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Generate impression based on findings. | Male 68 years old; Reason: metastatic Prostate cancer, evaluation of disease after 13 cycles of investigational therapy. History: metastatic Prostate cancer CHEST:LUNGS AND PLEURA: No significant abnormality noted plaquing with calcification. Mild pleural reticular changes.Nonspecific ground glass opacity in the lingula (image 8 series 4)MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. No mediastinal lymphadenopathy.CHEST WALL: Osseous metastatic disease to the left humerus and T7 vertebral bodies.OTHER: ABDOMEN:LIVER, BILIARY TRACT: Liver has a smooth contour. No suspicious hepatic lesions . Hepatic and portal veins are patent. Biliary ducts are normal in caliber.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Punctate right renal calcification may represent a nonobstructive calculus. Small probable bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: Calcific arteriosclerotic disease of the aorta.BOWEL, MESENTERY: Small bowel is normal in caliber. Few scattered diverticula of the sigmoid colon.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Stable exam with sclerotic metastases to the T9 vertebral body and left proximal humerus. |
Generate impression based on findings. | Male 53 years old; Reason: pancreatic cancer compare to last CT \T\ measure 1)liver met, 2) pancreatic lesion, 3) gastrohepatic node \T\ 4) retroperitoneal node History: post 3 cycles of chemo CHEST:LUNGS AND PLEURA: New hazy ground glass/tree in bud opacity in the left lower lobe (series 5 image 52).MEDIASTINUM AND HILA: No adenopathy noted. Coronary calcifications identified.CHEST WALL: Left Port-A-Cath is noted with its tip in the cavoatrial junction. Noaxillary adenopathy detected.ABDOMEN:LIVER, BILIARY TRACT: Multiple hypoattenuating lesions are noted in the liver stable. Reference lesion measures 2.5 x 2.7 cm, previously 2.8 x 2.8 mm in the inferior portion of the medial segment of the left lobe of the liver (series 3 image 115), stable in size. The liver contour is normal. The gallbladder is contracted but otherwise unremarkable.SPLEEN: No significant abnormality notedPANCREAS: Hypoattenuating expansile lesion in the mid to distal pancreas is noted measuring approximately 3.3 x 3.2cm previously 4.7 x 4.7 cm (series 3 image 11). There is distal pancreatic atrophy with peripancreatic edema. Stable thrombosis of the splenic vein, with reconstitution through the gastroepiploic vessels.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: A small retroperitoneal lymph nodes with the reference node measuring 0.8 x 1.6 cm previously 1.6 x 1.4 cm (series 3 image 119).BOWEL, MESENTERY: Numerous gastrohepatic and small bowel mesenteric nodes identified. A reference node measures 1.8 x 1.7 cm, previously 2.4 x 2.4 cm (series 3 image 104).BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Decrease in size of the pancreatic lesion and referenced metastatic disease as described above. Thrombosis of the splenic vein with multiple perigastric collaterals.2. New ground glass opacity in the left lower lobe. Differential considerations include infectious versus inflammatory process. |
Generate impression based on findings. | Germ cell tumor of testicle resected. CHEST:LUNGS AND PLEURA: Focal areas of hyperlucency are noted in the left upper lobe, right lower lobe superior segment, no nodules are identified. and left lower lobe medially.MEDIASTINUM AND HILA: Heart size is normal. Aberrant right subclavian artery is again visualized, normal variant anatomy. The thymus is replaced by fat and an epicardial fat pad is noted. No significant mediastinal lymphadenopathy is present.CHEST WALL: The BMI is increased. Minimal anterior wedging of T12 and L1 continues.ABDOMEN:LIVER, BILIARY TRACT: Focal area of decreased attenuation in dome of liver is again seen. This may be due to diaphragmatic leaf or focal fat. No focal hepatic lesion is seen. The liver remains enlarged with, measuring greater than 20 cm in craniocaudal dimension. The gallbladder is distended.SPLEEN: Normal in appearance.PANCREAS: Normal in appearance.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Two foci of high attenuation are seen in the left calyces and may be very tiny stones. Renal cortical enhancement is normal. No pelvicaliceal dilatation is present.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Duodenojejunal junction is normally positioned. No dilated bowel loops are seen. A large amount of mesenteric fat is present.BONES, SOFT TISSUES: The BMI is increased. There is diastases of the rectus abdominis muscles. A small fat containing ventral hernia is identified (image 109/207).OTHER: No free fluid or free air is present.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Incompletely distended.LYMPH NODES: No abnormalities seen.BOWEL, MESENTERY: No dilated bowel loops are present.BONES, SOFT TISSUES: Dependent edema is noted over the spinous processes. Bilateral pars defects are present at the L5 level, unchanged.OTHER: No free fluid is present. | No evidence of metastatic disease.Scattered air trapping/pulmonary mosaic perfusion.Hepatomegaly.Possible tiny left renal calculi.Bilateral L5 spondylolysis. |
Generate impression based on findings. | Male, 65 years old, intra-cerebral hemorrhage. Since the prior exam, there has been no significant change in the size or shape of a right thalamic parenchymal hematoma. Mild surrounding parenchymal edema is slightly more conspicuous, but still there is no significant generalized mass effect.Extension of blood into the ventricular system is also redemonstrated. The quantity and morphology of intraventricular blood appears similar to the prior exam except in the fourth ventricle where it is less conspicuous. There is evidence of some layering blood product within the left occipital horn.The ventricles remain within normal limits for size. There is perhaps some very subtle expansion of caliber in the region of the right atrium and right temporal horn. Periventricular hypoattenuation is seen bilaterally, a nonspecific finding which could indicate age indeterminate small vessel ischemic disease or possibly developing transependymal CSF migration.No new intracranial hemorrhage is seen. No new parenchymal abnormalities are detected. | Stable right thalamic and intraventricular hemorrhage allowing for some mild redistribution within the ventricles. No evidence of new intracranial hemorrhage is seen. The ventricles overall remain within normal limits for size. There is at most a mild increase in ventricular caliber at the level of the right atrium and right temporal horn. Periventricular hypoattenuation is difficult to assess without an old exam for comparison. The differential includes small vessel ischemic disease as well as transependymal CSF migration. |
Generate impression based on findings. | Fungal pneumonia status post treatment with vfend reevaluate. Patient has AML and is immunocompromised and neutropenic. LUNGS AND PLEURA: Mixed response compared to the previous examination. Air space opacities with in the left lower lobe have increased in size and density (6/46, 6/67). Faint peripheral opacity in the lingula is new (6/57) as is a new nodular air space opacity in the left costophrenic angle (6/96). In the right lung, lesions have improved in both size and number but have not completely resolved. No pleural fluid or pneumothorax.MEDIASTINUM AND HILA: Signs of prior CABG. Severe atherosclerotic disease of the native coronary arteries. Mild cardiomegaly. No significant lymphadenopathy. The E. main pulmonary artery appears mildly enlarged, suggestive of pulmonary arterial hypertension.CHEST WALL: Sternotomy with wires in place.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. Atherosclerotic disease. Subcentimeter lesion in the left hepatic lobe near the dome unchanged, possibly a cyst but incompletely characterized. | Mixed response in pulmonary opacities with improvement on the right but worsening on the left. |
Generate impression based on findings. | Thymoma large cell neuroendocrine carcinoma) diagnosed over 1-2 years ago status post chemo and RT. CHEST:LUNGS AND PLEURA: Bilateral pulmonary nodules, one of which in the left upper lobe is calcified. New nodule in the lingula (5/42).Bilateral paramediastinal radiation fibrosis.MEDIASTINUM AND HILA: Surgical clips in the thyroid bed. Bilateral paratracheal soft tissue at the level of the clips is unchanged and consistent with residual thyroid tissue. Previously measured high right paratracheal soft tissue stranding (3/8) unchanged. Left calcified mediastinal lymph nodes unchanged. Normal heart size. Small hiatal hernia.CHEST WALL: Severe degenerative changes of the spine with osteophyte formation. Cortical thickening and sclerosis of the right fifth rib posteriorly, unchanged.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Sludge and stones in the gallbladder.SPLEEN: Granulomas.ADRENAL GLANDS: Nodular appearance to the adrenal glands unchanged.KIDNEYS, URETERS: Numerous renal cysts and subcentimeter lesions which are too small to accurately characterize. Scarring in the interpolar region of the left kidney.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Peri-portal lymph nodes are again noted, one of which now measures 16mm in size, mildly enlarged.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Suture material along the stomach suggestive of gastric reduction surgery, correlate with surgical history.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Unchanged appearance of the mediastinum with no specific signs of localized tumor recurrence.2. New 5-mm nodule in the lingula may be post inflammatory however a metastasis cannot be entirely excluded without CT follow-up which may be performed in 6 weeks.3. Nonspecific mild interval enlargement of a peri-portal region lymph node; distribution would be atypical for metastatic disease from the patient's mediastinal primary. Correlate for abdominal etiology. |
Generate impression based on findings. | Male 48 years old; Reason: abdominal pain, hematuria, val for renal calculi, pyelonephritis History: belly pain ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: There is cirrhotic morphology of the liver. This patient is status post cholecystectomy.SPLEEN: Mildly enlarged without focal lesion.PANCREAS: Atrophic with minimal fat stranding. No peripancreatic fluid collections or splenic vein thrombosis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Appendix is normal in morphology without surrounding inflammatory changes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.No bowel obstruction, renal calculi or pyelonephritis as clinically questioned. |
Generate impression based on findings. | Female 61 years old; Reason: To restage for appendiceal adenocarcinoma History: Appendiceal adenocarcinoma CHEST:LUNGS AND PLEURA: Stable nonspecific 3-mm left upper lobe pulmonary nodule adjacent to the major fissure may represent an intrapulmonary lymph node (series 5 image 30). Bilateral dependent atelectasis.MEDIASTINUM AND HILA: Multinodular goiter. Prominent right upper paratracheal lymph node is not significantly changed. Small nonenlarged mediastinal lymph nodes, not significantly changed compared to prior. Mild coronary artery calcifications.CHEST WALL: Interval removal of the right chest port.ABDOMEN:LIVER, BILIARY TRACT: Hypoattenuating lesion adjacent to the portal vein measures 1.7 x 1 .1 cm, previously 2.1 x 1 .2 cm (series 5 image 99), relatively unchanged compared to prior. Hypoattenuating focus adjacent to the hepatic fissure may represent focal fat deposition.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small subcentimeter hypoattenuating foci in both kidneys are too small to characterize. RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: Postsurgical changes of a distal small bowel, cecum, and appendiceal resection.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: Left femoral head bone island unchanged.OTHER: No significant abnormality noted. | Stable examination with no evident recurrence or metastatic disease detected. |
Generate impression based on findings. | Clinical question: Status post left MCA stroke. Mental status change. Rule out bleed. Signs and symptoms: As above. Unenhanced head CT:There is no evidence of acute intracranial process in particular no evidence of hemorrhage as is questioned clinically. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.Unremarkable cerebral cortex, cortical sulci and ventricular system and maintained midline. | No acute intracranial process. |
Generate impression based on findings. | Lung cancer on Tarceva CHEST:LUNGS AND PLEURA: Left paramediastinal radiation fibrosis. Small left pleural fluid collection similar in size, partially loculated abutting the posterior mediastinum. Minimal paramediastinal atelectasis on the right.Left paramediastinal mass infiltrating the mediastinum between the origin of the left subclavian and carotid arteries not significantly changed at the reference level, 14 x 27 mm, previously 13 x 27 mm (3/30).MEDIASTINUM AND HILA: No significant lymphadenopathy; a mildly prominent left inferior pulmonary ligament lymph node is unchanged (3/55). Coronary artery calcifications. High riding pericardial recess versus pericardial cyst on the right.CHEST WALL: Sclerosis of the left posterior ninth rib unchanged.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted. PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Non-enlarged porta hepatis lymph node unchanged, 8mm. Very small lymph node at the GE junction (3/75)BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Stranding of the mesentery appears slightly worse compared to prior examination. Numerous small lymph nodes measuring up to 9-mm in short axis are noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Unchanged appearance of left paramediastinal mass. Chronic mesenteric stranding may be slightly worse with new small lymph node in the gastrohepatic ligament and numerous small mesenteric lymph nodes one of which has mildly enlarged. This may reflect chronic mesenteric panniculitis however lymphoma/lymphoproliferative disease may have a similar radiographic appearance and cannot be entirely excluded. |
Generate impression based on findings. | Reason: endocarditis History: endocarditis LUNGS AND PLEURA: Left basilar pleural and parenchymal scarring.Small bilateral pleural effusions, right greater than left with underlying atelectasis.Mild interlobular septal thickeningBronchiolar wall thickening and groundglass centrilobular nodules in the upper lobes suggestive of aspiration/bronchiolitis.6-mm nodule in the right upper lobe (image 68 series 4) is nonspecific. Itadditional scattered micronodules identified bilaterally.MEDIASTINUM AND HILA: Left chest ICD with lead wires ritual bandage and right ventricle and a third lead extending to the left posterior chest wall.Cardiac size is normal with evidence of mitral valve surgery. No paracardial effusion identified.Prominent precarinal lymph node (image 50 series 3) measuring 12 mm.CHEST WALL: Evidence of a median sternotomy.Degenerative changes in the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Peripheral hypodense region in the spleen may represent a splenic infarct.Nonspecific hepatic and right renal hypodensities are suggestive of cysts. | 1.Bilateral pleural effusions with scattered areas of interlobular septal thickening suggestive of edema.2.Upper lobe bronchiolar wall thickening and groundglass centrilobular nodules compatible with aspiration bronchiolitis.3.Nonspecific scattered micronodules with a 6-mm right upper lobe nodule. Recommend follow-up examination in 3 months if this patient has high risk factors for malignancy.4.Possible splenic infarct. |
Generate impression based on findings. | Female 63 years old; Reason: restaging scans s/p 8 cycles of investigational agent; please compare to previous scans. History: hx of metastatic bladder cancer CHEST:LUNGS AND PLEURA: Multiple pulmonary nodules have increased in size. The left upper lobe pulmonary nodule measures 3.0 x 2.4 cm (image 17/series 6) previously, 2.2 x 2.2 cm.The left lower lobe lesion measures 2.6 x 1.8 cm (image 65/series 6) previously, 2.6 x 1.8 cm.The lesion have more cavitation. The pleural spaces are clear.MEDIASTINUM AND HILA: Heart size is normal. Extensive necrotic mediastinal lymphadenopathy.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No definite new hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: Mild pancreatic ductal dilatation. No measurable mass.ADRENAL GLANDS: Right adrenalectomy. Left adrenal gland is unremarkable.KIDNEYS, URETERS: Right nephrectomy. No hydronephrosis in the left kidney.RETROPERITONEUM, LYMPH NODES: Calcific arteriosclerotic disease affects the aorta. Left para-aortic lymph node measures 1.8 x 1.7 cm (image 135/series 4) previously, 1.8 x 1.3 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Absent or atrophic.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Increase in the size of the metastatic lung deposits and mediastinal lymphadenopathy. |
Generate impression based on findings. | Neck cancer. Lump in the head and neck, check for metastatic disease LUNGS AND PLEURA: Multiple scattered peripheral micronodules of which many are calcified and greater in number within the lung bases. No distinct suspicious larger nodules or masses. No effusions.MEDIASTINUM AND HILA: No definite suspicious lymphadenopathyThe cardiac and paracardiac are significant for heavy coronary calcifications.Small hiatal herniaCHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted within this limited view of the upper abdomen and motion artifact. | Scattered granulomatous changes without definite suspicious findings to suggest metastatic disease. Please note that in this background, sensitivity is decreased and serial imaging will be helpful. |
Generate impression based on findings. | Female 52 years old; Reason: 52F with h/o biliary pancreatitis 8/2013, now with multiple pseudocysts, please evaluate for interval change History: abd pain ABDOMEN:LUNG BASES: No nodule detected. LIVER, BILIARY TRACT: Hepatic cyst located in segment 8 and segment 4b of the liver, unchanged.SPLEEN: A small hypodense cyst in the spleen.PANCREAS: The pancreas enhances homogeneously without areas of necrosis. No pancreatic ductal dilatation. The splenic vein is patent. There are multiple loculated fluid collections along the anterior surface of the liver capsule, gastrohepatic ligament, the mesenteric root, and along the pancreas. The largest collection measuring 5.6 x 5.0cm (series 4 image 44) previously 8 x 6 cm. The collection around the pancreatic tail measures 4.4 x 3.5cm (series 4 image 52) previously 5.5 x 4.2 cm. The collection around the mesenteric root measures 4.6 x 3.7 cm (series 4 image 75) previously 6.0 x 4.5 cm. The largest collection anterior to the liver surface measures 3.8 x 2.4 cm (series 4 image 32) 5.1 x 3.5 cm.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Status post hysterectomy. The ovaries appear normal.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: 2.5 x 3.0 cm enhancing nodule in the left aspect of the perineum, which is stable since previous exam. Differential considerations include infected Bartholin gland cyst, however neoplasm can appear similarly. | 1. Multiple loculated fluid collections located along the anterior surface of the liver, the gastrohepatic ligament, the mesenteric root, and along the pancreas have all decreased in size. 2. 2.5 x 3.0 cm enhancing nodule in the left aspect of the perineum, which is stable since previous exam. Differential consideration includes infected Bartholin gland, but incompletely characterized. |
Generate impression based on findings. | Follow-up of groundglass nodule as recommended. S.O.B. with family history of pulmonary fibrosis. LUNGS AND PLEURA: Interval resolution of left upper lobe ground glass nodules, presumably postinflammatory.Moderate to severe circumferential subpleural reticulation in a distribution suggestive of UIP. Mild subpleural emphysema but no specific evidence of honeycombing or bronchiectasis.MEDIASTINUM AND HILA: Scattered small lymph nodes in the lower left cervical region (3/7) probably present previously but obscured due to artifact. Atherosclerotic calcification of the aorta and left circumflex coronary arteries. Normal heart size. No pericardial fluid.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. Cholecystectomy clips. Possible cyst right hepatic lobe incompletely characterize but unchanged. Smaller but similar appearing lesions also seen in the right hepatic lobe are unchanged, too small to accurately characterize. Atherosclerotic calcification of the splenic artery and superior mesenteric artery near its origin.. | Interval resolution of left upper lobe ground glass nodule, presumably postinflammatory. Moderate subpleural reticulation consistent with early fibrosis, the distribution is most commonly seen with UIP however no bronchiectasis or definite honeycombing is observed. |
Generate impression based on findings. | Thyroid neoplasm CHEST:LUNGS AND PLEURA: Stable scattered mixed calcified and noncalcified pulmonary nodules as prominent a single left lung base. The reference larger lesion the minor fissure remains 6 mm (image 49 series 5). The reference left upper lobe solitary nodule is also unchanged (image 34 series 5). A new small focal area of groundglass in the posterior right lung is suggestive of aspiration. No effusions.MEDIASTINUM AND HILA: Thyroidectomy.The reference left supraclavicular reference node (image 10 series 3) remains 7 mm. No new lymphadenopathy.Severe coronary artery calcifications. The cardiac and pericardium are otherwise unremarkableCHEST WALL: ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Scattered hepatic cysts unchanged. CholecystectomySPLEEN: 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: Benign-appearing endplate cyst and L4 unchangedOTHER: No significant abnormality noted. | No findings to suggest metastatic disease and minimal changes suggesting aspiration |
Generate impression based on findings. | 745 year-old male with medullary thyroid carcinoma follow-up. The orbits are unremarkable. The paranasal sinuses and mastoid air cells are clear except for small maxillary sinus retention cysts. Limited view of the intracranial structure is unremarkable. There is redemonstration of a total thyroidectomy with ill-defined soft tissue along the right trachea into the tracheoesophageal groove. This appearance is unchanged and compatible with postoperative change. There is no discrete soft tissue mass or cartilage destruction to suggest locally recurrent or residual tumor.There is no cervical lymphadenopathy by CT criteria. Two enhancing sub-centimeter foci in the left level 3 station appear stable, each measuring less than 5 mm (series 6 image 48-50), unchanged. A left supraclavicular focus (series 6 image 51) measures 14 x 7 mm today compared to 14 x 7 mm previously. A stable cluster of subcentimeter lymph nodes in the right level IIB nodal stations. No new or enlarging lymph nodes identified.The aerodigestive tract reflects medialization of the right vocal cord consistent with paralysis. This is unchanged and there is no new site of focal effacement nor is there an exophytic mass.The salivary glands are unremarkable, containing no focal lesions. Cervical vascular structures reflect mild calcification at the carotid bifurcations. They are otherwise unremarkable.Visualized lung apices are unremarkable. See dedicated chest CT for further details.Cervical spine is unchanged reflecting mild degenerative changes worst at C6-C7 where posterior disk osteophyte complex effaces the ventral thecal sac and may mildly indent the cord. There is also some mild to moderate foraminal narrowing at this level due to uncovertebral hypertrophy. No destructive osseous lesions are seen. | Stable small reference cervical lymph nodes. No convincing evidence of local recurrence. |
Generate impression based on findings. | Status post pleurectomy/decortication for management of pleural mesothelioma. One-month follow-up. CHEST:LUNGS AND PLEURA: Bilateral calcified pleural plaques. Left hemithorax volume loss consistent with history of pleurectomy and mesothelioma. Left diaphragmatic graft.Mild septal thickening at the lung bases. Mild thickening of the left major fissure. No measurable pleural tumor.MEDIASTINUM AND HILA: Interval resolution of previously seen AP window region lymph node. Left hilar region lymph nodes about the same. Mildly enlarged left inferior interlobar lymph node measuring of 10-mm minimally larger, previously 8-mm. (3/51) mild high right paratracheal lymphadenopathy slightly worse (3/15). New enlargement of a high left paratracheal lymph node adjacent to the left carotid artery (3/21). Mild subcarinal lymphadenopathy not significantly changed (3/46). Coronary artery calcifications. Mild pericardial thickening, nonspecific.CHEST WALL: Interval development of mild left internal mammary chain lymphadenopathy (3/38).Left chest wall postoperative soft tissue stranding but no specific evidence of tumor.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Degenerative changes.OTHER: No significant abnormality noted. | No measurable pleural disease. Mixed response in lymphadenopathy with interval complete resolution of previously seen lymph node in the region of the aortopulmonary window, new left internal mammary chain lymphadenopathy, a new high left paratracheal lymph node and interval enlargement of lymph nodes in the right paratracheal chain, the subcarinal space and the left inferior interlobar region. The new and enlarging lymph nodes are highly suspicious for previously occult nodal metastases. |
Generate impression based on findings. | Neoplasm of the cervix and uterus. Shortness of breath and cough LUNGS AND PLEURA: Continued progression of the diffuse bilateral metastatic masses with cavitation. Interval enlargement fullness and confluence is observed. For reference the left lower lobe mass currently measures 11.8 cm x 7.7 cm (image 53 series 5) from a prior measurement of 10.3 cm x 6.7 cm. additionally other lesions are markedly larger with increased periphery of associated increased soft tissue. Increased diffuse tree in bud-like or nodular abnormality, slightly greater on the left, but changes noted within all 4 lobes suggesting at minimum aspiration and/or possibly diffuse spread of metastatic disease interstitially. No discrete effusions.Interval clearance of the upper lobe changes suggesting a possible drug reactionMEDIASTINUM AND HILA: Interval enlargement of multiple lymph nodes, for reference the precarinal lymph node currently measures 1.6 cm in short axis (image 35 series 4), previously 0.9 cm.The cardiac and paracardiac or otherwise grossly within limits and unchanged.Small hiatal hernia.CHEST WALL: Right chest port with tip projected into the mid SVCUPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Multiple scattered unchanged hypodensities suggesting simple hepatic cysts. Liver incompletely visualized. The remainder of the upper abdomen is otherwise grossly unremarkable in this limited evaluation | 1. Continued progression of metastatic disease with increased size, number and confluence of multiple cavitary masses, reference measurements above. New mediastinal lymphadenopathy.2. Interval clearance of the upper lobe changes suggesting a possible drug reaction. |
Generate impression based on findings. | Female 57 years old; Reason: Pancreatic cancer. Evaluate disease burden. History: NA ABDOMEN:LUNGS BASES: New bilateral lower lobe nodules highly suspicious for metastatic disease to the lungs.LIVER, BILIARY TRACT: The liver is normal in morphology. New segment 7 hypodense lesion measures 1.2 x 1.0 cm (image 29/series 4). No biliary ductal dilatation. The hepatic and portal veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: Progressive atrophy of the residual pancreas following Whipple procedure.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Enlarged retroperitoneal lymph nodes. A left para-aortic lymph node measures measures 1.3 x 1.2 cm (image 54/series 4). Mesenteric lymph nodes have enlarged in size. A representative mesenteric node measures 1.9 x 1.2 cm (image 60/series 4). BOWEL, MESENTERY: Post operative changes from Whipple procedure. A small amount of thrombus in the SMV is new.BONES, SOFT TISSUES: Soft tissue fluid collection has resolved.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 pelvic ascites. | 1.New lower lung nodules suspicious for metastatic disease.2.New liver lesion suspicious for metastatic disease.3.Increase in the size of the retroperitoneal and mesenteric lymphadenopathy suspicious for metastatic disease. |
Generate impression based on findings. | Thyroid cancer, check for progression CHEST:LUNGS AND PLEURA: Essentially stable pulmonary appearance with multiple stable bilateral pulmonary nodules including the reference left lower lobe nodule remaining 1.3 x 1.1 cm (image 26 series 4). The reference left lower lobe nodule (image 82 series 4) is also unchanged at 1.0 cm, previously 1.1 cm. The slight changes likely due to differences in breathing and motion artifact. A reference right lower lobe lesion is also unchanged at 1.0 cm (image 100 series 4).No effusions or new additional superimposed pulmonary abnormality. Mild centrilobular emphysema, again most pronounced superiorlyMEDIASTINUM AND HILA: The thin-walled cyst adjacent to the distal esophagus (image 89 series 3) remains unchanged measuring 1.4 cm. Thyroidectomy and no discrete lymphadenopathyThe cardiac and paracardiac remain unremarkable other than coronary calcifications.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Stable left adrenal cyst and measuring 4.3 cm (image 110 series 3).KIDNEYS, URETERS: Scattered renal cysts unchangedPANCREAS: 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: Mild to moderate degenerative changes most pronounced involving the lower lumbar levelsOTHER: No significant abnormality noted. | Interval stability of multiple pulmonary nodules and known metastatic disease. Reference measurements provided |
Generate impression based on findings. | EKG changes abdominal pain, epigastric rule out PE. PULMONARY ARTERIES: Technically adequate examination without evidence of acute pulmonary embolus.LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Right paratracheal air lucency at the level of the thoracic inlet most consistent with paratracheal diverticuli /air cysts. Significant streak artifact from the generator device and contrast bolus obscure the upper mediastinum. No visible lymphadenopathy. Mild multichamber cardiomegaly. ICD coil tip in the apex of the right ventricle. Proximal lead tip in the right atrial appendage.CHEST WALL: Left subclavian pacemaker wires and subcutaneous generator device.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. No evidence of free air. Small volume of perihepatic ascites, nonspecific. Sludge in the gallbladder. The stomach is markedly distended with fluid. Air-fluid levels noted within a dilated loop of small bowel in the upper abdomen near the midline. Adjacent small bowel in the right upper quadrant does not appear distended, this is incompletely included in the scanning range but highly suspicious for small bowel obstruction. | 1. No evidence of acute pulmonary embolus.2. Distended loops of small bowel and distention of the fluid-filled stomach in a pattern highly suspicious for small bowel obstruction but incompletely included in the scanning range. |
Generate impression based on findings. | 60 year-old male with esophageal cancer, evaluate. CT brain: The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, midline shift, or gross intra- or extra-axial fluid collection/acute hemorrhage, or abnormal contrast enhancement.The orbits are unremarkable. The paranasal sinuses and mastoid air cells are clear. Congenital non-union of C1.CT neck: No definite lesion is identified in the rightward aspect of the larynx/hypopharynx to correspond to the FDG avid uptake on the PET examination. Mild tracheal stenosis likely secondary to prior tracheostomy.No soft tissue lesions are identified in the neck. No pathologic lymphadenopathy by CT size criteria. The parotid, submandibular and thyroid glands are within normal limits. The cervical vasculature is patent. No mucosal masses or focal effacement of the upper aerodigestive tract.Biapical paramediastinal fibrosis/scarring likely secondary to prior radiation therapy. Partially visualized right chest port catheter. Left upper lobe lung nodule which was FDG avid on comparison PET examination.Multilevel degenerative changes of the visualized cervicothoracic spine without suspicious osseous lesions. | 1. No definite evidence of metastatic disease in the head or neck.2. Partially visualized left upper lung nodule which was FDG avid on comparison PET examination. Please see dedicated CT of the chest from today's date for further details. |
Generate impression based on findings. | 49-year-old male patient with history of pancreatitis and pancreatic cyst presents with abdominal pain. ABDOMEN:LUNG BASES: Right upper lobe lung nodule measures 4 mm (series 4 image 8), stable compared to examination on 7/25/2013. Right lower lobe pleural-based pulmonary nodule measures 5 mm (4 image 15), stable compared to examination on 7/25/13.LIVER, BILIARY TRACT: No significant abnormality noted. Portal vein is patent.SPLEEN: No significant abnormality noted. Splenic vein is patent.PANCREAS: Pancreatic stent is redemonstrated without ductal dilatation. No pancreatic edema, calcification or fluid collection is evident.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic changes in the abdominal aorta and iliac arteries.BOWEL, MESENTERY: Colonic diverticulosis without CT evidence of diverticulitis.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumber spine.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate, stable.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis without CT evidence of diverticulitis.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumber spine. Soft tissue postoperative changes in anterior abdominal wall.OTHER: No significant abnormality noted. | Resolution of pancreatitis. No evidence of pancreatic pseudocyst. Pancreatic stent in place without ductal dilatation. |
Generate impression based on findings. | Post trauma. Head: There is no intracranial mass, hemorrhage, hydrocephalus or CT evidence of acute ischemia. Incidental note is made of a well-defined CSF density at the straight sinus best seen on sagittal images which likely represents a small arachnoid cyst or granulation. The midline is intact. Orbits, sinuses and mastoids cells are normal. There are no depressed skull fractures.Cervical spine: There is normal alignment of the cervical spine. There is no fracture or dislocation. Vertebral body and intervertebral disk heights are normal. The odontoid is intact. There is no prevertebral soft tissue swelling and the visualized portion of the airway is patent. | No abnormality including traumatic sequela. |
Generate impression based on findings. | Clinical question: Patient with history of repair of abdominal aortic aneurysm, with a rate that she has a brain aneurysm. Doesn't currently have any symptoms. Nonenhanced head CT:The examination demonstrates unremarkable cerebral cortex, cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation.Unremarkable calvarium and soft tissues of the scalp.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.CTA:The right internal carotid artery remains patent across the skull base and in the supraclinoid portion.The right ophthalmic artery is visualized and unremarkable.The right anterior and middle cerebral arteries are visualized and unremarkable. There is anatomical variation off hypoplastic right A1 segment of anterior cerebral artery.There is a patent and unremarkable right posterior communicating artery.Left internal internal carotid artery remains patent across the skull base and in the supraclinoid portion. The left MCA is well visualized and unremarkable.There is dominant left A1 segment secondary to hypoplastic right A1. There is a wide neck aneurysm measuring approximately 1.4 mm in length and 2.3-mm at the base at the junction of left dominant A1 and anterior communicating artery a. Bilateral anterior cerebral arteries beyond anterior communicating artery are visualized are unremarkable.Unremarkable bilateral intracranial vertebral arteries, basilar artery, superior cerebellar and posterior cerebral branches. The proximal intracranial components of vertebral arteries and including origins of bilateral pica branches are not visualized on this study. | 1.Negative nonenhanced head CT.2.CTA of intracranial circulation demonstrate a wide neck aneurysm measuring at 1.4 mm in length and 2.3 mm at the base/neck at the junction of anterior communicating artery and left A1.3.Unremarkable intracranial CTA otherwise. |
Generate impression based on findings. | Lung CA CHEST:LUNGS AND PLEURA: Right hemithorax volume loss with right paramediastinal radiation fibrosis. Cavitary mass measures 2.5 x 5.4-cm (5/23), previously 2.8 x 5.3 cm.Left upper lobe lobulated nodule measures 11 x 11 mm (5/60), previously 8 x 8 mm.Left apical nodule measures 7 x 10 mm (5/12), previously 4 x 4 mm. Peripheral lesion in the right apex postero-medially is stable in appearance, more likely to be inflammatory change than metastatic and does not need to be measured given its stability.Nonindex nodule in the superior segment of the left lower lobe also larger.MEDIASTINUM AND HILA: Necrotic right paratracheal nodule (3/12) is larger. Paratracheal soft tissue opacity from the level of the great vessels to the main bronchi not significantly changed. Enhancing subcarinal lymph nodes are less than 1cm in size, about the same. Enhancing subcentimeter peribronchial lymph nodes also similar.Right supraclavicular lymph node 10-mm in short axis, previously 11-mm (3/8).Moderate circumferential pericardial fluid collection, not significantly changed.At the level of the suprahepatic IVC, there are a cluster of small enhancing lymph nodes near the distal thoracic esophagus (3/68), these are now suspicious for nodal metastases given the degree of enhancement.Aortic valve calcifications.CHEST WALL: Left chest port with tip in distal SVC. Eccentric filling defect in the superior vena cava consistent with chronic thrombus, slightly smaller.Right breast surgical clips.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Interval increase in size of pulmonary metastases.2. Cavitary mass in the right upper lobe not significantly changed.3. Increase in size of the non-index necrotic right paratracheal soft tissue nodule. 4. Chronic thrombus in the superior vena cava. |
Generate impression based on findings. | 59-year-old male with painful palpable 1 x 1 cm mass in the left paratracheal region, evaluate for malignancy. Limited intracranial views are unremarkable. The visualized paranasal sinuses and mastoid air cells are clear.No soft tissue masses are identified in the neck. No cervical lymphadenopathy by CT size criteria. The submandibular and parotid glands are free of focal lesions. The thyroid gland is within normal limits. No exophytic masses or focal effacement of the aerodigestive tract. The cervical vasculature is patent.Borderline enlarged partially visualized superior mediastinal lymph nodes.Multilevel severe degenerative changes of the upper cervical spine including near complete loss of disk space, disk osteophyte complexes and endplate changes. Irregularity of the tip of the dens which may be secondary to erosions. These findings are compatible with the patient's diagnosis of rheumatoid arthritis. No suspicious osseous lesions are identified. | 1. No soft tissue masses in the neck or evidence of cervical lymphadenopathy by CT size criteria.2. Severe degenerative changes of the upper cervical spine compatible with the patient's history of rheumatoid arthritis. If clinically warranted, MRI may be obtained for further characterization of these findings. |
Generate impression based on findings. | 52-year-old male with history of pancreatitis, evaluate fluid collection ABDOMEN:LUNG BASES: No significant abnormality noted. Small fat containing lesion in the left ventricular wall is noted, nonspecific. ICD leads partially visualized.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Small residual soft tissue density collection posterior to the spleen measures 4.6 x 3.1 cm (image 21, series 3). The spleen appears malrotated.PANCREAS: Mild prominence of the pancreatic duct and enlargement of the pancreas suggesting residual edema. No additional fluid collections are identified. The splenic vein and SMV are patent.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: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. Small soft tissue density collection posterior to the spleen without evidence of additional complication.2. Mild enlargement of the pancreas suggesting residual edema.3. Malrotation of the spleen. |
Generate impression based on findings. | 71-year-old female patient with cryptogenic cirrhosis. Evaluate for hepatocellular carcinoma. ABDOMEN:LUNG BASES: Small right-sided pleural effusion, decreased compared to prior examination.LIVER, BILIARY TRACT: Nodular liver contour, consistent with cirrhosis. Scattered punctate calcifications consistent with prior granulomatous disease. Multiple subcentimeter hyperenhancing hepatic foci without definitive washout characteristics. There is a hypoattenuating and hypoenhancing lesion in the right hepatic lobe (series 11 image 33 and series 12 image 33) that is too small to characterize and is nonspecific. Portocaval lymphadenopathy. Hepatic vein and portal veins are patent.Status post cholecystectomy.SPLEEN: Scattered punctate calcifications consistent with prior granulomatous disease. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Extensive atherosclerotic changes in the abdominal aorta and iliac arteries.BOWEL, MESENTERY: Colonic diverticulosis without CT evidence of diverticulitis.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumbar spine.OTHER: No significant abnormality noted. | Cirrhotic liver without suspicious enhancing lesions. |
Generate impression based on findings. | Male 60 years old; Reason: 60 yo male with squamous cell cancer of cervical esophagus w new pulmonary metastases on carbo taxol History: n/a. CHEST:LUNGS AND PLEURA: Chronic lung changes with architectural distortion and traction bronchiectasis are seen in the medial upper lobes bilaterally consistent with prior radiation. Multiple pulmonary nodules and mass like lesions are seen predominantly in a subpleural distribution bilaterally, concerning for metastases. the largest spiculated mass in the superior aspect of the left inferior lobe adjacent to the fissure measures 3.8 x 4.1 cm (series 6, image 47). No pleural effusions.MEDIASTINUM AND HILA: Multiple mediastinal and hilar lymph nodes. For reference a right subcarinal lymph node measures 1.4 cm (series 402, image 46). Enlarged right reference hilar lymph node measures 1.1 cm (series 40, image 48). Large area of calcification within the right hilum likely represents prior granulomatous disease. Mild cardiomegaly with a small pericardial effusion.CHEST WALL: Right-sided chest port terminates in the superior vena cava.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: There is air in the biliary system status post placement of a common bile duct stent. An ill-defined hypodensity is visualized in the posterior aspect of the right lobe of the liver which was not present on previous down the CT from 2010. This is concerning for metastasis.SPLEEN: Likely splenule adjacent to be inferior and anterior aspect of the spleen.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: The pancreatic duct is dilated up to 6 mm in diameter. The ill-defined pancreatic head mass seen on endoscopic ultrasound is not distinctly seen in this CT exam although there is a ill-defined hypodense region surrounding the distal common bile duct stent at the point where the pancreatic duct is no longer dilated.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Degenerative changes are noted of the spine predominately in the lumbar distribution.OTHER: No significant abnormality noted. | 1.Apical medial bilateral lung fibrosis consistent with prior radiation for esophageal cancer.2.Multiple bilateral predominantly subpleural nodules and masses concerning for pulmonary metastases.3.Mediastinal and hilar lymphadenopathy.4.Ill-defined hypodensity in the posterior right lobe of the liver concerning for metastasis.5.Common bile duct stent with likely post procedural air in the biliary system.6.The ill-defined pancreatic head mass seen on endoscopic ultrasound is not distinctly seen in this exam although there is a ill-defined hypodense region surrounding the common bile duct stent at the point where the dilated pancreatic duct terminates. |
Generate impression based on findings. | Clinical question: Parkinsonism, more on the right side. Signs and symptoms: As mentioned above. Nonenhanced head CT:Examination demonstrates focus of encephalomalacia in the right occipital lobe consistent with a chronic ischemic stroke.Subtle periventricular low-attenuation white matter is nonspecific however considering patient's stated age of 92 possibility of age indeterminant small vessel ischemic stroke should be considered.The cortical sulci and ventricular system appear symmetrical and unremarkable. The CSF spaces remain within normal.Mild bilateral cavernous/supraclinoid carotid and left vertebral artery vascular calcification is noted.Unremarkable calvarium and soft tissues of the scalp.Unremarkable orbits there is no overt evidence of bilateral cataract surgery.Unremarkable visualized paranasal sinuses with the exception of small retention cyst in the left maxillary sinus.All mastoid air cells and bilateral middle ear cavities are well pneumatized and unremarkable. | 1.No acute intracranial process.2.Suspected mild age indeterminate small vessel ischemic strokes.3.Chronic right occipital cortical stroke. 4.Unremarkable exam otherwise. |
Generate impression based on findings. | 61-year-old female with rectal cancer and rising CEA CHEST:LUNGS AND PLEURA: Unchanged bilateral pulmonary nodules.MEDIASTINUM AND HILA: Right port catheter extends to the SVC. No mediastinal or hilar lymphadenopathy. The heart size is normal.CHEST WALL: Right chest wall port.ABDOMEN:LIVER, BILIARY TRACT: Status post right hepatectomy with compensatory hypertrophy of the left liver. No new lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Unchanged left adrenal nodularity measures 9 mm (image 105, series 3) and previously measured 9 mm.KIDNEYS, URETERS: Bilateral hypoattenuating lesions, likely represent cysts, are again noted. There is moderate left hydronephrosis and hydroureter extending to the mid left ureter, where there is an abrupt transition and associated polypoid soft tissue mass filling and expanding the ureter, which is increased in size compared with prior studies (image 154, series 3).RETROPERITONEUM, LYMPH NODES: Multiple small retroperitoneal lymph nodes are again identified. Reference left periaortic lymph node measures 1.6 x 1.1 cm and previously measured 1.5 x 1.1 cm (image 121, series 3).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Reference left common iliac lymph node measures 8 x 6 mm (image 143 series 3) and previously measured 9 x 7 mm.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Unchanged sclerotic focus in the left proximal femur.OTHER: No significant abnormality noted | 1. Unchanged reference lymph nodes without new metastatic lesions.2. Left hydro-ureteral nephrosis with transition point in the mid left ureter and associated polypoid soft tissue mass filling the ureter concerning for primary TCC. Further follow up is suggested. |
Generate impression based on findings. | Reason: metastatic lung cancer History: FTT CHEST:LUNGS AND PLEURA: Interval increase in size and number of multiple bilateral nodules. A reference right mass measures 38 x 23 mm (series 4, image 63), previously measuring 32 x 18 mm.Right upper lobe subpleural consolidation and cavitation is unchanged. New bilateral small pleural effusions.MEDIASTINUM AND HILA: Interval increase in size in right paratracheal, subcarinal, and right hilar lymph nodes. Reference right paratracheal lymph node previously measuring 25 mm now measures 27 mm (series 3, image 28).Heart size is normal. No pericardial effusions. Moderate coronary artery calcifications. Right chest port with tip in the SVC.Mild compression of the bronchus intermedius by subcarinal lymphadenopathy.Circumferential thickening of the distal esophagus and narrowing of the lumen consistent with localized invasion.CHEST WALL: Interval increase in size of lower cervical lymph nodes. Chronic right distal clavicular fracture. Posterior medial chest wall invasion near the right costophrenic angle.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Interval increase in size and number of multiple hepatic metastases. Reference left lobe hepatic lesion measures 6.7 x 6.1 cm (series 2, image 25), previously measuring 4.5 x 5.7 cm. No intrahepatic biliary ductal dilatation. Mild periportal edema.SPLEEN: Multiple punctate calcifications likely representing calcified granulomas. New hyperdense lesion in the spleen may represent a metastatic focus.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Hypodense lesions distorting the renal cortex, right greater than left, with interval increase in size since prior exam. Perirenal fat stranding is again seen.PANCREAS: Atrophic and difficult to visualize.RETROPERITONEUM, LYMPH NODES: Moderate atherosclerotic calcification of the aorta and bilateral iliac arteries. Left para-aortic lymphadenopathy.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Confluent lymphadenopathy surrounding the celiac axis, gastrohepatic ligament and around the porta hepatis.BONES, SOFT TISSUES: Stable anterolisthesis of L4 over L5. Stable sclerotic focus in the left iliac bone.OTHER: Perihepatic ascites and numerous peritoneal nodules. | Interval progression of metastatic disease in the lungs, mediastinum and abdomen. |
Generate impression based on findings. | Reason: Does the patient have actinomyces lung infection History: Positive culture LUNGS AND PLEURA: There are moderate-sized bilateral pleural effusions with overlying basilar atelectasis.No significant pulmonary edema or focal air space opacities.Marked upper lobe predominant centrilobular emphysema.MEDIASTINUM AND HILA: Mild cardiac enlargement without evidence of a pericardial effusion.Moderate coronary artery calcification.No mediastinal or hilar lymphadenopathy.CHEST WALL: Degenerative changes involving the the lower cervical and upper thoracic spineUPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Scattered small hepatic hypodensities too small to characterize. | 1.Bilateral pleural effusions with accompanying basilar atelectasis.2.Moderate upper lobe predominant centrilobular emphysema. 3.No specific evidence of infection. |
Generate impression based on findings. | Malignant neoplasm of the rib. Check for progression of known chondrosarcoma CHEST:LUNGS AND PLEURA: Extensive postsurgical abnormality in the right apex with scarring and volume loss again not changed. Nodular scar opacity in the right costophrenic angle is also unchanged.Suspicious nodules or masses. No effusions. Persistent elevated right hemidiaphragmMEDIASTINUM AND HILA: Borderline scattered paratracheal lymph nodes unchanged. Mild persistent soft tissue the anterior mediastinum, possibly recurrent thymus unchangedThe cardiac and pericardium are within normal limits.CHEST WALL: Right clavicle and upper rib resections/deformities are again observed, unchanged.ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: 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. | Postsurgical rib and right upper lung changes without evidence of recurrent tumor |
Generate impression based on findings. | 72-year-old male with hematuria and hematospermia ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Cholelithiasis. Mild diffuse hepatic steatosis. No focal hepatic lesions.SPLEEN: No significant abnormality notedPANCREAS: Fatty atrophy of the pancreas, appropriate for age.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Small exophytic hyperdense left renal lesion likely represent a complex cyst. Symmetric renal contrast excretion filling the ureters and bladder without filling defect.RETROPERITONEUM, LYMPH NODES: Infrarenal IVC filter. Scattered atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Air in the bladder likely from prior instrumentation.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality noted | 1. No findings to account for the patient's hematuria. Hemorrhagic left renal cyst. Air in the bladder, correlate for recent instrumentation.2. Cholelithiasis without evidence of cholecystitis. Narrowing of the mid gallbladder with wall thickening, correlate with ultrasound if clinically warranted.3. Mild diffuse hepatic steatosis. |
Generate impression based on findings. | Male 50 years old; Reason: evaluate for HCC History: Cirrhosis ABDOMEN:LUNGS BASES: Calcification noted along the pericardium, correlate for prior history oftrauma, previous pericarditis, or infection.LIVER, BILIARY TRACT: Liver contour: The liver contour is nodular..The gallbladder is normal without evidence of intrahepatic or extrahepatic biliary ductal dilation. Portal vein: Patent Hepatic veins: patentHepatic artery: patent with conventional anatomyLesions: No definite lesion detected. No collaterals noted.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas is atrophic. The splenic vein is patent.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Cirrhotic morphology without evidence of HCC.2.Severe pancreatic atrophy. No evident mass. |
Generate impression based on findings. | 49-year-old female with malignant neoplasm at the base of the tongue, reevaluate. Limited intracranial views are unremarkable. Limited views of the orbits are unremarkable. Interval development of bilateral air fluid levels in the maxillary sinuses as well as near complete opacification of the right sphenoid sinus and near complete opacification of the visualized ethmoid air cells.Redemonstration of postsurgical changes of a previous glossectomy and at least partial floor of the mouth resection with flap reconstruction. Interval development of diffuse reticulation of the right neck subcutaneous fat and fascial planes with marked mucosal enhancement compatible with posttherapy changes. Lesions are again identified involving the surgical bed of the oral cavity, extending to the bilateral tonsillar region, hypopharynx, larynx and nasopharynx. The lesions again encase the bilateral carotid arteries which remain patent. There has been an interval increase in the size of the rim enhancing ulcerated tumor adjacent to the tongue flap which extends to the left carotid space and measures approximately 1.7 x 1.6 cm (series 6 image 24). This lesion nearly completely effaces the oropharyngeal tract. Redemonstration of a defect of the superficial tissues in the right neck with air extending and communicating with the aerodigestive tract compatible with a fistulous connection. Tracheostomy tube remains in place.There has been interval decrease in the size of the lesion seen previusly just anterior to the flap reconstruction in the left submental space which measures approximately 2.0 x 1.0 cm (series 6 image 27), previously 3.2 x 1.7 cm.Interval development of large supraclavicular conglomerate masses bilaterally. Reference right supraclavicular mass measures approximately 4.4 x 4.0 cm (series 6 image 42). No suspicious osseous lesions are identified. The visualized lung apices are clear. Please see dedicated chest CT from today's date for further details. | 1. Interval progression of disease in the neck with significant interval increase in size of a necrotic soft tissue lesion adjacent to the tongue flap which nearly completely effaces the oropharyngeal tract.2. Interval development of bilateral supraclavicular lymphadenopathy. |
Generate impression based on findings. | 82-year-old male status post endoscopic ampullectomy with pancreatic mass seen on EUS. ABDOMEN:LUNG BASES: Basilar scarring/atelectasis, and paraseptal emphysema.LIVER, BILIARY TRACT: Air in the gallbladder likely relates to reflux. No focal hepatic lesions. SPLEEN: No significant abnormality notedPANCREAS: Infiltration of the fat surrounding the pancreatic head and uncinate process indicates acute pancreatitis likely relating to recent procedure. No pancreatic mass is identified. The splenic vein and SMV are patent. No evidence of pseudocyst or additional complication.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple bilateral renal cysts. Perinephric lipomatosis.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the abdominal aorta and its branches with focal ectasia of the infrarenal abdominal aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: L2 vertebral body lesion, likely a hemangioma. Mild loss of height of the L2 vertebral body.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: Sclerotic lesion of the left ilium is nonspecific.OTHER: No significant abnormality noted | Infiltration of the fat surrounding the pancreatic head and uncinate process compatible with acute pancreatitis. No evidence of pancreatic mass, pseudocyst or additional complication. |
Generate impression based on findings. | 49 year-old female with known pulmonary artery aneurysm. Interval follow-up. PULMONARY ARTERY ANGIOGRAPHY: No filling defects are present to the level of the subsegmental pulmonary arteries to indicate pulmonary emboli.There is a stable bilobed left pulmonary artery aneurysm. The transverse dimension of the proximal left pulmonary artery measures 22 mm (series 8 image 109), previously 22 mm. In the coronal plane it measures 24 mm (series 80720 image 34), previously 23 mm. The left descending pulmonary artery portion of the aneurysm is also stable measuring 22 mm in transverse dimension (series 8 image 127), previously 22 mm. In a coronal plane it measures 23 mm (series 80720 image 26), previously 24 mm.CHEST:LUNGS AND PLEURA: Subpleural nodular opacity in the posterior basilar segment of the left lower lobe is not significantly changed measuring 5 cm (series 9 image 107). No new or suspicious pulmonary nodules.MEDIASTINUM AND HILA: The heart is normal in size. No pericardial effusion. No mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted. | Bilobed left pulmonary artery aneurysm without significant interval change. |
Generate impression based on findings. | Clinical question: History of subdural hematoma and status post bilateral goals. Signs and symptoms: Surveillance. Unenhanced head CT:Examination demonstrate no areas of new hemorrhage since prior exam.Examination he demonstrate low-density bilateral anterior frontal subdurals. Multiple measurements of the larger left anterior frontal subdural demonstrate no convincing evidence of interval change since prior exam. Similarly multiple measurements of the right anterior frontal low-density subdural demonstrate no interval significant change. Bilateral subdurals resulting subtle flattening of the adjacent parenchyma and minimal effacement of cortical sulci. This is also similar observation is prior exam. The remaining subdural on the left measures maximum 13.7-mm compared to prior exam measurement of 13.9. The maximum thickness of subdural on their right measures at 9.7-mm compared to prior study measurement of 10.7.Left hemispheric subcortical and cortical low attenuation of white matter similar to prior study and likely representing a chronic ischemic stroke.Stable normal size of ventricular system and maintained midline.Calvarium demonstrate postoperative changes of bilateral anterior parietal burr holes. | 1.No evidence of acute new findings since prior exam.2.Stable to possibly minimally smaller size of low-attenuation bilateral frontal subdural collections as detailed/measured above.3.Left hemispheric foci of encephalomalacia consistent with a chronic left MCA territory stroke similar to prior exam. |
Generate impression based on findings. | 23-year-old female patient status post right percutaneous nephrolithotomy CHEST:LUNGS AND PLEURA: Large right pleural effusion with associated atelectasis and volume loss. Left lung base scarring versus atelectasis.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: Atrophic pancreas with tiny cystic lesions versus fatty infiltration (series 3 image 93).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right duplicated collecting system. Superior collecting system on the right with percutaneous nephroureterostomy.RETROPERITONEUM, LYMPH NODES: Free fluid in the retroperitoneum.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Large amount of intraperitoneal fluid. No evidence of hemoperitoneum. No intramural or free air.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Foley catheter in place.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Nonspecific bowel thickening at the splenic flexure. Large amount of impacted stool in the colon, which may cause stercoral colitis.BONES, SOFT TISSUES: Right thoracolumbar curve is redemonstrated. Posterior spinal fusion instrumentation is again noted.OTHER: Large amount of abdominal and pelvic fluid. | 1.No obvious acute intra-abdominal pathology.2.Large amount of peritoneal and retroperitoneal fluid.3.Large amount of impacted feces in the rectum, which may lead to stercoral colitis.4.Large right pleural effusion.Findings discussing with Dr. Andrew Cohen via telephone at 3:45 PM on 11/6/13 by Dr. Stephanie McCann. |
Generate impression based on findings. | 58-year-old female with history of known mitral valve disease presenting with shortness of breath. VESSELS:Conventional aortic arch anatomy. The thoracic and abdominal aorta is normal in size with a smooth luminal contour. No filling defect to indicate a dissection. The origins of the celiac axis, superior mesenteric artery, and bilateral renal arteries are widely patent. Iliac arteries are normal in size.SINUS OF VALSALVA: 3.4 X 3.1 X 3.0 cmSINOTUBULAR JUNCTION: 2.1 X 2.9 cmASCENDING THORACIC AORTA AT LEVEL OF MAIN PULMONARY ARTERY: 3.0 X 3.1 cmASCENDING THORACIC AORTA IMMEDIATELY PROXIMAL TO THE INNOMINATE ARTERY: 3.1 X 3.0 cmPROXIMAL DESCENDING THORACIC AORTA IMMEDIATELY DISTAL TO THE LEFT SUBCLAVIAN ARTERY: 2.3 X 2.3 cmDESCENDING THORACIC AORTA AT LEVEL OF HIATUS: 2.2 X 2.2 cmSUPRARENAL ABDOMINAL AORTA: 1.9 X 1.8 cmINFRARENAL ABDOMINAL AORTA: 1.3 X 1.2 cmRIGHT COMMON ILIAC ARTERY: 9 X 8 mmRIGHT EXTERNAL ILIAC ARTERY: 6 X 6 mmRIGHT COMMON FEMORAL ARTERY: 7 X 7 mmLEFT COMMON ILIAC ARTERY: 9 X 8 mmLEFT EXTERNAL ILIAC ARTERY: 7 X 8 mmLEFT COMMON FEMORAL ARTERY: 7 X 8 mmCHEST:LUNGS AND PLEURA: Bibasilar and dependent subsegmental atelectasis / scarring. No pleural effusion or pneumothorax.MEDIASTINUM AND HILA: The heart is upper limit of normal in size. Prominent mitral valve annular calcification with associated left atrial dilatation. No pericardial effusion. No mediastinal or hilar lymphadenopathy.Heterogeneous thyroid with multiple small hypodense nodules.CHEST WALL: No significant abnormality noted.ABDOMEN:The bowel is incompletely evaluated due to the lack of oral contrast. LIVER, BILIARY TRACT: Small focus of early arterial hyper enhancement in the caudate lobe measures 8 x 6 mm (series 5 image 56). This is too small to fully characterize, but likely represents a flash filling hemangioma. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal nodule measures 1.4 x 1.2 cm (series 5 image 79). While this may represent a benign adenoma, on this single phase exam it lacks the characteristics to confirm benignity. KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes from partial colectomy with an associated right lower quadrant ileostomy.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: Postsurgical changes affect the colon.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Normal caliber aorta and iliac arteries without dissection or luminal irregularity.2.Extensive mitral valve annular calcifications and associated left atrial enlargement.3.Left adrenal nodule which is incompletely evaluated on this single phase exam as described. If clinically warranted this can be evaluated with a multi-phase CT abdomen.4.Postoperative changes affecting the colon with right lower quadrant ileostomy. |
Generate impression based on findings. | Reason: mets lung cancer, s/p 2 cycles of chemo, pls c/w previous study and evaluate tx response. History: lung cancer. CHEST:LUNGS AND PLEURA: Significant interval reduction in the right hilar mass (image 45 series 3) now measuring 2.5 cm x 2.9 cm previously measuring 3.6 cm by 4.3 cm.Focal peripheral opacity peripherally in the superior segment of the right lower lobe is decreased in size and most likely was inflammatory in origin.Stable micronodules , several which may represent pulmonary lymph nodes.No new suspicious pulmonary nodules or masses.No pleural effusions.Mild left basilar scarring/discoid atelectasis.Right subpleural lipoma unchanged.Upper lobe an apical predominance paraseptal and central lobular emphysema.MEDIASTINUM AND HILA: Interval reduction of the right hilar lymphadenopathy (image 44 series 3) not measuring 8 mm previously measuring 19 mm.Additional reduction of other mildly enlarged mediastinal lymph nodes.Cardiac size is normal without evidence of a pericardial effusion.CHEST WALL: Osteolytic lesion in the left sixth rib identified with interval decrease in the soft tissue component.Fat containing 3-cm mass in the right supraspinatus muscle unchanged from the prior exam and does represent a previous site of metastatic involvement (PET/CT dated 8/28/13).ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Interval decrease in the reference right hepatic metastasis (image 124 series 3) now measuring 3.1 cm x 3.6 cm previously measuring 3.6 cm x 4.2 cm. Additional hepatic lesions have also decreased in size.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Interval decrease in left adrenal nodules with reference left adrenal nodule (image 90 series 3) now measuring 14 mm x 22 mm previously measuring 16 mm x 24 mm.KIDNEYS, URETERS: Stable left renal cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic disease of the aorta.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Significant interval reduction in size of known right hilar mass.2.Interval decrease in mediastinal and right hilar lymphadenopathy.3.Interval decrease in size of hepatic, adrenal, and left sixth rib metastatic foci.4.Stable right shoulder intramuscular mass with decreasing internal attenuation suggesting fat and fluid liquefication of previously known metastatic site. Most likely representing treatment response.5.No new sites of disease identified. |
Generate impression based on findings. | Female 67 years old; Reason: 67 yo female with h/o lymphoma, s/p MUD SCT, day 180 evaluation History: re-stage CHEST:LUNGS AND PLEURA: Bibasilar atelectasis. Biapical scarring/atelectasis.MEDIASTINUM AND HILA: Vascular calcifications of the aorta.CHEST WALL: Right-sided chest port terminates in the cavoatrial junction. Mild degenerative change of the thoracic spine. Calcified nodule in the inferior pole of the left lobe of the thyroid is stable.ABDOMEN:LIVER, BILIARY TRACT: Normal hepatic morphology.SPLEEN: Normal size of the spleen.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Punctate calcification in the left adrenal gland likely represents prior hemorrhage or infection.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Small shotty retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Moderate degenerative change in thoracolumbar spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic adenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: A small amount of free fluid is noted within the pelvis. | Stable examination. No lymphadenopathy in the chest, abdomen or pelvis. |
Generate impression based on findings. | 48 year old male. Reason: CAD History: chest pain. Liver disease, cryptogenic cirrhosis, bilateral flank pain, on transplant list. No known cardiac risk factors. Height: 71 in. Weight: 190 lbs. BSA: 2.1 m^2BMI: 26.5 kg/m^2Calcium Score:LM: 0LAD: 40LCx: 35RCA: 0Total: 36.2 , This represents the 85% for this patient's age and gender.Cardiac Function and Morphology:Left Ventricle:EDV: 221-231 ml The left ventricle is mildly dilated with normal uniform wall thickness. Right Ventricle:EDV: 177-196 ml The right ventricle is mildly dilated, but otherwise within normal limits. Left Atrium: The left atrial volume minus the pulmonary veins is 158 ml. There are four distinct pulmonary veins which drain normally into the left atrium.Right Atrium: The right atrial volume is 92 ml. The right atrium is structurally normal. Cardiac Veins: The coronary sinus is normal.Cardiac Valves: There are no aortic calcifications. There is no mitral annular calcification.Great Vessels:Aorta: The aortic arch is left sided. The brachiocephalic vessels branch normally from the arch. Visualized portions of the aorta demonstrate no evidence of dissection or aneurysm. Largest dimensions of the thoracic aorta are as follows:Sinuses of Valsalva: 38 mm Ascending: 27 mm Sinotubular junction: 30 mm Descending 22 mmPulmonary Artery: The pulmonary arteries are incompletely evaluated, as they are not fully included in the field of view. The visualized part of the pulmonary arteries is within normal limits. Vena Cavae: The SVC is normal in size and without structural abnormality. The IVC is normal in size and without structural abnormality.Pericardium: The pericardium is normal in thickness. There is no pericardial effusion.Coronary Artery Anatomy:LM: The left main coronary artery arises normally from the left sinus of valsalva and bifurcates into the left anterior descending and left circumflex coronary arteries. There is no significant plaque in the left main.LAD: The LAD gives rise to the diagonal and septal branches. There are several discrete foci of calcification in the proximal LAD. The largest in the proximal LAD before the 1st diagonal branch is associated with a 20% stenosis. There is no significant plaque in the LAD or its branches.LCx: The left circumflex artery gives rise to the obtuse marginal branches. There is a focal calcification in the proximal LCx with an estimated 20% stenosis. There is no significant plaque in the LCx or its branches. It is the dominant coronary artery giving rise to the posterior descending artery and a posterolateral branch. RCA: The RCA arises normally from the right sinus of valsalva. The RCA is relatively small. There is no significant plaque in the RCA or its branches.CHEST CT | 1.Normal left ventricular shape with mildly dilated LV and RV. Dominant left circumflex coronary artery. Small RCA. Multifocal calcification in the LCx and LAD with minimal associated stenoses (~20%). 2.Total Calcium score was 36.2; 85% for age and gender.3.No critical coronary stenoses. |
Generate impression based on findings. | Male 83 years old; Reason: metastatic and recurrent head and neck ca, on therapy, eval for progressive dz with measurements History: as above. CHEST:LUNGS AND PLEURA: Centrilobular and paraseptal emphysema again seen. Again seen is Underinflated lungs. The previously described nodules are not visible for the last two exams. Dependent opacities consistent with mild fibrosis are again present. The atelectasis is somewhat improved. There are no significant sized pleural effusions. MEDIASTINUM AND HILA: Moderate to severe cardiomegaly with severe coronary artery stenosis. ICD device in place. Atherosclerotic calcification of the thoracic aorta and its proximal major branches. No significant hilar or mediastinal lymphadenopathy. Patulous and fluid-filled esophagus which places the patient at risk for aspiration.CHEST WALL: Degenerative abnormalities affect the thoracic spine. The thoracic spine is markedly kyphotic. Chronic fracture of the proximal left humerus unchanged.ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Multiple hepatic cystlike hypodensities unchanged presumably benign. Focal calcification in the right hepatic lobe stable.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple hyper and hypodense renal lesions unchanged likely cysts, some hemorrhagicPANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Aortobiiliac atherosclerosis.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Small fat-containing ventral hernias.OTHER: No significant abnormality noted. | 1.Previously seen metastases are again not visible. No new metastases elsewhere.2.Bibasilar fibrosis/atelectasis again seen.3.Esophageal stasis again seen which places the patient at risk for aspiration. |
Generate impression based on findings. | Reason: r/o PE History: SOB, tachy PULMONARY ARTERIES: Motion degrades quality of the exam. No evidence of pulmonary embolism. Main pulmonary artery caliber is within normal limits.LUNGS AND PLEURA: Small nodule in the anterior right upper lobe is probably an intrapulmonary lymph node. Few nonspecific micronodules are statistically likely to be benign unless patient has known malignancy or is at high risk of malignancy.Minimal bronchial debris in the lingula.No pneumothorax. Minimal dependent bibasilar atelectasis. No pleural effusions. MEDIASTINUM AND HILA: No evidence of right heart strain. Heart size is normal. No pericardial effusions.CHEST WALL: Compression fracture of T8 vertebral body. Mild compression fracture of T2 vertebral body.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. NG tube with tip in the gastric fundus. Subcapsular right hepatic fluid collection versus volume averaging with a fluid-filled loop of bowel. | 1.No evidence of pulmonary embolism.2.Right upper quadrant fluid attenuating lesion in a represent and incompletely visualized a fluid-filled loop of bowel versus a subcapsular lesion in the right lobe of the liver such as an old subcapsular hematoma, cyst or abscess. Ultrasound may be considered for further evaluation. |
Generate impression based on findings. | Tongue cancer CHEST:LUNGS AND PLEURA: Minimal basilar atelectasis. No discrete nodules or masses. No effusionsMEDIASTINUM AND HILA: On the superior images, multiple heterogeneous nodular masses are observed bilaterally. The largest is on the right measuring 5.0 x 4.0 cm of Frances image 4 series 4). Smaller subcentimeter lesions are otherwise observed side. Please correlate with dedicated neck imaging.Tracheostomy tube unchanged. More centrally, a discrete enlarged subcarinal lymph node is identified with a necrotic center measuring approximate 1 cm in short axis (image 45 series 4). No discrete hilar involvementCardiac and pericardium are otherwise within limitsCHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.G-tube projects over left upper quadrantBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Interval lower neck masses scalp please correlate with dedicated pending neck CT giving greater sensitivity. Centrally however a borderline subcarinal lymph node is observed. Otherwise no intra-pulmonary abnormalities |
Generate impression based on findings. | Mesothelioma post 3 cycles of chemo. CHEST:LUNGS AND PLEURA: Right hemithorax pleural thickening and volume loss consistent provided clinical history of mesothelioma. Reference measurements on the right as follows:Level of the left brachiocephalic vein at the 4 o'clock position (3/32) 11-mm compared to 8mm.Level of the carina (3/46) 4 o'clock position 19-mm compared to 20-mm previously. Please note that this and previous measurements likely include tumor within the right major fissure as it inserts posteriorly at this level. 7 o'clock position 5 mm, previously 4-mm.Level of the roof of the left atrium (3/60): 4 o'clock position 7 mm, previously 5-mm. 8 o'clock position 5 mm, unchanged.Severe nodular thickening of the visceral pleura involving the right major and minor fissures is worse. Extensive peribronchial consolidation involving the right lower and middle lobe with consolidation of all but the superior segment of the lower lobe. Hypoattenuation of the lung parenchyma consistent with hypoperfusion likely secondary to tumor obliteration of the pulmonary arteries. Extensive subpleural consolidation around the lung periphery is also progressed along with septal thickening and numerous endobronchial nodules presumably reflecting tumor (for example right upper lobe series 4 image 46).MEDIASTINUM AND HILA: Tumor extends into the low neck past the cranial extent of the scanning range, please refer to dedicated neck CT. Confluent tumor at the right thoracic inlet is inseparable from the esophagus and trachea and surrounds the great vessels. The right internal jugular vein is intermittently obstructed and opacified by flow from adjacent small collateral vessels. Infiltrative tumor in the mediastinum bilaterally, right greater than left with severe narrowing of the left brachiocephalic vein, superior vena cava and azygos arch, appearing progressed compared to previous. The right descending pulmonary artery is also severely narrowed by the mass. Hypoattenuating lung parenchyma suspicious for hypoperfusion due to proximal arterial obstruction. Pulmonary veins on the right also slightly narrowed.There is circumferential encasement of the descending thoracic aorta at the level of the esophageal hiatus (3/88). The proximal thoracic esophagus is encased by the mass, with intermittent obstruction of the esophageal lumen above the level of the carina. Distal to the level of the carina the lumen is narrowed but patent.Mild leftward mediastinal shift. No significant pericardial fluid. Lymphadenopathy/tumor nodules in the anterior pericardial fat are unchanged. Nodular enhancement of the pericardium.CHEST WALL: Diffuse tumor infiltration of the right chest wall at the thoracic inlet and axilla extending into the neck. Paraspinal tumor infiltration of the lower thoracic spine with involvement of right sided neural foramina from approximately T10 to T12. This would be better seen by MRI.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Suprahepatic IVC is slightly effaced by isoattenuating lymphadenopathy (3/83). Right diaphragmatic graft noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Small soft tissue deposit in the right superior pararenal soft tissues (coronal image 32).KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: Pancreas is caudally displaced by infiltrated tumor. Pancreatic invasion cannot be excluded.RETROPERITONEUM, LYMPH NODES: Circumferential tumor surrounds the proximal abdominal aorta at the level of the esophageal hiatus. There is mild anterior effacement of the aorta at this level. The celiac axis and superior mesenteric artery are encased by tumor. Left para-aortic chain lymphadenopathy is slightly worse. Unable to assess for left hydroureter without delayed phase imaging.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Severe motion artifact limits assessment.BONES, SOFT TISSUES: Right paraspinal tumor infiltration with extension into the the neural foramina of L1 through L4. The right psoas muscle contains areas of internal hyperattenuation consistent with tumor but could alternatively reflect hematoma or hemorrhage.OTHER: No significant abnormality noted. | Extensive disease in the chest and abdomen as detailed in body of the report with slight increase in reference measurements. MRI of the spine may be considered if the patient is having symptoms of cord compression. Right lower lobe consolidation likely combination of tumor and infarcted lung. |
Generate impression based on findings. | 70-year-old male patient with right hydrocele and testicular retraction. Please evaluate for etiology and evaluate anatomy along the right gonadal vein. ABDOMEN:LUNG BASES: Bilateral lung base atelectasis versus scarring.LIVER, BILIARY TRACT: Hypoattenuating lesion in the right liver near the porta hepatis demonstrates peripheral nodular enhancement and measures 3.0 x 1.8 cm (series 3 image 27), consistent with a hemangioma. There is a hypoattenuating, nonenhancing subcentimeter lesion in the right hepatic lobe that is too small to characterize and likely represents a cyst.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral hypoattenuating subcentimeter foci are too small to characterize and likely represent cysts. 1.8 x 1.9 cm inferior pole cyst in the right kidney (coronal series 80228 image 39).No soft tissue masses in the path of the right gonadal vein.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy or fibrosis.BOWEL, MESENTERY: Colonic diverticulosis without CT evidence of diverticulitis.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumbar spine.OTHER: Extensive atherosclerotic changes in the abdominal aorta and iliac arteries.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted. Right testicle is smaller in size compared to the left testicle.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumbar spine.OTHER: Left inguinal hernia repair. | 1.Right testicle smaller than left testicle located most superiorly. Scrotal sonography for an intrinsic testicular process should be considered.2.No soft tissue masses in the path of the right gonadal vein, no retroperitoneal lymphadenopathy or fibrosis.3.Hepatic hemangioma and cyst. |
Generate impression based on findings. | Floor of mouth cancer LUNGS AND PLEURA: Multiple interval continued progression of numerous bilateral spiculated and cavitary pulmonary nodules and masses.Left upper lobe reference nodule (image 42 series 4) currently measures 2.6 by 2.2 cm, previously 2.6 x 1.8 cm. Increased is adjacent pleural thickening is also observed.Left lower lobe reference nodule (image 57 series 4) currently measures 6.4 by 4.1 cm, previously 5.1 x 3.1 cm. Associated compression of the central cavitation and engulfs bronchus. Adjacent satellite nodules are also observed peripherally.The right upper lobe lesion otherwise appears grossly unchanged, again measuring 2.2 x 1.4 cm (image 35 series 4) unchanged.Two new moderate pleural effusions with suspected atelectasis. Mild changes again suggesting aspirationMEDIASTINUM AND HILA: Postsurgical changes involving the lower neck on the uppermost images, partially visualized.Calcified lymph nodes again compatible with old prior granulomatous infection.The cardiac and pericardium other than coronary calcifications remain within limitsCHEST WALL: Right lateral rib deformities representing old healing fractures. Left chest portUPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Multiple bilateral renal lesions which have enlarged and suspicious for metastatic disease. Consider dedicated complete imaging. In addition, similar heterogeneous possibly cystic liver lesions are also observed. For example the previous reference left liver lobe lesion currently measures 2.5 x 1.7 cm (image 111 series 3) from a prior measurement of 1.2 x 0.9 cm. Probable small right hepatic lobe hemangioma and simple cysts are also observed. | Marked interval progression of multiple pulmonary cavitary lesions and known metastatic disease. Additional new effusions and concerning lesions in the liver and kidneys, of which the latter are both only partially evaluated. Reference measurements provided. |
Generate impression based on findings. | 26-year-old female with pain, evaluate for stone. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Hyperdense bile.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No nephrolithiasis, hydronephrosis or hydroureter. Hyperdense renal papillae may relate to dehydration.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Multiple enlarged mesenteric lymph nodes.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Bilateral simple adnexal cysts, measuring up to 3.2 cm.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No nephrolithiasis, hydronephrosis or hydroureter. Bilateral adnexal cysts, which may be physiologic. |
Generate impression based on findings. | Female 56 years old; Reason: PT with complicated renal cyst. Follow up. History: none 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: The kidneys enhance homogeneously. The previously visualized focal lesion involving the lateral aspect of the right kidney with some calcifications on nonenhanced CT. The lesion has slightly decreased in size and measures at least 1.6 x 1.9cm on image 48 series 9; (previously, 1.8 x 1.9 cm ). The precontrast constant units measure 13, and enhances by at least 35 Hounsfield units. This lesion washes out to 25 Hounsfield units. This lesion is stable since 2002.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.No change in the complex enhancing lesion in the right kidney since 2002, which favors benign complex cyst, however; consider follow exam as an MRI which may be able to better classify the lesion. |
Generate impression based on findings. | 79-year-old female patient with microscopic hematuria. ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Multiple well circumscribed hypoattenuating, nonenhancing lesions in the liver most likely represent cysts.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral superior pole renal cysts. Punctate calcification in the right superior pole of the left kidney. No hydronephrosis, suspicious masses or perinephric fat stranding. Symmetric bilateral excretion on delayed images without filling defects.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: S-shaped scoliosis of the thoracolumbar spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: S-shaped scoliosis of the thoracolumbar spine.OTHER: No significant abnormality noted. | 1.Bilateral renal cysts with left-sided non obstructing renal calculus. No suspicious masses or filling defects.2.Hepatic cysts. |
Generate impression based on findings. | 42 year-old female with elevated white blood cell count evaluate diverticulitis ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Hyperdense bile in a nondistended gallbladder.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: Wall thickening and pericolonic stranding along the sigmoid colon with multiple extraluminal foci of gas indicating microperforation. Fat infiltration extends to the appendix and obliterates the normal fat plane between the sigmoid colon and bladder. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Foley catheter extends within the bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Wall thickening and pericolonic stranding along the sigmoid colon with multiple extraluminal foci of gas in the adjacent mesentery indicating microperforation. Fat infiltration extends to the appendix and obliterates the normal fat plane between the sigmoid colon and bladder. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Severe sigmoid diverticulitis with localized microperforation, appearing similar to prior study. No mature abscess. |
Generate impression based on findings. | Reason: evaluate for changes in ILD History: cough sob LUNGS AND PLEURA: No interval change in the basilar predominant honeycombing and subpleural cyst formation.Groundglass opacity posteriorly in the superior segment of the right lower lobe slightly improved.No evidence of air trapping.No pleural effusion.Stable calcified and noncalcified micronodules compatible with old granulomatous disease.No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Stable mildly prominent mediastinal lymph nodes.Cardiac enlargement with mild pericardial effusion/thickening unchanged.Moderate coronary artery calcifications and/or coronary artery stent.CHEST WALL: Noted is changes in the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Status post cholecystectomy. Splenic calcifications. | No interval change in the UIP pattern of interstitial fibrosis compatible with underlying scleroderma. |
Generate impression based on findings. | Male, 56 years old, left-sided weakness for 4 months. Fairly extensive patchy areas of subcortical hypodensity are demonstrated. In some places, these lesions are focal and discretely marginated while in other places the abnormality is ill-defined. Involved regions include the periventricular white matter, corpus callosum, the bilateral basal ganglia, thalami and pons.No evidence of significant associated mass effect is seen. No intracranial hemorrhage or abnormal extra-axial collections are detected. The ventricular system is patent and within normal limits for size.The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are normally pneumatized. | Extensive scattered areas of hypoattenuation are demonstrated bilaterally. The pattern and morphology of these lesions are atypical for small vessel ischemic disease. Other etiologies including demyelination, infection and noninfectious inflammatory processes should be considered. Further evaluation with contrast-enhanced MRI is recommended. |
Generate impression based on findings. | Male 48 years old; Reason: abdominal pain History: abdominal pain ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Native kidneys are atrophic.RETROPERITONEUM, LYMPH NODES: Small amount of fluid tracks along the retroperitoneum.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Post operative changes in the anterior abdominal wall with a surgical drain. A small amount of body wall fluid adjacent to the inferior aspect near the transplant kidney.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: Bladder decompressed by a Foley catheter.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Changes in the small bowel in the right lower abdomen.BONES, SOFT TISSUES: Body wall anasarca. OTHER: Calcified left iliac fossa allograft.Right pelvic kidney has a large subcapsular hematoma causing mass effect. The hematoma measures 10 x 5cm on image 108 series 3.No hydronephrosis. | 1.Large subcapsular hematoma involving the pelvic transplant kidney.2.Findings discussed with the surgical ICU resident at the time of the dictation by telephone. |
Generate impression based on findings. | Effusion pain with inspiration. Question PE. PULMONARY ARTERIES: Technically adequate study without evidence of filling defects to the segmental level. Small subsegmental emboli cannot be excluded. The main pulmonary artery is normal in caliber.LUNGS AND PLEURA: Small right pleural fluid collection.Right middle and lower lobe air space opacities and subsegmental atelectasis. Mild bronchial wall thickening and endobronchial debris in the posterior segment of the right lower lobe. Single focal air space opacity in the left lower lobe. Dependent change elsewhere if left lung base. Mosaic attenuation of the lung parenchyma and lung bases could be a sign of reactive airways disease.MEDIASTINUM AND HILA: Trace pericardial fluid collection. Normal heart size. No signs of right heart strain. Anterior mediastinal soft tissue consistent with hyperplastic thymus. Mildly prominent right inferior interlobar level lymphatic tissue which may be reactive.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. The spleen appears nodular and atrophic suggestive of prior infarcts, incompletely assessed. Incompletely visualized cystic lesion in the upper pole of the left kidney. | 1. No evidence of acute pulmonary embolus to the segmental level. Small subsegmental emboli cannot be excluded. No signs of right heart strain.2. Air space opacities in the right lower and middle lobes most consistent with infection and/or acute chest syndrome depending upon the clinical scenario.3. Small right pleural fluid collection.4. Thymic hypertrophy and atrophic nodular appearance of the spleen likely the result of sickle cell disease.5. The patient was reported to have a minor contrast extravasation by the radiology resident on call. Approximately 30 cc of nonionic contrast extravasated into the left antecubital fossa with result in swelling. Patient was assessed by Dr. Igor Trilsky, please refer to separate note. Discharge instructions were given to the patient prior to leaving the Radiology Department. |
Generate impression based on findings. | Sharp left-sided chest pain history of breast cancer, no known metastases. Evaluate for PE. PULMONARY ARTERIES: Technically adequate examination without evidence of acute pulmonary embolus. Differential fluid opacification in the proximal right upper lobe pulmonary artery secondary to contrast mixing and motion artifact. No suspicious filling defects are identified to suggest presence of acute pulmonary embolus. Main pulmonary arteries normal in caliber.LUNGS AND PLEURA: No pneumothorax or pleural fluid. Mild dependent atelectasis in the right lower lobe likely the result of patient positioning. No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Right chest port tip at the SVC/RA junction. Mild nonspecific enlargement of the thyroid gland with substernal extension. Internal areas of hypoattenuation incompletely assessed by CT and could reflect colloid cyst or other pathology. This may be further assessed by ultrasound or nuclear scintigraphy if clinically warranted.Normal heart size. No signs of right heart strain. Physiologic volume of pericardial fluid. The left atrium appears mildly enlarged, correlate for signs of mitral valve disease.CHEST WALL: Punctate high-density foci in the left internal mammary chain region most likely small surgical clips. Nodular soft tissue density with internal hypoattenuation noted in the chest wall anterior to this level within an area of scarring; without comparison the possibility of a focal recurrent tumor cannot be differentiated from chronic hematoma. For reference, this nodular component measures 15 x 19 by 21-mm (7/125, sagittal series image 66).Left mastectomy with mild skin thickening of the left chest wall. No significantly enlarged lymph nodes. Largest lymph node in the left axilla measures 8-mm in largest lymph node in the right axilla measures 9-mm. Again this is nonspecific without comparison to prior study for reference. Right chest port.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range is unremarkable. | 1. No evidence of acute pulmonary embolus.2. Nodular soft tissue lesion contained within a surgical scar along the anterior chest wall is of unclear etiology without comparison to prior examinations. This may represent a focal area of recurrence, organizing hematoma or complex seroma. Recommend further characterization with chest wall ultrasound. 3. Mild enlargement of the left atrium, correlate for mitral valve disease.4. Minor contrast extravasation of 30 cc normal saline in the right antecubital region with swelling. Patient was assessed by Dr. Igor Trilsky at the time of the event and was given discharge instructions prior to leaving the Radiology Department. Please refer to separately reported note. |
Generate impression based on findings. | Clinical question: Evaluate multiple myeloma metastases. Signs and symptoms: Progressive right hand weakness. Unenhanced head CT:Examination demonstrate a well demarcated high density extra axial mass in the left posterior frontal -- parietal convexity measuring at 32 x 44-mm in size axial and 30-mm in cranial cephalad axis. There is resultant buckling and deviation of the brain parenchymal away from the inner table of the skull very minimal vasogenic edema is also noted. The mass effect is regional and without evidence of midline shift. Findings is consistent with than extra axial tumor. There is no evidence of any associated calvarial abnormalities.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells. Recommend further follow-up with an MRI exam for assessment. Unremarkable study otherwise. | 1.Well-demarcated loculated hyperdense mass in the left posterior frontal -- parietal convexity measuring at 32 x 44 x 30 mm sized and with resultant regional mass-effect as detailed.2.Unremarkable exam otherwise.3.Unremarkable calvarium, paranasal sinuses and orbits. |
Generate impression based on findings. | Clinical question: Hemorrhage. Signs and symptoms: Fat. Nonenhanced head CT:No detectable acute posttraumatic intracranial, calvarial or soft tissues of the scalp findings.Unremarkable cerebral cortex, vertebral sulci, ventricular system, CSF spaces and gray -- white matter differentiation.Unremarkable orbits, visualized paranasal sinuses, mastoid air cells and calvarium. | Negative nonenhanced head CT. |
Generate impression based on findings. | Clinical question: Altered mental status. Signs and symptoms: Altered mental status. Unenhanced head CT: No detectable acute intracranial process.CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.Prominence of cortical sulci and ventricular system is noted. Minimal periventricular and subcortical low attenuation of white matter likely representing age indeterminate small vessel ischemic strokes.Heavy bilateral cavernous carotid and vertebral vascular calcification is noted.Unremarkable calvarium, soft tissues of the scalp, orbits, paranasal sinuses and mastoid air cells. | No acute intracranial process. |
Generate impression based on findings. | Shortness of breath, tachycardia, fever. Tachypnea. Rule out PE. PULMONARY ARTERIES: Adequate infusion quality without evidence of pulmonary embolus. Main pulmonary arteries normal in caliber.LUNGS AND PLEURA: Numerous calcified nodules with scarring in the left upper lobe and lung apices consistent with history of prior tuberculosis. Mild subpleural scarring left apex. Volume loss left upper lobe and lingula. Moderate bronchial wall thickening, especially in the upper lobes, right greater than left with mild associated mosaic attenuation of the lung parenchyma. This may be the result of acute or chronic bronchitis.MEDIASTINUM AND HILA: Calcified mediastinal and hilar lymph nodes consistent with history of healed granulomatous disease. No signs of right heart strain. Mild enlarged left atrium with dilatation of the left atrial appendage.CHEST WALL: Mild degenerative changes. The ligamentous calcification versus an osteophyte in the mid thoracic spine it projects into the spinal canal and causes mass effect upon the thecal sac (series 9 image 106), correlate for symptoms.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range, please refer to separately reported abdomen and pelvis CT regarding the appearance of the left kidney which could be secondary to mild hydronephrosis but is incompletely assessed given the limited images. Left adrenal gland is slightly nodular in appearance, nonspecific. Fluid attenuating lesion in the liver may represent a cyst. | No evidence of acute pulmonary embolus. Moderate bronchial wall thickening suggestive of bronchitis, of unclear chronicity. This may be infectious or post inflammatory. The margin of the left atrium and dilatation of the left atrial appendage suspicious for underlying mitral valve disease. Please refer to separately report of abdominal CT for details. |
Generate impression based on findings. | Clinical question: Evaluate for disease progression prior to new systemic therapy. Signs and symptoms : Stage IV metastatic melanoma. Unenhanced head CT:There is no detectable abnormal parenchymal or leptomeningeal enhancement to suggest metastatic disease.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation.Calvarium and soft tissues of the scalp are unremarkable.Images through the orbits, paranasal sinuses and mastoid air cells are unremarkable. | Negative nonenhanced head CT. |
Generate impression based on findings. | 36 year old female patient with abdominal pain and vomiting. Evaluate for obstruction. ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is dilation of the stomach and small bowel with delayed progression of oral contrast. Small bowel dilatation measures up to 3-cm. Distal small bowel is collapsed. Possible transition points are noted within the left of the abdomen (coronal series 80212 images 46 and 51). There is hyperenhancement of a dilated small bowel with interloop fluid. No pneumoperitoneum or pneumatosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of abdominal ascites.PELVIS:UTERUS, ADNEXA: Intrauterine device in place. Tampon in the vagina.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is dilation of the stomach and small bowel with delayed progression of oral contrast. Small bowel dilatation measures up to 3-cm. Distal small bowel is collapsed. Possible transition points are noted within the mid small bowel in the left hemiabdomen (coronal series 80212 images 46 and 51). There is hyperenhancement of the dilated small bowel loops with interloop fluid. No pneumoperitoneum or pneumatosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of ascites. | Small bowel obstruction with multiple possible transition points noted in the left hemiabdomen. |
Generate impression based on findings. | Clinical question:status post biopsy. Signs and symptoms: brain mass. Nonenhanced head CT:Examination demonstrate a tiny focus of hyperdensity measuring 2.7 mm size in the left frontal lobe lesion which could represent a small punctate acute hemorrhage (axial image 19).Stable diffuse focus of low-attenuation all left frontal lobe similar to prior exam. Associated mass effect of this lesion also remains similar to prior study.Stable normal size of ventricular system.Calvarium demonstrate a small right parietal burr hole for biopsy approach and unremarkable otherwise. | 1.Status post left frontal burr hole approach for left frontal lobe tumor biopsy.2.2.7-mm focus of increased density within left frontal lesion could represent a tiny focus of postbiopsy hemorrhage.3.Unremarkable and stable exam otherwise. |
Generate impression based on findings. | Clinical question: Patient with confusion, abdominal mass. Signs and symptoms: Confusion. Nonenhanced head CT:There is no detectable acute intracranial process. CT Homer is insensitive for early detection of acute nonhemorrhagic ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation.Calvarium and soft tissues of the scalp are unremarkable.Images through the orbits, paranasal sinuses, mastoid air cells are unremarkable. | Unremarkable nonenhanced head CT. |
Generate impression based on findings. | Clinical question: Concern for CVA, diabetes, hyperosmolar state, altered mental status and focal deficit. Signs and symptoms: Left upper extremity weakness and pain. Nonenhanced head CT:There is no detectable acute intracranial process. CT however is insensitive for early detection of a nonhemorrhagic acute ischemic stroke.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation.Unremarkable calvarium and soft tissues of the scalp.Unremarkable orbits.Unremarkable all visualized paranasal sinuses, mastoid air cells and bilateral middle ear cavities. | Stable and unremarkable nonenhanced head CT since prior study from 11 -- 4 -- 2013. |
Generate impression based on findings. | Reason: 51 yo F w sickle cell disease and beta thal pw hypoxia and negative CXR. Eval for PE History: hypoxia, dyspnea, chest pain PULMONARY ARTERIES: Technically adequate examination. No evidence of pulmonary embolism. Main pulmonary artery caliber is high-normal. LUNGS AND PLEURA: Bilateral low lobe scarring and/or linear atelectasis. Punctate calcified foci within the right lung likely represent calcified granulomas. Dystrophic calcifications of bilateral lower lobe bases are increased from prior exam.MEDIASTINUM AND HILA: Mild cardiomegaly with right sided enlargement. No evidence of pericardial effusion.CHEST WALL: Right humeral head arthroplasty. Sclerotic focus in the T2 spinous process is unchanged from prior exam. Vertebral body endplate depression and sclerosis of the left humeral head compatible with history of sickle cell disease.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Autoinfarcted spleen. | 1.No evidence of pulmonary embolism.2.Bibasilar scarring and/or linear atelectasis probably chronic in nature. |
Generate impression based on findings. | Clinical question: 79 year old male with 10 days of pounding headaches associated with BP up to 180/90 and blurry vision. Rule out bleed and structural pathology. Signs and symptoms: As detailed. Unenhanced head CT: No detectable acute intracranial process. CT is however insensitive for early detection of acute nonhemorrhagic ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation for patient's stated age of 79.Unremarkable calvarium, soft tissues of the scalp, visualized orbits, paranasal sinuses and mastoid air cells. | Unremarkable nonenhanced head CT. |
Generate impression based on findings. | Male 73 years old; Reason: Sessile nodular large renal pelvic mass on the left highly suspicious for high grave invasive urothelial carcinoma History: as above ABDOMEN: The absence of intravenous and oral contrast limits evaluation of the solid organs and of the bowels. Given these limitations, the following observations were made:LUNGS BASES: Tortuous aorta. Bibasilar atelectasis. No nodule is detected.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Multiple granulomas. No detected.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple hyper and hypoattenuating lesions are noted throughout the kidneys. The largest lesion measures 2.7 x 2.9 cm in the midpole left kidney. These lesions are incompletely characterized given lack of IV contrast.There is an exophytic 1.3 x 1.4 cm lesion in the midpole left kidney which measures soft tissue attenuation (30HU), incompletely characterized given lack of IV contrast although remains worrisome for neoplasm.Left pelvis is full and measures soft tissue attenuation, which is worrisome for neoplasm, and is compatible with the findings on prior ultrasound of 9/19/13. Again this is incompletely characterized given lack of IV contrast.Left double J ureteral stent noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic disease of the aorta and iliac vessels.BOWEL, MESENTERY: Diverticulosis without diverticulitisBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Findings worrisome for urothelial neoplasm in the left renal pelvis, although incompletely evaluated given lack of IV contrast.2.Exophytic soft tissue lesion off the lower pole left kidney worrisome for neoplasm, although incompletely evaluated given no IV contrast. |
Generate impression based on findings. | 44-year-old female patient with left lower quadrant abdominal pain. Note that the lack of intravenous contrast limits evaluation of vasculature, lymph nodes and solid viscera.ABDOMEN:LUNG BASES: Bilateral dependent atelectasis.LIVER, BILIARY TRACT: Cholelithiasis without CT evidence of cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Redemonstration of a nonobstructing renal calculus in the superior pole of the left kidney.RETROPERITONEUM, LYMPH NODES: Borderline left retroperitoneal lymphadenopathy is nonspecific.BOWEL, MESENTERY: Proximal sigmoid colon with wall thickening and adjacent inflammatory changes. No pneumoperitoneum or pneumatosis. Adjacent to this area of inflammation there is a well-circumscribed, hypoattenuating focus that likely represents a left ovarian cyst, however cannot exclude a peridiverticular abscess.No evidence of obstruction.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumbar spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Hypoattenuating, well-circumscribed lesion in the area of the left adnexa likely represents an ovarian cyst (coronal series 80256 image 49).BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Extensive colonic diverticulosis. Proximal sigmoid colon with wall thickening and adjacent inflammatory changes. No pneumoperitoneum or pneumatosis. Adjacent to this area of inflammation there is a well-circumscribed, hypoattenuating focus that likely represents a left ovarian cyst, however cannot exclude a peridiverticular abscess.No evidence of obstruction.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumbar spine.OTHER: No significant abnormality noted. | Colonic diverticulosis with CT evidence of diverticulitis in the proximal sigmoid colon. Adjacent hypoattenuating lesion likely represents an ovarian cyst, however cannot exclude peridiverticular abscess in this noncontrast study. Cannot exclude underlying colon cancer and would recommend colonoscopy after acute phase of disease. |
Generate impression based on findings. | Endometrial cancer ABDOMEN:LUNG BASES: There is 6-mm nodule in the right middle lobe image number 8, series number 3. Further evaluation of the chest with chest CT may be helpful..LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal nodule measuring 1.7 x 1.6 cm and number 37, series number 3. The etiology is unknown.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Multiple small retroperitoneal lymph nodes. No evidence of enlarged retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Status post hysterectomy and oophorectomy. There is a two by 2-cm hypodense lesion anterior to the left psoas muscle on image number 85, series number 3. The etiology of this lesion is unknown and recurrence cannot be excluded.BLADDER: No significant abnormality notedLYMPH NODES: A left external iliac enlarged lymph node measuring 1.7 x 1.1 cm image number 92, series number 3 all suspicious for metastatic disease. There are multiple other enlarged/borderline enlarged pelvic lymph nodes suspicious for metastatic disease.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Pelvic metastatic adenopathy.Chest CT is recommended for further evaluation of the lungs for nodules. Indeterminate right middle lobe nodule.Indeterminate left adrenal nodule. |
Generate impression based on findings. | Clinical question: Rule out hemorrhage. Signs and symptoms: AMS. Nonenhanced head CT:There is extensive encephalomalacia of left cerebellum and with resultant ex vacuo dilatation of the fourth ventricle without significant change since prior exam. There is a evidence of very significant interval increased size of previously known left sided extra-axial mass since prior brain MRI from 2010. On this non-enhanced exam there is evidence of a well demarcated loculated and most likely extra-axial mass appears to extending from the level of tentorial notch superiorly and invaginating into the left hemisphere. This mass also has a large left sided upper cerebellopontine angle component with significant mass-effect and rightward deviation of the pons. The mass measures at least 65 x 81-mm in size on coronal reformatted images. On axial image 20 the mass measures approximately 69 x 67 mm. There is mild surrounding edema. There is however fairly significant mass effect on the left lateral ventricle and midline shift of approximately 22 mm to the right. There is enlargement of right lateral ventricle with surrounding low attenuation suspected of hydrocephalus and transependymal exudate of CSF. Recommend follow-up with a pre-and post enhanced brain MRI for more precise assessment. On prior MRI exam this mass was centered at the level of the left petroclinoid ligament and with a left subtemporal component as well as left superior cerebellopontine angle component. The appearance of the finding on prior MRI exam and is highly suggestive of a meningioma.Findings on this exam were discussed by phone with the referring clinical physician Dr. Joseph Venturini patient number 3691 at the time of review of the study at 8:53 am. | 1.Significant interval increased patient's previously known left sided extra-axial mass since 2010 exam as detailed above. Recurrent mass extends from left upper cerebellopontine angle superiorly and with significant invagination into the left hemisphere and measuring at least 65 x 81 mm in size.2.Midline shift to the right of approximately 22 mm, unilateral right-sided hydrocephalus and suspected trans ependymal exudate of CSF as detailed. |
Generate impression based on findings. | 77-year-old female patient with flank pain. Evaluate for right-sided nephrolithiasis. Note the lack of intravenous contrast limits evaluation of the vasculature, lymph nodes and solid viscera.ABDOMEN:LUNG BASES: Bilateral scarring versus atelectasis, left greater than right.LIVER, BILIARY TRACT: Scattered punctate calcifications, consistent with prior granulomatous disease.SPLEEN: Scattered punctate calcifications, consistent with prior granulomatous disease.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral nonobstructing renal calculi and vascular calcifications. No obstructing renal calculi, hydronephrosis or perinephric fat stranding. There are small hypoattenuating lesions bilaterally they cannot be completely characterized and are stable compared to prior examination.RETROPERITONEUM, LYMPH NODES: Atherosclerotic changes in the abdominal aorta and iliac arteries.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumbar spine. OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No bladder calculi.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Sigmoid colon diverticulosis and mild wall thickening, stable compared to prior examination.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumbar spine. Right hip arthroplasty.OTHER: No significant abnormality noted. | 1.Bilateral nonobstructing renal calculi without evidence of obstruction. 2.Small hypoattenuating lesions in the renal parenchyma bilaterally are too small to characterize and are stable compared to prior examination. |
Generate impression based on findings. | 65 year-old female status post fall. 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 paranasal sinuses and mastoid air cells are clear. There is an area of lucency in the clivus. The osseous structures are otherwise unremarkable. There is straightening of the cervical lordosis. The cervical spine alignment is anatomic. The vertebral bodies, dens, lateral masses, pedicles, lamina, facets, and posterior elements are intact with no evidence of fracture or subluxation. Within the limits of CT scanning, the thecal sac and spinal cord are preserved with no evidence of spinal canal stenosis. The neural foramen are patent. The intervertebral disk spaces are preserved. The paraspinal soft tissues are unremarkable.There are mild disc bulge and small vertebral osteophytes from C4-C7. There is mild atherosclerotic calcification at the bilateral carotid bifurcations. | 1. No acute intracranial abnormality. 2. No evidence of cervical spine fracture or subluxation, if spinal cord or ligamentous injury is suspected MRI is recommended.3. Mild degenerative disc disease of the cervical spine. 4. Focal lucency in the clivus is of uncertain etiology. |
Generate impression based on findings. | Pleural mesothelioma on the vorinostat/paclitaxel phase I trial. There has been interval increase in size of an infiltrating mass that extends from the right apical pleural surface into the right axilla, supraclavicular fossa, right lower neck, including the right tracheoesophageal groove, retrovisceral space, prevertebral space, and crosses the midline, extending into the left upper mediastinum and lower left tracheoesophageal groove. Overall, the mass measures 6.6 AP x 13.0 RL cm, previously 6.2 AP x 11.9 RL cm. The mass is not completely imaged in the craniocaudal dimension of this exam. The mass encases the right brachiocephalic,subclavian,axillary, vertebral, and carotid arteries, although the vessels are not significantly narrowed. There has been interval evolution of the right internal jugular vein thrombosis. The right brachiocephalic vein measures 2 mm in width at its narrowest point. The trachea is also encased by tumor in the upper mediastinum and is mildly narrowed. The right brachial plexus remains encased and appears swollen. There is probable neural foraminal invasion at several levels, including C7-T1, C6-7, and perhaps C5-6. There is no significant discrete cervical lymphadenopathy. The thyroid gland appears heterogeneous. There is an unchanged 9 mm diameter left vallecular cyst. The imaged intracranial structures are grossly unremarkable. The lungs are evaluated on a separately dictated chest CT. | Interval enlargement of the large right apical pleural mesothelioma that invades the right supraclavicular fossa, right tracheoesophageal groove, with extension across the midline and associated encasement of critical neurovascular structures, as described in the findings section. Also refer to the separately dictated chest CT for additional details. |
Generate impression based on findings. | 84 year old status-post valvuloplasty undergoing preparation for TAVR VESSELS:Conventional 3 vessel arch anatomy. The ascending aorta is borderline ectatic. Mild atherosclerotic calcification affects the arch and branch vessels. No filling defect to indicate a dissection.The abdominal aorta is normal in size. A focal atherosclerotic plaque creates a 30% narrowing at the origin of the superior mesenteric artery. There is a thrombosed saccular aneurysm extending from the posterolateral infrarenal aorta. It measures 3.9 x 1.6 cm in the axial plane (Series 7, Image 401). The mouth measures 2.1cm in AP dimension. Moderate to severe atherosclerotic calcification affects the distal abdominal aorta and iliac vessels. The common and external iliac arteries are tortuous, right greater than left. The dilated collecting system of the left iliac fossa renal transplant abuts and displaces the left external iliac artery. Severe atherosclerotic calcification affects the external iliac arteries and common femoral arteries.SINUS OF VALSALVA: 3.7 X 3.4 X 3.9 cmSINOTUBULAR JUNCTION: 3.2 X 3.3 cmASCENDING THORACIC AORTA AT LEVEL OF MAIN PULMONARY ARTERY: 3.9 X 3.9 cmASCENDING THORACIC AORTA IMMEDIATELY PROXIMAL TO THE INNOMINATE ARTERY: 3.5 X 3.6 cmPROXIMAL DESCENDING THORACIC AORTA IMMEDIATELY DISTAL TO THE LEFT SUBCLAVIAN ARTERY: 2.6 X 2.4 cmDESCENDING THORACIC AORTA AT LEVEL OF HIATUS: 2.4 X 2.5 cmINFRARENAL ABDOMINAL AORTA: 1.7 X 1.5 cmRIGHT COMMON ILIAC ARTERY: 11 X 9 mmRIGHT EXTERNAL ILIAC ARTERY: 10 X 10 mmRIGHT COMMON FEMORAL ARTERY: 6.8 X 6.2mmLEFT COMMON ILIAC ARTERY: 13 X 11 mmLEFT EXTERNAL ILIAC ARTERY: 10 X 10 mmLEFT COMMON FEMORAL ARTERY: 9 X 8 mmCHEST:LUNGS AND PLEURA: Bilateral pleural effusions, large on right and moderate on left. Associated compressive atelectasis and consolidation. Scattered pulmonary granulomas and nonspecific micronodules. Thickened interlobular septa compatible with edema.MEDIASTINUM AND HILA: Moderate to severe cardiomegaly with left ventricular and left atrial enlargement. Severe annular calcifications affects the aortic valve. Additional calcification affects the inferior and lateral aspects of the mitral annulus. Extensive 3 vessel atherosclerotic calcification status post multiple stent placement. No pericardial effusion.The main pulmonary artery is mildly dilated measuring 3.2 cm in diameter compatible with pulmonary hypertension.Diffuse mild enlargement of the mediastinal lymph nodes likely reflecting edema.CHEST WALL: Diffuse soft tissue edema. Subacute left sided rib fractures. Gynecomastia. Left internal jugular central venous catheter with tip at the cavoatrial junction.ABDOMEN:LIVER, BILIARY TRACT: Vicarious excretion of contrast opacifies the gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Severely atrophied and multicystic native kidneys. Enlarged left iliac renal transplant graft with marked hydronephrosis.RETROPERITONEUM, LYMPH NODES: Numerous prominent retroperitoneal lymph nodes may reflect diffuse edema.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Severe degenerative changes affect the thoracolumbar spine. Posterior spinal stabilization rods and pedicular screws affix L4 through S1.OTHER: No significant abnormality noted.PELVIS:PROSTATE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Multiple prominent pelvic lymph nodes appearing similar to prior.BOWEL, MESENTERY: Extensive diverticulosis affecting the entirety of the colon without CT evidence of diverticulitis.BONES, SOFT TISSUES: Orthopedic hardware affixing prior right femoral neck fracture.OTHER: No significant abnormality noted. | 1.Small thrombosed saccular infrarenal aortic aneurysm as described. Moderate to severe atherosclerotic calcifications affecting tortuous iliac arteries and severe atherosclerotic calcification affecting the common femoral arteries bilaterally. The dilated renal transplant collecting system abuts and displaces the left external iliac artery.2.Unchanged moderate to severe cardiomegaly with severe calcification of the aortic and mitral valves.3.Mildly dilated main pulmonary artery compatible with pulmonary hypertension and evidence of pulmonary edema.4.Findings of end-stage renal disease with failed left iliac fossa graft. |
Generate impression based on findings. | Female 19 years old; Reason: evaluate for appendicitis History: diarrhea, RLQ 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: 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: Right corpus luteal cyst with physiologic fluid within the endometrial canal.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The appendix is not clearly visualized, however there is no inflammatory reaction, mesenteric lymph nodes, or abscess collection in the right lower quadrant to suggest appendicitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.No evidence of appendicitis. 2.Right corpus luteal cyst which could be the cause of patients right lower quadrant pain. |
Generate impression based on findings. | Caseating granulomas on porta hepatis mass. Biopsy showed granulomatous disease. Technique CT chest to rule out evidence of old or active TB. CHEST: Please note the motion artifact degrades image quality, limiting evaluation.LUNGS AND PLEURA: Calcified nodules left upper lobe (6/73) is consistent with a granuloma. A second calcification in abutting the left hemidiaphragm (4/55) is probably within the collapsed lung. Significant atelectasis in the lung bases bilaterally. Mild mosaic attenuation of the lung parenchyma incompletely assessed but could be the result of chronic thromboembolic disease.MEDIASTINUM AND HILA: Motion artifact. The right atrium and ventricle appear prominent with straightening of the intraventricular septum. Although the main pulmonary artery appears normal in caliber, the distal main left and right pulmonary arteries as well as a lobar branches appear to be dilated.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Pneumobilia. Periportal edema. Poorly defined soft tissue density periportal mass surrounds a biliary stent. Probable very sees in the portal region are difficult to assess due to adjacent soft tissue stranding and lack of contrast.SPLEEN: Spleen appears at least upper normal in size.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: Pancreas is poorly assessed without IV contrast. There is inflammatory change surrounding it the pancreatic head region however the anatomy is not clearly delineated.RETROPERITONEUM, LYMPH NODES: Retroperitoneal mass posterior to the region of the pancreatic head appears isoattenuating to pancreatic parenchyma and without significant change from a recent MRI.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Varices versus small lymph nodes in the gastrohepatic ligament region. Mild diffuse wall thickening of the colon is nonspecific in the postoperative setting. Patency of vasculature cannot be assessed without IV contrast.BONES, SOFT TISSUES: Skin staples project over the midline abdomen.OTHER: Moderate ascites. Moderate volume of free intraperitoneal air. | Calcified granulomas in the left lung and faintly calcified ipsilateral hilar region lymph nodes are most consistent with healed granulomatous disease. Significant atelectasis in the lung bases limit assessment of the lower lung fields, but there is no evidence of active pulmonary disease elsewhere. Moderate pneumoperitoneum is presumably postoperative and was discussed with Dr. Cardin. Moderate ascites. Wall thickening of the colon incompletely assessed without IV contrast. Retroperitoneal and periportal masses not significantly changed from a recent MRI dated 10/29/13 where they were better evaluated, please refer to separately reported exam for details. |
Generate impression based on findings. | 65-year-old male with abdominal pain, nausea, evaluate for sequela of Crohn's disease. ABDOMEN:LUNG BASES: Basilar scarring or atelectasis.LIVER, BILIARY TRACT: Status post cholecystectomy with stable prominence of the common bile duct and pancreatic duct. No focal hepatic lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral hypoattenuating lesions, some too small to characterize, but likely representing cysts.RETROPERITONEUM, LYMPH NODES: Scattered atherosclerotic calcification and plaque.BOWEL, MESENTERY: Postsurgical change including total colectomy and small bowel resections with ileoanal pull-through. Relative change in caliber of the distal ileum is unchanged from the prior study. Mild diffuse small bowel and gastric dilatation. No evidence of fistula or fluid collection. A polypoid opacity in the distal ileum adjacent wall thickening may represent oral contrast or small polyp.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: Postsurgical change including total colectomy and small bowel resections with ileoanal pull-through. Relative change in caliber of the distal ileum is unchanged from the prior study. Mild diffuse small bowel and gastric dilatation. No evidence of fistula or fluid collection. A polypoid opacity in the distal ileum adjacent wall thickening may represent oral contrast or small polyp.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Extensive postsurgical change with chronic small bowel dilatation and change in caliber in the distal ileum, unchanged from prior studies. 2. Polypoid opacity in the distal ileum which may represent oral contrast, however, a small polyp cannot be excluded. |
Generate impression based on findings. | 60 year-old female with altered mental status. 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. | Female 54 years old; Reason: 54 yo female with hx roux-en-y and hx SBO, please evaluate for abscess/ progression of obstruction History: LLQ abdominal pain and vomiting ABDOMEN:LUNGS BASES: A hypoattenuating lesion in the left lateral lobe with peripheral discontinuous nodular enhancement most compatible with a hemangioma. No other focal lesion detected.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: Postsurgical changes from a Roux-en-Y gastric bypass are noted. Contrast is seen throughout the bowel loops, with mild distention of the jejunal loops. There is also contrast extending into the excluded portion of the Roux-en-Y stomach as well as duodenum. Jejunal wall thickening (series 3 image 60) as well as distal terminal ileal wall thickening (series 3 image 64), of unclear clinical etiology. Mottled appearance of feces noted in the distal small bowel, however contrast is seen progressing into the colon, suggesting against obstruction. No loculated fluid collection or abscess identified. No free air identified.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Atrophic or surgically absent.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Oral contrast progressing into the colon ruling against obstruction. No free air or loculated abscess detected. Filling of the excluded portion of the stomach and duodenum noted.2.Mild dilation of the jejunal loops with associated jejunal and ileal wall thickening. This of unclear etiology and should be correlated clinically. |
Generate impression based on findings. | 42 year-old female status post BMT and with frontal headache, congestion and rhinorrhea. The orbits are unremarkable. The mastoids are clear. Limited view of the intracranial structure is unremarkable. There is mild polypoid mucosal thickening in the dependent portions of the bilateral maxillary sinuses, unchanged from prior. The frontal sinuses, frontal-ethmoid recesses, anterior/posterior ethmoids, and sphenoid 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 and nasal septum are normal. The cribriform plate, fovea ethmoidalis and lamina papyraceae appear normal. The osseous structures are unremarkable. | No evidence of acute sinusitis. Stable mild maxillary sinus mucosal disease. |
Generate impression based on findings. | 81 year-old female with fevers and tachypnea, evaluate for cervical cancer, disease progression. ABDOMEN:LUNG BASES: Right lower lobe calcified granuloma is unchanged.LIVER, BILIARY TRACT: Status post cholecystectomy. Hypoattenuating hepatic lesions, likely representing cysts, are unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left nephroureteral catheter extends to the bladder.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diffuse wall thickening of the right hemicolon is identified. The small bowel is normal in caliber. No evidence of obstruction or loculated fluid collection.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Coarse calcifications in the uterus.BLADDER: Distended, but otherwise unremarkable.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Free fluid in the right hemi-pelvis. | Diffuse wall thickening of the right hemicolon, which may be infectious, inflammatory or ischemic in etiology. This finding was discussed with Dr. Goodenow (3082) at the time of dictation. |
Generate impression based on findings. | Clinical question: IPH. Signs and symptoms: IPH Nonenhanced head CT:Examination demonstrates no convincing evidence of further increased hemorrhage since prior exam.A large dissecting right posterior temporal, occipital and history of parietal and hemorrhage remains similar to prior study in size and extent. Residual right hemispheric subarachnoid hemorrhage also remain similar to prior study. Residual left hemispheric severe temporal/occipital/parietal subarachnoid hemorrhage is also very similar to prior study. Blood within the dependent portion of bilateral ventricles shows also no interval change. The ventricular system remain within normal size and unchanged and with maintained midline. | 1.No convincing evidence of any new or increased hemorrhage since prior study.2.Stable large dissecting right hemispheric hemorrhagic stroke since prior exam.3.Stable intraventricular and subarachnoid hemorrhage since prior study.4.Stable normal size of ventricular system patent with maintained midline. |
Generate impression based on findings. | Male 56 years old; Reason: evaluate for intraabdominal pathology History: abdominal pain, nausea/vomiting ABDOMEN:LUNGS BASES: Marked emphysematous changes with bullae are seen in bilateral lung fields. No nodule or mass is detected.LIVER, BILIARY TRACT: Fatty infiltration of the liver is seen without focal lesion. Gallbladder, intrahepatic, extrahepatic, biliary ducts are normal.SPLEEN: No significant abnormality noted.PANCREAS: Small hypoattenuating lesion in the pancreatic tail is seen (series 3 image 41, coronal image 42, sagittal image 97) of unclear etiology. Further correlation with MRI M.R.C.P. advised. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Emphysematous changes of the lungs and fatty liver. No acute intra-abdominal pathology to suggest the patient's pain.2.Hypoattenuating lesion in the distal pancreatic tail, which should be further characterized with MRI M.R.C.P.3.Findings discussed with Reginald Saint-Hailare at 9:56 on 11/7/13 |
Generate impression based on findings. | Chromophobe renal cell carcinoma CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left nephrectomy site clear.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Stable examination without acute, inflammatory, or neoplastic process. No metastatic disease. |
Generate impression based on findings. | Female 97 years old; Reason: renal stone protocol-evaluate for evidence of urinary obstruction History: abdominal pain, urinary retention The absence of intravenous and oral contrast limits evaluation of the solid organs and of the bowels. Given these limitations, the following observations were made:ABDOMEN:LUNG BASES: Bibasilar subsegmental atelectasis or scarring. No pulmonary air space opacities. No pleural effusion. The pacemaker leads are again noted in the heart.LIVER, BILIARY TRACT: No focal hepatic lesions are identified. Multiple calcified gallstones without evidence of cholecystitis. No intra-or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Large 2.2 x 1.3 cm calcific stone in the right renal pelvis, unchanged in position. Other large stone in the right renal calyx has increased in size since previous examination. Stable mild right sided hydronephrosis, appearing chronic in nature.Punctate left non-obstructing renal calculus. Left distal ureteral calculus (series 4 image 115) is noted with stable mild left-sided hydronephrosis and subtle soft tissue inflammatory changes.RETROPERITONEUM, LYMPH NODES: Markedly ectatic abdominal aorta. The abdominal aorta is mildly dilated with a diameter is 3.4 cm, previously 3.4 cm (image 50; 80312), not significantly changed.BOWEL, MESENTERY: Marked uncomplicated diverticulosis of the transverse, descending, and rectosigmoid colon. There are multiple duodenal diverticula. Note is made of small bowel diverticulosis. No evidence of obstruction. No pneumatosis intestinalis or free intraperitoneal air is identified.BONES, SOFT TISSUES: Large right inguinal hernia containing small bowel and mesenteric fat without evidence of obstruction or incarceration. Small fat containing umbilical hernia.OTHER: Extensive coronary artery calcifications. AICD leads in place.PELVIS:UTERUS, ADNEXA: The uterus is not visualized and may be atrophic or surgically absent.BLADDER: Foley catheter within the bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Marked uncomplicated diverticulosis of the transverse, descending, and rectosigmoid colon. There are multiple duodenal diverticula. Note is made of small bowel diverticulosis. No evidence of obstruction. No pneumatosis intestinalis or free intraperitoneal air is identified.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Distal left ureteral calculus with subtle inflammation and stable left hydronephrosis.2. Bilateral renal calculi with mild chronic appearing right sided hydronephrosis.3. Large right inguinal hernia containing mesenteric fat and small bowel without obstruction or strangulation.4. No significant interval change in abdominal aortic aneurysm with measurements as described.5. Cholelithiasis without evidence of cholecystitis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 84-year-old female past medical history of spinal stenosis, hypertension, admitted for right pleuritic pain. Concern for infection. Evaluate for infection and LAD. LUNGS AND PLEURA: Multiple scattered pulmonary nodules, some of which are calcified. No pulmonary mass identified. No pulmonary opacities to suggest infection. No pleural effusions or pneumothorax. Mild dependent atelectasis bilaterally.MEDIASTINUM AND HILA: Bilateral thyroid hypodensities, likely thyroid nodules. No evidence of a mediastinal or hilar lymphadenopathy. Mild coronary artery calcifications.CHEST WALL: No axillary lymphadenopathy. No soft tissue findings to suggest infection or a mass.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Multiple hepatic hypodensities, statistically likely cysts. Right parapelvic cyst identified. Otherwise, no significant abnormalities in the visualized upper abdomen. | No findings to suggest infection as clinically questioned. |
Generate impression based on findings. | 23 year-old female with abdominal pain, rule out SBO. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Unchanged dilatation of the neorectal pouch and distal small bowel proximal to the anal anastomosis. Proximal small bowel is normal in caliber.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Status post proctocolectomy. Unchanged dilatation of the neorectal pouch and distal small bowel proximal to the anal anastomosis. The proximal small bowel is normal in caliber. No evidence of fluid collection or free air.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Unchanged bowel dilatation proximal to the anal anastomosis suggesting an anastomotic stricture. |
Generate impression based on findings. | 15-year-old male with abdominal distention. Evaluate for mass. CHEST:LUNGS AND PLEURA: No pulmonary masses or focal airspace opacities are identified. No pleural effusions are present.MEDIASTINUM AND HILA: There is no mediastinal or hilar lymphadenopathy. The esophagus contains oral contrast material.The heart size is normal. No pericardial effusion is present.The azygos vein is distended.Small density noted at the location of the ligamentum arteriosum may represent ligamentum arteriosum calcification or a PDA ligation clip. CHEST WALL: No osseous lesions identified. No fractures are present.ABDOMEN:LIVER, BILIARY TRACT: The liver is displaced to the right by a large upper abdominal mass centered in the porta hepatis. This mass abuts the left hepatic lobe, biliary system, and main portal vein. However, no discrete intrahepatic lesions are present.The gallbladder is distended.SPLEEN: The spleen appears normal in attenuation. No splenic lesions are identified.PANCREAS: The pancreas is diffusely enlarged and the pancreatic head appears contiguous with the more superior abdominal mass. The main pancreatic duct is not visualized. No areas of pancreatic low attenuation are present to suggest necrosis. The splenic vein, SMV, and portal veins appear patent without evidence of thrombosis. ADRENAL GLANDS: The adrenal glands are difficult to visualize but appear grossly normal.KIDNEYS, URETERS: There is a delayed right nephrogram and right hydroureteronephrosis secondary to obstruction from the large intraabdominal mass. The left kidney appears normal in attenuation without hydronephrosis. RETROPERITONEUM, LYMPH NODES: The infrahepatic IVC becomes flattened at approximately the level of the SMA origin and is not visualized distally. This likely reflects mass effect but an IVC thrombus is not excluded. The aorta and iliac vessels are displaced by the patient's large intra-abdominal mass though appear patent. No retroperitoneal lymphadenopathy is present. BOWEL, MESENTERY: Two large mass lesions are present throughout the abdomen which occupy the majority of the abdomen and displace the bowel and mesentery peripherally. The larger abdominal mass occupies the majority of the lower abdomen and measures up to 19 x 14 x 24 centimeters. This mass contains a large region of central fluid attenuation and an irregular wall. The mass also contains a small amount of internal calcification (series 3, image 149). A second large mass is present centered at the gastrohepatic ligament which measures up to 11 x 8 by 9 cm and is heterogeneous but contains regions of fluid attenuation. Numerous tortuous dilated mesenteric veins are present, particularly along the anterior abdomen.BONES, SOFT TISSUES: No osseous lesions are identified. No fractures are present.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: The bladder is displaced inferiorly by the tumor.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: As above.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Two large intraabdominal masses as described above. Given the patient's history of abdominal trauma two months prior, pancreatic enlargement, and the location and attenuation of these masses, pancreatic pseudocysts are possible with a malignant lesion such as a sarcoma considered less likely but also possible. 2. Flattening of the infrahepatic IVC which likely reflects mass effect but an IVC thrombus is not excluded. Further evaluation with ultrasonography is recommended for further evaluation. 3. No osseous or intrathoracic lesions are present. |
Generate impression based on findings. | 19 year-old female with general abdominal discomfort and nausea, evaluate for ventriculoperitoneal pseudocyst. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Left VP shunt catheter extends within the abdomen with its tip adjacent to the bladder. Right orphaned catheter is again noted. Small of associated free fluid is noted. No evidence of loculated pseudocyst.OTHER: Free fluid in the pelvis is again noted.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Left VP shunt catheter extends within the abdomen with its tip adjacent to the bladder. Right orphaned catheter is again noted. Small of associated free fluid is noted. No evidence of loculated pseudocyst.OTHER: Mild ascites. | VP catheter with mild associated free fluid in the abdomen and pelvis. No evidence of loculated fluid collection/pseudocyst. No acute abdominal or pelvic abnormality. |
Generate impression based on findings. | Newly diagnosed gastric cancer with possible perforation outside CT scan CHEST:LUNGS AND PLEURA: Bilateral large pleural effusions. Bilateral dependent atelectasis.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hypodense lesions in the liver which are too small to characterize.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Retroperitoneal adenopathy. An index left para-aortic node measures 1.1-cm image number 124, series number 3.BOWEL, MESENTERY: Large mass in the antrum of the stomach causing gastric outlet obstruction. The mass extends into the peritoneum and there is associated peritoneal carcinomatosis. Transverse colon may is also invaded by the mass.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Radiation pellets in the prostate.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of fluid in the pelvis. | Very large infiltrating mass involving the gastric antrum and invading the transverse colon consistent with patient's known gastric cancer.. Extensive peritoneal carcinomatosis. Gastric outlet obstruction.Retroperitoneal and mesenteric adenopathy.Bilateral large pleural effusions. |
Generate impression based on findings. | 65 years old male intra-cerebral hemorrhage. Since the prior exam, there has been no significant change in the size or shape of a right thalamic parenchymal hematoma. Mild surrounding parenchymal edema is unchanged, there is no significant generalized mass effect.Extension of blood into the ventricular system is also redemonstrated. The quantity and morphology of intraventricular blood appears similar to the prior exam except in the fourth ventricle where it is less conspicuous. There is evidence of some layering blood product within the occipital horns.The ventricles remain unchanged in size. Minimal periventricular hypoattenuation is seen bilaterally.No new intracranial hemorrhage is seen. No new parenchymal abnormalities are detected.There is partial opacification of the paranasal sinuses. | Stable right thalamic and intraventricular hemorrhage and ventricular size. No evidence of new intracranial hemorrhage is seen. |
Generate impression based on findings. | 32-year-old male with history of pulmonary hypertension. Evaluate for lung abnormality. LUNGS AND PLEURA: There is a pulmonary opacity in the right upper lobe measuring approximately 2.0 x 1.8 cm (series 4, image 34) that is new compared to the previous examination. There is marked mosaic perfusion through both lungs, creating the appearance of groundglass opacities. There is a focal subpleural right upper lobe ground glass opacity with sharply defined central component which is likely a pulmonary infarct, as mentioned above. Multiple pulmonary micronodules, likely benign intrapulmonary lymph nodes.Small amount of right pleural effusion, new compared to prior exam. MEDIASTINUM AND HILA: Straightening of the pericardial septum and a large right ventricle. Moderately large pericardial effusion, grossly unchanged. The pulmonary artery measures approximately 3.2 cm in the transverse dimension. No mediastinal or hilar lymphadenopathy. Multiple collateral vessels in the mediastinum identified.CHEST WALL: Collateral vessels in right chest wall noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. The liver is edematous. Small amount of ascites in the visualized upper abdomen. Visualized left kidney is noted to be atrophic with multiple hypodensities, likely cysts. Osseous findings likely secondary to renal osteodystrophy. | 1. Findings compatible with pulmonary hypertension, and marked pulmonary mosaic perfusion with likely an infarct in the right upper lobe.2. Interval development of right small pleural effusion. 3. Severe right sided cardiomegaly with moderately large pericardial effusion. 4. Edematous hepatic parenchyma and small amount of ascites. |
Generate impression based on findings. | 75-year-old female presenting with back pain. Evaluate for dissection. ANGIOGRAPHY:Conventional 3-vessel arch anatomy. Severe atherosclerotic calcification affects the aortic arch. The aorta is normal in size. No luminal contour abnormality. No filling defects to indicate a dissection flap.Focal atherosclerotic calcification creates an approximately 50% narrowing at the origin the celiac axis, superior mesenteric artery, and left renal artery. Moderate atherosclerotic calcification affects the distal abdominal aorta and iliac arteries.CHEST:LUNGS AND PLEURA: Numerous bilateral pulmonary nodules that are predominately peripheral in location. A superior segment left lower lobe nodular opacity appears partially cavitary (series 4 image 50). In the setting of infection this is highly suspicious for septic emboli. Dependent bibasilar atelectasis/consolidation, right greater than left. No pleural effusion or pneumothorax.MEDIASTINUM AND HILA: Heterogeneous nodular thyroid.Dilated main pulmonary artery measuring 3.6 cm in diameter compatible with pulmonary hypertension. No large pulmonary emboli are noted in the lobar and segmental branches.Mild cardiomegaly. No pericardial effusion.CHEST WALL: Small focus of subcutaneous emphysema in the left breast with associated overlying skin thickening (series 3, image 38). Correlate for recent instrumentation or superficial infection.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.LIVER, BILIARY TRACT: Well-circumscribed subcapsular segment 4A lesion measuring 4.0 x 4.0 cm (series 13 image 108). Lesion is approximately isodense with the background normal liver parenchyma on the unenhanced phase and is hypodense on the arterial phase. This is incompletely evaluated, but can be further evaluated with a dedicated triple phase CT examination or MRI.SPLEEN: No significant abnormality noted.PANCREAS: 10 x 8 mm hypodense focus in the pancreatic tail is nonspecific but could represent a cystic pancreatic neoplasm (series 13 image 105). Further evaluation with MRI is recommended.ADRENAL GLANDS: Partially calcified nodular focus adjacent to the left adrenal may represent sequela of prior hemorrhage or alternatively a calcified lymph node.KIDNEYS, URETERS: Atrophic bilateral kidneys compatible with end-stage renal disease. Multiple bilateral hypodense renal foci are too small to characterize but likely represent renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Uncomplicated diverticulosis affects the visualized sigmoid colonBONES, SOFT TISSUES: Postoperative changes from ventral hernia repair.OTHER: No significant abnormality noted. | 1. No evidence of aortic dissection or aneurysm.2. Multiple bilateral peripheral nodules highly suspicious for septic emboli.3. Small focus of subcutaneous emphysema in the left breast with associated overlying skin thickening; correlate for recent instrumentation or superficial infection.4. Hypodense focus in the pancreatic tail is incompletely evaluated, but could represent a cystic pancreatic neoplasm. Further evaluation with MRI is recommended.5. Incompletely evaluated right hepatic lobe lesion as described. This can also be evaluated further with MRI if clinically warranted.6. Atrophic bilateral kidneys compatible with end-stage renal disease.7. Uncomplicated diverticulosis of the sigmoid colon.Findings discussed with Gina Bradley p6598 of the clinical service at time of dictation. |
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