic valves are not well visualized.Pericardium: The pericardium is normal in thickness. There is no pericardial effusion. | The inflow canula to the left ventricular assist device is noted in the LV apex. Image interpretation is limited by a significant amount of beam hardening artifact; however, there appears to be a hypodensity near the orifice of the inflow canula which may represent a thrombus. The abnormality is better visualized on the TTE. The canula does not appear to be obstructed and the interventricular septum bows into the RV. The outflow canula is anastomosed to the ascending aorta. It does not appear to have an obstruction in it, but the most proximal portion of the canula can not be assessed due to severe image artifact.Service notified of above finding.This portion of the report pertains to the heart and great vessels only. The remaining soft tissues of the thorax and upper abdomen will be interpreted by the attending chest radiologist and included as an addendum to this report. |
Generate impression based on findings. | Clinical question: Altered mental status. Signs and symptoms clearly AMS. Unenhanced head CT:No detectable acute intracranial process. CT is insensitive for detection of acute nonhemorrhagic ischemic strokes.Mild periventricular and subcortical low attenuation white matter likely representing age indeterminate small vessel ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation otherwise.Unremarkable calvarium, orbits and paranasal sinuses. | Mild age indeterminate small vessel ischemic strokes. |
Generate impression based on findings. | Clinical question; rule out out CVA. Signs and symptoms: vertigo for 4 days. Nonenhanced head CT:No detectable acute intracranial process. CT however is insensitive for detection of acute nonhemorrhagic ischemic strokes.Encephalomalacia of the left anterior frontal consistent with a chronic left MCA territory ischemic stroke. There is resultant widening of the left frontal cortical sulci and minimal enlargement of left frontal horn.Unremarkable exam otherwise.Unremarkable calvarium, orbits and paranasal sinuses. | 1.No acute intracranial process.2.Chronic left frontal cortical stroke and unremarkable nonenhanced head CT otherwise. |
Generate impression based on findings. | Clinical question : Altered mental status, evaluate for bleed etc. signs and symptoms: As above. Nonenhanced head CT:No detectable acute intracranial process. CT however is insensitive for detection of acute non-hemorrhagic ischemic strokes.Prominence of cortical sulci, ventricular system and cerebellar -- vermian folia for patient of stated age of 37 is concerning for underlying parenchymal volume loss.Calvarium, orbits and paranasal sinuses are unremarkable. | 1.No acute intracranial process.2.Prominence of cortical sulci, ventricular system and cerebellar -- vermian folia for patient stated age. Correlate with history and risk factors. |
Generate impression based on findings. | Clinical question: Evaluate intracranial mass. History of HIV. Signs and symptoms: Left-sided facial decreased sensation and occipital decreased sensation. Nonenhanced head CT:No evidence of acute intracranial process CT Homer is insensitive for detection of acute nonhemorrhagic ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation.Unremarkable calvarium and soft tissues of the scalp.Unremarkable orbits.Diffuse mucosal thickening all of the paranasal sinuses consistent with chronic sinusitis.Bilateral mastoid air cells and middle ear cavities remain well pneumatized. | No acute intracranial process. Chronic pansinusitis. |
Generate impression based on findings. | Clinical question: Leukopenia status post liver transplant. Signs and symptoms: As above. Nonenhanced head CT:No detectable acute intracranial process.Unremarkable cerebral cortex, cortical chest heart, ventricular system, CSF spaces and gray -- white matter differentiation.Unremarkable calvarium and soft tissues of the scalp.Unremarkable orbits and paranasal sinuses.Well pneumatized mastoid air cells and middle ear cavities. | Unremarkable head CT. |
Generate impression based on findings. | Clinical question: Assess for intracranial hemorrhage, masses or signs of increased intracranial pressure. Signs and symptoms: Severe headache, dizziness worse with coughing. Nonenhanced head CT:No detectable acute intracranial process. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.There are several periventricular and subcortical low attenuation are white matter which are nonspecific although considering patient's age age indeterminate to small vessel ischemic strokes as well as demyelinating disease should be considered. Correlate with history and risk factor and follow-up with MRI exam to exclude other white matter possible pathology.Unremarkable intracranial content otherwise.Unremarkable calvarium and soft tissues of the scalp.Unremarkable orbits.Mild chronic sinusitis.Well pneumatized bilateral mastoid air cells and middle ear cavities. | 1.No acute intracranial process. CT is insensitive for early dictation of acute nonhemorrhagic ischemic strokes.2.Nonspecific periventricular and subcortical low attenuation white matter as detailed. |
Generate impression based on findings. | 46 year old female patient with no past medical history presents with mid abdominal pain, nausea and vomiting x 2 weeks. ABDOMEN:LUNG BASES: Trace left-sided pleural effusion with associated atelectasis. 5-mm well-circumscribed left lower lobe nodule (series 4 image 11).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: Hypoattenuating, subcentimeter well-circumscribed lesion in the interpolar region of the right kidney is too small to characterize and likely represents a cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Stomach with some mucosal edema and increased mucosal enhancement, consistent with gastritis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Enlarged uterus with hypoattenuating lesion, which may be consistent with a degenerating fibroid. Exophytic lesion located anteriorly and superiorly with heterogeneous attenuation is consistent with an exophytic fibroid. There is a left corpus luteum 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.Submucosal edema and mucosal enhancement of the stomach, consistent with gastritis.2.Uterus with two lesions, which likely represent uterine fibroids. Pelvic sonography is suggested.3.5-mm left lower lung nodule. |
Generate impression based on findings. | Female, 26 days old, with apparent life threatening event, abnormal movements and breathing, possible seizure. The cerebral and cerebellar hemispheres and brainstem are normal for age 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 paranasal sinuses are rudimentary. The bones of the calvarium and skull base are intact. | No acute intracranial abnormality or other specific findings to account for the patient's symptoms. |
Generate impression based on findings. | Female 60 years old; Reason: Re-evaluate disease status prior to new systemic therapy for newly diagnosed metastatic disease; compare to previous scan and provide bi-dimensional measurements History: Stage IV metastatic melanoma CHEST:LUNGS AND PLEURA: Numerous lung nodules are again seen throughout both lungs ranging from several millimeters in size to the largest in the right lower lobe (series 6, image 70) measuring 3.3 x 3.3 cm stable from previously 3.5 x 3.3cm. The second reference lung nodule in the left upper lobe (series 6, image 28) is stable and measures 0.9 x 0.9 cm. No new lesions detected. No pleura abnormalities or effusions are seen.MEDIASTINUM AND HILA: No significantly enlarged lymph nodes are seen. No masses or other abnormalities.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Benign cysts are seen ranging in size from subcentimeter to the largest 5-cm. No solid lesions are seen to suggest metastatic disease.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Right adrenal mass (series 4, image 97) has increased in size measuring 3.4 x 4 .4 cm, previously 3.2 x 2.6 cm. KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Numerous abdominal soft tissue nodules are noted, non specific.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: Diverticulosis without diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Stable numerous bilateral pulmonary, parenchymal masses, most consistent with metastatic disease. No new lesions. 2. Increase in size of the large right adrenal mass, compatible with metastatic disease. |
Generate impression based on findings. | 82 year old male with history of chest pain evaluate for aneurysm or dissection CHEST:LUNGS AND PLEURA: Micronodules some of which are calcified indicating chronic granulomatous disease.MEDIASTINUM AND HILA: The ascending aorta is ectatic and measures 4.1 cm. Moderate coronary arterial calcification. Minimal thinning of the cardiac apex suggests old vascular insult. The heart size is normal. There is atherosclerotic and calcification and plaque at the origin of the great vessels without evidence of occlusion. No evidence of dissection.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: High density material within the gallbladder likely from vicarious excretion from prior exam. No focal hepatic lesions.SPLEEN: No significant abnormality notedPANCREAS: Mild prominence of the pancreatic and biliary ducts.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts and hypodensities, too small to characterize.RETROPERITONEUM, LYMPH NODES: Moderate atherosclerotic calcification of the abdominal aorta and its branches. Moderate atherosclerotic plaque at the ostia of both renal arteries, SMA, and celiac axis, causing mild narrowing. No evidence of dissection or occlusion.BOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis. Nonspecific haziness of the mesentery anterior to the lower abdominal aorta with small social lymph nodes.BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis. Nonspecific haziness of the mesentery anterior to the lower abdominal aorta with small social lymph nodes.BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine. Infiltration of the soft tissues about the right groin and blood product suggests prior catheterization.OTHER: No significant abnormality noted | 1. Ascending thoracic aortic ectasia without evidence of aneurysm or dissection.2. Moderate atherosclerotic calcification and plaque of the aorta and coronary arteries with associated mild narrowing of the ostia of the renal arteries.3. Colonic diverticulosis without evidence of diverticulitis. |
Generate impression based on findings. | Clinical question: Rule out stroke. Signs and symptoms: Acute onset of slurred and confusion and left face droop at 8:30. Nonenhanced head CT:There is evidence of interval extensive hemorrhage in the right posterior temporal -- occipital subacute ischemic stroke since prior study. Hematoma at the site measures approximately 39 x 65-mm in size. There is also extension of hemorrhage into the subarachnoid space surrounding the right hemispheric hematoma. There is also subarachnoid hemorrhage in the left posterior temporal -- occipital region. There is subtle mass effect on the right lateral ventricle secondary to right posterior temporal -- occipital hematoma however there is no evidence of midline shift. | 1.Internal large acute hemorrhage in the right posterior temporal -- occipital ischemic stroke measuring at least 65 x 39-mm in size. There is resultant subtle mass effect on the right lateral ventricle all over without midline shift.2.There is evidence of subarachnoid hemorrhage surrounding the parenchymal hematoma in the right as well subarachnoid hemorrhage in the left posterior temporal and occipital regions. |
Generate impression based on findings. | Male, 11 years old, status post motor vehicle accident. The cerebral and cerebellar hemispheres and brainstem are normal in attenuation and morphology. No intracranial hemorrhage or abnormal extra-axial fluid collection is seen. There is no evidence of mass effect or midline shift. The ventricles and basal cisterns are patent and normal in size. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.The bones of the calvarium and skull base are intact. | Unremarkable examination of the head. |
Generate impression based on findings. | 59-year-old male with leukopenia status post liver transplant Evaluation of solid organ pathology and vasculature is limited due to lack of IV contrast.CHEST:LUNGS AND PLEURA: Increased right pleural effusion involving 50% of the hemithorax with associated atelectasis of the right lower lobe.MEDIASTINUM AND HILA: No mediastinal or hilar adenopathy.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Evaluation of the transplant liver parenchyma and vasculature is limited due to lack of IV contrast. Periportal edema is again noted. Pneumobilia is identified.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: Interval improvement in the previously noted partial small bowel obstruction with a few minimally distended loops now noted in the abdomen. Small bowel anastomosis is identified.BONES, SOFT TISSUES: Ventral abdominal wall defect.OTHER: No abdominal ascites.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Resolution of previously noted bowel obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No pelvic ascites. | 1. Large right pleural effusion with associated atelectasis of the entire right lower lobe.2. No intra-abdominal fluid collection/ascites.3. Resolution of previously identified bowel obstruction. |
Generate impression based on findings. | 71-year-old male patient presents with abdominal pain, nausea and decreased oral intake. Concern for complete/partial bowel obstruction. ABDOMEN:LUNG BASES: Scattered micronodules, some of which are calcified.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: Atherosclerotic changes in the abdominal aorta and iliac arteries.BOWEL, MESENTERY: There is a loop of jejunum in the midabdomen with adjacent focal collection and fat stranding containing air and extravasation of oral contrast into the mesentery. Collection measures 3.0 x 3.7 cm (series 4 image 47). There is tracking of air along the mesentery. Findings are consistent with small bowel perforation. No proximal small bowel dilatation or evidence of obstruction.Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Multilevel degenerative changes of the thoracic and lumbar spine.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumbar spine.OTHER: No significant abnormality noted. | 1.Small bowel perforation of unclear etiology with extravasation of oral contrast into adjacent collection. Ischemia cannot be excluded. No evidence of bowel obstruction.2.Clonic diverticulosis without CT evidence of diverticulitis. |
Generate impression based on findings. | Clinical question: Intracranial hemorrhage. Signs and symptoms: Intracranial hemorrhage. Unenhanced head CT:New since prior exam is evidence of dissection of right posterior temporal -- occipital hematoma into the right lateral ventricle and with acute blood now layering in the dependent portion of body and trigone as well as the occipital horn of right lateral ventricle. There is however no evidence of any change in the size of supratentorial ventricular system.Although the morphology and previously noted homogeneous density of hematoma has changed there is no convincing evidence of an new interval hemorrhage since prior study although this possibility cannot be entirely excluded. The change in the appearance of hemorrhage is believed to be secondary to suction into the right lateral ventricle as well as interval contraction. Extensive residual right hemispheric subarachnoid hemorrhage shows no convincing evidence of change. There is also subtle redistribution of hemorrhage. Similar observation is noted of the left posterior temporal -- occipital subarachnoid hemorrhage as well. | 1.No convincing evidence of any significant new or increased hemorrhage since prior exam.2.Interval dissection of right hemispheric hematoma and with resultant acute blood in the right lateral ventricle.3.No significant appreciable interval change in the extent of bilateral subarachnoid hemorrhage.4.No change in the size of supratentorial ventricular system and maintained midline. |
Generate impression based on findings. | 11-year-old male status post high-speed motor vehicle collision presents with lumbar spine tenderness. ABDOMEN:LUNG BASES: No focal air space opacities or pleural effusions.LIVER, BILIARY TRACT: The liver is normal in size and attenuation. No focal hepatic lesions are identified. There is no intrahepatic or extrahepatic biliary ductal dilatation.The gallbladder is distended and appears normal.SPLEEN: The spleen is normal in size and attenuation.PANCREAS: The pancreas is normal in size and attenuation.ADRENAL GLANDS: The adrenal glands are symmetric in size and attenuation.KIDNEYS, URETERS: The kidneys are symmetric in size and attenuation with preserved corticomedullary differentiation. There is no hydronephrosis.RETROPERITONEUM, LYMPH NODES: Normal appearance of the aorta and inferior vena cava. No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: The bowel appears normal. The mesentery appears normal.BONES, SOFT TISSUES: Alignment is within normal limits. No fractures are identified.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: The bladder is distended.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No intraperitoneal free fluid or free air is present. | Normal examination. |
Generate impression based on findings. | Female 41 years old; Reason: r/o pancreatic abscess History: abdominal pain, nausea, vomiting ABDOMEN:LUNGS BASES: Heart size is enlarged. Minimal basilar atelectatic changes. No basilar pleural effusions.LIVER, BILIARY TRACT: Liver is enlarged and hypoattenuating suggestive of fatty infiltration. No suspicious hepatic lesions. The portal veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The kidneys are atrophic. Small hypodensities in the right kidney are too small to characterize.RETROPERITONEUM, LYMPH NODES: Abdominal aorta is tortuous.BOWEL, MESENTERY: No bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small bowel is normal in caliber.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No pelvic fluid collections. | 1.No bowel obstruction.2.Hepatomegaly.3.Atrophic native kidneys. |
Generate impression based on findings. | 38 year-old female with fever, leukocytosis, evaluate for abscess. ABDOMEN:LUNG BASES: Bilateral extensive groundglass air space opacities, suggesting edema/ARDS or infection. Paraseptal emphysema.LIVER, BILIARY TRACT: Vicarious excretion of contrast into the gallbladder.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: There is a 9.7 x 6.6 and are high density collection involving the lower pole of the right kidney extending into the right psoas muscle consistent with hematoma.BOWEL, MESENTERY: Diffuse small bowel dilatation indicating ileus.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Moderate abdominal pelvic ascites, which measures fluid density. Anasarca.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diffuse small bowel dilatation indicating ileus. A rectal tube is noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Moderate abdominal and pelvic ascites which measures fluid density. Anasarca. Right femoral catheter extends into the IVC. | 1. Right lower pole renal hematoma. 2. Increased abdominal and pelvic ascites and anasarca.3. Extensive pulmonary opacities better evaluated on prior chest CT indicating edema/ARDS or infection.4. Diffuse ileus. |
Generate impression based on findings. | Closed fracture of nasal bones. This exam confirms the presence of a fracture of the nasal bones which is minimally depressed (3 mm). The septum is normal and there is no blow out fracture. There is very lucency around the third (unerupted) these molars bilaterally as well as the left first mandibular molar. This could represent periapical cysts or abscesses.There are no other visualized fractures. TMJs are normally aligned. Paranasal sinuses are aerated. Limited assessment of the superior cervical spine is unremarkable. | Displaced/mildly comminuted nasal bone fractureperiapical lucencies associated with the left first mandibular molar and unerupted bilateral third molars which could represent periodontal disease, periapical cysts or abscesses. |
Generate impression based on findings. | 32-year-old male with suspected urosepsis, evaluate for pyelonephritis or abscess. 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: Cortical thinning and right lower pole hypodensity likely representing chronic scarring/post inflammatory change. No evidence of pyelonephritis or abscess.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: A bullet is again noted in the L1 vertebral body. Atrophy of the paraspinal muscles.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: The bladder is poorly distended, with apparent wall thickening. A Foley balloon is inflated within the mid urethra.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Extensive soft tissue infiltration/post inflammatory change involving the ischiorectal fossa, and gluteal folds is again noted. Right hip effusion. Sclerotic lesion of the left ilium is nonspecific. Atrophy of paraspinal muscles.OTHER: A bullet is again noted in the L1 vertebral body. Sclerosis/deformity of the right ischium. Nonspecific sclerotic lesion of the left ilium. | 1. No evidence of pyelonephritis or abscess. Bladder wall thickening, which may be chronic/related to cystitis. 2. Right hip effusion3. Decubitus ulcer.4. Foley balloon inflated in the mid urethra. |
Generate impression based on findings. | Clinical question: Evaluate for hemorrhage. Signs and symptoms: Headache. Nonenhanced head CT:Examination demonstrates expected post operative changes of a wide left suboccipital craniotomy/neck to me and good placement of prostheses. The anterior leading edge of the craniotomy extends into the left mastoid air cells and the very immediate adjacent mastoid air cells remain opacified.Expected residual epidural air and minimal fluid under the craniotomy flap.No detectable parenchymal hemorrhage or edema.No detectable intracranial subarachnoid hemorrhage.Third ventricle is a small however remains in midline and patent. There are no prior exams for comparison.The subarachnoid space at the level of foramen magnum, cerebellopontine angle cistern and prepontine cistern and quadrigeminal plate cistern remain widely patent.Mild supratentorial subarachnoid pneumocephalus is noted. Unremarkable images were supratentorial space otherwise. | Expected postoperative changes of a left suboccipital craniotomy/craniectomy as detailed. No prior exams for comparison. |
Generate impression based on findings. | Female 41 years old; Reason: assess for fluid collection explaining persistent bacteremia History: fevers, left hip pain ABDOMEN:LUNGS BASES: Left basilar atelectasis and subsegmental consolidation.LIVER, BILIARY TRACT: Liver is mildly enlarged. Gallbladder is contracted. Hepatic vasculature are patent. No suspicious hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mild heterogeneous enhancement of the kidneys. No hydronephrosis in either kidney.RETROPERITONEUM, LYMPH NODES: No retroperitoneal adenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Calcified uterine fibroids.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Infiltration of the soft tissues in the anterior abdomen.OTHER: No pelvic ascites. | 1.Mild heterogeneous enhancement of the kidneys. Correlate for urinary tract infection or pyelonephritis.2.No drainable fluid collections in the abdomen or pelvis.3.No bowel obstruction. |
Generate impression based on findings. | 53-year-old female patient presents with abdominal pain, constipation bloating. Evaluate for mass or obstruction. ABDOMEN:LUNG BASES: Trace bilateral dependent atelectasis.LIVER, BILIARY TRACT: Homogenously hypoattenuating liver parenchyma, consistent with fatty infiltration.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left kidney with renal sinus cyst. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Sigmoid diverticulosis. Distal sigmoid colon with wall thickening and inflammatory changes consistent with mild uncomplicated diverticulitis. No adjacent fluid collection or evidence of perforation.No bowel dilatation or evidence of obstruction.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumbar spine.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Left adnexal cyst measures 2.0 cm (series 3 image 122) and is within normal limits in a perimenopausal female.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Sigmoid diverticulosis. Distal sigmoid colon with wall thickening and inflammatory changes consistent with mild uncomplicated diverticulitis. No adjacent fluid collection or evidence of perforation.No bowel dilatation or evidence of obstruction.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumbar spine.OTHER: No significant abnormality noted. | 1.Mild, uncomplicated distal sigmoid diverticulitis. Consider colonoscopy after acute phase of illness.2.Fatty liver. |
Generate impression based on findings. | Clinical question: Chronic sinusitis, history of ESS and nasal polyp. Signs and symptoms: Nasal obstruction, rhinorrhea, recurrent sinusitis. Medtronic fusion sinus CT:Frontal sinuses.Complete opacification of bilateral frontal sinuses unchanged since prior exam.Ethmoid sinuses.Complete opacification of bilateral ethmoid air cells. Evidence of prior ethmoidectomy. No significant change since prior exam.Sphenoid sinus.Minimal interval re-pneumatization of bilateral chambers of the sphenoid sinus since prior exam. Extensive residual mucosal thickening and highly suspected overlapping acute sinusitis is noted. Widened bilateral sphenoethmoidal recess as a result of interval surgery. They however remain completely occluded on the right and significantly compromised on the left.On coronal reformatted images there is evidence of bony thinning of planum sphenoidale.Maxillary sinuses.Near complete opacification of bilateral maxillary sinuses with interval worsening on the right and minimally better pneumatization of the left maxillary sinus since prior study. Bilateral sinonasal windows are also completely opacified secondary to mucosal thickening.Nasal cavity demonstrate near complete opacification superiorly and with interval worsening since prior exam.Well pneumatized bilateral mastoid air cells and middle ear cavities. | Extensive pansinusitis as detailed above. |
Generate impression based on findings. | 58 year old female with phantom pain, which does not improve with medication. Complains of swelling of the left thigh. Dopplers are negative for DVT. Rule out thigh pathology. The patient has undergone amputation through the knee. Note is made of an intra-medullary rod and screw device affixing a healed fracture of the femoral diaphysis in near-anatomic alignment. Metal artifact from the orthopedic hardware slightly limits evaluation of the adjacent bone and soft tissue. There is atrophy of the musculature of the thigh as expected given the prior surgery. Multiple metallic densities within the soft tissues of the thigh presumably represent old bullet fragments. There is reticulation of the subcutaneous fat of the thigh, compatible with edema with bandlike density traversing the anteromedial and posterior subcutaneous fat, presumably representing scars.There is a rim enhancing collection adjacent to the posterolateral aspect of the distal margin of the femur measuring approximately 6.0 x 5.0 cm with associated erosion of the underlying bone. These findings are suggestive of abscess formation with underlying osteomyelitis. There is adjacent inflammatory changes which extend to the skin surface, but we see no gas density within the soft tissues to confirm the presence of a sinus tract. An additional larger rim enhancing collection along the distal diaphysis of the femur extending from the mid-diaphysis to the level of the distal orthopedic screws measures approximately 14 cm in the craniocaudal dimension and 8 cm in the transverse dimension, which essentially surrounds the femur, but is most pronounced along the posteromedial aspect and is also concerning for abscess formation, which may communicate with the aforementioned distal abscess. There is a small defect of the posterior cortex of the distal femur, which we suspect represents a erosion from the adjacent abscess, although this could conceivably represent a defect secondary to prior orthopedic hardware. An additional rim enhancing collection is identified within the gluteus medius and minimus muscles along the superior aspect of the greater tuberosity, which has irregular margins and is suspicious for a third abscess. There is no frank underlying bone destruction in the surrounding area. | Postoperative changes, as described above, with fluid collections adjacent to the femur and associated underlying erosion, compatible with abscess formation and osteomyelitis. These findings were relayed to Dr. Hong at the time of dictation. |
Generate impression based on findings. | Female 70 years old; Reason: source of atypical chest pain, repeated fever, persistent upper abdominal pain and nausea; history of hiatal hernia repair, GERD, labile hypertension. CHEST:LUNGS AND PLEURA: Right lung basecalcified granuloma.The pleural spaces are clear. Mild bronchial wall thickening and volume the right upper lobe airways.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. No mediastinal lymphadenopathy. Calcific arteriosclerotic disease affecting aorta, coronary vessels.Esophagus is mildly dilated and patulous. There is a hiatal hernia extending into the thorax.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. Liver is otherwise unremarkable for unenhanced technique.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Two nodules in the left adrenal gland measure less than 10 Hounsfield units compatible with adrenal adenomas are unchanged. Right adrenal gland is nodular without focalityKIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Calcific arteriosclerotic disease affecting aorta.BOWEL, MESENTERY: Large hiatal hernia. Bulge at the level of the fundus suboptimally evaluated by CT. No bowel obstruction. The appendix is normal.There are nodular changes of the gastric folds.Colonic diverticulosis.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: Colonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Status post cholecystectomy.2.No bowel obstruction.3.Suboptimal evaluated soft tissue mass at the level of the fundus may represent changes from hiatal hernia surgery ; Follow up is suggested.4.Nodular changes of the gastric folds. |
Generate impression based on findings. | 23 year-old male with ALL receiving chemo, neutropenia, low platelets and headaches. CT HEADThe ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. CT PARANASAL SINUSThe orbits are unremarkable. The left mastoid air cells are clear, and the right is underdeveloped. Limited view of the intracranial structure is unremarkable. The frontal sinuses, frontal-ethmoid recesses, anterior/posterior ethmoids, sphenoid sinuses, and maxillary sinuses are well developed and clear. The osteomeatal complexes are normal with intact uncinate processes and patent infundibuli. The intersphenoid septum is normal. The nasal turbinates are normal. The cribriform plate, fovea ethmoidalis and lamina papyraceae appear normal. The osseous structures are unremarkable. There is rightward nasal septal deviation with a bony spur. | 1. No acute intracranial abnormality. 2. No evidence of acute sinusitis. 3. Rightward nasal septal deviation with a bony spur. |
Generate impression based on findings. | Altered mental status. There is hyperattenuation symmetrically distributed within the basal ganglia bilaterally most likely representing mineralization. There is no intracranial mass, hemorrhage, hydrocephalus or CT evidence of ischemia. The midline is intact. Paranasal sinuses and mastoid air cells are unremarkable. There is very mild left-sided proptosis with no intraorbital abnormality. There is no bony abnormality. | Mild nonspecific left-sided proptosis without other visualized abnormality. CT is a suboptimally sensitive modality for assessing ischemia and if there is persistent concern, MR is recommended. |
Generate impression based on findings. | Male, 65 years old, intracerebral hemorrhage. Evaluate for source of bleeding. Non-angiographic findings:Right thalamic acute parenchymal hemorrhage is demonstrated measuring 1.8 x 1.4 cm with very mild surrounding edema. Hemorrhage has dissected into the ventricular system where it casts a large portion of the right frontal horn, body and atrium. Blood product is also seen within the third ventricle, at the level of the foramina of Monro and minimally in the left lateral ventricle. A small amount of blood product is also seen in the fourth ventricle.Very mild local mass effect is demonstrated at the site of parenchymal hemorrhage. No significant generalized mass effect has developed. The basal cisterns remain patent. No brain herniation is demonstrated. The ventricular system is not significantly dilated at this point.The calvarium is intact. Patchy opacification of the ethmoid air cells and sphenoid sinuses is demonstrated.Angiographic findings:Aortic branching is conventional. Origins of the great vessels are patent. The carotid vessels are patent throughout the neck. Minimal atherosclerotic disease is seen at the carotid bifurcations without significant stenosis. Likewise, the vertebral vessels are patent throughout the neck.Mild atherosclerotic calcification affects the intracranial ICAs. There is no evidence of significant vascular stenosis or occlusion. The vessels of the anterior and posterior circulation are patent. No evidence of aneurysm is seen. No vascular malformations are detected. The ACOM artery is visualized and normal. The PCOM arteries are not discretely seen. | 1. Right thalamic parenchymal hemorrhage with intraventricular extension. Mild local mass effect is seen. No significant generalized mass effect or brain herniation is demonstrated. No evidence of significant ventricular dilatation is detected at this point.2. CTA of the neck and head demonstrates no significant vascular abnormalities. In particular, no evidence of intracranial aneurysm or vascular malformation is seen. |
Generate impression based on findings. | 50 year-old male with mitral valve regurgitation. The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. | No acute intracranial abnormality. |
Generate impression based on findings. | 47-year-old female patient with abdominal pain. Evaluate for acute abdominal process. ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Heterogeneously enhancing right hepatic lobe is consistent with a partially recanalized right portal vein thrombosis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal nodule is stable compared to prior examination and incompletely characterized.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Cecal postoperative changes and bowel anastomosis in the right lower quadrant. Ventral hernia without evidence of strangulation or bowel obstruction.BONES, SOFT TISSUES: Mild multilevel degenerative changes in the thoracic and lumbar spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Right ovarian cyst measures 2.2 x 4.7 cm (series 5 image 111), stable compared to prior examination.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild multilevel degenerative changes in the thoracic and lumbar spine.OTHER: No significant abnormality noted | 1.No acute intra-abdominal process.2.New cavernous transformation of the right portal vein.3.Right ovarian cyst is unchanged. Consider pelvic sonography.4.Stable left adrenal nodule. |
Generate impression based on findings. | Clinical question: Follow-up lead placement. Signs and symptoms: Lead placement. Nonenhanced head CT:Examination demonstrate interval placement of bilateral DBS leads. No detectable there is soft parenchymal edema or hemorrhage.The leads bilaterally entered the calvarium via bilateral hypodensity paramedian posterior frontal burr hole. Delayed on the right extends inferiorly and with the tip of the lead in the anterior/inferior paramedian aspect of right cerebral peduncle. The lead on the left terminates few millimeter more superiorly on the left. Due to streak artifact it is difficult to determine with certainty the exact location of the tip of the lead on the left. It however project in the expected location of the left cerebral peduncle. Appropriate placement of the leads should be determined by referring clinical physician.Minimal post operative pneumocephalus in the right frontal region is noted.Mildly dilated supratentorial ventricular system and slight prominence of cortical sulci remains identical to prior exam. | 1.Expected minimal postoperative pneumocephalus in the right frontal region.2.Bilateral DBS needle placement with the tips appear to project in bilateral cerebral peduncles. The appropriate placement of the leads should be determined by referring clinical physician.3.Stable exam otherwise since prior study. |
Generate impression based on findings. | 57 year-old male with hemorrhage and hemiparesis. Right basal ganglia/thalamic hematoma has decreased in density. The degree of surrounding parenchyma edema has not substantially changed.A small amount of blood at the level of the foramina of Monro and within the third and lateral ventricles has been less. Blood product within the cerebral aqueduct and fourth ventricle has cleared. A small amount of subarachnoid blood product in the occipital region and posterior interhemispheric fissure and right tentorium appears less conspicuous. The ventriculomegaly has mildly increased since prior exam. For instance, the right lateral ventricle atrium measures 21 mm versus 17 mm on the prior exam. Right frontal approach the shunt catheter remains in stable position just anterior to the level of the foramina of Monro. No brain herniation is evident. | 1.Resolving right basal ganglia/thalamic, intraventricular, posterior interhemispheric fissure and right tentorium hemorrhage. .2.Mild interval increase of ventriculomegaly.3.No definite evidence of new hemorrhage. |
Generate impression based on findings. | Severe headache following MVA without loss of consciousness. No intracranial hemorrhage, mass, hydrocephalus or CT evidence of ischemia. The midline is intact. Ventricles and cisterns have normal size and morphology. The mandibular condyles are anteriorly subluxed bilaterally overlying the articular eminence which may be positional. There is no visualized fracture. Paranasal sinuses and mastoid air cells are clear. The orbits are unremarkable. | No abnormality demonstrated. |
Generate impression based on findings. | MVA. No loss of consciousness. Beam hardening artifact limits sensitivity within the inferior portion of the field of view. Within this limitation there is normal alignment. Vertebral body and intervertebral disk is maintained and there is no visualized fracture. The odontoid is intact. There is no prevertebral soft tissue swelling. Incidental note is made of minimal anterior subluxation mandibular condyles bilaterally which overlie the articular eminences. This is likely positional | No sequela of trauma demonstrated. |
Generate impression based on findings. | Altered mental status. There is minimal ill-defined periventricular hypodensity and some mild prominence of the ventricular system which has been stable since the prior exam. No intracranial mass, hemorrhage or mass effect. There is no CT evidence of acute CVA, however MR is a more sensitive modality for assessment. There are no bony abnormalities and the paranasal sinuses and mastoid air cells are aerated. Orbits are normal. | Subtle patchy periventricular hypoattenuation and stable mild prominence of the ventricular system. CT is suboptimal in its ability to assess acute ischemia. If there is concern for CVA, MRI would be more sensitive. |
Generate impression based on findings. | Reason: r/o Pulmonary embolism History: shortness of breath PULMONARY ARTERIES: Technically adequate examination. No evidence of pulmonary embolism. Main pulmonary artery caliber is within normal limits.LUNGS AND PLEURA: Bibasilar scarring and dependent atelectasis not significantly changed from prior exam. MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. No evidence of right heart strain. No significant mediastinal or hilar lymphadenopathy.CHEST WALL: Mild scattered lower cervical, supraclavicular, and axillary lymphadenopathy.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Mild nonspecific mesenteric lymphadenopathy. | 1.No evidence of pulmonary embolism.2.No other acute cardiopulmonary abnormalities. |
Generate impression based on findings. | Male 60 years old; Reason: metastatic prostate cancer evaluation of disease as baseline for initiation of investigational therapy. History: metastatic prostate cancer CHEST:LUNGS AND PLEURA: 5-mm nodule in the superior segment left lower lobe along the fissure. Few other micronodules scattered frontal lungs.MEDIASTINUM AND HILA: No mediastinal adenopathy detected. Coronary artery calcifications noted.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: The liver morphology is normal. A few subcentimeter too small characterize lesions noted throughout the liverSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Exophytic heterogeneously enhancing mass off the mid pole left kidney measures 2.4 x 2.7 x 2.5 cm (AP by transverse by CC). The renal veins are patent. No associated perinephric nodes are detected. Cysts noted in the kidneys bilaterally, largest measuring 8 x 8.7 cm and the left.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: Sclerotic focus in the posterior portion of the L4 vertebral body, punctate sclerotic foci in the pelvis and in the left ribs compatible with metastatic disease from prostate carcinoma.OTHER: No significant abnormality noted | 1.Exophytic enhancing mass in the mid pole left kidney concerning for RCC2.Extensive osseous metastasis. 3.Elia Martinez was notified of the findings at 9:32 am on 11/5/13 |
Generate impression based on findings. | 79 years old male with retromolar trigone squamous cell carcinoma status post surgery. Area of encephalomalacia involving the right cerebellar hemisphere is consistent with old ischemia. The orbits are unremarkable. The paranasal sinuses and mastoid air cells are clear. Postoperative change is demonstrated within the left retromolar trigone. A buccal fat pad has been interposed within the surgical bed. Surrounding this, there is ill-defined enhancement within the masticator space which is most likely reactive to surgery and therapy. The adjacent cortex of the mandibular ramus has been thinned consistent with a rim mandibulectomy.The left palatine tonsil is asymmetrically thickened and heterogeneous relative to the right at the level of its junction with the soft palate and slightly below.Postsurgical change consistent with a left neck dissection is demonstrated. Scattered small lymph nodes remain, none of which is pathologically enlarged by size criteria.Infiltration of the subcutaneous and deep fascial planes as well as mucosal edema involving the pharynx and soft palate is consistent with therapy. Prominence of the aryepiglottic folds, particularly on the right, may also be therapy related.The parotid and submandibular glands are unremarkable. The thyroid is free of suspicious lesions.A filling defect is seen in the right internal jugular vein, which is adjacent to the jugular vein catheter at level of the right thyroid gland. Cervical vessels remain patent otherwise. Lung apices are unremarkable. No concerning bony lesions are demonstrated. | 1.Stable postoperative changes. No definite evidence of residual or recurrent disease is seen in the operative bed. No pathologic adenopathy by size criteria.2. Interval development of the right internal jugular vein thrombosis. |
Generate impression based on findings. | 74 year-old female with known abdominal aortic aneurysm presenting with left-sided abdominal pain. ANGIOGRAPHY:Revisualization of the patient's known type B aortic dissection with the dissection flap originating cranial to the superior most aspect of the exam. The flap extends to the level of the right renal artery; unchanged. The origins of the celiac axis, superior mesenteric artery, and renal arteries are widely patent and arise from the true lumen.There is aneurysmal dilatation of the suprarenal aorta with associated intramural thrombus. At the level of the left renal vein the sac measures 6.2 x 3.5 cm (series 10 image 41), previously 5.8 x 4.0 cm,The infrarenal aorta is ectatic measuring 2.9 cm in maximum diameter (series 10 image 67), previously 2.9 cm. In addition there is mild aneurysmal dilatation of the common iliac arteries which measure 1.6-cm in diameter bilaterally (series 10 image 81), previously 1.6 cm bilaterally.Moderate atherosclerotic calcification affects the abdominal aorta and iliac arteries.ABDOMEN:The lack of oral contrast limits evaluation of the bowel. The phase of intravenous contrast limits evaluation of the abdominal solid organs; the exam was protocoled for examination of the arterial system.LUNG BASES: Unchanged right subpleural scarring.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Status post splenectomy.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple bilateral renal cysts, unchanged. No hydronephrosis, perinephric inflammatory changes, or perinephric fluid collections. Multiple calcifications anterior to the left psoas muscle in the territory of the left ureter appears similar to prior and are presumably vascular in etiology.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Moderate degenerative disk disease affects the lumbar spine with grade 1 anterolisthesis of L4 on L5.OTHER: Small unchanged loculated subdiaphragmatic fluid collection is presumably postoperative.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Uncomplicated diverticulosis with retained contrast material and/or inspissated debris.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Partially visualized type B aortic dissection extending to the level of the right renal artery is not significantly changed compared to prior. Aneurysmal dilatation of the suprarenal abdominal aorta and the bilateral common iliac arteries is also similar to prior.2. Uncomplicated diverticulosis of the sigmoid colon.3. No specific findings to account for the patient's abdominal pain. |
Generate impression based on findings. | ICH. There has been interval mild progression in the amount of intraparenchymal blood products and edema in centered in the right temporo-occipital region with evolution of blood products including development of a fluid fluid level posteriorly (axial image 21 - 6.0 x 4.6 cm). There has been redistribution of intraventricular hemorrhage with blood layering in the right and left trigones as well as extensive subarachnoid extension overlying both hemispheres (unchanged). There is stable mild ventriculomegaly including prominence of ventricular bodies and temporal horns bilaterally. There is no herniation or midline shift. There is lobulated soft tissue attenuation within right maxillary sinus. The remaining paranasal sinuses and mastoid air cells are clear. No bony fractures visualized. | 1.Mild interval progression in the amount of intraparenchymal hemorrhage and edema with evolution of blood products including development of a fluid fluid level.2.Redistribution of intraventricular and subarachnoid hemorrhage.3.Stable mild ventriculomegaly. No herniation or midline shift. |
Generate impression based on findings. | 69-year-old male with metastatic RCC. CHEST:LUNGS AND PLEURA: Right perihilar mass with associated distal basilar atelectasis and consolidation has progressed from the prior study.MEDIASTINUM AND HILA: Necrotic subcarinal mass measures 8.5 x 3.8 cm and previously measured 8.1 x 4.2 cm (image 45 series 11).CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Interval development of multiple hepatic metastases with one right hepatic lesion measuring 2.6 x 3.3 cm (image 74 series 11).SPLEEN: No significant abnormality notedPANCREAS: Peripancreatic nodularity, compatible with metastatic disease with interval increase in size of metastatic nodules adjacent to the pancreatic head.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: . Status post right nephrectomy. Enhancing mass in the left kidney measures 8.3 x 8.4 cm and previously measured 7.6 x 7.1 cm (image 112, series 11). Additional masses are also increased in size.RETROPERITONEUM, LYMPH NODES: Extensive retroperitoneal adenopathy.BOWEL, MESENTERY: Multiple gastric masses, likely representing metastases are identified. There are new and increase in size of multiple mesenteric implants. The bowel is normal in caliber.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Prominent bilateral iliac lymph nodes.BOWEL, MESENTERY: Multiple mesenteric implants, some of which are new and others which are increased in size.BONES, SOFT TISSUES: Left hip hardware with associated soft tissue mass is again noted.OTHER: No significant abnormality noted | 1. Interval progression of multifocal metastatic disease as detailed above.2. Right paramediastinal mass with associated basilar atelectasis/consolidation, correlate for postobstructive pneumonia. |
Generate impression based on findings. | 64 year-old male with left ear swelling and facial droop. The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. There is soft tissue swelling of the left ear drum and membranous external auditory canal. | 1. No acute intracranial abnormality. 2. Soft tissue swelling of the left ear drum and membranous external auditory canal. |
Generate impression based on findings. | Male 52 years old; Reason: newly diagnosed parotid cancer, right upper quadrant pain with mass palpated on exam History: r/o lung mets CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Hypoattenuating 2.5 x 2.5 cm thyroid lesion in the right lobe, incompletely characterized .CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Multiple borderline enlarged mesenteric lymph nodes are seen, nonspecific.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.No evident metastatic disease2.Thyroid nodule incompletely characterized by CT. |
Generate impression based on findings. | Male, 69 years old, history of renal cell carcinoma, screening scans per IRB 13-0696. An 8 x 8 mm round intrinsically hyperdense and enhancing nodule is present within the right frontal lobe compatible with a hemorrhagic metastasis. Moderate surrounding edema is observed.A second 10 x 9 mm enhancing focus is present within the left frontal lobe, again with moderate surrounding edema. This lesion does not seem to contain a significant amount of blood product.No definite evidence of additional lesions is seen elsewhere in the brain. There is local mass effect at the sites of metastasis, but no significant or generalized mass effect is demonstrated. No abnormal extra-axial fluid collections are seen. The ventricular system is patent and within normal limits for size.No concerning osseous lesions are seen. The paranasal sinuses are normally pneumatized. | Two metastatic lesions are demonstrated, one in the right frontal lobe and one in the left frontal lobe. |
Generate impression based on findings. | Male 46 years old; Reason: eval for PE History: dyspnea, increased O2 requirement PULMONARY ARTERIES: There has been interval recurrence of the small filling defect in the right upper lobe segment branch (series 8, image 91). This filling defect likely represents recurrence of pulmonary embolism, which was not seen on previous exam but was documented two exams ago. The main pulmonary artery is again dilated up to 2.4 cm suggestive of pulmonary artery hypertension. No evidence of right heart strain.LUNGS AND PLEURA: Again seen are diffuse relatively upper lobe predominant areas of architectural distortion, fibrosis and extensive traction bronchiectasis consistent with the patient's history of chronic sarcoidosis. There are nodular areas but no definite groundglass opacities or honeycombing. These findings do not appear to be significantly changed from previous exam. No pleural effusions.MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. Confluent bilateral hilar lymphadenopathy is again noted and appears to be unchanged. Subcarinal and paratracheal lymphadenopathy is also present and unchanged.CHEST WALL: Bilateral gynecomastia. Axillary lymphadenopathy. UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.Recurrence of the right upper lobe segment pulmonary embolus. 2.No significant change in the chronic lung changes from pulmonary sarcoid.3.Redemonstration of enlargement of the main pulmonary trunk diameter consistent with pulmonary artery hypertension.Findings discussed with the reason ED resident Dr. Saint-Hilaire at the time this dictation on 1/6/2013 and 11:19 hrs. |
Generate impression based on findings. | 65-year-old male patient with hematuria status post cystectomy and neobladder and 2007 and status post artificial urethral sphincter placement. ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Hypoattenuating subcentimeter lesion in the right lobe of the liver (series 7 image 14) is too small to characterize.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Thickened adrenal glands bilaterally, unchanged compared to prior examination.KIDNEYS, URETERS: No significant abnormality noted. No renal calculi or suspicious masses.RETROPERITONEUM, LYMPH NODES: Redemonstrated is an aortic dissection terminating just below the level of the right renal artery and above the level of the left renal artery with extension into the origin of the superior mesenteric artery. Findings stable compared to CT on 3/23/2012.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Status post cystoprostatectomy.BLADDER: Neobladder in place with mild hyperenhancement and thickening of the wall. Continence device noted with a reservoir in the left anterior abdominal wall.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Left inguinal hernia containing a loop of small bowel without evidence of strangulation. | 1.No specific findings to explain etiology of patient's hematuria.2.Mild thickening and enhancement of the neobladder wall is nonspecific.3.No evidence of recurrent disease. |
Generate impression based on findings. | Male 71 years old; Reason: 71 year old man with DLBCL. S/p chemo. Compare to prior scan. History: none CHEST:LUNGS AND PLEURA: The pleural are clear. No dominant lung lesion has developed. The central airways are patent.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. No mediastinal lymphadenopathy.CHEST WALL: Small thyroid nodules.OTHER: ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. Multiple hypodense lesions in the liver are unchanged.The right segment 6 lesion measures 0.8 x 0.7 cm (image 85/series 3) previously, 0.8 x 0.5 cm. Hepatic and portal veins are patent.Multiple calcified gallstones within the gallbladder. No gallbladder distention.SPLEEN: Hypodense splenic lesions are unchanged.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Calcific arteriosclerotic disease affects the aorta. The reference left para-aortic lymph node measures 2.2 x 1.2 cm (image 130/series 3) previously, 2.2 x 1.2 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostate is enlarged with coarse calcifications.BLADDER: No significant abnormality notedLYMPH NODES: Small pelvic lymph nodes.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes affect the lower lumbar spine and hipsOTHER: No significant abnormality noted | 1.Stable examination with no significant size change in the reference lesions.2.Cholelithiasis |
Generate impression based on findings. | Reason: lung ca History: RA/CA/SOB/SMOKER LUNGS AND PLEURA: Mild interval increase in left lung aeration and residual postsurgical scar and suture material in the left upper lobe. The adjacent focal thickening measures 14 x 7 mm (series 4, image 24), previously measuring 13 x 7 mm.Focal poorly defined groundglass opacity in the superior segment of the left lower lobe remains unchanged from prior exam. Multiple small micronodules and nodules are unchanged. Mild bilateral mosaic attenuation with faint tree in bud appearance in the upper lung zones appear unchanged. Interval increase in size of patchy groundglass opacity in the anterior right upper lobe is most consistent with aspiration.MEDIASTINUM AND HILA: Mildly enlarged precarinal lymph nodes are unchanged.Ectatic descending aorta are unchanged. Moderately severe atherosclerotic calcifications of the coronary artery.Small hiatal hernia.CHEST WALL: Degenerative disease to the thoracic spine is unchanged..UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Stable small solid nodules, micronodules, and groundglass opacities. No specific evidence of recurrent disease. |
Generate impression based on findings. | Male, 50 years old, new diagnosis of head and neck cancer, evaluate disease. The maxillary sinuses are only partially visualized but there is evidence of bilateral endoscopic sinus surgery. The right maxillary sinus is opacified by soft tissue material which extends to involve the nasal cavity back to the level of the choana. Correlation with history of sinus mucosal disease or polyps is recommended.A 2.0 x 1.6 cm calcified sialolith is present within the left submandibular gland. The gland itself is enlarged and there are some dilated ductal structures within the gland parenchyma.The right submandibular gland is unremarkable. There is a 9-mm enhancing nodule within the deep left parotid gland which statistically most likely represents a lymph node or a benign adenoma. The parotid glands are otherwise unremarkable.No pathologically enlarged or aggressive appearing lymph nodes are seen in the neck.The nasopharynx is somewhat full but no discrete lesions are detected. The oral tongue and floor of mouth are unremarkable. The epiglottis and aryepiglottic folds are free of focal lesions. The glottis and subglottic airway are within normal limits.There is a focus of calcification within the left thyroid lobe but otherwise the thyroid is unremarkable. Motion degrades imaging of the lung apices but at most there may be one or two small micronodules. A dedicated chest CT will be dictated separately. Quality of the contrast bolus is not adequate to assess the cervical vessels. No worrisome osseous lesions are demonstrated. | 1. Large left submandibular sialolith with evidence of mild glandular inflammation and ductal dilatation.2. No mucosal based mass, pathologic adenopathy or other specific findings of active malignancy are seen in the neck.3. Evidence of prior sinus surgery with extensive soft tissue opacification of the right maxillary sinus and the nasal cavity. Correlation with history of sinus disease/polyposis is suggested. |
Generate impression based on findings. | 45-year-old male with peritoneal mesothelioma, evaluate for progression ABDOMEN:LUNG BASES: Left subpleural nodularity and atelectasis.LIVER, BILIARY TRACT: Status post cholecystectomy. No focal hepatic lesions.SPLEEN: Status post splenectomy.PANCREAS: No significant abnormality notedADRENAL GLANDS: Nodule abutting the left adrenal gland measures 2.0 x 1.4 cm and previously measured 1.9 x 1.9 cm (image 34, series 3).KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Index gastrohepatic lymph node measures 1.5 x 1.0 cm (image 36, series 3) and previously measured 1.4 x 1.0 cm.BOWEL, MESENTERY: Multiple peritoneal implants are again identified. Reference soft tissue mass posterior to the stomach measures 4.2 x 3.3 cm and previously measured 4.2 x 2.9 cm.Reference pericecal mass measures 7.8 x 5.1 cm and previously measured 7.8 x 5.5 cm (image 85, series 3).Scattered mesenteric lymph nodes with a small reference node measuring 8 x 8 mm and previously measuring 6 x 5 mm (image 83, series 3).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: Reference peritoneal implant in the cul-de-sac measures 2.2 x 1.7 cm and previously measured 1.4 x 1.1 cm (image 122, series 3).BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Stable to slightly increased size of index lesions as detailed above. |
Generate impression based on findings. | 64-year-old male patient with melanoma of the skin. Reevaluate disease status for recurrence; compare to previous scan. CHEST:LUNGS AND PLEURA: Stable calcified right lower lobe nodule.MEDIASTINUM AND HILA: No enlarged mediastinal or hilar lymph nodes. Stable calcified mediastinal and right hilar lymph nodes consistent with prior granulomatous disease.CHEST WALL: Right axillary surgical clips, stable compared to prior examination.ABDOMEN:LIVER, BILIARY TRACT: Redemonstrated are subcentimeter hepatic hypodensities that are too small to characterize. Lesions appear stable compared to examination from 1/11/2011.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: Atherosclerotic changes in the abdominal aorta and iliac arteries.BOWEL, MESENTERY: Colonic diverticulosis without CT evidence of diverticulitis.BONES, SOFT TISSUES: Mild multilevel degenerative changes in the thoracic and lumber spine.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Reference left external iliac lymph node measures 0.9 x 0.6 cm (series 3 image 168), stable compared to prior examination.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild multilevel degenerative changes in the thoracic and lumber spine.OTHER: Stable fat containing left inguinal hernia. | Stable examination without suspicious appearing lymphadenopathy. |
Generate impression based on findings. | Mesothelioma status post two further doses of treatment. CHEST:LUNGS AND PLEURA: Left hemithorax pleural thickening and volume loss consistent with provided history of mesothelioma. Reference measurements as follows:Level of the aortic arch (3/34): 4 o'clock position 5 mm, previously 6-mm. 9 o'clock position 2 mm, previously 4-mm.Level of the main pulmonary artery (3/49): 6 o'clock position 6 mm, previously 9-mm. However, architectural distortion makes anatomic matching compared to the prior difficult. Soft tissue mass lesion abutting the aorta near this level is overall larger and numerous lesions along the mediastinal pleural surface are also slightly larger.Level of the left atrium (3/61): 3-mm at the 7 o'clock position, previously 5-mm. An adjacent trace volume of pleural fluid is not included in the measurement. 6-mm the 10 o'clock position, previously 5-mm.Intraparenchymal micronodules bilaterally unchanged and may be the result of prior granulomatous infection.No conclusive contralateral pleural tumor.MEDIASTINUM AND HILA: New moderate pericardial fluid collection. Nodularity along the pericardium suspicious for tumor. No significant lymphadenopathy. Coronary artery calcifications. Normal heart size.CHEST WALL: Left para-aortic tumor invades the paravertebrally and subpleural fat (3/52), but there is no evidence of extension outside of the bony thorax at the level. Mildly enlarged left intercostal lymph node noted (3/66). There is also invasion of the extrapleural fat postero-laterally on the left (3/87), 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: Bilateral cortical cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Small tumor nodule in the extraperitoneal space anterior to the diaphragm (3/90).OTHER: No significant abnormality noted. | Although the reference level measurements are not significantly changed, this does not accurately reflect the overall tumor burden which has slightly increased since the previous examination. New pericardial fluid collection with thickening and nodularity suspicious for pericardial involvement by tumor. Invasion of the paravertebral and subpleural fat by tumor, but no conclusive signs of chest wall invasion outside of the bony thorax. Very small extraperitoneal nodule, but no signs of intraperitoneal tumor. |
Generate impression based on findings. | Non-small cell lung cancer, follow-up CHEST:LUNGS AND PLEURA: Postsurgical changes with a left upper wedge resection unchanged. Residual scarring stable. No evidence of for localized recurrence in this region. The focal nodular thickening along the left inferior margin (image 66 series 4) remains 14 x 7 mm. No suspicious pulmonary nodules. Scattered granuloma. Mild bronchial wall thickening without new air space abnormality. Mild central lobular emphysema with the faint groundglass subcentimeter focus in the right middle lobe (image 55 series 4) unchanged. No effusionsMEDIASTINUM AND HILA: Stable small subcentimeter suspected thyroid cysts.No lymphadenopathy.The cardiac and pericardium other than extensive coronary calcifications are unchanged. Small hiatal herniaCHEST WALL: T12 vertebro-plasty and multilevel compression deformities throughout the mid and lower thoracic spine 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: Left renal cyst without new abnormalities observed bilaterally.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic changes unchanged.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Degenerative changes and mild scoliosis unchangedOTHER: No significant abnormality noted. | No evidence of focal recurrence. Reference measurements provided |
Generate impression based on findings. | 53-year-old female with DLBCL lymphoma on therapy, evaluate prior. CHEST:LUNGS AND PLEURA: Multiple scattered micronodules many of which are calcified consistent with prior granulomatous disease.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Note is made of a subcentimeter polypoid gastric lesion (image 86, series 3).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. No significant interval change or new adenopathy.2. Sub-centimeter polypoid gastric lesion. |
Generate impression based on findings. | Male 44 years old; Reason: pulm abnorm? History: dyspnea. LUNGS AND PLEURA: Dependent subsegmental atelectasis bilaterally but no focal opacities to indicate pneumonia. Scattered calcified and noncalcified pulmonary micronodules which is nonspecific and likely post inflammatory. No suspicious nodules or masses in the lungs. No pleural effusion or pneumothorax.MEDIASTINUM AND HILA: Scattered subcentimeter lymph nodes in the mediastinum. No hilar lymphadenopathy. Mild cardiomegaly. No pericardial effusion. The main pulmonary artery is normal caliber.CHEST WALL: Degenerative changes, anterior wedging , and kyphoscoliosis of the thoracic spine with subsequent deformity of the chest wall .UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Right renal hypodensity with simple cyst cystic features and which is fluid attenuating is incompletely seen on this exam but likely represents a benign renal cyst. | No acute cardiopulmonary abnormalities to explain the patient's shortness of breath. |
Generate impression based on findings. | Screening for malignancy and other cause of dyspnea on exertion. COPD and CHF history. Aortic valve replacement. LUNGS AND PLEURA: Diffuse moderate centrilobular emphysema again greater in the upper lungs. No superimposed acute abnormality, however multiple small granulomas are again observed scattered. No effusions.MEDIASTINUM AND HILA: Heavy calcification of the aortic valve or prosthesis. Small more moderate coronary calcifications.A descending aorta remains 4.0 cm in AP dimension when measured similarly, previously 3.8 cm. A definite significant interval change given differences in patient positioning and gantry angle.No lymphadenopathy.Possible small hiatal herniaCHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Splenic granuloma without additional abnormality in the partially visualized upper abdomen | Essentially stable diameter of the descending aorta and moderate COPD changes. No superimposed acute new findings |
Generate impression based on findings. | Acute respiratory failure, question ARDS. Hypoxia. LUNGS AND PLEURA: Extensive air space opacities bilaterally as follows: Dense consolidation in the posterior lower lobes bilaterally. A elsewhere there is a lobular pattern of air space opacities ranging from groundglass to solid in appearance and the majority is not associated with septal thickening with the exception of the extreme left apex. Within the anterior right lower lobe, the bronchioles are faintly thickened (4/64).Patchy areas of hyperlucent lung are noted (left upper lobe abutting the mediastinum with (4/44) left lower lobe posterior medially (4/59). Small right subpulmonic fluid collection.MEDIASTINUM AND HILA: Tracheostomy tube tip above the level of the carina. Mild right paratracheal chain lymphadenopathy. Subaortic lymphadenopathy (3/35). Mild subcarinal lymphadenopathy (3/49). Moderate right hilar lymphadenopathy measuring 3-cm (3/42). Mild perihilar lymphadenopathy bilaterally elsewhere. Of note, the mediastinal lymph nodes appear to be enhancing wall the hilar lymph nodes are relatively hypoattenuating.Heart size appears upper normal for age. Main pulmonary artery upper normal in size, 28-mm. Feeding tube is present in the esophagus, the tip is off the caudal margin of the scanning range.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. No significant abnormality appreciated. | Extensive bilateral segmental and lobar distribution groundglass and air space opacities with lower lobe consolidation and bronchial wall thickening. Radiographic pattern may be consistent with early acute stage ARDS however if the patient is not clinically in the acute stage, the lack of septal thickening would be atypical and the appearance would be more consistent with infection such as mycoplasma pneumonia. Other atypical infection such as PJP may be considered in the appropriate clinical context. Mild mediastinal and moderate right hilar lymphadenopathy. Small subpulmonic effusion on the right. |
Generate impression based on findings. | Asthma. Now with cough and dyspnea LUNGS AND PLEURA: Right apical scarring and diffuse central lobular emphysema unchanged. Persistent bronchial wall thickening consistent with patient's underlying known asthma unchanged. No new findings to suggest subpleural changes or air trapping. The two previously identified micronodules in the right middle lobe along the major fissure and left cardiac margin are both unchanged (image 75 series 5). No effusions.MEDIASTINUM AND HILA: No lymphadenopathy.Previously identified tracheal and bronchial debris has resolved.The cardiac and pericardium remain within limits.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Stable right renal cyst and stable appearing splenic calcification. | Persistent chronic bronchitis and/or asthma. No new superimposed acute abnormalities. No findings to suggest interstitial lung disease |
Generate impression based on findings. | Head and neck cancer, follow-up CHEST:LUNGS AND PLEURA: No suspicious pulmonary nodules or masses. No effusions. No new focal air space opacities. MEDIASTINUM AND HILA: No acute lymphadenopathy stable calcified AP window and hilar lymph nodes representing old granulomatous disease exposure. Mild increased pericardial thickening suggesting a small new questionable pericardial effusion along the anterior aspect. Moderate coronary calcifications unchanged.Moderate hiatal herniaCHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Unchanged right renal cystsPANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Moderate atherosclerotic changes unchangedBOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Small umbilical hernia and moderate degenerative changes scattered throughout the thoracic and lumbar spine. No suspicious new lytic or blastic lesions observed.OTHER: No significant abnormality noted. | No findings to suggest metastatic disease |
Generate impression based on findings. | 71 year-old female with head and neck cancer. The orbits are unremarkable. The paranasal sinuses are clear. There is partial opacification of the mastoid air cells. Limited view of the intracranial structure is unremarkable. There is redemonstration of treatment related changes consisting of pharyngeal and laryngeal mucosa edema. There is also hyperemic appearance of the submandibular glands and some reticulation of fat over the anterior neck, both consistent with radiation therapy also. There is no focal salivary gland lesion, In this background, there is no exophytic mass or focal effacement to suggest tumor. Additionally, there is no cervical lymphadenopathy by CT imaging criteria. There are scattered subcentimeter lymph nodes throughout the neck and superior mediastinum which lack aggressive features and are unchanged. No new or enlarging lymph nodes identified.The thyroid glands are unremarkable apart from tiny hypodensities.Cervical vascular structures are again notable for moderate atherosclerotic calcification at the carotid bifurcations. Lung apices reflect very mild centrilobular emphysema. There are otherwise clear. See dedicated chest for further details.Cervical spine has normal curvature, alignment, and mineralization. There is no destructive osseous lesion seen. There is some minimal degenerative change, principally uncovertebral hypertrophy and facet hypertrophy, also narrowing of intervertebral disk spaces. | Stable treatment related changes of the neck without recurrent neck mass or cervical lymphadenopathy. |
Generate impression based on findings. | 60 year old male with history of large cell neuroendocrine carcinoma, follow up examination. Postsurgical change is redemonstrated in the upper mediastinum status post resection of a large tumor which was visualized on the exam of 06/08/11. Today's exam remains stable with only mild residual soft tissue thickening in the surgical bed and along the vertebral bodies, unchanged. There is no mass effect upon the airway or the vasculature.The mucosal tissues of the nasopharynx, oropharynx and hypopharynx are within normal limits. Asymmetric dilatation of the right laryngeal ventricle and piriform sinus suggest right vocal cord paralysis. No pathologically enlarged lymph nodes are evident in the neck or upper mediastinum. The salivary glands are free of focal lesions. The thyroid has been partially resected. The cervical vessels are patent. Linear scarring in the lung apices is likely related to prior radiation therapy and stable. No focal destructive bony lesion are seen. | Stable postsurgical change in the upper mediastinum and lower neck with no evidence of recurrent tumor or pathologic adenopathy. |
Generate impression based on findings. | Reason: h/o doe with VATs c/f NSIP v chronic microaspiration, still with sx after tx for gerd/aspiration eval for progression of dz History: cough w mucus, pain w deep inspiration LUNGS AND PLEURA: Post surgical changes seen in the periphery of the right mid and lower lung zones. Basilar predominant ground glass opacities with interval increase while associated with interval decrease of the associated reticular component. There is architectural distortion in traction bronchiectasis. There is no peripheral sparing or honeycombing. There is no air trapping. No evidence of pleural effusion or pneumothorax.MEDIASTINUM AND HILA: No lymphadenopathy.Suspected lymph node adjacent to the right atrium, unchanged (series 3, image 46).Heart size is normal. No pericardial effusion.CHEST WALL: No axillary lymphadenopathy.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Status post cholecystectomy. . | Interval new groundglass component and shift in appearance, again non specific but concerning for possible NSIP. No new superimposed pulmonary abnormality |
Generate impression based on findings. | Tongue cancer CHEST:LUNGS AND PLEURA: Interval enlarging of a small subpleural nodule in the left lower lobe (image 67 series 6). Current measurement is 4 mm, previously 2 mm and not identified in 2012. Old scarring in the right middle lobe unchanged. Mild centrilobular and paraseptal emphysema greater in the upper lungs. No effusionMEDIASTINUM AND HILA: No lymphadenopathy. Scattered lymph nodes remain stable in appearance.The cardiac and pericardium remain unchanged with interval resolution of a small pericardial effusion previously described. Moderate coronary calcifications.CHEST WALL: Left breast surgery and surgical clips. No suspicious new abnormalities bilaterallyABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Gallstones. Liver otherwise unremarkableSPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple scattered suspected renal cysts 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. | Suspicious new solitary nodule in the left lung base concerning for metastatic disease or possibly a new primary given its solidarity |
Generate impression based on findings. | 52-year-old male with neck swelling and pain, newly diagnosed parotid cancer Limited intracranial views are unremarkable. Limited views of the mastoid air cells clear. Limited views of the paranasal sinuses demonstrate mild mucosal thickening of the maxillary sinuses.Necrotic appearing rim enhancing lesion along/abutting the inferior most aspect of the right parotid gland measures 1.8 x 1.4 cm (series 6 image 26). No additional cervical lesions are identified.Dominant hypoattenuating lesion in the right lobe of the thyroid gland. The submandibular and left parotid glands are within normal limits. No evidence of cervical lymphadenopathy by CT size criteria. No exophytic mass or focal effacement of the aerodigestive tract. The cervical vasculature is patent bilaterally. The visualized lung apices are unremarkable. Mild degenerative changes of the visualized cervicothoracic spine without suspicious osseous lesions. | Solitary rim enhancing necrotic appearing lesion along/abutting the inferior most aspect of the right parotid gland measures 1.8 x 1.4 cm (series 6 image 26). No lymphadenopathy by CT size criteria. |
Generate impression based on findings. | Mesothelioma status post neoadjuvant chemo/RT and surgical resection CHEST:LUNGS AND PLEURA: Fluid-filled left pneumonectomy cavity without significant change in appearance. Left diaphragmatic graft. Trace right pleural fluid collection. Subcentimeter nodular density in the subpleural fat anteriorly on the right which appears to be in association with the costochondral junction (3/48) new but too small to be accurately characterized. This should be monitored on subsequent examinations.MEDIASTINUM AND HILA: Several small lymph nodes in the lower cervical region on the left are similar in size compared to previous but less well defined, with adjacent soft tissue stranding. Previously noted enlarged left prevascular lymph node is smaller (3/22). A mildly enlarged lymph node slightly cranial to this level (3/19) is unchanged.Right prevascular lymph node decreased in size, 9-mm compared to 14-mm previously (3/27). Hilar region lymph nodes are unchanged.Severe leftward mediastinal shift with compression of the left atrium by the spine unchanged. Right mainstem bronchus is patent.CHEST WALL: Asymmetric right parasternal soft tissue (3/55) with possible focal cortical erosion along the lateral sternal body (3/60), unchanged given the benefit of retrospect compared to prior examinations dating back to 3/4/13 though difficult to appreciate as it appears isoattenuating and similar in size to costochondral cartilage. This could represent an anatomic variant of supernumerary costochondral cartilage however the apparent erosive change of the adjacent sternum would be atypical. The anterior costochondral cartilage is of the lower thorax appear slightly thickened, correlate for symptoms of costochondritis.Left seventh rib displaced fracture shows adjacent callus formation suggesting healing however periosteal reaction secondary to osteomyelitis cannot be entirely excluded. The adjacent cortex remains intact. Lateral to this abnormality there is a persistent soft tissue collection which is hyperattenuating to muscle, this has minimally increased in thickness since the previous examination. Lack of resolution would be atypical for bland hematoma. Possibilities include infected hematoma in the appropriate clinical setting or possibly tumor though chest wall tumor is typically more nodular in appearance.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cyst in the left lobe near the dome.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.Gastric wall appears diffusely but mildly thickened, correlate for symptoms of gastritis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Persistent soft tissue mass in the left lateral chest wall, unable to exclude infected hematoma or atypical appearance of tumor.2. Small soft tissue mass isoattenuating to costochondral cartilage between the right third and fourth ribs may represent supernumerary anterior costochondral cartilage versus an occult mass. There is questionable focal area of cortical breakthrough in the adjacent lateral sternal body raising the possibility of a non-benign process.3. Interval improvement in lymphadenopathy.4. Nonspecific thickened appearance of the gastric wall, correlate for gastritis. Nonspecific thickened appearance of the costochondral cartilage, correlate for signs of costochondritis.5. Suggest FDG-PET imaging for further clarification regarding #1 and #2 above if diagnosis would alter medical management.6. Subpleural soft tissue opacity in the anterior chest wall too small to be accurately characterized and should be followed on subsequent studies. |
Generate impression based on findings. | Kidney cancer, follow-up for metastatic disease LUNGS AND PLEURA: Minimal and upper lobe predominant ground glass opacities are again observed and possibly persistent mild aspiration. No suspicious new acute focal air space abnormalities. No effusions. Scattered micronodules and basilar scarring are unchanged, many micro-nodules are calcified.MEDIASTINUM AND HILA: Cardiac and paracardial remain within limitsNo lymphadenopathyCHEST WALL: Scattered stable degenerative changes throughout the thoracic spine. No suspicious osseous blastic or lytic lesionsUPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No appreciated discrete lesions throughout the limited view of the liver, however without enhancement and complete imaging evaluation is limited. Mild atherosclerotic changes. The remainder of the upper abdomen is otherwise unremarkable in the limited evaluation | No findings to suggest metastatic pulmonary or osseous disease |
Generate impression based on findings. | Male 42 years old; Reason: ct pe History: SOB. PULMONARY ARTERIES: No evidence of pulmonary emboli. Main pulmonary artery diameter is 2.9 cm which is within normal limits.LUNGS AND PLEURA: No focal opacities, pleural effusions or pneumothorax. Scattered nonspecific micronodules and no suspicious pulmonary nodules.MEDIASTINUM AND HILA: No cardiomegaly or 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. Fluid-filled structure in the region of the left adrenal gland could represent a duplication cyst or a gastric diverticulum. | No pulmonary emboli and no findings to explain the patient's shortness of breath. |
Generate impression based on findings. | Hydatidiform mole, check for metastatic disease. LUNGS AND PLEURA: Scattered micronodules and cysts, all unchanged. No suspicious new nodules or masses. No effusions. Stable mild scarring in the left lung and faint ground glass nonspecific focal changes in the left upper lobe and left lower lobes again also unchanged. Left basilar scarring and surgical clips.MEDIASTINUM AND HILA: Upper mediastinum is severely limited in evaluation secondary to streak artifact from a right shoulder arthroplasty. Otherwise within this limitation noted discrete distinct new abdomen, specifically no lymphadenopathy. These note however evaluation for thrombus is difficult to excludeThe cardiac and pericardium are within normal limits. Minimal residual thymic tissue or rebound thymic tissue essentially unchanged anteriorlySmall hiatal hernia.CHEST WALL: Right upper chest port unchangedUPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Cholecystectomy clips | Improvement with stable appearing lymph nodes and pulmonary changes suggesting bronchiolitis and scarring. Previously referenced lesions discussed |
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