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Generate impression based on findings. | Status post grid insertion. There has been interval insertion of bilateral subdural grid electrodes overlying the cerebral hemispheres. Considerable streak artifact related to the hardware obscures surrounding structures. There is a mixed extra-axial collection of fluid, air, and hemostatic material that measures up to 15 mm on the left and a mixed extra-axial collection of fluid, air, and hemostatic material that measures up to 5 mm on the right. There is approximately 3 mm of midline shift to the right. There is no definite evidence of hydrocephalus. The encephalomalacia demonstrated on the prior MRI is not readily depicted on this exam due to technical limitations. There is postoperative emphysema and fluid within the scalp. | Limited exam due to metal streak artifacts demonstrates interval bilateral subdural electrode grid insertion with postoperative subdural collections that measure up to 5 mm in width on the right and 15 mm in width on the left with approximately 3 mm of midline shift the the right. |
Generate impression based on findings. | Surgical evaluation for lung cancer. Post chemo/radiation. CHEST:LUNGS AND PLEURA: Significant post therapeutic architectural distortion is present within the posterior segment of the right upper lobe, the posterior aspect of the anterior segment of the right upper lobe and within the medial aspect of the right lower lobe. Masslike soft tissue lesion appears to have its epicenter along the right minor fissure measuring 3.9 x 2.8 cm in transaxial dimensions (5/47) and 2.4-cm in cranial caudal dimension. Allowing for architectural distortion, the mass likely originated in the superior segment of the right lower lobe.Indeterminate irregular cystic lesion in the right lower lobe (4/219) is associated with some groundglass opacity and could reflect scarring or possibly a synchronous primary. This should be monitored on subsequent examinations. Linear scarring or atelectasis extends in a vertical fashion within the right lower lobe. The right inferior pulmonary ligament and medial aspect of the right major fissure are thickened, the latter is slightly nodular in quality at the level of the radiation reaction.Minimal paramediastinal radiation reaction in the left lung.1.7-cm ground glass density nodule in the left upper lobe (4/69) is spherical in appearance and is suspicious for a synchronous adenocarcinoma in situ or possibly atypical adenomatous hyperplasia though it is larger than typically seen.No pleural fluid or pneumothorax. Mild posterior pleural thickening at the level of the radiation reaction, likely inflammatory.MEDIASTINUM AND HILA: There is mild effacement of the lateral wall of the bronchus intermedius by lymphadenopathy which also thickens the proximal right middle and lower lobe airways. This inferior interlobar lymph node measures 1.6-cm (3/47). Adjacent mildly enlarged lobar level lymph nodes noted adjacent to both the right middle and lower lobe airways. High right paratracheal chain lymph nodes appear upper normal in size (3/9-10).Distal esophageal thickening most likely represents radiation esophagitis.Atherosclerotic calcification of the thoracic aorta and coronary arteries. Normal heart size without pericardial effusion.CHEST WALL: Subcutaneous soft tissue nodule right lateral chest wall near the cranial aspect of the axilla (3/20) appears centrally hypoattenuating. This appearance is most suggestive of a sebaceous cyst in this lesion can be monitored on subsequent exams to assess for growth. A soft tissue metastasis is considered much less likely.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Subcentimeter hypoattenuating lesion right hepatic lobe too small to characterize, possibly a cyst.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Probable cortical cyst interpolar region of the left kidney. Additional subcentimeter cortical lesions are too small to accurately characterize.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.Moderate mesenteric lymphadenopathy in the right lower quadrant measuring up to 16 x 19 mm (3/140). The adjacent bowel is incompletely assessed without oral contrast.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Right lung mass at the level of the minor fissure, probably originating in the superior segment of the right lower lobe measures up to 3.9-cm.2. Ipsilateral inferior interlobar and lobar level lymphadenopathy.3. Left upper lobe ground glass nodule unlikely to be metastatic but is suspicious for adenocarcinoma in situ based on its size. Three month follow-up CT recommended to exclude a postinflammatory lesion. If the lesion persists on a subsequent examination, further characterization may be made by tissue diagnosis at that time.4. Indeterminate ground glass opacity associated with the cyst in the right lower lobe unlikely to be a metastasis. This most likely reflects scarring but should be monitored on subsequent examinations to exclude a primary lesion.5. Right lower quadrant mesenteric lymphadenopathy. |
Generate impression based on findings. | 70 year-old male with abdominal pain and nausea, history of diverticulitis, rule out intra-abdominal abscess. Limited exam due to lack of IV contrast.ABDOMEN:LUNG BASES: Basilar scarring and atelectasis and volume loss on the left. Coronary arterial calcifications.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Fatty atrophy of the pancreas, appropriate for age.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral hypoattenuating lesions, some too small to characterize, but likely representing cysts are incompletely evaluated on this study.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: Status post diverting colostomy. Diffuse diverticulosis involving the left hemicolon without evidence of inflammation.BONES, SOFT TISSUES: Multiple vertebral body compression fractures of unclear chronicity. T12 and T10 and body cement. Small amount of cement posterior to the 12 vertebral body is noted. No loculated or free fluid.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Mild apparent bladder wall thickening.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Status post diverting colostomy. Diffuse diverticulosis involving the left hemicolon without evidence of inflammation. No loculated or free fluid.BONES, SOFT TISSUES: Multiple vertebral body compression fractures of unclear chronicity. T12 and T10 and body cement. Small amount of cement posterior to the 12 vertebral body is noted.OTHER: No significant abnormality noted | Status post diverting colostomy. Extensive colonic diverticulosis without evidence of inflammation. No loculated fluid collections. |
Generate impression based on findings. | 56 year-old female with lower abdominal pain, rule out abscess. ABDOMEN:LUNG BASES: Small pleural effusions.LIVER, BILIARY TRACT: Cholelithiasis and distended gallbladder. Hypoattenuating lesion with peripheral nodular enhancement along the hepatic dome, likely represents a hemangioma, but is incompletely characterized on this exam. 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: Dilated appendix measures 16 mm without significant associated inflammatory change and may represent a mucocele or early appendicitis (image 107, series 3). The bowel is normal in caliber.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Left adnexal fluid attenuating lesion measures 5.4 x 2.6 cm (image 108, series 3) and may represent an adnexal cyst or postoperative seroma.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Dilated appendix measures 16 mm without significant associated inflammatory change and may represent a mucocele or early appendicitis (image 107, series 3). The bowel is normal in caliber.BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality noted | 1. Dilated appendix in the right lower quadrant without significant peri-appendiceal inflammatory change may represent early appendicitis or mucocele.2. Left adnexal fluid collection could represent adnexal cyst or postoperative seroma, correlate with history and follow up imaging.3. Nonspecific hepatic dome lesion which may represent a hemangioma, however, further evaluation with dedicated MRI may is recommended if clinically warranted. |
Generate impression based on findings. | 45-year-old female who presents for follow-up of pulmonary nodule seen on prior CT examination. LUNGS AND PLEURA: There are numerous pulmonary nodules scattered throughout both lungs. Previously noted nodule in the left lower lobe measures approximately 7 mm on the current examination (series 4, image 64), previously measuring 8 mm (series 5, image 16); this can be seen as far back as 3/30/2012.Reference spiculated right upper lobe nodule measures approximately 7 mm in short axis (series 4, image 37).Reference irregular right middle lobe nodule measures approximately 6 mm (series 4, image 51).Additionally, there is a pulmonary opacity with irregular borders in the left apex (series 4, image 11).No pleural effusions or pneumothorax.MEDIASTINUM AND HILA: There are multiple enlarged mediastinal lymph nodes. Reference precarinal lymph node measures proximally 13 mm (series 3, image 34) in short axis. Reference AP window lymph node measures approximately 7 mm. No hilar lymphadenopathy.CHEST WALL: No axillary lymphadenopathy. Dense breast parenchyma bilaterally without evidence of a focal breast mass.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. Numerous scattered pulmonary nodules throughout both lungs. 2. Mediastinal lymphadenopathy.3. The above findings could represent sarcoidosis. indolent atypical (fungal) infection, but metastatic disease is unlikely given the very indolent course. |
Generate impression based on findings. | Status post chemoradiation for an advanced stage oral squamous cell carcinoma after complex resection. There are postoperative findings related to radiotherapy and complex resection of a left oral cavity tumor and neck dissection. There is persistent gap in the mandible at the parasymphysial surgical margin. There is diffuse stranding of the cervical subcutaneous fat and diffuse pharyngeal mucosal edema, which is likely related to radiation therapy. Patchy areas of hyperattenuation scattered within the oral cavity and pharyngeal mucosa likely represent mucositis. However, there is no discrete mass lesion to suggest tumor recurrence. Likewise, there is no definite evidence of significant cervical lymphadenopathy. There are postoperative findings related to closure of a tracheostomy. The remaining portions of the thyroid gland.There is a left internal jugular venous catheter. The major cervical vessels are otherwise patent. The osseous structures appear unchanged with multilevel degenerative spondylosis. The partially imaged intracranial structures are unchanged. There are numerous pulmonary nodules demonstrate interval increase in size and new bilateral pleural effusions, which are described in more detail in the separate chest CT report. | 1. Stable post-treatment findings for left oral squamous cell carcinoma without evidence of locoregional tumor recurrence of significant cervical lymphadenopathy.2. Interval enlargement of numerous pulmonary metastases and new bilateral pleural effusions are described in more detail in the separate chest CT report. |
Generate impression based on findings. | 75 year-old female with acute right-sided weakness, evaluate Enhancement of the dura, leptomeninges and vasculature is secondary to a recent contrast enhanced examination. On this background of enhancement, no gross evidence of hemorrhage.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No edema is identified within the brain parenchyma. Empty sella. Atherosclerotic vascular calcifications of the intracranial internal carotid arteries.The visualized portions of the paranasal sinuses are clear. The frontal sinuses are hypoplastic. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | No acute intracranial abnormalities.Please note CT is insensitive for the detection of acute ischemia. |
Generate impression based on findings. | 46 year old male patient with ulcerative colitis and Clostridium difficile present with worsening abdominal pain. Concern for pancreatitis or Clostridium difficile complication. ABDOMEN:LUNG BASES: Bilateral dependent atelectasis.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No CT evidence of acute pancreatitis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Concentric wall thickening of the proximal cecum from a stable compared to prior examination. Post surgical changes noted adjacent to the cecum. Sigmoid diverticulosis without CT evidence of diverticulitis.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumbar spine.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: Concentric wall thickening of the proximal cecum from a stable compared to prior examination. Post surgical changes noted adjacent to the cecum. Sigmoid diverticulosis without CT evidence of diverticulitis.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumbar spine.OTHER: No significant abnormality noted. | 1.No acute intra-abdominal pathology.2.Concentric thickening of the cecum is stable. Colon cancer cannot be ruled out in this high-risk patient. Recommend follow-up colonoscopy.Findings and recommendation for colonoscopy were communicated to Dr. Labis via telephone at 9:50 AM on 11/7/13 by Dr. McCann. |
Generate impression based on findings. | Reason: lung cancer History: s/p lung resection January 2013 LUNGS AND PLEURA: Interval resection of left lower lobe nodule with postsurgical changes and suture lines along the left hilum.Small ground glass opacity in the posterior left lung apex (series 4, image 22) is likely a scar. Mild predominantly apical centrilobular emphysema.Bilateral calcified granulomas are again noted although changed in position on the left. No pleural effusions. No pneumothorax.MEDIASTINUM AND HILA: Scattered mediastinal lymph nodes are likely reactive. No supraclavicular, axillary, or hilar lymphadenopathy. Moderate coronary artery calcifications. Heart size is normal. No pericardial effusions. Moderate atherosclerotic calcification of the aorta.CHEST WALL: Mild degenerative changes of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Atrophic right kidney. Cholelithiasis. | 1.Interval resection of left lower lobe nodule.2.No evidence of residual or recurrent disease. |
Generate impression based on findings. | 44 year-old female with possible seizure. 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 mastoid air cells are clear. There is inflammatory change of the paranasal sinuses. | No acute intracranial abnormality. |
Generate impression based on findings. | 71-year-old male with chronic cough and right basilar crackles. Evaluate for interstitial lung disease. LUNGS AND PLEURA: There is a cluster of nodules with an adjacent linear component in the right upper lobe (series 4, image 38). Small region of nodular opacities/groundglass opacities in the right middle lobe (series 4, images and 51 and 52) and left upper lobe, suggestive of inflammation. Right lower lobe pulmonary nodule measures 5 mm in short axis (series 4, image 44).There is bronchiectasis and bronchiolectasis with septal thickening. Findings are suggestive of fibrosis.MEDIASTINUM AND HILA: Heart size is unremarkable. No mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. There is an exophytic component to the left kidney on the axial images which is not confirmed on the coronal series. Findings are likely secondary to renal contour and can be followed up if clinically indicated. Degenerative changes in the visualized spine. | Cluster of nodules, groundglass opacities, and findings suggestive of fibrosis as detailed. Follow-up with ILD protocol (prone and expiratory imaging) is recommended to confirm fibrosis. Differential considerations include mixed connective tissue disease, fibrosing NSIP, and atypical UIP. |
Generate impression based on findings. | Lungs a status post surgery and RT. Follow for recurrent disease. CHEST:LUNGS AND PLEURA: Left hemithorax volume loss with obstruction of the lower lobe bronchus and collapse of the paramediastinal lung. Large left pleural fluid collection is unchanged in size. Patchy micronodule opacities in the aerated portion of the left lung difficult to characterize due to motion but most likely post inflammatory. Calcified pleural plaque at the left lung base is unchanged.Subpleural fibrosis in the anterior right upper lobe in a pattern most commonly seen secondary to chest wall irradiation, correlate with history. Very mild bronchial wall thickening seen posteriorly in the right lung apex. Unchanged 4-mm nodule adjacent to the right major fissure within the right upper lobe.MEDIASTINUM AND HILA: Severe atherosclerotic calcification of the aorta and coronary arteries. Bronchial wall calcifications noted especially on the left. Calcified lymph nodes noted in the left mediastinum which may be the result of healed granulomatous disease.Pain pulmonary artery mildly dilated, suggestive of pulmonary hypertension.CHEST WALL: Healed sternotomy with wires in place. Severe thoracic kyphosis with chronic compression fracture of the T5 vertebral body and superior endplate depression of T6 and T7, unchanged. A lipoma in the soft tissues of the left axilla lateral to the pectoralis musculature. A small left axillary lymph node has enlarged in the interim, 7-mm compared to 4-mm previously (4/30) adjacent small lymph nodes also appear more prominent. Patient is noted to have a large volume of dense glandular breast tissue which is highly atypical for the patient's age. The breast tissue also contains nonspecific calcifications. Please note that breast pathology may not be visible on CT.ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Scattered granulomas.SPLEEN: Vascular calcifications.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Vascular calcifications.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Severe atherosclerotic calcifications of the aorta and its branches, including the ostia of the renal arteries as well has the proximal superior mesenteric artery which is likely stenotic (4/85, 4/91).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. Subtle increase in size in a left axillary lymph node of unclear clinical significance. Short-term CT follow-up suggested to assess for resolution. Also suggest correlation with physical examination of the breasts to exclude palpable nodules. Mammography may be performed if clinically warranted.2. Otherwise, no significant change in chronic abnormalities. |
Generate impression based on findings. | 54 year-old male with parapharyngeal space tumor. The orbits are unremarkable. The paranasal sinuses and mastoid air cells are clear except for minimal maxillary sinus mucosal thickening. Limited view of the intracranial structure is unremarkable. The previously seen lesion within the right parapharyngeal space has mildly increased in size measuring 1.8 x 1.4 cm (image 57 of series 7), compared to 1.7 x 1.0 cm on the prior. No additional soft tissue mass or focus of abnormal enhancement is seen. The oral cavity, oro/nasopharynx, hypopharynx, larynx and subglottic airways are unremarkable/patent. The epiglottis, vallecula, piriform sinuses, and vocal cords are normal. The parotid, submandibular, and thyroid glands are unremarkable. No lymphadenopathy or mass is noted. The carotid arteries and jugular veins are patent. The osseous structures are unremarkable. There is mild degenerative disk disease of the cervical spine. Periapical lucency is seen associated with multiple teeth, consistent with chronic periodontal disease.Limited view of the chest is unremarkable. | Mild interval increase in size of a right parapharyngeal space soft tissue lesion. The differential diagnosis for the lesion in this location includes a lymph node, nerve sheath tumor, ectopic salivary gland tissue / tumor or a minor salivary gland lesion. |
Generate impression based on findings. | 60 year-old female patient with metastatic colon cancer (peritoneal disease only), please evaluate for interval change. CHEST:LUNGS AND PLEURA: Scattered micronodules, stable compared to prior examination on 1/10/2013.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Right chest port with catheter tip terminating in the superior vena cava.ABDOMEN:LIVER, BILIARY TRACT: Serosal implants adjacent to the liver are not significantly changed. Reference implants along the inferior margin measures 1.8 x 1.2 cm (series 3 image 127), not significantly changed compared to examination on 1/10/2013. There is a hypoattenuating lesion in segment II that appears to be involving the liver parenchyma, measures 1.0 x 1.3 cm (series 3 image 103) and is suspicious for metastatic disease.Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic changes in the abdominal aorta and iliac arteries.BOWEL, MESENTERY: Postsurgical changes from multiple segmental colectomy and anastomoses.Mildly enlarged colonic bowel loops contain large amount of stool, stable.There appears to be an interval increase in metastatic disease in the lesser sac (series 3 image 118). This area appears more full and demonstrates homogenous soft tissue attenuation.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumbar spine. Stable hemangiomas in the T10 and T12 vertebral bodies.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Reference left internal iliac lymph node measures 1.4 x 1.3 cm (series 3 image 177), stable.BOWEL, MESENTERY: Postsurgical changes from multiple segmental colectomy and anastomoses.Mildly enlarged colonic bowel loops contain large amount of stool, stable.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumbar spine. Stable sclerotic focus in the right posterior iliac wing.OTHER: No significant abnormality noted. | 1.Progression of disease with new lesion in the segment II liver parenchyma and interval increase metastatic disease involving the lesser sac. Reference lesions are stable. |
Generate impression based on findings. | 62 year-old female with asymmetrically cool lower extremities. Evaluate for dissection. ANGIOGRAPHY:Variant aortic arch anatomy with the left common carotid arising from the right brachiocephalic artery. The aorta is normal in size. No filling defect to indicate dissection. Mild atherosclerotic calcification affects the aortic arch.The origins of the celiac axis, superior mesenteric artery, renal arteries, and inferior mesenteric artery are widely patent. Mild to moderate atherosclerotic calcification affects the distal abdominal aorta and bilateral iliac arteries.CHEST:LUNGS AND PLEURA: Bibasilar consolidation, right great than left suggestive of pneumonia/aspiration. In addition there are diffuse patchy groundglass opacities which may represent superimposed edema or infection infection.MEDIASTINUM AND HILA: Moderate cardiomegaly with suggestion of left ventricular hypertrophy. Mild 3-vessel coronary atherosclerotic calcification. Small pericardial effusion. Prominent AP window lymph nodes are non-specific.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Moderate degenerative changes affect the thoracolumbar spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Enlarged heterogeneous and partially calcified uterus. This likely reflects underlying leiomyomas, but can be further evaluated with pelvic ultrasound or MRI.BLADDER: Foley catheter within the bladder.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Moderate degenerative changes affect the lumbar spine.OTHER: No significant abnormality noted. | 1. No aortic dissection or aneurysm.2. Bibasilar airspace consolidation suggestive of aspiration/pneumonia. Additional diffuse groundglass opacities may reflect infectious sequela or superimposed edema.3. Enlarged heterogeneous uterus as described. This can be further evaluated with pelvic ultrasound or MRI. |
Generate impression based on findings. | Female 77 years old; Reason: DUODENAL CANCER RESTAGING History: DUODENAL CANCER CHEST:LUNGS AND PLEURA: Scattered granulomata and micro-nodules redemonstrated.MEDIASTINUM AND HILA: Calcified right hilar and subcarinal nodes. Trace pericardial fluid stable. Stable previously provided reference noted high right paratracheal measured on series 3 image 27 9 x 8 mm. Previously 9 x 7 mm.CHEST WALL: Port-A-Cath right chest wall.ABDOMEN:LIVER, BILIARY TRACT: Punctate hypodensities in the medial and lateral segments left lobe unchanged. Calcific granuloma. No suspicious lesions. Stable mild biliary ductal dilation.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: Previously measured index node in the mesenteric root is stable in size measuring 1.7 x 1.2cm previously 1.6 x 1.3 cm, series 3 image 117.BOWEL, MESENTERY: Redemonstration of circumferential thickening and stent in place in the duodenum. No evidence of ascites. Index lesion in the mesenteric root in the midline series 4 image 105 also is stable in size measuring 1.6 x 1.4cm previously 1.3 x 1.6.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: 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. | Stable size of peri-duodenal lymph nodes in the mesenteric root just anterior to the stented primary neoplasm. |
Generate impression based on findings. | Lung nodules. LUNGS AND PLEURA: Subpleural honeycombing and traction bronchiectasis consistent with pulmonary fibrosis. Right upper lobe nodule measures 8 x 5 mm (4/73) unchanged compared to the most recent prior examination but larger when comparing back to remote earlier scans.Flat angular lesion along the right minor fissure (5/47) has a location and appearance most consistent with a subpleural lymph node. Similarly, a nodular sub-pleural lesion in the posterior aspect of the left upper lobe has an appearance most suggestive of an intrapulmonary lymph node (5/14). Scattered calcified nodules in the left lung likely reflect granulomas. 7-mm groundglass nodule posterior aspect left upper lobe (5/22) could be an area of atypical adenomatous hyperplasia however should be followed to exclude AIS/MIA. This lesion is probably unchanged in overall size compared to the last study allowing for differences in lung volumes though it appears minimally more dense on the current examination. When comparing back to 3/2/11 the lesion was more scarlike in appearance and did not appear nodular.Subpleural nodule postero-laterally in the left lower lobe measures 6 x 6 mm (5/50). When comparing back to 3/2/11 the lesion has slightly increased in size and density, previously 5 x 6 mm. On the most recent previous examination this measured 6 x 3 mm, differences may be the result of atelectasis due to variability in lung inflation .Subpleural groundglass opacity in the right lower lobe associated with a minor fissure (5/50) is of unclear etiology, larger but less solid compared to the most recent prior examination. In 2011 it was much smaller it had the appearance of a subpleural lymph node. For future reference this measures 9 x 9 mm in transaxial dimensions (5/50) and approximately 5 mm craniocaudally.No pleural fluid or pneumothorax.MEDIASTINUM AND HILA: Severe dilatation of the thoracic esophagus with a high fluid/debris level may be seen in connective tissue disease.Mildly enlarged mediastinal and hilar lymph nodes appear unchanged. Normal heart size. No pericardial fluid.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. | 1. Indeterminate 8 x 5 mm right upper lobe nodule unchanged compared to the most recent previous study.2. Subpleural 9-mm groundglass nodular opacity in association with the right minor fissure has slowly increased in size over the last two studies and is of unclear clinical significance. It is mildly suspicious for adenocarcinoma in situ or minimally invasive adenocarcinoma but could reflect an atypical appearance of an enlarged subpleural lymph node.3. 6-mm nodule in the left lower lobe moderately suspicious for a small indolent malignancy such as an adenocarcinoma given increase in size and density over the last two exams. This lesion is too small to characterize by PET.4. 7-mm left upper lobe ground glass lesion is now nodular in configuration and mildly suspicious for MIA/ AIS5. 6 month CT follow-up is suggested for above lesions.6. Chronic pulmonary fibrosis and esophageal dilatation not significantly changed since the previous study. |
Generate impression based on findings. | 88-year-old male with right flank pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Nonobstructive right nephrolithiasis, measuring 5 mm, unchanged. Multiple bilateral renal lesions many of which are hyperdense and likely representing complex cysts appear similar to the prior studies.RETROPERITONEUM, LYMPH NODES:. Extensive atherosclerotic calcification of the abdominal aorta and its branches appear similar on the prior study. Dilatation of the right internal iliac artery is also unchanged measuring 1.7 cm. An IVC filter is again noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Marked degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Marked degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality noted | 1. Unchanged 5-mm nonobstructive right nephrolithiasis. No hydronephrosis or ureteral stones.2. Stable extensive atherosclerotic calcification of the aorta and its branches and right internal iliac artery aneurysm.3. Multiple bilateral hyperdense renal lesions appearing similar to the prior study but incompletely evaluated on this noncontrast study. |
Generate impression based on findings. | 64-year-old male patient with history of prostate cancer status post 59 months of oral investigation and agent. CHEST:LUNGS AND PLEURA: Upper lobe subpleural and scattered cysts and bullae, stable compared to prior examination. Scattered pulmonary nodules, some of which are calcified, stable.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Multiple sclerotic foci within the ribs are stable compared to prior examination.ABDOMEN:LIVER, BILIARY TRACT: Stable multiple hepatic cysts. Largest cyst is in the left lobe of the liver and is mildly hyperattenuating, which likely represents internal complexity. No suspicious hepatic lesions. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Bilateral adrenal nodules, stable compared to prior examination.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No suspicious retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: T10 vertebral body sclerotic lesion involving the posterior elements is unchanged compared to prior examination. Scattered sclerotic foci in the iliac wings bilaterally are stable compared to prior examination. Multilevel degenerative changes in the thoracic and lumbar spine.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Reference left femoral lymph node measures 1.7 x 1.2 cm (series 3 image 178), previously 1.9 x 1.3 cm. No other suspicious lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: T10 vertebral body sclerotic lesion involving the posterior elements is unchanged compared to prior examination. Scattered sclerotic foci in the iliac wings bilaterally are stable compared to prior examination. Multilevel degenerative changes in the thoracic and lumbar spine.OTHER: No significant abnormality noted. | 1.Stable examination without new lymphadenopathy.2.Stable sclerotic lesions within the ribs, spine and pelvis. |
Generate impression based on findings. | 61 year old female evaluate for retroperitoneal bleed This study is limited due to lack of IV contrastABDOMEN:LUNG BASES: Bilateral pleural effusions and dependent atelectasis. Cardiomegaly. Artifacts from LVAD limits optimal evaluation of the upper abdomen.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Interval development of significant high density fluid within the ascites. Most likely etiology is hemorrhage given the drop in patient's hemoglobin level. Differential diagnosis for the increased density of the ascites fluid also includes extravasation of oral contrast. However lack of free intraperitoneal air makes this possible to less likely.BONES, SOFT TISSUES: Generalized anasarca.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Possible right adnexal mass lesion which cannot optimally evaluated due to lack of IV contrast.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Interval development of high density material within the ascites which most like represents hemorrhage given the patient's drop in hemoglobin. Another diagnostic possibility is dextroposition of oral contrast which is less likely given the lack of free air. Possible right adnexal cystic lesion. Further evaluation with contrast-enhanced CT or MRI maybe helpful.ICU intern (6666) was notified about the above findings at the time of preliminary and final dictation. |
Generate impression based on findings. | 84-year-old male with colon cancer, restaging. Lack of intravenous contrast limits the evaluation of solid organ pathology and vasculature.CHEST:LUNGS AND PLEURA: Multiple bilateral pulmonary nodules, some of which are mildly increased in size. The reference nodule in the left upper lobe measures 6 mm and previously measured 5 mm (image 49, series 5).MEDIASTINUM AND HILA: Trace pericardial fluid. No mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality notedABDOMEN: 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: Low lying slightly malrotated right kidney is again noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Stable degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality noted | Multiple pulmonary nodules, some of which are increased in size. No new evidence of metastatic disease. |
Generate impression based on findings. | Neuroendocrine carcinoma Sensitivity limited due to noncontrast examinationABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Probable progression both with respect to size and number of hepatic metastatic lesions. A segment 6 lesion best seen on image 57 of series 3, now measures 1.6 x 1.4 cm; this is in comparison to 1.1 x 1.3 cm on 7/18/2013. A segment 5 low-attenuation focus as seen on image 44, series 3, measuring 1.6 x 1 .3 cm, was not clearly present on the prior study, and a new metastatic focus is suspected.Mildly dilated left hepatic biliary ducts again noted with pneumobilia. Unchanged biliary stent.Dilated gallbladder with diffuse gallbladder wall thickeningSPLEEN: No significant abnormality notedPANCREAS: Stable prominence of pancreatic headADRENAL GLANDS: Stable left adrenal thickeningKIDNEYS, URETERS: Stable left renal atrophy with nonobstructing subcentimeter left renal stones.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 | Probable progression both with respect to size and number of hepatic metastatic lesions. |
Generate impression based on findings. | Male 73 years old; Reason: 73 M with colon and rectal cancer s/p surgical resection, now with rising CEA concerning for disease recurrence. History: none CHEST:LUNGS AND PLEURA: Interval resolution of the large bilateral pleural effusions. No nodule or mass detected.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Hypodense liver lesions appear much larger and more numerous although are compared to previously unenhanced CT. For example, a segment 6 lesion measures 3.2 x 2 .7 cm, previously not visualized.Slight interval increase in the intrahepatic biliary ductal dilation. SPLEEN: Granulomata.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Probable large right renal cyst, unchanged.RETROPERITONEUM, LYMPH NODES: Necrotic lymph node in the porta hepatis measuring 3.8 x 1.9 cm is new since the examination. Atherosclerotic calcification of the abdominal aorta.BOWEL, MESENTERY: No evident small bowel wall thickening as previously seen. No evidence of obstruction. Interval placement of a G-tube.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Moderate ascites, decreased from prior exam. Anasarca.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: The markedly thickened bladder wall, likely related to radiation change.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No evidence of obstruction. Bowel wall thickening a rectal wall thickening are likely related to radiation changeBONES, SOFT TISSUES: No significant abnormality notedOTHER: Interval removal of the surgical drain. Anasarca. | 1.Interval resolution of the moderate pleural effusions. 2.Progression of metastatic lesions in the liver and retroperitoneum. |
Generate impression based on findings. | 48-year-old male with history of rectal cancer status post Hartmann's pouch for sigmoid perforation, evaluate for abnormalities. ABDOMEN:LUNG BASES: Small left pleural effusion and basilar atelectasis.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Left heterogeneous enhancing metastatic lesion posterior to the spleen with adjacent percutaneous drain measures 8.1 x 4.2 cm (image 41, series 3) and previously measured 8.0 x 4.5 cm. Mild residual surrounding fluid is noted.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post left nephrectomy.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Interval resolution of multiple abdominal fluid collections. Heterogeneously enhancing left lower quadrant metastatic lesion adjacent to the bowel is increased in size and measures 6.4 x 5.2 cm and previously measured 5.8 x 5.0 cm (image 118, series 3). BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Left lower quadrant colostomy. Interval resolution of multiple abdominal fluid collections. Heterogeneously enhancing left lower quadrant metastatic lesion adjacent to the bowel is increased in size and measures 6.4 x 5.2 cm and previously measured 5.8 x 5.0 cm (image 118, series 3). BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Increase in size of the left lower quadrant metastatic lesion. Metastatic lesion posterior spleen appears similar to the prior study. Resolution of multiple abdominal fluid collections with mild residual fluid adjacent to the peri-splenic metastasis.2. Small left pleural effusion. |
Generate impression based on findings. | 75-year-old female with shortness of breath. Evaluate for pulmonary embolus. PULMONARY ARTERIES: No evidence of a pulmonary embolus.LUNGS AND PLEURA: Multiple bilateral micronodules with the largest nodule in the right upper lobe measuring under 0.4 cm in diameter. Bilateral small pleural effusions with underlying atelectasis, right greater than left.MEDIASTINUM AND HILA: Heart size is within normal limits. Moderately enlarged right hilar lymph nodes measuring up to 1.2 cm (series 7, image 144). Conglomerate subcarinal lymphadenopathy measuring up to 2 cm (series 7, image 135).There is abnormal air collection in the mediastinum, which is likely related to a prior intervention.Pulmonary artery measures approximately 3.9 cm, suggestive of pulmonary hypertension.CHEST WALL: Extensive anterior chest wall emphysema that dissects through the fascial planes of the anterior chest wall musculature and extends into the left axilla.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. No evidence of a pulmonary embolus. 2. Moderate nonspecific lymphadenopathy, most likely reactive or secondary to sarcoid in absence of known malignancy. 3. Abnormal air collections in the mediastinum and the chest wall, likely related to prior intervention. 4. Findings suggestive of pulmonary hypertension.5. Bilateral small pleural effusions. |
Generate impression based on findings. | Clinical question: Hemorrhage. Signs and symptoms: Altered, on Coumadin. Unenhanced head CT:There is no evidence of an acute intracranial process CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.There are diffuse bilateral subcortical and periventricular confluence of white matter low attenuation as well as foci of decreased attenuation in the left basal ganglia and left thalamus which are highly suspected of age indeterminate small vessel ischemic strokes.There is mild ex vacuo dilatation of supratentorial ventricular system in particular of the left frontal horn as a result of chronic strokes. Unremarkable exam otherwise. Unremarkable calvarium and soft tissues of the scalp, unremarkable orbits, paranasal sinuses and mastoid air cells. | Extensive age indeterminate small vessel ischemic strokes. |
Generate impression based on findings. | S.O.B. and known pulmonary fibrosis. LUNGS AND PLEURA: Severe bilateral interstitial lung disease, predominantly in a subpleural and basilar distribution comprised of honeycombing, traction bronchiectasis and dependent basilar ground glass opacities. Areas of focal lobular sparing are noted in the lower lobes bilaterally and there is relative sparing of the superior segment of the left lower lobe from disease. Scattered dendriform ossifications noted in the parenchyma. New nodular peribronchovascular lesion in the posterior aspect of the right upper lobe (5/75) measuring approximately 9 x 6 mm though this measurement does include the pulmonary artery which passes through the lesion. Three-month CT follow-up recommended to assess for resolution.Since the 10/18/12 study, the degree of fibrosis in the lung bases has slightly progressed, especially on the left.Small anterolateral intercostal herniation on the left again observed on the prone sequences (series 10 image 15).Suture line from prior biopsy at the left base.MEDIASTINUM AND HILA: Mildly enlarged hilar region lymph nodes are unchanged additional small and mildly enlarged mediastinal lymph nodes similar to previous. Coronary artery calcifications. Postsurgical findings of CABG.CHEST WALL: Healed sternotomy with wires in place.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Atherosclerotic calcification of the aorta. Cholelithiasis. | Interval progression of interstitial lung disease in a pattern most consistent with UIP. New nodular density in the right upper lobe for which 3 month CT follow-up is recommended to assess for growth or resolution. |
Generate impression based on findings. | E. coli meningitis and right subdural empyema. There has been recent interval insertion of a drainage catheter within the right subdural collection with expected foci subdural pneumocephalus. The right frontoparietal subdural collection measures approximately up to 15 mm in width, which is not significantly changed. There is a small amount of debris within the collection, which is less conspicuous than on the prior MRI, which may be attributable to differences in technique. There is also no significant interval changed in the prominent left frontal convexity subarachnoid spaces, measuring up to 10 mm in width. There is no significant change in size or configuration of the ventricular system. There is no significant midline shift. There is no evidence of acute intracranial hemorrhage. The brain parenchyma appears grossly unremarkable. There is persistent complete left tympanomastoid opacification, while the right tympanomastoid effusion has cleared. The skull and extracranial soft tissues are otherwise unremarkable. | Recent interval insertion of a drainage catheter within the right subdural collection that measures approximately up to 15 mm in width, which is not significantly changed. No significant interval change in the prominent left subarachnoid spaces, which may represent external hydrocephalus and no evidence of acute intracranial hemorrhage. |
Generate impression based on findings. | Male 63 years old; Reason: PANCREATIC protocol please // pt with documented severe acute pancreatitis please r/o pancreatic tumor; cyst; fluid collection History: pt with documented severe acute pancreatitis please r/o pancreatic tumor; cyst; fluid collection ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Large residual 8.6 Cm x 12 cm x 11.2cm ( AP x Tran x CC) fluid collection in the body and tail of the pancreas compatible with a pseudocyst. Hypoenhancement of the body of the pancreas measuring up to 6 cm in transverse dimension (series 11 image 50) likely necrosis. The splenic vein is markedly attenuated, however still patent. No definite mass detected. 1.6 x 1.3 cm nonspecific peripancreatic node (series 11 image 46). Numerous other gastrohepatic, gastropancreatic, and pancreatic splenic nodes are noted. Extensive inflammatory reaction in the mesentery and retroperitoneum is seen.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: 1.6 x 1.3 cm nonspecific peripancreatic node (series 11 image 46). Numerous other gastrohepatic, gastropancreatic, and pancreatic splenic nodes are noted. Extensive inflammatory reaction in the mesentery and retroperitoneum is seen.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.Pancreatitis with necrosis and pseudocyst as described above. |
Generate impression based on findings. | Ear discomfort. The bilateral Eustachian tubes do not appear patulous. The middle ear cavities are pneumatized and clear. There are bilateral tonsilloliths, left greater than right. The nasopharynx appears unremarkable. There is partial effacement of the left piriform sinus related to mild supraglottic edema. There is no significant suprahyoid lymphadenopathy. The major salivary glands are unremarkable. There is no significant paranasal sinus opacification. The imaged intracranial structures and orbits are grossly unremarkable. There is no evidence of mass lesions or abnormal enhancement. | 1. Unremarkable bilateral Eustachian tubes and middle ear cavities. 2. Partial effacement of the left piriform sinus related to mild supraglottic edema may be related to the clinically-suspected GERD-related laryngopharyngitis.3. Bilateral tonsilloliths, left greater than right, may represent sequelae of prior tonsillitis. |
Generate impression based on findings. | New onset atrial fibrillation and desats postop day two status post parathyroidectomy rule out pulmonary embolus. PULMONARY ARTERIES: A filling defect in the anterior segmental branch of the right upper lobe extending into a subsegmental branch, consistent with pulmonary embolus. The main pulmonary artery is normal in caliber.LUNGS AND PLEURA: Moderate thickening of the interlobular septa and bronchial walls as well as the fissures. Patchy atelectasis at the lung bases with trace pleural fluid bilaterally. Mild basilar ground glass opacity bilaterally may reflect dependent change or could be the result of an earlier aspiration event.MEDIASTINUM AND HILA: Enlargement of the left lobe of the thyroid with substernal extension. The thyroid gland contains hypoattenuating nodules bilaterally which are nonspecific by CT and may be further assessed by nuclear scintigraphy if clinically warranted as they are in a location that may not be amenable to ultrasound imaging. The proximal intrathoracic trachea is mildly deviated rightward. Mild cardiomegaly with enlargement of the left atrium and left ventricle. No signs of right heart strain. Small hiatal hernia is present.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. The collecting system of the left kidney appears mildly dilated and there is a least one peripelvic cyst present, incompletely assessed. The cortex of the visualized left kidney appears atrophic. Nonspecific subcentimeter hypoattenuating lesion in the spleen, too small to characterize. Atherosclerotic calcifications of the aorta and origin of the left renal artery noted. | Acute segmental level pulmonary embolus right upper lobe without signs of right heart strain. Mild interstitial edema with basal atelectasis and possible signs of prior aspiration event. Nonspecific hypoattenuating nodules in the thyroid gland may be accessed by nuclear scintigraphy if clinically warranted. Dr. Jose (answering 2637/5756) verbally notified of both the PE and thyroid gland nodules at 11:17 a.m. on 11/7/13. |
Generate impression based on findings. | Female 32 years old; Reason: pancreatitis vs CBD inflam vs appendicitis vs gastroenteritis History: nausea, vomiting, diarrhea, RUQ/epigastric abd pain ABDOMEN: Exam is somewhat limited by patient body habitus.LUNGS BASES: No focal lesion detected. Patient status post cholecystectomy.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: Numerous borderline lymph nodes in the retroperitoneum are noted measuring up to 8 mm in short axis..BOWEL, MESENTERY: The appendix is clearly visualized morphologically unremarkable.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: IUD noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Surgical pins in the left hip are seen, and partially obscure fine detail of the pelvis.OTHER: No significant abnormality noted. | 1.No acute intra-abdominal pathology detected. |
Generate impression based on findings. | Left nasal congestion and facial pain. The maxillary sinuses are hypopneumatized and contain minimal mucosal thickening. The infundibula are patent. The ethmoid sinuses are clear. There is no significant pneumatization of the sphenoid sinuses. There is a small amount of bubbly secretions within the left frontoethmoid recess. There are minimal secretions along the floor of the left nasal cavity. The nasal septum is nearly midline. The imaged intracranial structures and orbits are grossly unremarkable, as are the overlying facial soft tissues. | Mild bubbly secretions within the left frontoethmoid recess with hypopneumatized maxillary sinuses and no significant pneumatization of the sphenoid sinuses. Unremarkable nasal cavity contents. |
Generate impression based on findings. | Renal carcinoma status post left partial nephrectomy ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Stable subcentimeter segment two low-attenuation focus is seen on image 32 of series 4; favor benign etiologySPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post partial left nephrectomy and resection of previously noted superior pole left renal mass. Interval appearance of 1.4 x 2 cm soft tissue focus within the left suprarenal region best seen on image 46 series 4. This lesion appears to be separate from the left adrenal gland.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Status post partial left nephrectomy and resection of superior pole left renal mass. Interval appearance of left suprarenal soft tissue focus; a metastatic lesion cannot be excluded. |
Generate impression based on findings. | Optic neuritis, evaluate for sarcoidosis. LUNGS AND PLEURA: No suspicious pulmonary nodules or masses. No focal air space opacities or pleural fluid. The airways are patent bilaterally. No signs of pulmonary fibrosis. The expiration sequence is unremarkable.MEDIASTINUM AND HILA: Normal heart size. No pericardial fluid. No significantly enlarged hilar or paratracheal lymph nodes.CHEST WALL: Prominent axillary and subpectoral lymph nodes bilaterally measuring up to 8mm in short axis.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | No evidence of intrathoracic sarcoidosis or other acute pulmonary abnormality. Mild bilateral axillary and sub-pectoral lymph node enlargement is a nonspecific finding but may be seen in patients with SLE. |
Generate impression based on findings. | Female 55 years old; Reason: History of metastatic breast cancer on treatment, evaluate for response and extent of disease. History: History of metastatic breast cancer on treatment, evaluate for response and extent of disease. CHEST: Evaluation of the chest limited by respiratory motion.LUNGS AND PLEURA: Severe emphysematous changes. Suture material in the right upper lobe, likely from prior resection. Scattered scarlike opacities bilaterally are unchanged. Biapical scarring. Bilateral micronodules are unchanged.MEDIASTINUM AND HILA: Heterogeneous nodular thyroid appear somewhat to the prior exam. No mediastinal or hilar lymphadenopathy. Moderate coronary artery calcifications. Mildly enlarged main pulmonary artery diameter may be suggestive of pulmonary artery hypertension.CHEST WALL: Surgical clips in the left axilla. No left axillary lymphadenopathy. Bilateral breast reconstructions.ABDOMEN:LIVER, BILIARY TRACT: Multiple hepatic hemangiomas are unchanged. No suspicious hepatic lesions are evident. Prominent common bile duct measured 7 mm in diameter, unchanged. No choledocholithiasis.SPLEEN: Small accessory spleen.PANCREAS: Prominent main pancreatic duct measures 4 mm in diameter. No pancreatic lesions evident.ADRENAL GLANDS: Right adrenal nodule is stable since April 2011 measuring 1.4 x 0.7 cm (85/609). Left adrenal gland is normal.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the abdominal aorta and its branches. Subcentimeter retroperitoneal lymph nodes are unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes along the anterior abdominal wall.OTHER: No significant abnormality notedPELVIS: UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic lesions in the left sacrum, left ilium and left superior pubic ramus are unchanged since previous exam, although have progressed since 2011. Metastatic disease cannot be excluded.OTHER: No significant abnormality noted. | 1. interval progression of the sclerotic lesions in the left sacrum compared to CT dated 7/25/2011. These changes are stable compared to immediately Previous CT. Metastatic lesions in the left sacrum cannot be excluded. |
Generate impression based on findings. | Female 59 years old; Reason: Evaluate bilateral hypodense renal cysts, evaluate for malignancy; patient with ESRD History: CT scan from 10/26 CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Nodular bilateral adrenal glands are unchanged when compared to the MRI of 2010. These likely represent adenomas and stability favors benignity.KIDNEYS, URETERS: Again noted are multiple bilateral hypodense lesions, some of which are too small to reliably characterize. The large lesions do not enhance, and they are unchanged from previous study. This favors a benign entity. Calcifications involving the bilateral kidneys are new but are likely vascular in origin. Punctate stones cannot be excluded.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Bilateral renal hypodense lesions likely simple cysts. Other lesions are too small to reliably characterize.2. Stable bilateral adrenal nodules, likely adenomas. |
Generate impression based on findings. | Nasopharyngeal cancer diagnosed in 2007 with relapse in 2011 (nonkeratinizing nasopharyngeal carcinoma), s/p chemoradiation, currently in remission. Head: There is no evidence of intracranial mass or abnormal enhancment. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is moderate scattered paranasal sinus mucosal thickening and persistent left tympanomastoid opacification. Neck: There are stable post-treatment findings in the nasopharynx without evidence of recurrent tumor. There are postoperative findings related to neck dissection without evidence of significant cervical lymphadenopathy. There is unchanged erosion of the left sphenoid sinus floor and left clivus. There is mild residual supraglottic mucosal edema is noted. The airways remain patent. The left jugular vein remains partially effaced. The other major cervical vessels are unremarkable. There is degenerative spondylosis, which is most pronounced at C5-C6. The imaged portions of the lungs are clear. | 1. Stable post-treatment findings without evidence of locoregional tumor recurrence or significant cervical lymphadenopathy. 2. No evidence of intracranial metastasis. |
Generate impression based on findings. | Reason: h/o HNC, s/p CRT, compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: No evidence of pleural or pulmonary metastases.MEDIASTINUM AND HILA: Heart size remains normal. No interval pericardial effusion.CHEST WALL: No axillary lymphadenopathy.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Stable hypodensity at the hepatic dome. Cholelithiasis.SPLEEN: Splenic granuloma.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Unchanged sclerotic foci in T8,T9, L1 and left glenoid, likely bone islands.OTHER: No significant abnormality noted. | No evidence of pulmonary metastases. |
Generate impression based on findings. | Reason: Chest NODULE//PPD + History: NONE LUNGS AND PLEURA: Multiple bilateral micronodules compatible with previous infection, unchanged.Focal streaky opacity laterally in the right middle lobe compatible with atelectasis and scarring, unchanged.Sharply defined pulmonary nodule in the right lower lobe measuring 13 mm in diameter with laminar calcification highly compatible with previous infection, most likely due to histoplasmosis. Distally located subpleural nodular and scarlike opacity, not significantly changed.Increased size of a right lower lobe nodule adjacent to the major fissure (series 4 image 154) measuring 8 mm in diameter compared to 4 mm previously, with some adjacent micronodules or tree in bud opacity, suggestive of infection.MEDIASTINUM AND HILA: Multiple enlarged mediastinal lymph nodes, particularly in the lower paraesophageal and subcarinal region measuring up to 18 mm in short axis diameter, not significantly changed.Mild coronary artery calcifications.CHEST WALL: Degenerative disease in the spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. New small cluster of nodular opacities anteriorly in the right lower lobe, suggestive of infection. 2. Multiple other findings as previously described, including mediastinal lymphadenopathy, without significant change. |
Generate impression based on findings. | Male 71 years old; Reason: 71M s/p OHT and ex-lap p/w abdominal wound infection History: see above CHEST:LUNGS AND PLEURA: There is a loculated left pleural effusion measuring 11.3 x 2.4 cm on image number 84, series number 3, unchanged from previous study. which appears stable since prior examination with associated bibasilar atelectasis.MEDIASTINUM AND HILA: The previously described anterior mediastinal fluid collection appears stable since the prior examination now measuring 3.8 x 11.1 cm , previously 2.5 x 9.5 cm (image 57, series 3). Postsurgical changes consistent with prior heart transplant are evident.CHEST WALL: The previously described fluid collection superficial to the superior sternum appears stable since the prior examination a measuring 1.4 x 1.4 cm previously 1.1 x 1.9 cm (image 24, series 3).ABDOMEN:LIVER, BILIARY TRACT: There is no evidence of intrahepatic biliary ductal dilatation and hepatic vasculature appears patent.SPLEEN: There is a small amount of peri-splenic ascites.PANCREAS: There has been interval removal of the drain within the previous the described hypodense intrapancreatic fluid collection, which now appears mostly resolved.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: An exophytic fluid density lesion is again seen arising of the right kidney consistent with a simple cyst. There is no evidence of hydronephrosis. There are punctate bilateral calcifications in the renal collecting systems consistent with nonobstructive nephrolithiasis.RETROPERITONEUM, LYMPH NODES: There is prominent atherosclerotic disease of the abdominal aorta and its branches.BOWEL, MESENTERY: There is decrease in the diffuse mesenteric fat stranding predominantly surrounding the pancreas and porta hepatis. Resolution of the foci of free intraperitoneal air are seen surrounding the pancreatic drainage catheter. No new drainable fluid collection is evident. Gastrostomy tube is in place.BONES, SOFT TISSUES: Stable body wall edemaOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlargement of the prostate noted at the base of the bladder.BLADDER: No significant abnormality detected.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Worsening body wall edemaOTHER: No significant abnormality noted | 1.Interval removal of the drain within the intrapancreatic fluid collection, with interval resolution of the collection.2.Stable anterior mediastinal and loculated left pleural fluid collections3.Interval stability of the fluid collection superficial to the superior sternum.4.No new evidence of intra-peritoneal fluid collection.5.Stable body wall edema. |
Generate impression based on findings. | Post inflammatory pulmonary fibrosis. S.O.B. Lung transplant evaluation. LUNGS AND PLEURA: Suture line from a left lower lobe wedge resection. Anterior bowing of the posterior tracheal membrane and mild to moderate attenuation of the mainstem bronchi and distal airways suggesting that scanning was done during mid expiratory phase. On the dedicated expiratory sequence, this attenuation of the airway is becomes more obvious and subsegmental regions of diminished attenuation are seen bilaterally. Mild interlobular septal thickening at the apices. Diffuse mild groundglass opacity bilaterally with focal sparing in the areas that remain hyperlucent on the expiratory sequence. Within some of these areas, pulmonary vasculature appears diminished. Single thin-walled intrapulmonary cyst right lower lobe is unchanged. Lung volumes appear decreased compared to the previous examination however this may be the result of mid expiratory scanning.Sub-solid nodular lesion in the left upper lobe (6/85) increased in size from the prior examination, possibly up to 9 x 5 mm compared to 3 mm previously on the last two scans. This is difficult to accurately characterize due to its small size and the presence of motion artifact. 2 to 3 mm subpleural nodule right lower lobe (6/164 too small to characterize but may contain internal calcification based on appearance on prior study. Similarly sized subpleural calcified nodule right lower lobe (6/145) unchanged.MEDIASTINUM AND HILA: Thoracic esophagus is mildly patulous. Main pulmonary artery appears normal in caliber. Moderate calcifications involving the coronary arteries are noted. Normal heart size. No pericardial effusion or significant lymphadenopathy.CHEST WALL: Mild thoracic scoliosis.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Probable fatty infiltration of the liver. Cholecystectomy clips. | 1. Although the lung volumes appear to be diminished compared to the prior examination, this could be artifactual as the patient appears to have been scanned during the mid-expiration. 2. Partial collapse of the airways is consistent with tracheobronchomalacia.3. Suspect growth of a left upper lobe micronodule which is very poorly assessed given the degree of motion and incomplete expansion of the lungs. 6 to12 month CT follow-up is suggested.4. Diffuse groundglass abnormality consistent with known NSIP not significantly changed.5. Mosaic attenuation of the lung parenchyma which in some areas appears to be the result of air trapping from distal airways disease or collapse though in other areas there is attenuation of the lung parenchyma suggesting a perfusion abnormality. |
Generate impression based on findings. | Male 45 years old; Reason: H/o SMV and splenic vein thrombosis in 2011, eval for current clot burdon and hepatosplenomegally History: thrombosis history ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Heterogeneity of the liver is noted with peripheral wedge shaped hyper enhancing areas, non specific. Hypoattenuating lesion in segment 5 is too small to reliably characterize.There is thrombosis of the main portal veins with cavernous transformation. The splenic, SMV and IMV are all thrombosed, with numerous gastroepiploic, perigastric, and other collateral vessels. Right and left portal veins are also not visualized and there are collateral vessels within their expected tracts.There is no ascitesSPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Heterogenity of the liver which can be further evaluated with MRI.1.Thrombosis of the portal vein, SMV, and splenic veins. |
Generate impression based on findings. | Reason: rule out lung disease History: decreased breath sounds diffusely, h/o tobacco use +30 pack-years LUNGS AND PLEURA: Stable pulmonary micronodule superior segment left lower lobe since 2006. No pleural effusion.No suspicious pulmonary nodule or mass.MEDIASTINUM AND HILA: Heart size remains stable. No interval pericardial effusion.No mediastinal lymphadenopathy.Small hiatal hernia.CHEST WALL: Multilevel osteophytes of the thoracic spine not significantly changed.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Postsurgical findings reflect prior cholecystectomy. Low density exophytic lesion arising from the posterior superior cortex (series 3 image 84). This is of water density, measuring 1.4 x 1.5 cm and favors that of a cyst. It is not well visualized on the prior study. | Stable pulmonary micronodule superior segment left lower lobe since 2006. |
Generate impression based on findings. | Clinical question: History of recurrent meningioma. Signs and symptoms: New complaints of confusion and increased behavior problem. Nonenhanced head CT:There is no detectable acute intracranial process. CT however is insensitive for very detection of acute non-hemorrhagic ischemic strokes.A previously known extra-axial basal cisterna mass/meningioma is again identified. Precise comparison due to lack of intravenous contrast is difficult however based on this exam it measures 48 x 31 mm in its transaxial dimensions which are not significantly different than prior MRI examination from August of 2013.Extensive right frontal cystic encephalomalacia and focal encephalomalacia along the medial aspect of the left anterior and mid temporal lobe remains grossly similar to prior exam.A previously noted right-sided posterior frontal -- parietal subdural is again identified. This finding measures maximum off 13-mm in thickness compared to prior MRI measurements of approximately 15 mm.Ventricular system remains within normal size and unchanged since prior exam. There is tenderness of the right high convexity immediate paramedian frontal approach ventricular catheter with the tip traversing along the right side of falx, traversing the midline and with the tip in the occipital horn of left lateral ventricle. This is also similar to prior study.Examination demonstrate a 5 x 4.5-mm focus of calcification in the pons which was also identified on prior MRI susceptibility sequence and without change. | 1.No evidence of acute intracranial process.2.No convincing evidence of any change in constellation of intracranial findings of extensive right anterior frontal encephalomalacia, left medial temporal encephalomalacia, large residual meningioma of basal cistern and its associated mass effect, unremarkable size of shunted lateral ventricles and the placement of catheter and a right-sided parietal chronic subdural collection. |
Generate impression based on findings. | Radiation therapy completed in 2009 for T1N1 squamous cell carcinoma of the right tonsil. There are post-treatment findings related to radiation therapy to the upper neck with diffuse fat stranding, heterogeneity of the submandibular glands, and mucosal edema. There is no discernable tonsillar mass. However, there is a right level 2A lymph node adjacent to the atrophic sternocleidomastoid muscles that measures approximately 18 x 13 mm. The airways are patent. There is a heterogenous left thyroid nodule that measures up to 30 mm. There is diffuse calcified plaque involving the bilateral common carotid arteries, but no evidence of critical stenosis. There is extensive multilevel degenerative cervical spondylosis and osteopenia, but no suspicious lytic or blastic lesions. There is extensive pulmonary emphysema and scattered subcentimeter pulmonary nodules. There is mild scattered paranasal sinus opacification. The imaged intracranial structures are grossly unremarkable. | 1. No evidence of locoregional tonsillar squamous cell carcinoma recurrence, but an enlarged right level 2 lymph node may represent metastasis.2. Left thyroid nodule that measures up to 30 mm. Ultrasound is recommended for further evaluation.3. Extensive pulmonary emphysema and scattered subcentimeter pulmonary nodules. Considered a dedicated chest CT for further evaluation. |
Generate impression based on findings. | Male 45 years old; Reason: assess for stone History: hematiria ABDOMEN:LUNGS BASES: Status post cholecystectomy. No liver 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: Large heterogenous mass deforming the right kidney is seen in the midpole extending down in to the lower pole. Areas of high attenuation within the lesion suggest areas of hemorrhage. This lesion in not completely characterized given lack of IV contrast, however remains worrisome for neoplasm . No hydronephrosis or renal calculi detected. 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.Large right renal lesion suspicious for renal cell carcinoma. Dedicated renal CT advised. |
Generate impression based on findings. | Metastatic T4N0 cervical esophageal SCC, currently progressing on 4th line chemotherapy. There is a heterogeneous mass in the mid esophagus, centered just inferior to the cricoid, which obliterates the lumen and measures approximately 19 AP x 20 RL x 23 SI mm. There are obstructed secretions as well as diffuse hyperenhancment of the esophageal and hypopharyngeal mucosa proximal to the mass, suggestive of inflammation. The esophageal mass abuts the left lobe of the thyroid, which otherwise appears unremarkable. The airways are patent. There are small, but hyperattenuating bilateral level 4 and 6 lymph nodes, which measure up to 5 mm. The extracranial left external jugular vein is not present and there are prominent vertebral collateral veins. There is mild right and moderate left carotid bifurcation atherosclerotic plaque. The imaged intracranial structures are grossly unremarkable. There is a heterogeneous mass in the right lung apex adjacent to sutures that measures 30 AP x 50 RL x 35 SI mm. | 1. Mid esophageal mass, centered just inferior to the cricoid, which obliterates the lumen and measures approximately up to 23 mm is compatible with recurrent squamous cell carcinoma. 2. Small, but hyperattenuating bilateral level 4 and 6 lymph nodes are not enlarged by CT size criteria and may be inflammatory or neoplastic. 3. Heterogeneous mass in the right lung apex that measures up to 50 mm is compatible with metastases. |
Generate impression based on findings. | Esophageal cancer. Chemotherapy follow-up examination, evaluate for metastatic disease. CHEST:LUNGS AND PLEURA: Suture line presumably from a wedge resection of the right apex. Surrounding the suture line is a soft tissue mass consistent with a recurrent tumor which is inseparable from the right major fissure and right paraspinal soft tissues. Additional masses are seen in the lungs bilaterally, one in the right middle lobe, three in the left upper lobe/lingula and one in the left lower lobe. For future reference, largest lesion in the left lower lobe measures 3 x 6 cm (4/58). Mild scarring at the lung apices.MEDIASTINUM AND HILA: Left chest port tip in the superior vena cava.Abnormal enhancement pattern of the visualized cervical esophagus with nonvisualization of the lumen, highly suspicious for tumor on these limited images, please refer to separately reported neck CT of the same date for further characterization. Small enhancing subcentimeter lymph nodes are noted in the adjacent left low cervical region.Invasion of the right paravertebral fat by the right upper lobe mass. The medial lingular mass is inseparable from the anterior pericardial fat pad which contains several punctate enhancing nodules and soft tissue stranding near the mass, suspicious for a localized invasion. The right middle lobe mass is inseparable from the pericardium. The inferior lingular mass is inseparable from the pericardial fat pad. No conclusive evidence of invasion through the pericardium however and no pericardial fluid. Numerous subcentimeter mediastinal lymph nodes are noted in all compartments. An enlarged left hilar lymph node measures 14-mm in short axis (3/45).A filling defect in a proximal branch of the left superior pulmonary vein (3/43) extending out to an intrapulmonary mass is highly suspicious for tumor thrombus.CHEST WALL: Right upper lobe mass extends into the extrapleural fat in the posterior apex.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis. No conclusive hepatic metastases are appreciated.SPLEEN: Granuloma in the spleen. Small splenule beneath the diaphragm in the left upper quadrant. Vascular calcifications. Splenic vein appears enlarged, correlate for portal hypertension.ADRENAL GLANDS: The adrenal glands are mildly thickened bilaterally, somewhat nodular on the left but again no conclusive focal lesions.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Gastrostomy tube retention device in the distal stomach.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Multiple bilateral pulmonary masses consistent with metastases. Apparent mass in the cervical esophagus, please refer to separately reported neck CT. Numerous small lymph nodes in the mediastinum and hila; the enlarged left hilar lymph node has an attenuation pattern similar to the primary tumor and pulmonary metastatic lesions, compatible with nodal metastasis. Probable tumor thrombus in a branch of the left superior pulmonary vein. No specific evidence of intra-abdominal metastases. |
Generate impression based on findings. | 64 year old female with right upper quadrant abdominal pain, nausea and vomiting ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Normal study. |
Generate impression based on findings. | 81-year-old male with history of prostate cancer CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Ascending aorta is ectatic measuring 4.7-cm in diameter.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Infrarenal abdominal aortic aneurysm measuring 2.9 cm in largest AP dimension.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Large tumor involving the right side of the prostate.BLADDER: No significant abnormality notedLYMPH NODES: Bilateral pelvic adenopathy. Index left external iliac lymph node measures 2.1 x 1.3 cm on image number 192, series number 4.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Metastatic pelvic adenopathy. Enlarged prostate with heterogeneous mass on the right side.Ectatic ascending thoracic aorta and infrarenal abdominal aortic aneurysm. |
Generate impression based on findings. | 63 year-old female wtih AML, to rule out baseline sinusitis. The orbits are unremarkable. The mastoids are clear. Limited view of the intracranial structure is unremarkable. There is small amount of foamy materials and mucosal thickening in the sphenoid sinus. The sphenoethmoidal recesses are obstructed. The frontal sinuses, frontal-ethmoid recesses, anterior/posterior ethmoids, and maxillary sinuses are well developed and clear. The osteomeatal complexes are normal with intact uncinate processes and patent infundibuli. The intersphenoid septum is normal. The nasal turbinates and nasal septum are normal. Concha bullosa of the middle turbinates. The cribriform plate, fovea ethmoidalis and lamina papyraceae appear normal. The osseous structures are unremarkable. | Small amount of foamy materials and mucosal thickening in the sphenoid sinus is suggestive of acute sinusitis and inflammatory disease. |
Generate impression based on findings. | ICH and IVH. There is no significant interval change in size of the intraparenchymal hematoma centred in the right thalamus that measures up to 35 mm with intraventricular extension and surrounding vasogenic edema. However, there has been interval increase in size of the lateral ventricles, despite the presence of a right transfrontal ventricular shunt catheter. There is unchanged mild effacement of the right basal cisterns. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unchanged. | Interval increased dilatation of the lateral ventricles despite a right transfrontal ventricular shunt, but no significant interval change in size of the intraparenchymal hematoma centered in the right thalamus and associated intraventricular extension and surrounding vasogenic edema. |
Generate impression based on findings. | 33-year-old female patient with history of refractory Hodgkin's lymphoma status post GVD chemotherapy. CHEST:LUNGS AND PLEURA: Scattered pulmonary micronodules are stable compared to prior examination. Left upper lobe subpleural nodule measures 7 mm (series 6 image 38), stable.MEDIASTINUM AND HILA: Prevascular cluster of lymph nodes measures 4.8 x 0.7 cm (series 4 image 94), stable compared to prior examination.CHEST WALL: Left-sided chest port with catheter tip in the right atrium.ABDOMEN:LIVER, BILIARY TRACT: Well-circumscribed subcentimeter hypoattenuating, nonenhancing lesions are stable compared to prior examinations and most likely represent cysts.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No suspicious lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic focus in the left iliac wing is stable compared to prior examination (coronal series 402 image 54).OTHER: No significant abnormality noted. | Stable mediastinal lymphadenopathy and left upper lobe pulmonary nodule. |
Generate impression based on findings. | 75 year old female with CLL CHEST:LUNGS AND PLEURA: Scattered ground glass opacity/atelectasis. Calcified nodules likely representing prior granulomatous disease. MEDIASTINUM AND HILA: Unchanged reference paratracheal lymph node measures 8 mm and previously measured 5 mm (image 13, series 3). Central venous catheter extends to the SVC. Coronary arterial calcifications.CHEST WALL: Right chest wall port catheter.ABDOMEN:LIVER, BILIARY TRACT: Unchanged peripheral right posterior hepatic cyst. Patent hepatic vasculature. No biliary ductal dilatation. Unremarkable gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Interval increase in size of enhancing left renal mass, which now measures 2.4 x 2.6 cm and previously measured 1.6 x 1.5 cm (image 83, series 3).RETROPERITONEUM, LYMPH NODES: Reference confluent retroperitoneal adenopathy measures 1.9 x 2.8 cm and previously measured 2.0 x 28 cm (image 109, series 3).BOWEL, MESENTERY: Reference mesenteric adenopathy measures 6.1 x 2.3 cm and previously measured 5.5 x 2.5 cm (image 112, series 3).BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Unchanged index left external iliac lymph node measures 10 x 5 mm and previously measured 10 x 4 mm (image 152, series 3).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality noted. | 1. Interval increase in size of enhancing left renal mass.2. Reference lymphadenopathy is not significantly changed. |
Generate impression based on findings. | Reason: 63 female with AML, r/o baseline infiltrate History: AML LUNGS AND PLEURA: Diffuse bronchial wall thickening and mild bronchiectasis, most prominent within the right lower lobe. Associated scattered ground glass opacities with patchy consolidation in the lower lobes, largest in the lateral basal segment right lower lobe. Findings are suspicious for aspiration pneumonia.No pleural effusion.MEDIASTINUM AND HILA: Right PICC terminates within the SVC.Mildly enlarged mediastinal lymph nodes. Evidence of prior granulomatous disease with calcified left hilar and subcarinal lymph nodes.Heart size is normal. No pericardial effusion. Small right cardiophrenic lymph nodes.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Splenic granuloma. Left adrenal nodule measures 11 x 13 mm. This could be better characterized with in and opposed phase MRI imaging. | Diffuse bronchial wall thickening and mild bronchiectasis, most prominent within the right lower lobe. Associated scattered ground glass opacities with patchy consolidation in the lower lobes, largest in the lateral basal segment right lower lobe. Findings are suspicious for aspiration bronchiolitis with lower lobe pneumonia. |
Generate impression based on findings. | Male 67 years old Reason: extent of HO History: hip HO Mature bone extends from the superior acetabulum and ilium to the greater trochanter measuring at least 5.0 cm thick. The joint capsule is calcified. There is a deep ulcer adjacent to the greater trochanter with thickening of the soft tissues but no underlying cortical destruction. There is diffuse fatty atrophy of the muscles of the thigh.A suprapubic catheter is in place and there is nonspecific thickening of the bladder wall. Bilateral hydroceles are present. There is moderate subcutaneous edema. There is severe degenerative changes of the visualized lower lumbar spine. There is diverticulosis of the sigmoid colon. | Extensive bridging heterotopic bone formation extending across the joint causing fusion. |
Generate impression based on findings. | 7-year-old male with cyclic neutropenia, recurrent abdominal/pelvic pain and fevers. ABDOMEN:LUNG BASES: Minimal dependent atelectasis. No focal air space opacities or pleural effusions.LIVER, BILIARY TRACT: The liver is normal in attenuation. No focal hepatic lesions are identified. There is no intrahepatic or extrahepatic biliary ductal dilatation present. The gallbladder is distended.SPLEEN: Linear areas of low attenuation throughout the spleen reflect phase of contrast administration. A 9 mm round region of hypoattenuation is noted along the inferior aspect of the spleen (series 3, image 36). PANCREAS: The pancreas appears normal. ADRENAL GLANDS: The adrenal glands appear normal.KIDNEYS, URETERS: The kidneys are symmetric in size and attenuation. There is no hydronephrosis.RETROPERITONEUM, LYMPH NODES: There is no retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No bowel obstruction is present. The appendix is visualized in the right lower quadrant and appears normal.BONES, SOFT TISSUES: No focal osseous lesions are identified. There are no fractures present.OTHER: No intra-abdominal fluid collections are present. There is no intra-abdominal free fluid.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Distended and normal.LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: Normal.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. No acute abnormalities in the abdomen or pelvis to explain the patient's fevers and pelvic pain. 2. Subcentimeter splenic hypodensity may reflect phase of contrast or possibly represent a small nonspecific focal lesion. A repeat ultrasound examination may be considered for follow up as clinically indicated. |
Generate impression based on findings. | CLL on clinical trial. There is no significant cervical lymphadenopathy. The Waldeyer ring structures are not enlarged. The thyroid gland and major salivary glands are unremarkable. The airway appears patent. The major cervical flow voids are intact. The imaged intracranial structures are grossly unremarkable. The imaged paranasal sinuses and mastoid air cells are clear. There is unchanged multilevel degenerative changes present in the cervical spine which are stable. The imaged lung apices appear clear. | No evidence of significant cervical lymphadenopathy. |
Generate impression based on findings. | 56 year-old male with hepatitis C cirrhosis, pre-liver transplant evaluation. Evaluate questionable punctate micronodules and compare to previous. Evaluate for coronary calcifications, reported history of carcinoid with plan for hemicolectomy. LUNGS AND PLEURA: Previously identified micronodule in the right upper lobe is stable and measures approximately 2 mm (series 5, image 68). Previously noted micronodule in the right upper lobe (series 5, image 55 on the prior examination) is not clearly identified on the current examination. Interval improvement in moderate to large right pleural effusion with persistent small right pleural effusion.MEDIASTINUM AND HILA: No significant hilar or mediastinal lymphadenopathy identified.No significant coronary artery calcifications identified. There are mild atherosclerotic calcifications that affect the thoracic aorta. There is one focus of calcification at the aortic valve. Curvilinear calcification inferior to the left AV groove likely represents the mitral annulus. Heart is normal in size. No pericardial fusion.There are multiple new small nodules extending from the trachea, into the right main bronchus, and into the right lower lobe bronchi. The largest nodule at the posterior wall of the right main bronchus measures approximately 5 x 4 mm (series 5, image 51).CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Nodular morphology to the liver suggestive of cirrhosis. Cholelithiasis. Splenomegaly. Multiple enlarged retroperitoneal and peripancreatic lymph nodes are again noted. There is stranding of the mesenteric fat. | 1. Multiple nodules extending from the trachea into the right mainstem bronchus and right lower lobe bronchi. Given multiplicity, papillomatosis may be considered. Although the patient has a history of GI carcinoid, this is atypical for the appearance of multiple endobronchial carcinoid tumors. Bronchoscopy and biopsy may be considered.2. No coronary artery calcifications identified as clinically questioned.3. One micronodule in the right upper lobe is stable. Other micronodule in the right upper lobe is not identified on the current examination. 4. Interval improvement in the large right pleural effusion with persistent small right pleural effusion. 5. Cirrhotic liver morphology with ascites and multiple enlarged retroperitoneal and peripancreatic lymph nodes.Findings relayed to Dr. Andrew Aronsohn, pager 3023, over the phone at approximately 1550 hrs on November 7, 2013. |
Generate impression based on findings. | 63 year old female with history of partial nephrectomy 2002 for renal cell carcinoma ABDOMEN:LUNG BASES: Multiple basilar pulmonary cysts are again identified. Mild coronary arterial calcifications.LIVER, BILIARY TRACT: Status post cholecystectomy. Diffuse hepatic steatosis. No focal hepatic lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Status post left adrenalectomy.KIDNEYS, URETERS: Status post partial left nephrectomy with multiple surgical clips again identified. No evidence of recurrent or metastatic disease.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Stable interval exam with no evidence of recurrent or metastatic disease.2. Diffuse hepatic steatosis. |
Generate impression based on findings. | 87-year-old female patient with acute drop in hemoglobin overnight after a fall and tachycardia. Concern for retroperitoneal hematoma. Note that the left of intravenous contrast limits evaluation of vasculature, lymph nodes and solid viscera.ABDOMEN:LUNG BASES: Interval increase in left-sided pleural effusion with associated atelectasis and volume loss.Interval increase in atelectasis versus consolidation in the right lung base. Consolidation versus rounded atelectasis in the right lower lobe is stable compared to prior examination.Slight interval increase in pericardial effusion.LIVER, BILIARY TRACT: Redemonstrated are multiple hypoattenuating lesions in the liver parenchyma, consistent with hepatic cysts.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Redemonstrated are left kidney exophytic and renal sinus cysts. RETROPERITONEUM, LYMPH NODES: No CT evidence of retroperitoneal hematoma or hemorrhage. Atherosclerotic changes in the abdominal aorta and iliac arteries.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Levoscoliosis of the lumbar spine. Multilevel degenerative changes in the thoracic and lumbar spine.OTHER: Interval increase in abdominal ascites.PELVIS:UTERUS, ADNEXA: Status-post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Levoscoliosis of the lumbar spine. Multilevel degenerative changes in the thoracic and lumbar spine.OTHER: Interval increase in abdominal ascites. | 1.No CT evidence of retroperitoneal hematoma.2.Interval increase in abdominal ascites.3.Interval increase in left-sided pleural effusion.4.Slight interval increase in pericardial effusion. |
Generate impression based on findings. | Nasal polyposis. There is mild rightward nasal septal deviation and spur. The nasal cavity is clear. There are postoperative findings related to bilateral uncinectomy and internal ethmoidectomy. There is mid scattered opacification of the remaining ethmoid air cells. There is mild mucosal thickening within the posterior left sphenoid sinus. The maxillary and frontal sinuses are clear. The imaged intracranial structures and orbits are grossly unremarkable. | Postoperative findings related to endoscopic sinus surgery with mild scattered paranasal sinus opacification and mild rightward nasal septal deviation, but on evidence of residual sinonasal polyposis. |
Generate impression based on findings. | Almost 6 months after right lower lobectomy for management of T1 A. N0 stage I A. adenocarcinoma. LUNGS AND PLEURA: Postoperative changes of right lower lobectomy with small volume of residual pleural fluid or, appearing partially loculated medially. Improved appearance of the lung adjacent to the suture line compared to the most recent postoperative exam. No suspicious pulmonary nodules or pneumothorax. No pleural fluid on the left. Mild apical scarring on the right.MEDIASTINUM AND HILA: Rightward mediastinal deviation precarinal lymph node measures 10 mm, previously 7-mm. No visible lymphadenopathy elsewhere. Severe coronary artery calcifications. Moderate cardiomegaly, unchanged.CHEST WALL: Dense calcification adjacent to a scar like opacity in the deep right breast is unchanged in appearance as is an adjacent lateral nodular density at the same level. Please note that breast findings are entirely nonspecific by CT. Intramuscular lipoma in the left superior back. Soft tissues of the right chest wall appear asymmetric, correlate with surgical history. Thoracic kyphosis and scoliosis.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. No visible lymphadenopathy. | No specific evidence of localized recurrence or of pulmonary metastases. The reference precarinal lymph node is minimally larger than the preoperative study and should continue to be monitored. |
Generate impression based on findings. | 39-year-old male with history of Hodgkin's lymphoma, restaging study. CHEST:LUNGS AND PLEURA: No nodules or masses.MEDIASTINUM AND HILA: Unchanged reference mediastinal lymph nodes. Left supraclavicular nodular density measures 1.0 x 0.4 cm and previously measured 1.0 x 0.6 cm (image 7, series 3).Reference right paratracheal lymph node measures 9 x 6 mm in pre-lesion measured 9 x 6 mm (image 17, series 3).Anterior mediastinal soft tissue measures 1.9 x 1.0 cm and previously measured 1.6 x 1.0 cm (image 33 series 3).No new mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral small, hypodense lesions likely representing cysts are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis without evidence of inflammation.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Colonic diverticulosis without evidence of inflammation.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Stable reference lesions without new adenopathy. |
Generate impression based on findings. | Female 43 years old; Reason: Stage IV pancreas cancer please compare to previous scan and provide measurements for RECIST History: As above CHEST:LUNGS AND PLEURA: No significant change in the micronodules.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Index right lobe lesion measures 1.7 x 1.9 cm, previously 2.4 x 2 .3-cm image number 102, series number 3, decreased in size compared to previous study. Other metastatic liver lesions also decreased in the interval.SPLEEN: No significant abnormality noted.PANCREAS: Postsurgical changes involving the pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Interval decrease in the size of the portacaval lymph node. This node now measures 0.9cm previously 1.3 cm in diameter on image number 92. Other retroperitoneal lymph nodes also decreased in size compared to previous study.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Interval decrease in the size of the hepatic metastatic lesions and retroperitoneal adenopathy |
Generate impression based on findings. | Known type B dissection CHEST:LUNGS AND PLEURA: Emphysema and bilateral scapula and dependent atelectasis are unchanged.MEDIASTINUM AND HILA: Again identified are type B aortic dissection beginning just distal to the origin of the left subclavian artery. At the level of the right main pulmonary artery it measures4.9 by 4.9-cm image number 68, series number 9, unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Hypodense liver lesions are unchanged. Enhancing liver lesion in the inferior right lobe, unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Probable left adrenal adenoma, unchanged.KIDNEYS, URETERS: Bilateral renal cysts are unchanged. Some of the hypodensities are too small to characterize but are grossly unchanged.RETROPERITONEUM, LYMPH NODES: Patient's known dissection extends to the level of aortic bifurcation and to the left external iliac artery, unchanged. The size of the aorta at the level of the IMA is now increased to 4.2 centimeter on image number 194 from 3.4-cm in previous study. BOWEL, MESENTERY: Small fluid containing ventral or umbilical hernia.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Interval increase in the size of the infrarenal abdominal aortic aneurysm. Type B dissection extending from the level of the arch to the level of the left external iliac artery, unchanged. |
Generate impression based on findings. | Reason: Hx of Hodgkin's Lymphoma History: s/p 5 cycles of chemotherapy There is no residual significant cervical lymphadenopathy. The Waldeyer ring structures are unremarkable. The thyroid gland and major salivary glands are unremarkable. The airway appears patent. The imaged intracranial structures are grossly unremarkable. The paranasal sinuses are clear. The mastoid air cells are clear. The major cervical vessels appear patent. There are unchanged lucent foci within the C5 and T2, without corresponding hypermetabolism on PET. The imaged lung apices are clear. | No significant residual cervical lymphadenopathy. |
Generate impression based on findings. | Hodgkin's lymphoma, HIV. LUNGS AND PLEURA: Bilateral peripheral ground glass and mixed density lesions with focal internal consolidation in some of the lesions, increased in density and size compared to the previous examination, though not in number.MEDIASTINUM AND HILA: Mildly enlarged left low cervical lymph node measures 11-mm in short axis (3/9), minimally increased compared to the 8/7/13 exam when it was not reportedly FDG avid on PET scan of the same date. Anterior mediastinal soft tissue has an appearance most consistent with thymic hyperplasia however at the level of the aortic arch the left lateral border is convex which could indicate an underlying lesion producing mass effect. Upper normal heart size. No mediastinal or hilar lymphadenopathy.CHEST WALL: Chest wall incompletely included within the field of view. Scattered small bilateral axillary and subpectoral lymph nodes appear similar to previous. Unilateral gynecomastia on the right (3/31), unchanged compared to the 8/7/13 examination however mammography would be more sensitive to evaluate.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Interval progression in size and density of bilateral pulmonary opacities. Differential diagnosis includes eosinophilic or multi-focal cryptogenic organizing pneumonia or evolving pulmonary infarcts. Lack of peribronchial or perivascular nodularity argues against Kaposi's sarcoma and the appearance is atypical for pulmonary lymphoma. Opportunistic infection cannot be excluded however the appearance is not specific for any single entity. |
Generate impression based on findings. | Female 69 years old Reason: pre op planning for R TSA, assess bone stock History: R shoulder pain BONES, SOFT TISSUES: There are subchondral cysts in the humeral head and glenoid with associated subchondral sclerosis, bone-on-bone apposition and osteophytosis of the humeral head and anterior glenoid compatible with severe osteoarthritis of the glenohumeral joint. There is mild/moderate atrophy of the supraspinatus muscle and the inferior belly of the infraspinatus. The humeral head is high riding suggesting a rotator cuff tear. No joint effusion is present.OTHER: Multiple small hyperdense lesion or seen in the thyroid compatible with thyroid cysts. | Moderate/severe osteoarthritis of the glenohumeral joint and high riding humeral head suggesting a rotator cuff tear. |
Generate impression based on findings. | 68-year-old female with history of pancreatic cancer CHEST:LUNGS AND PLEURA: No new nodules or masses. Scattered micronodules are unchanged.MEDIASTINUM AND HILA: No new mediastinal or hilar adenopathy.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Multiple hepatic metastases have increased in size. Reference segment 6 lesion measures 1.1 x 1.1 cm and previously measured 1.0 x 0.9 cm (image 76, series 3). Large, peripheral left and right hepatic lesions have increased in size.SPLEEN: No significant abnormality noted.PANCREAS: Hypoattenuating pancreatic tumor measures 2.3 x 3.3 cm and previously measured 2.2 x 2.3 cm (image 74, series 3). It encases the celiac axis and now compresses the SMA and SMV with unchanged thrombosis of the splenic vessels. Dilated pancreatic duct is again noted.ADRENAL GLANDS: Bilateral nodular adrenal glands, are unchanged.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Reference gastrohepatic lymph node measures 1.3 x 1.7 cm and previously measured 1.5 x 1.4 cm (image 70, series 3).BOWEL, MESENTERY: Soft tissue encases the distal stomach. Status post gastrojejunostomy.BONES, SOFT TISSUES: Injection granulomas are noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Unchanged uterine calcifications.BLADDER: Distended but otherwise normal.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Progression of pancreatic mass and multiple hepatic and gastrohepatic metastases as detailed above. |
Generate impression based on findings. | AMS. There is no evidence of acute intracranial hemorrhage, mass, or cerebral edema. There is unchanged mild nonspecific cerebral white matter hypoattenuation. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There are partially imaged endotracheal and enteric tubes. Fluid within the left maxillary and sphenoid sinuses and opacification of the bilateral mastoid air cells may be related to intubation. The bones and extracranial soft tissues are otherwise unchanged. | No evidence of acute intracranial hemorrhage, mass, or cerebral edema. However, non-contrast CT is not sensitive for acute non-hemorrhagic stroke. |
Generate impression based on findings. | Reason: PE protocol with and without contrast; has mild allergy History: dyspnea at rest. PULMONARY ARTERIES: Motion and body habitus degrades the quality of the exam. No evidence of pulmonary embolism. Main pulmonary artery caliber is high-normal.LUNGS AND PLEURA: Interval increase in reticulonodular component of previously noted areas of peribronchial groundglass opacities. There is interval increase size of involved areas. There is architectural distortion with bronchiectasis. No evidence of honeycombing. No pleural effusions. No evidence of pneumothorax. There is no apical or basilar predominance. There is no peripheral predominance or sparing.2 mm solid well-circumscribed micronodule in the periphery of the right upper lobe remains unchanged in size (series 9, image 112).Evidence of right lung wedge resection with suture lines.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. Stable mediastinal lymph nodes measuring 14 mm, previously measuring 16 mm (series 7, image 109). Right hilar lymphadenopathy measuring up to 17 mm (series 7, image 105). Prior studies are completed without contrast making comparison difficult.CHEST WALL: Degenerative changes to the lower thoracic vertebra.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Status post cholecystectomy. Punctate calcifications in the spleen consistent with granulomata. | 1.No evidence of pulmonary embolism.2.Progression of bilateral peribronchial opacities with increased reticulonodular component and decreased ground glass component suggestive of chronic hypersensitivity pneumonitis. |
Generate impression based on findings. | Female 69 years old; Reason: 69F with Stage IIIC peritoneal cancer presenting for survelleince image History: peritoneal cancer LUNGS AND PLEURA: Unchanged moderate sized right pleural effusion with associated atelectasis and consolidation. No suspicious nodules or masses.MEDIASTINUM AND HILA: The reference right prevascular lymph node is stable and measures 0.7 x 0.3 cm (3/27), previously 0.8 X 0.4 cm. No other mediastinal or hilar lymphadenopathy. Normal sized heart without pericardial effusion.CHEST WALL: No significant abnormality noted.ABDOMEN: LIVER, BILIARY TRACT: Stable subcapsular implants along the right hepatic lobe. Stable small amount of perihepatic fluid.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable right renal angiomyolipoma.PANCREAS: Fatty replacement of the pancreas.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Interval surgical revision of the ventral hernia. No obstruction or free air noted.Status post distal colonic resection. Nondistended bowel loops without wall thickening or abnormal enhancement.BONES, SOFT TISSUES: Trace amount of fluid attenuation in the anterior bowel wall likely postsurgical.OTHER: Stable peritoneal thickening. Unchanged nodular thickening of the peritoneum along the subhepatic space. Decreased mild ascites.PELVIS: Evaluation of the pelvis is limited by streak artifact from bilateral total hip arthroplasties.UTERUS, ADNEXA: Not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Bilateral total hip arthroplasties.OTHER: Mild ascites. | 1. Stable to decrease in lymph nodes and peritoneal thickening.2. Decreased ascites.3. Interval surgical revision of the previously seen ventral hernia without obstruction, or free air. |
Generate impression based on findings. | 64-year-old male patient with pancreatic cancer. Restaging. CHEST:LUNGS AND PLEURA: Diffuse severe centrilobular emphysema.Redemonstration of several clustered, well-defined smoothly marginated right middle lobe subpleural nodules measuring up to 5 mm (series 5 image 64), stable.Interval resolution of left-sided pleural effusion. Stable right basilar subsegmental atelectasis.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Right-sided chest port with catheter tip in the superior vena cava.ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. Well-circumscribed, hypoattenuating nonenhancing lesion in segment II of the liver measures 2.1 x 1.4 cm (series 4 image 81) and is stable compared prior examination. Patent portal vein.SPLEEN: Status post splenectomy with residual splenule. Interval improvement in peri-splenic left upper quadrant fluid.PANCREAS: Status post distal pancreatectomy. Diffuse punctate calcifications throughout the remaining pancreatic parenchyma, consistent with chronic pancreatitis.ADRENAL GLANDS: Left adrenal nodule, stable.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Significant atherosclerotic changes in the abdominal aorta and iliac arteries.BOWEL, MESENTERY: Superior mesenteric vein thrombosis, stable compared to prior examinations with formation of collateral vessels.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumber spine. Chronic degenerative changes in the L4 and L5 vertebral bodies with vacuum disk phenomenon.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumber spine. Chronic degenerative changes in the L4 and L5 vertebral bodies with vacuum disk phenomenon.OTHER: No significant abnormality noted. | 1.No CT evidence of recurrent disease or suspicious lymphadenopathy.2.Interval resolution of intra-abdominal fluid.3.Resolution of left pleural effusion. |
Generate impression based on findings. | 34 year-old male with AML and neutropenic fevers. The orbits are unremarkable. The mastoids are clear. Limited view of the intracranial structure is unremarkable. There is mild mucosal thickening within the dependent portions of the bilateral maxillary sinuses, unchanged. The mucosal thickening within the bilateral sphenoid sinuses has resolved. The frontal sinuses, frontal-ethmoid recesses, and anterior/posterior ethmoids are well developed and clear. The osteomeatal complexes are normal with intact uncinate processes and patent infundibuli. The intersphenoid septum is normal. There is nasal septal deviation and rightward spur that contract he medial wall of the right maxillary sinus. The nasal turbinates are normal. The cribriform plate, fovea ethmoidalis and lamina papyraceae appear normal. The osseous structures are unremarkable. | No evidence of acute sinusitis. Improvement of paranasal sinus mucosal disease. |
Generate impression based on findings. | 70 year-old male with asymmetric pupils. There is postsurgical change of a left sided craniotomy. There are multiple metallic foreign bodies in the left temporal squamous bone. There is a large area of encephalomalacia in the left MCA territory. There is mild periventricular white matter hypodensity. The ventricles, sulci, and cisterns are prominent, representing volume loss. 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 except for partial opacification of the left sphenoid sinus. | Large area of encephalomalacia in the left MCA territory. Small vessel ischemic disease of indeterminate age. In this background, no mass effect, midline shift, intra- or extra-axial fluid collection/acute hemorrhage is seen. However, CT is insensitive to early detection of CVA. MRI should be considered if clinical suspicion for CVA persists. |
Generate impression based on findings. | 56 year-old male with history of seizure disorder. 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. | Chest pain rule out PE PULMONARY ARTERIES: Adequate infusion quality however examination is limited by motion artifact, especially in the lung bases. Small filling defect in a proximal segmental artery to the right lower lobe is very poorly seen due to motion artifact but confirmed on the reconstruction sequences. LUNGS AND PLEURA: Assessment of the lung bases markedly limited by motion artifact. Mild paraseptal emphysema. Very subtle subpleural reticulation and several nonspecific 1 to 2 mm subpleural nodular densities, too small to accurately characterize. Subpleural lesion adjacent to the anterior aspect of the left major fissure (12/84) could be a subpleural lymph node. No pleural fluid or pneumothorax.MEDIASTINUM AND HILA: Mildly prominent hilar region lymph nodes bilaterally have a thin appearance similar to the previous examination.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. Proximal segmental level embolus in a right lower lobe pulmonary artery. No signs of pulmonary infarct or right heart strain.2. Tiny subpleural nodules bilaterally are too small to accurately characterize. If the patient has a history of smoking or high risk for malignancy 6 month CT follow-up may be obtained. |
Generate impression based on findings. | 73-year-old female with advanced endometrial cancer and new left leg swelling, evaluate for obstructive lymphadenopathy or thrombus in the left common iliac or IVC. ABDOMEN:LUNG BASES: Right lower lobe nodule is again noted.LIVER, BILIARY TRACT: Dilatation of the common bile duct and intrahepatic ducts mildly progressed from the prior study. Filling defects in the distal common bile duct are suggestive of choledocholithiasis, but an ampullary lesion is not excluded. Status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: Prominence of the pancreatic duct. Incidental note of a lipoma in the pancreatic head.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: New moderate bilateral hydronephrosis and hydroureter extending to the mid ureter where there is soft tissue/tumor encasing and compressing the ureter.RETROPERITONEUM, LYMPH NODES: Retroperitoneal soft tissue mass adjacent to the left psoas muscle is increased in size. Reference left para-aortic lymph node measures 1.1 x 1.5 cm and previously measured 1.2 x 0.9 cm (image 43 series 3).BOWEL, MESENTERY: The bowel is normal in caliber. Carcinomatosis with reference right as mesenteric lymph node measuring 1.1 x 1.5 cm and previously measuring 0.8 x 1.1 cm (image 58, series 3).BONES, SOFT TISSUES: Sclerotic lesion of L2 suspicious for metastasis.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Status post hysterectomy and bilateral salpingo-oophorectomy.BLADDER: New carcinomatosis encasing the bladder.LYMPH NODES: Bilateral conglomerate iliac lymph nodes are again identified, increased from the prior study. The reference left obturator lymph node measures 1.3 x 3.2 cm and previously measured 1.0 x 1.8 cm (image 74, series 3). Additional soft tissue mass compresses the left iliac veins and arteries. Increasing right pelvic lymphadenopathy.BOWEL, MESENTERY: Carcinomatosis encasing the bladder.BONES, SOFT TISSUES: Soft tissue swelling and edema of the visualized left upper extremity. Sclerotic lesion of the left pubis, suspicious for metastasis.OTHER: No significant abnormality noted | 1. Soft tissue swelling/edema of the visualized proximal left upper extremity with associated lymph node/soft tissue mass encasing the left iliac vasculature.2. New bilateral hydronephrosis and hydroureter secondary to soft tissue/tumor encasing the mid ureters.3. Progression of pelvic lymphadenopathy and extensive new carcinomatosis encasing the bladder and ureters.4. Mild progression of biliary ductal dilatation with filling defects in the distal common bile duct suggestive of stones although an ampullary lesion cannot be excluded.5. Lumbar vertebral body and pelvic sclerotic osseous metastases. |
Generate impression based on findings. | Female 58 years old; Reason: colon cancer s/p surgery,chemotherapy and now abdominal pain History: abdominal pain CHEST:LUNGS AND PLEURA: No suspicious pulmonary nodules.MEDIASTINUM AND HILA: Borderline mediastinal or hilar lymphadenopathy.CHEST WALL: Interval removal of right chest wall Port-A-Cath with scarring at prior port site.ABDOMEN:LIVER, BILIARY TRACT: Diffuse fatty infiltration of the liver.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post rectosigmoid colectomy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No evidence of metastatic disease in the chest, abdomen or pelvis. |
Generate impression based on findings. | AML and recurrent neutropenic fever. LUNGS AND PLEURA: Interval development of diffuse extensive peribronchial opacities, centrilobular nodules and peripheral areas of tree-in-bud opacity. Motion artifact limits assessment for detail. Probable pseudo-cavitation in the right upper lobe (5/111). Peribronchial ground glass opacity in the anterior left upper lobe (5/109). Nodularity is most pronounced in the lung bases. Foci of consolidation in the right middle lobe and have a somewhat nodular or teardrop appearance and contain internal air bronchograms. No pleural fluid or pneumothorax.MEDIASTINUM AND HILA: Normal heart size. No significant lymphadenopathy. Right upper extremity PICC tip at the SVC/RA junction.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Splenomegaly. | Interval development of diffuse peribronchial opacities, centrilobular nodules and distal endobronchial filling compatible with opportunistic infection. Although bacterial infection is most likely, this pattern is nonspecific and can also be seen in mycobacterial, viral and fungal pneumonias. |
Generate impression based on findings. | 55-year-old female with history of pain and dark stools, status post polypectomy ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Limited study due to lack of IV contrast. No CT findings to explain patient's abdominal pain. |
Generate impression based on findings. | 51-year-old female with history of pancreas cancer CHEST:LUNGS AND PLEURA: Bilateral scattered micronodules, unchanged.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Patient's known metastatic lesion near the caudate lobe of the liver measures 3 by 2 cm on image number 87, series number 3, not significantly changed compared to previous study. Other perihepatic metastatic lesions are also stable.SPLEEN: No significant abnormality noted.PANCREAS: Patient's known pancreatic body mass measures 2.7 x 2.8 cm on image number 94, series number 3, slightly smaller compared to previous study. Pancreatic ductal dilatation is unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Metastatic retroperitoneal adenopathy, again noted. Index lesion measures 2.9 x 3 cm on image number 119, series number 3, slightly smaller compared to previous study.BOWEL, MESENTERY: Peritoneal carcinoma ptosis, again noted. Index lesion around the liver now measures 1.2 by 1 cm image number 104, series number 3, unchanged from pre-study. Other extensive peritoneal nodules are also unchanged.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: Peritoneal carcinomatosis. The lesion underneath the abdominal wall and 7 mm of image number 154, series number 3. More inferior second index lesion is slightly smaller measuring 7 mm on image number 154, series number 3.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Interval decrease in the size of the pancreatic body mass and retroperitoneal adenopathy and some of the peritoneal nodules. Extensive carcinomatosis, again noted. |
Generate impression based on findings. | 68 year old female with history of pancreatic cancer CHEST:LUNGS AND PLEURA: Bilateral upper lobe scarring, more prominent on the left compared to the right. Follow-up imaging with chest CT is recommended to exclude the possibility of neoplasm.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: There is a large mass in the body of the pancreas measuring 4.9 x 6.1 cm encasing the splenic vein and the main portal vein as well as celiac trunk and SMA. Pancreatic duct is dilated in the tail.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is a large, multicystic complicated mass involving the right kidney measuring 16.5 x 11.6 cm. This lesion likely represents multilocular cystic nephroma, however, possible due of cystic renal cell carcinoma cannot be entirely excluded.RETROPERITONEUM, LYMPH NODES: Borderline enlarged retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Large locally aggressive mass involving the pancreatic body consistent with pancreatic adenocarcinoma.Large complex multiloculated cystic mass involving the right kidney suspicious for multilocular cystic nephroma. Cystic renal cell carcinomas are much less likely diagnostic possibility.Bilateral scarring in upper lobes of the lungs. Follow-up imaging is recommended to exclude neoplasm. |
Generate impression based on findings. | 40 year-old female with tachycardia and low oxygen saturations. Evaluate for pulmonary embolus PULMONARY ARTERIES: Adequate opacification with no evidence of pulmonary embolus.LUNGS AND PLEURA: No pulmonary opacities to suggest infection. Small bilateral pleural effusions with underlying atelectasis. There is a nonspecific pleural-based pulmonary nodule measuring approximately 6 mm in the left lower lobe (series 9, image 53).MEDIASTINUM AND HILA: Heart size is normal. There is a trace pericardial effusion. No mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. No evidence of pulmonary embolus. 2. Small bilateral pleural effusions with underlying atelectasis. 3. Trace pericardial effusion. |
Generate impression based on findings. | Pneumonia, COPD. Emphysema. Question pulmonary abnormality. LUNGS AND PLEURA: Lobular groundglass opacities in the lung apices and bases with geographic areas of sparing. Within the areas of groundglass, severe intralobular septal thickening and thickening of the bronchial walls is present. Trace pleural fluid bilaterally with adjacent dependent atelectasis. Along the anterior lung fields, there are additionally signs of pulmonary fibrosis with subpleural honeycombing and cyst formation but no significant bronchiectasis. Findings have worsened in some areas and improved in others, with new areas of peripheral consolidation and atelectasis in the bases but partial clearing of groundglass opacities previously seen in the right upper lobe and anterior mid lungs.MEDIASTINUM AND HILA: Enlarged AP dimension of the thoracic trachea consistent with provided history of COPD. Main pulmonary artery appears mildly dilated, measuring 3.2-cm in transverse dimension suggestive of pulmonary arterial hypertension. Mild bilateral mediastinal and hilar lymphadenopathy is present. For reference, a low right paratracheal lymph node measures 12-mm (3/37). Left hilar lymph node measures 15-mm (3/45). Upper normal heart size.CHEST WALL: Punctate sclerotic focus in the left seventh rib too small to characterize but most likely a benign bone island.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. Cholecystectomy clips. | Mixed response of extensive lobular groundglass opacities with clearing in some areas and worsening in others, such as development of focal peripheral consolidation in the right lower lobe. Severe bronchial wall thickening. Reticulation and subpleural cyst formation in the anterior lung fields is suspicious for development of a post inflammatory pulmonary fibrosis. In the appropriate clinical setting, some of the CT features are suggestive of a late phase acute interstitial pneumonia. Mild mediastinal and hilar lymphadenopathy. Signs of COPD and pulmonary hypertension. |
Generate impression based on findings. | 51-year-old female patient with hemoglobin dropped from 8 to 6.5 without evidence of small cyst. Evaluate for possible bleeding source. Note that the lack of intravenous and oral contrast limits evaluation of vasculature, lymph nodes and solid viscera.ABDOMEN:LUNG BASES: Bilateral pleural effusions, left greater than right with associated atelectasis and volume loss.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 evidence of retroperitoneal hemorrhage.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate amount of abdominal ascites.PELVIS:UTERUS, ADNEXA: Enlarged uterus with scattered calcifications, consistent with leiomyomatous uterus. Well circumscribed mass in the area of the left adnexa is noncalcified, has heterogeneous attenuation and measures 8.0 x 10 cm (series 3 image 74) and may represent an exophytic fibroid versus an adnexal mass.BLADDER: Foley catheter in place.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate abdominal ascites. | 1.No evidence of retroperitoneal bleed.2.Bilateral pleural effusions.3.Abdominal ascites.4.Exophytic uterine fibroid versus adnexal mass. Recommend further evaluation with pelvic ultrasound.5.Fibroid uterus. |
Generate impression based on findings. | 71 -year-old status post mitral and tricuspid valve repairs with a ventricular septal defect identified on echocardiogram. Evaluate size and location of VSD. ANGIOGRAPHY: Conventional three vessel arch anatomy. The thoracic aorta is normal in size. No focal aortic luminal defect and dissection flap. Multifocal atherosclerotic calcification affects the arch. CHEST:LUNGS AND PLEURA: Limited views of the lungs show small right and moderate left pleural effusions with associated compressive atelectasis/consolidation. Calcified left lower lobe granuloma. Thickening of interlobular septae suggestive of pulmonary edema.MEDIASTINUM AND HILA: Moderate four chamber cardiomegaly. Severe 3-vessel coronary atherosclerotic calcification. AICD leads are in appropriate position. The left atrial appendage is not well visualized and likely ligated. Postoperative changes from mitral and tricuspid valve replacements. Mild aortic valve calcification. Left internal mammary to left anterior descending graft. The is a triangular defect in the base of the membranous interventricular septum. The broad base of the defect is positioned cranially immediately adjacent to the tricuspid valve prosthesis and measures 8mm in basilar to apical dimension (Series 13 image 34). The defect tapers as it extends caudally for approximately 6mm. No significant pericardial effusion.CHEST WALL: Postoperative changes from median sternotomy.UPPER ABDOMEN: No significant abnormality noted | 1. Triangular defect in the basal membranous septum measuring 8mm in greatest apical-basal dimension and extending approximately 6mm in cranial-caudal dimension.2. Postoperative changes from mitral and tricuspid valve replacements.3. Congestive heart failure with pulmonary edema and bilateral pleural effusions. |
Generate impression based on findings. | Hypoxia, evaluate for pulmonary AVM. Artifact from patient motion limits assessment for fine detail.LUNGS AND PLEURA: No pulmonary arteriovenous malformations are identified. Mild basilar atelectasis or scarring. No focal air space opacities or suspicious pulmonary nodules. Moderate centrilobular and paraseptal emphysema.MEDIASTINUM AND HILA: Mild cardiomegaly.. Small circumferential pericardial fluid collection. Main pulmonary artery appears normal in caliber. No significant lymphadenopathy, some of the small lymph node presents are calcified, suggestive of old, healed granulomatous disease..CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. Subcentimeter lesions hypoattenuating relative to the remainder of the hepatic parenchyma are too small to accurately characterize but statistically most likely represent cysts. | Moderate emphysema and mild atelectasis and/or scarring, but no visible pulmonary arterial venous malformation or other acute abnormality to account for the patient's hypoxia. |
Generate impression based on findings. | Clinical question: rule out hemorrhage. Signs and symptoms: altered mental status. Nonenhanced head CT:No detectable acute intracranial process CT however is insensitive for detection of acute nonhemorrhagic ischemic strokes.Moderate periventricular and subcortical low attenuation of white matter consistent with age indeterminate small vessel ischemic strokes. There is also evidence of a chronic left MCA territory right lung cortical stroke. Mild ex vacuo dilatation of supratentorial ventricular system and prominence of cortical sulci are noted. There is very heavy vascular calcification of bilateral cavernous carotids and the vertebral basilar system.Unremarkable calvarial, orbits, paranasal sinuses and mastoid air cells. | 1.No acute intracranial process.2.Indeterminate small vessel ischemic strokes and a chronic left MCA parietal cortical stroke. |
Generate impression based on findings. | Clinical question: Lung cancer with brain metastases. Signs and symptoms: As above. Nonenhanced head CT:There is significant interval decrease in the extent of right parietal vasogenic edema since prior exam. Residual edema at this site however this is still present.No evidence of acute intracranial process CT however is insensitive for early detection of nonhemorrhagic ischemic strokes.Unremarkable cerebral cortex and cortical sulci as well as the supratentorial ventricular system and maintained midline.Unremarkable calvarium and soft tissues of the scalp.Unremarkable orbits and partially visualized mastoid air cells and middle ear cavities. | No acute intracranial process. Noticeable decrease in right parietal vasogenic edema since prior exam. |
Generate impression based on findings. | Clinical question: CVA/bleed? Signs and symptoms: Headache and prior history of CVA. Nonenhanced head CT:No acute intracranial process. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.Small focus of low attenuation in the right basal ganglia is consistent with a chronic lacunar infarct. This finding was noted as a larger area of low attenuation at its acute to early subacute phase on prior CT exam.A tiny focus of cortical low attenuation in the right frontal lobe at the site of previously noted subacute stroke which also demonstrate interval decreased size due to its progression to a chronic phase.Unremarkable cerebral cortex and cortical sulci otherwise.Normal size supratentorial ventricular system and with maintained midline. Unremarkable images through posterior fossa.Unremarkable calvarium and soft tissues of the scalp.Unremarkable mastoid air cells and middle ear cavities.Mild chronic sinusitis. | 1.No acute intracranial process.2.Evolution of previously noted right MCA territory strokes to chronic phase as detailed. |
Generate impression based on findings. | Clinical question:concern for hemorrhage. Signs and symptoms: Septic emboli. Nonenhanced head CT:Examination demonstrates multiple tiny foci of acute hemorrhage likely at the site of patient's previously known septic emboli. The largest focus off hemorrhage measures approximately 5 x5 mm sized and is located in the right posterior parietal -- occipital junction. There is no mass effect as result of these minute hemorrhages. The cortical sulci remain widely patent, ventricular system is within normal and the maintained midline, gray -- white matter differentiation is preserved and on CSF spaces remain patent. | Multiple very small foci of hemorrhage likely at the site of patient's known septic emboli as detailed above. |
Generate impression based on findings. | 45-year-old male patient with hematuria and renal mass. ABDOMEN:LUNG BASES: Trace bilateral dependent atelectasis.LIVER, BILIARY TRACT: Status-post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right kidney interpolar hypoattenuating mass measures 6.2 x 5.2 cm (series 4 image 50). There are areas of hyperattenuation suggestive of hemorrhage. The mass abuts the liver capsule. On delayed images, there appears be a filling defect in the proximal right ureter, which likely represents blood clot (series 6 image 43 and coronal series 80560 image 55) given clinical history. Minimal perinephric fat stranding adjacent to the interpolar and inferior pole of the right kidney. No vascular invasion or adjacent lymphadenopathy.There is a subcentimeter hypoattenuating focus in the interpolar region of the left kidney is too small characterize and likely represents a cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild multilevel degenerative changes in the thoracic and lumbar spine. No definite lytic lesions, however there is significant endplate degeneration of the inferior L5 vertebral body.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: Filling defects in the bladder on delayed images likely represent small blood clots.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild multilevel degenerative changes in the thoracic and lumbar spine. No definite lytic lesions, however there is significant endplate degeneration of the inferior L5 vertebral body.OTHER: No significant abnormality noted. | Right renal mass highly suspicious for renal cell carcinoma. No evidence of vascular invasion or lymphadenopathy. |
Generate impression based on findings. | Reason: possible PE; lung abnormality History: acute respiratory distress LUNGS AND PLEURA: Acquisition of images at a later phase of contrast limits evaluation for pulmonary embolism, and within this limitation no large filling defect is seen within the main pulmonary arteries.Extensive bilateral, right greater than left, peribronchial ground glass opacities with mixed internal solid airspace opacities. Within the right lower lobe consolidated and atelectatic lung (3/49) some of the atelectatic lung appears hypoattenuating compared to adjacent parenchyma which could be the result of hypoperfusion or necrosis.Mild pleural thickening at and enhancement on the left, the left pleural fluid collection may be partially loculated. New moderate right and small left pleural effusions with overlying atelectasis. MEDIASTINUM AND HILA: Mild cardiomegaly. Postoperative changes consistent with OHT. No pericardial effusion. Mild atherosclerotic calcifications of the aorta.Multiple mildly enlarged mediastinal and right hilar lymph nodes measuring up to 14-mm (subcarinal, 3/44). Mild right cardiophrenic lymphadenopathy.Multiple surgical clips and sternotomy wires are noted.ET tube and NG tube noted.CHEST WALL: Multiple small lower cervical lymph nodes are noted..UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. New 14 x 21 mm hypodense lesion with possible peripheral enhancement in the left lobe of the liver, segment 4. Status post cholecystectomy. Bilateral atrophic kidneys. Air-filled loops of small and large bowel suggestive of ileus. | 1. Bilateral extensive peribronchial ground glass and solid airspace opacities most suggestive of acute pulmonary edema and infection. Diffuse pulmonary hemorrhage or drug reaction can be considered in the appropriate clinical context. 2. New hypodense hepatic lesion with possible peripheral enhancement. CT abdomen with contrast is recommended for further characterization to exclude possibility of neoplasm or atypical infection. Additional hepatic lesions cannot be excluded given the phase of contrast.3. Pleural thickening and enhancement on the left is noted. In addition, the small left pleural fluid collection may be partially loculated. This could be the result of infection in the pleural space.4. Mild intrathoracic lymphadenopathy. |
Generate impression based on findings. | Male 30 years old; Reason: r/o colitis, mass History: wt loss, n/v ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver has a smooth contour. Hepatic and portal veins are patent. The gallbladder is present without intra-or extrahepatic periductal location it no definite focal hepatic lesion.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: A few too small to characterize lesions in the kidneys. No stones or hydronephrosis detected.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Stomach is well distended with contrast, and with area of focal wall thickening. Subtle area of narrowing (coronal series 60). Submucosal edema about the pylorus.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: Appendix is normal in caliber and fills with air.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Focally of gastric wall thickening with mild edema and mucosal edema about the pylorus further evaluation with endoscopy is suggested.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 37-year-old male with fever, rectal discomfort ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: The gallbladder is poorly distended. No focal hepatic lesions.SPLEEN: Splenomegaly.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post total colectomy with ileal pouch anal anastomosis. Multiple enlarged mesenteric lymph nodes. The proximal small bowel is normal in caliber. Mild dilatation of the distal small bowel.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: Status post total colectomy with ileal pouch anal anastomosis. Diffuse wall thickening of the neorectal pouch. Multiple large mesenteric lymph nodes, likely reactive in etiology. No evidence of loculated fluid collection, perforation, or obstruction. Mild distal small bowel dilatation. Linear sutures noted along the pouch. BONES, SOFT TISSUES: Mild retrolisthesis of L5 on S1.OTHER: No significant abnormality noted | 1. Diffuse wall thickening of the neorectal pouch, consistent with pouchitis. No evidence of abscess or obstruction.2. Splenomegaly. |
Generate impression based on findings. | 77-year-old male with newly diagnosed neuroendocrine tumor, needs CT for staging. CHEST:LUNGS AND PLEURA: Calcified left apical nodule, likely representing prior granulomatous disease. No evidence of metastatic disease.MEDIASTINUM AND HILA: Severe atherosclerotic calcification of the coronary arteries. Small calcified mediastinal and hilar lymph nodes, likely from prior granulomatous disease.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Multiple large peripherally enhancing, centrally hypoattenuating liver metastases. One right hepatic lesion measures 3.0 x 3.0 cm (image 35, series 7) for reference. Diffuse hepatic steatosis. The gallbladder is unremarkable.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Punctate nonobstructive left lower pole nephrolithiasis.RETROPERITONEUM, LYMPH NODES: Multiple subcentimeter retroperitoneal lymph nodes. Atherosclerotic calcification and noncalcified plaque of the abdominal aorta and its branches.BOWEL, MESENTERY: 6.3 x 4.5 mass along the greater curvature of the stomach.BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Rods are noted in the prostate.BLADDER: No significant abnormality notedLYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality noted | 1. Gastric mass and multiple hepatic metastases as detailed above.2. Diffuse hepatic steatosis. |
Generate impression based on findings. | Female 61 years old; Reason: SBO vs herniation vs pancreatitis? History: N/V, abd distention, h/o SBO ABDOMEN:LUNGS BASES: Cardiomegaly. No basilar atelectasis or consolidation.LIVER, BILIARY TRACT: Liver has a smooth contour. No intra-or extrahepatic ductal dilatation. Hepatic and portal veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts. The smaller hypodense lesions are too small to characterize. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Status post colectomy. Dilatation of the small bowel loops in the right lower abdomen prior to the entry into the ostomy. There is focal narrowing and mucosal hyperenhancement enhancement at the level of the abdominal fascial plane. The distal small bowel loop in the subcutaneous tissues is dilated measuring up to 3.5-cm due to obstruction at the level of the stoma. This desiccated material within the small bowel.Small amount of mesenteric fluid adjacent to the bowel obstruction indicates the obstruction is severe.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: HysterectomyBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Please see aboveBONES, SOFT TISSUES: Multiple pelvic clips.OTHER: No significant abnormality noted. | 1.Small bowel obstruction at the level of the stoma with a proximal small bowel feces sign and mesenteric edema indicating obstruction is severe.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
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