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Generate impression based on findings. | Fall. Head: There is a left parietal scalp hematoma that measures up to 10 mm in width. However, there is no evidence of intracranial hemorrhage, mass, cerebral edema, or skull fracture. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The mastoid air cells are clear. There is a small right maxillary sinus retention cyst.Cervical Spine: There is no evidence of acute fracture of spondylolisthesis. The vertebral column alignment is within normal limits. The vertebral and disc space heights are preserved. The prevertebral soft tissues are unremarkable. | 1. Small left parietal scalp hematoma, but no evidence of acute intracranial hemorrhage or skull fracture.2. No evidence of acute fracture of spondylolisthesis. |
Generate impression based on findings. | Female, 62 years old, right-sided headache and left-sided weakness, now resolved. Areas of encephalomalacia are redemonstrated within the left frontal, parietal and occipital lobes compatible with old strokes appearing similar to the prior exam. Numerous small old strokes are also redemonstrated within the cerebellum.No definite CT evidence of acute territorial ischemia is seen, though given the abnormal background, subtle or early ischemia may not be detected. No mass effect is seen. No intracranial hemorrhage is demonstrated. The ventricular system is patent and normal in size. There is a small focal hypodensity within the left thalamus which is also stable and likely reflects age indeterminate small vessel ischemic disease. Basal ganglia calcifications are noted.The bones of the calvarium are intact. The paranasal sinuses are well pneumatized. | 1. Chronic strokes are redemonstrated appearing unchanged within the left frontal, parietal and occipital lobes. Scattered small strokes are also unchanged in the cerebellum.2. No definite evidence of acute territorial ischemia is seen. However, CT can be insensitive in this regard, and if clinical concern warrants, further evaluation with MRI would be appropriate. |
Generate impression based on findings. | 70 year-old female patient with AML status post stem cell transplant and known diagnosis of graft versus host disease presents with worsening nausea, vomiting and diarrhea. Evaluate for bowel wall thickening. ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Small hypoattenuating lesion in the lateral left lobe of the liver is stable compared to prior examination and likely represents a cyst.New periportal edema. Interval increase in pericholecystic fluid. Gallbladder with sludge, stable.SPLEEN: No significant abnormality noted.PANCREAS: Multiple low-density lesions are again seen in the pancreas with the largest lesion in the body, which appears to communicate with the pancreatic duct. Appearance of these lesions is consistent with intraductal papillary mucinous neoplasms.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Irregular contour of the left kidney is stable compared to prior examination and is likely secondary to scarring.Nonobstructing renal calculus in the inferior pole of the right kidney, stable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small hiatal hernia. Interval increase in pericolonic fat stranding, diffuse bowel wall thickening, submucosal edema and mucosal enhancement compared to prior examination.BONES, SOFT TISSUES: Mild multilevel degenerative changes in the thoracic and lumbar spine.OTHER: Abdominal ascites.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Interval increase in pericolonic fat stranding, diffuse bowel wall thickening, submucosal edema and mucosal enhancement compared to prior examination.BONES, SOFT TISSUES: Mild multilevel degenerative changes in the thoracic and lumbar spine.OTHER: Moderate amount of free pelvic fluid. | 1.Findings consistent with progression of graft versus host disease with near complete involvement of the small and large bowel.2.Increased abdominal ascites.3.Stable distention of the gallbladder with sludge. If there is clinical concern for acute cholecystitis, right upper quadrant ultrasound is recommended. |
Generate impression based on findings. | MVC. Head: There is no evidence of intracranial hemorrhage, mass, cerebral edema, or skull fracture. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. Cervical Spine: There is no evidence of acute fracture of spondylolisthesis. There is loss of cervical lordosis, which may be related to muscle spasm or positioning. The vertebral and disc space heights are preserved. The prevertebral soft tissues are unremarkable. | 1. No evidence of acute intracranial hemorrhage or skull fracture.2. No evidence of acute fracture of spondylolisthesis. |
Generate impression based on findings. | Female 21 years old; Reason: diffuse abdominal pain. History: Diffuse abdominal pain with hx of VP shunt ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: The liver has a smooth contour. Subcentimeter hypodense segment 6 lesion is too small to characterize. The hepatic and portal veins are patent.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 bowel obstruction.BONES, SOFT TISSUES: Via a midline anterior abdominal approach. A peritoneal catheter terminates within the left midabdomen.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Right adnexal subcentimeter fat containing lesion. Most likely represent a small ovarian dermoid. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Pelvic free fluid possibly from the catheter.OTHER: No significant abnormality noted. | 1.Subcentimeter right ovarian fat containing lesion. Follow up sonography is suggested.2.Fluid within the pelvis possibly due to the shunt catheter. If patient has peritoneal symptoms, consider sampling the fluid. |
Generate impression based on findings. | Female, 62 years old, transient right arm weakness. Precontrast CT findings are unchanged including evidence of old strokes in the left frontal, parietal and occipital lobes as well as the cerebellum. Small focal hypodensity is also stable in the left thalamus. No CT evidence of acute territorial ischemia is seen. No mass effect is demonstrated. No intracranial hemorrhage is present. The ventricular system is patent and normal in size.Atherosclerotic calcification affects the cavernous ICAs. No definite high-grade focal stenosis or vascular occlusion is seen anywhere in the anterior or posterior circulation.A 2-mm aneurysm adjacent to the origin of the left PCOM artery is unchanged. No new aneurysms are detected.The left PCOM artery is small. Fetal origin of the right PCA is noted. The right A1 segment is smaller than the left. The ACOM artery is unremarkable. | 1. No evidence of significant vascular stenosis or occlusion.2. Stable 2-mm aneurysm adjacent to the origin of the left PCOM artery. |
Generate impression based on findings. | 39-year-old female with history history of pancreatitis and pseudocyst status post percutaneous drainage now with increased white blood cell count ABDOMEN:LUNG BASES: Left pleural effusion with enhancement of the pleura and adjacent atelectasis decreased in size from the prior study.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas enhances homogeneously and the parenchyma is mildly distorted from adjacent fluid collections. ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: A large peri-pancreatic fluid collection containing 3 cystgastrostomy drains measures 10.5 x 2.9 cm and previously measured 12.3 x 3.5 cm (image 55, series 3). This collection contains gas, likely related to cystgastrostomy catheters, although superinfection cannot be excluded.Extension of the lesser sac collection along the left paracolic gutter which contains a percutaneous drain and measures 4.3 x 3.7 cm and previously measured 4.9 x 4.67 m (image 80, series 3). The collection further extends into the pelvis.Small fingerlike fluid collections extend inferiorly and posteriorly within the mesentery and into the right retrocolic gutter.Loculated fluid collection in the lower abdomen/pelvis measures 6.0 x 2.6 cm and previously measured 5.9 x 3.0 cm (image 120, series 3).BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: An IUD is again noted.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Multiple enhancing fluid collections extending inferiorly within the mesentery and anterior to the uterus are decreased in size but still persist. Free fluid tracks within the mesentery as well layering in dependent pelvis without loculation.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Pelvic ascites. | 1. Multiple loculated peripancreatic and abdominopelvic fluid collections as detailed above are decreased in size. Gas in the largest peripancreatic collection likely relates to cystgastrostomy catheters although superimposed infection cannot be excluded. 2. Decrease in size of left pleural effusion with adjacent atelectasis and enhancing pleura. |
Generate impression based on findings. | Metastatic epithelioid sarcoma evaluate L trapezius mass. There is an ill-defined partially calcified soft tissue mass within the left trapezius at the level of the C7 vertebral body, which measures approximately 13 x 25 mm. There is also an ill-defined left level 5 lymph node that measures up to 6 mm adjacent to the left external jugular vein. Although not enlarged by size criteria, the lymph node demonstrates hypermetabolism on FDG-PET. Similarly a cluster of small, but ill-defined, left supraclavicular lymph nodes measuring up to 5 mm also demonstrate hypermetabolism on FDG-PET. There are irregular left apical lung nodules that are partially imaged that demonstrate corresponding hypermetabolism on FDG-PET. Linear and plaque-like partially calcified opacities within the right lung apex and overlying pleural do not demonstrate appreciable corresponding hypermetabolism on FDG-PET and likely represent scar. The osseous structures, thyroid and major salivary glands, major cervical vessels, and imaged portions of the intracranial structures and orbits are unremarkable. | Multiple cervical and upper thoracic lesions, compatible with metastatic epithelioid sarcoma, including a dominant partially calcified left trapezius implant that measures up to approximately 25 mm, left level 5 and supraclavicular lymph nodes, and pulmonary nodules. However, these lesions are more conspicuous on the prior PET and MRI. |
Generate impression based on findings. | 27-year-old female patient with a right lower quadrant pain. Evaluate for appendicitis or tubo-ovarian abscess. ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Large and small bowel are normal in caliber.Thickened, enlarged appendix with mucosal enhancement extends into the pelvis with adjacent fat stranding (series 3 images 96 through 99). No evidence of perforation or loculated fluid collection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Pessary noted in the vagina.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Thickened, enlarged appendix with mucosal enhancement extends into the pelvis with adjacent fat stranding (series 3 images 96 through 99). No evidence of perforation or loculated fluid collection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Retrocecal appendicitis without perforation or abscess. |
Generate impression based on findings. | 26-year-old female patient with right upper quadrant pain. Evaluate for cholecystitis. Note that streak artifact from spinal hardware limits examination.ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No gallbladder distention, radiopaque gallstones or pericholecystic fluid.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Hypoattenuating, subcentimeter lesion in the inferior pole of the right kidney is too small to characterize and likely represents a cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Spinal hardware in the thoracic and lumbar spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No acute intra-abdominal abnormalities identified. |
Generate impression based on findings. | Reason: h/o HNC, s/p CRT, compare to previous measurement History: none CHEST:LUNGS AND PLEURA: Interval appearance of clustered nodules within the right upper lobe adjacent to the major fissure (series 5 image 114/series 4 image 39) with associated mucoid impaction. Localized bronchial wall thickening within the superior segment right lower lobe with associated clustered nodules more superiorly. Constellation of findings are suggestive of inflammation.No suspicious pulmonary nodules. No pleural effusion.MEDIASTINUM AND HILA: Heart size is normal. No mediastinal or hilar lymphadenopathy. No pericardial effusion.CHEST WALL: Right port catheter terminates at the superior cavoatrial junction. Symmetric gynecomastia.Metallic device within the left common carotid artery unchanged. At the base of the left neck, there is an ill-defined, supraclavicular soft tissue mass. It is not included in its entirety in this field of view. Please see CT head in soft tissue neck performed on the same day for complete evaluation.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Percutaneous gastrostomy tube in appropriate position.BONES, SOFT TISSUES: Multilevel osteophytes involving the thoracolumbar spine.OTHER: No significant abnormality noted. | At the base of the left neck, there is an ill-defined, supraclavicular soft tissue mass. It is not included in its entirety in this field of view. Please see CT head in soft tissue neck performed on the same day for complete evaluation.Interval appearance of clustered nodules within the right upper lobe adjacent to the major fissure with associated mucoid impaction. Localized bronchial wall thickening within the superior segment right lower lobe with associated clustered nodules more superiorly. Constellation of findings are suggestive of inflammation.No suspicious pulmonary nodules. |
Generate impression based on findings. | Female, 21 years old, headache. Right frontal approach ventricular shunt catheter is in stable position, tip along the body of the left lateral ventricle.Ventricular caliber and morphology are unchanged. The left lateral ventricle is completely decompressed and the right lateral ventricle is small in caliber. The fourth ventricle is unchanged in size.Again seen is asymmetry of the cerebellar hemispheres left side smaller than right.No new parenchymal abnormalities are seen. No mass effect is demonstrated. No evidence of intracranial hemorrhage is detected.The left posterior fossa is smaller than the right which is reflected by asymmetry of the occipital bone. The paranasal sinuses and mastoid air cells are clear. | 1. Stable positioning of the right frontal approach ventricular shunt catheter. Stable caliber of the ventricular system.2. Stable posterior fossa asymmetry.3. No definite evidence of an acute intracranial abnormality. |
Generate impression based on findings. | Male, 65 years old, left hand weakness. Evaluate intraparenchymal and intraventricular hemorrhage. The right thalamic hematoma is unchanged in size. Also unchanged is the degree of surrounding parenchymal edema. Very mild local mass effect persists.Intraventricular blood clot is also redemonstrated appearing perhaps slightly less bulky than on the prior exam. Clot is evident primarily within the right lateral ventricle but there is a small amount of layering blood product within both occipital horns. No evidence of blood is seen in fourth ventricle. No new hemorrhage is detected.Ventricular caliber and morphology are unchanged. Mild nonspecific periventricular hypodensity is also unchanged. | No significant interval changes. |
Generate impression based on findings. | 46 year old female. Gastric cancer, restaging. CHEST:LUNGS AND PLEURA: Scattered pulmonary micronodules, unchanged.Increasing bilateral areas of groundglass opacity. New 9 x 6 mm right upper lobe nodule (image 22; series 5) and similar but larger irregularly-shaped opacity at the right lung base (image 68) measuring 21 x 12 mm. MEDIASTINUM AND HILA: New mediastinal lymphadenopathy. For reference purposes, low right paratracheal lymph node (image 29) measures 11 x 14 mm. Cardiac size is normal. No pericardial effusion. CHEST WALL: Right chest port with tip in SVC. Increasing lytic lesions in the thoracic spine compatible with osseous metastatic disease.ABDOMEN:LIVER, BILIARY TRACT: Increasing perihepatic and upper abdominal ascites. Right hepatic lobe cyst is unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Reference perigastric soft tissue nodule has resolved. New retroperitoneal lymphadenopathy. For reference purposes, left para-aortic lymph node (image 118; series 3) measures 1.7 x 1.7 cm.BOWEL, MESENTERY: Diffuse gastric wall thickening appears similar to prior exam. Peritoneal and omental nodularity is difficult to assess given increasing ascites but probably unchanged.BONES, SOFT TISSUES: Increasing metastases in the spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post bilateral salpingo-oophorectomy.BLADDER: No significant abnormality noted.LYMPH NODES: Left external iliac lymph node is unchanged in size. BOWEL, MESENTERY: Moderate pelvic ascites, increased. Omental and peritoneal nodularity.BONES, SOFT TISSUES: Enlarging lytic lesion in the right ilium about the sacroiliac joint compatible with osseous metastatic disease. OTHER: No significant abnormality noted. | Progression of disease with increasing ascites, new lymphadenopathy, and progressive osseous metastatic disease. New diffuse scattered groundglass opacities in the lungs which could represent pulmonary metastases. |
Generate impression based on findings. | Female 55 years old; Reason: lung nodule History: SOB and cough. Previously reported history of rheumatoid arthritis, prior wedge resection pulmonary nodule biopsy report demonstrating rheumatoid nodules. LUNGS AND PLEURA: Compared to the outside hospital examination, multiple bilateral subcentimeter pulmonary nodules are again visualized. However, the reference measured pulmonary nodules are smaller. For example in the left upper lobe is a 0.5 x 0.7 cm nodule (series 4, image 90) that has decreased in size from 0.7 x 0.9 cm, and in the right upper lobe is a nodule that measures 0.4 x 0.5 cm (series 4, image 155) that previously measured 0.5 x 0.7 cm. Scarring in the left lower lobe posterior region consistent with prior wedge biopsy. No pleural effusions or pneumothorax.MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. No cardiomegaly or pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Cholecystectomy clips are visualized. | Interval decrease in the size of the multiple bilateral subcentimeter pulmonary nodules. Previously biopsy proven rheumatoid nodules. No new nodules identified. |
Generate impression based on findings. | Female 78 years old; Reason: history of large hepatic flexure polyp/carcinoma s/p piecemeal resection. Elevated CEA to 34. Evaluate interval change from 5/2013. Cirrhosis/ascites History: ascites CHEST:LUNGS AND PLEURA: No nodule noted. Vascular congestion and diffuse ground glass haziness represents CHF changes. Calcified left lower lobe granuloma.MEDIASTINUM AND HILA: The heart is mildly enlarged with coronary artery calcifications. Low attenuating thyroid nodules detected, nonspecific.CHEST WALL: No significant abnormality notedABDOMEN: The absence of intravenous contrast limits evaluation of the solid organs. Given these limitations, the following observations were made:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Focal hypoattenuating lesion in segment 6 measures 1 x 0.8cm. This lesion is incompletely characterized given lack of IV contrast. No intrahepatic or extrahepatic ductal dilatation. Peritoneal nodule adjacent to the hepatic flexure measures 1.3 x 1.1 cm (image 91/series 3). Marked interval decrease in ascites with trace residual. Numerous gastroesophageal varices.SPLEEN: Splenomegaly.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left renal cyst is stableRETROPERITONEUM, LYMPH NODES: Nonspecific portal caval and gastrohepatic lymph nodes, unchanged and nonspecific in the setting of chronic liver disease.BOWEL, MESENTERY: Known gastric mass is unchanged measuring 4.4 x 3.9 cm (image70, series 3).BONES, SOFT TISSUES: Anasarca.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Probable calcified fibroids.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Known colonic lesion at the hepatic flexure is not well visualized on this exam.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Peritoneal nodule adjacent to the hepatic flexure suspicious for disease.2. Findings of advanced cirrhosis with a subcentimeter lesion in segment 6, incompletely characterized. Dedicated liver protocol CT advised for full characterization.3. Unchanged gastroesophageal junction mass. |
Generate impression based on findings. | 39-year-old female with incisional hernia and bulge in abdomen ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Status post cholecystectomy. Pneumobilia and left hepatic atrophy redemonstrated.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: Postsurgical change of gastric bypass and partial gastrectomy again noted.BONES, SOFT TISSUES: New right ventral incisional hernia between the right rectus and linea alba containing loops of small bowel and mesentery without evidence of obstruction. The neck the hernia sac measures 4.1 cm (image 86, series 3). No fluid in the hernia sac. Postsurgical change of gastric bypass again noted.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: An IUD is noted.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Normal caliber small bowel and colon.BONES, SOFT TISSUES: Postsurgical change of L5 laminectomy and degenerative changes worst at L5/S1.OTHER: No significant abnormality noted | 1. Ventral incisional hernia containing small bowel and mesentery without evidence of obstruction as detailed above.2. Postoperative changes of Roux-en-Y gastric bypass and partial gastrectomy. Stable pneumobilia and atrophy of the left hepatic lobe. |
Generate impression based on findings. | Female, 55 years old, with nausea and vomiting. The cerebral and cerebellar hemispheres and brainstem are normal in attenuation and morphology. No enhancing lesions are detected.No intracranial hemorrhage or abnormal extra-axial fluid collection is seen. There is no evidence of mass effect or midline shift. The ventricles and basal cisterns are patent and normal in size. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.The bones of the calvarium and skull base are intact. | Unremarkable evaluation with no specific findings to account for the patient's symptoms. |
Generate impression based on findings. | Confusion. There is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. | No evidence of intracranial hemorrhage, mass, or cerebral edema. |
Generate impression based on findings. | 39-year-old patient with abdominal pain, distention, nausea and vomiting. Evaluate for small bowel obstruction or perforation. ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Hypoattenuating, well-circumscribed lesion in the inferior pole of the right kidney is stable compared to prior examination and likely represents a cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Interval increase in bowel thickening in the jejunum and ileum with increased mesenteric fluid. Mesenteric vasculature is patent. The bowel is dilated up to 4.0cmNo pneumatosis or pneumoperitoneum.There is previously administered oral contrast in the colon. Colon is within normal limits.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Interval increase in abdominal ascites.PELVIS:UTERUS, ADNEXA: Status post hysterectomy, omentectomy and bilateral salpingo-oophorectomy.BLADDER: No significant abnormality notedLYMPH NODES: Index left pelvic lymph node measures 0.8 X 1.2 cm (series 3 image 136), previously 1.1 x 0.7 cm.BOWEL, MESENTERY: Interval increase in bowel thickening in the jejunum and ileum with increased mesenteric fluid. Small bowel is slightly less dilated compared to prior examination. Mesenteric vasculature is patent.No pneumatosis or pneumoperitoneum.There is previously administered oral contrast in the colon. Colon is within normal limits.BONES, SOFT TISSUES: Soft tissue nodularity in the pelvis is suspicious for peritoneal carcinomatosis (series 3 image 147), stable compared to prior examination.OTHER: Increase in abdominal ascites. | 1.Progression of severe enteritis in the small bowel is nonspecific and may be secondary to drug toxicity versus an infectious etiology. The bowel is dilated up to 4.0cm and serosal tumor involvement causing bowel obstruction is also a possibility.2.Interval increase in abdominal ascites.3.Soft tissue nodularity is suspicious for peritoneal carcinomatosis and is stable compared to prior examination. |
Generate impression based on findings. | SDH. There is a large heterogenous caput succedaneum and mild overlap of the calvarial sutures. There is scattered subdural hemorrhage along the left falx cerebri, and bilateral tentorial leaflets, which measure up to 2 mm in thickness. There may also be a punctate focus of extra-axial hemorrhage underlying the left coronal suture. The brain parenchyma otherwise appears unremarkable for age. The ventricles and basal cisterns are normal in size and configuration, including cavum septum pellucidum. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. | 1. Scattered subdural hemorrhage along the left falx cerebri, and bilateral tentorial leaflets, which measure up to 2 mm in thickness, and possible punctate focus of extra-axial hemorrhage underlying the left coronal suture. 2. Large heterogenous caput succedaneum and mild overlap of the calvarial sutures. |
Generate impression based on findings. | 46-year-old male patient with history of renal cell carcinoma status post left radical nephrectomy. CHEST:LUNGS AND PLEURA: Scattered pulmonary micronodules, some of which are calcified. Interval resolution of bilateral pleural effusions.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post left nephrectomy without evidence of recurrent disease. Right kidney within normal limits.RETROPERITONEUM, LYMPH NODES: No suspicious lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild multilevel degenerative changes of the thoracic and lumbar spine. No lytic lesions identified.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: Mild multilevel degenerative changes of the thoracic and lumbar spine. No lytic lesions identified.OTHER: No significant abnormality noted. | 1.Status post left nephrectomy without evidence of recurrent or metastatic disease.2.Nonspecific scattered pulmonary micronodules. |
Generate impression based on findings. | Male, 56 years old, tonsil cancer. No mass effect, focal edema or suspicious enhancement is seen to suggest brain parenchymal metastatic disease. The bones of the calvarium and skull base are intact. Left ICA embolization coils are redemonstrated.Extensive post surgical change is redemonstrated compatible with left neck dissection and flap reconstruction. Also noted is diffuse radiation related change including infiltration of the subcutaneous fat and edema of the mucosa of the soft palate, epiglottis and supraglottic larynx. These treatment related findings have progressed from the prior exam.Within the left lateral retropharyngeal space, at the superior margin of the left neck flap, there is a questionable hypodense region measuring 2.7 x 1.6 cm (image 16 series 6). Evaluation of this region is significantly limited by the presence of streak artifact, as it was on the prior exam as well. This region, however, was not as conspicuous on the prior examination.Elsewhere in the neck, no definite evidence of active disease is seen including no evidence of pathologic adenopathy. Residual salivary glands are free of focal lesions. The thyroid is unremarkable. The left carotid system has been sacrificed. Remaining vessels are patent.Mild reticulation is seen in the lung apices. Extensive degenerative disk disease is present in the cervical spine but no concerning or destructive osseous lesions are demonstrated. | An ill-defined hypodense region is seen within the left lateral retropharyngeal space, at the superior margin of the left neck flap. Streak artifact on the present and prior examinations makes this area very difficult to assess. However, this finding was not as conspicuous on the prior examination.Given the extensive developing radiation related change within the soft tissues of the neck, and the lack of other findings to suggest progressive disease, this finding may simply be artifactual or related to edema in the flap.However, the location of this finding is close to the site of the patient's original tumor, and as such, a developing lesion cannot be completely excluded. MRI with contrast may be helpful to distinguish these possibilities. Otherwise, close attention to this region on subsequent studies will be necessary. |
Generate impression based on findings. | VP shunt removal. There has been interval ventricular shunt removal with resultant mild pneumoventricle. The ventricular system has otherwise not significantly changed in size, with persistent dilatation of the lateral ventricles. There is unchanged bifrontal encephalomalacia and mild scattered nonspecific cerebral white matter hypoattenuation. There is no evidence of acute intracranial hemorrhage, mass, or cerebral edema. There is no midline shift or herniation. The right subgaleal fluid has decreased slightly. | Interval ventricular shunt removal with no significant changed in size of the ventricular system, including persistent dilatation of the lateral ventricles. |
Generate impression based on findings. | 29 year-old female with metastatic breast cancer on therapy CHEST:LUNGS AND PLEURA: No pulmonary nodules or masses.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size is normal.CHEST WALL: Interval decrease in axillary lymphadenopathy with reference right axillary lymph node measuring 1.8 x 1.7 cm and previously measuring 3.0 x 2.7 cm (image 30, series 4). Several axillary nodes demonstrate calcification, likely reflecting treatment effect. Diffuse mixed lytic/sclerotic osseous metastatic disease and multiple rib deformities.ABDOMEN:LIVER, BILIARY TRACT: Right inferior hepatic hypodensity too small to characterize measures 1.0 x 0.8 cm (image 109, series 4).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: Diffuse mixed lytic/sclerotic osseous metastatic disease. Multiple rib deformities.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Prominent inguinal lymph nodes are reidentified.BOWEL, MESENTERY: Small ventral hernia containing mesenteric fat without evidence of obstruction. The bowel is normal in caliber.BONES, SOFT TISSUES: Diffusely mixed lytic/sclerotic osseous metastatic disease. New pathologic fracture of the right ilium (image 151, series 4). Multiple vertebral body compression fractures.OTHER: No significant abnormality noted. | 1. Interval decrease in axillary adenopathy. 2. Diffuse mixed lytic/sclerotic osseous metastatic disease with new pathologic fracture of the right ilium. Multiple vertebral body compression fractures are again noted.3. Hypoattenuating right inferior hepatic lesion too small to characterize. |
Generate impression based on findings. | Male 52 years old; Reason: mets lung cancer, s/p palliative chest RT. Pls c/w previous study and evaluate dz status. History: lung cancer. CHEST:LUNGS AND PLEURA: The previously characterize left apical nodule is no longer discretely measurable. No interval change in the scattered pulmonary nodules elsewhere.MEDIASTINUM AND HILA: Left perihilar mass has decreased in size compared to previous exam measuring 1.8 x 3.9 cm (series 4, image 44) and previously measured 3.7 x 5.2 cm. No other significant mediastinal or hilar lymphadenopathy. Normal heart size. Small pericardial effusion.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: A small hypodensity in the medial left lobe of the liver anteriorly is too small to characterize but was seen previously and likely represents a benign hepatic cyst. However there has been interval development of multiple ill-defined hypodense lesions throughout the liver that are concerning for metastasis. For reference the largest lesion in the medial left lobe measures 3.2 x 2.4 cm (series 4, image 104).SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple nonobstructive renal stones and multiple complex cystic renal lesions with peripheral calcification which appear grossly unchanged.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Aortobiiliac atherosclerosis.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Mild degenerative changes are noted about the spine. No suspicious lesions for metastasis.OTHER: No significant abnormality noted. | 1.Interval development of multiple liver lesions concerning for metastases. 2.Interval near complete resolution of the previous left apical pulmonary nodule.3.Interval reduction in the size of the left hilar mass. |
Generate impression based on findings. | Evaluation of right upper lobe cavitary lesion. No additional clinical information provided. LUNGS AND PLEURA: Severe centrilobular emphysema.Thick-walled cavitary lesion in the posterior right upper lobe has an inverted U.-shaped configuration, best appreciated on the coronal sequence. Largest dimensions of the lesion are seen on the sagittal sequence, image 23 where it measures 8.2-cm craniocaudally and 4-cm in in the anteroposterior dimension. The apex of the lesion on transaxial images measures 6.3 x 2.6 cm (4/22). Walls of this lesion measure up to 9-mm in thickness, and a focal area of dystrophic calcifications are noted within its wall posteriorly abutting the right major fissure. Fluid is noted in the dependent caudal progression of the cavity. Adjacent to the lesion, small nodules ranging from 1 to 2-mm up to 5-mm in size are seen. Additional nodules in the right upper lobe measure up to 8mm (4/34).Extensive coarsened, nodular septal thickening throughout the right lung base with focal masslike consolidation along the diaphragm (4/88, coronal image 22). Dependent consolidation more cranially in the lower lobe the superior segment of contains small internal areas of lucency which probably reflect aerated areas of emphysema within the lesion. A single small cavity is noted posteriorly (4/62).A small focus of consolidation is seen at the left lung base along the diaphragm (4/90). Small subpulmonic pleural fluid collection on the right.Compared to the previous examination, the right upper lobe lesion has increased in size, degree of cavitation and developed internal fluid attenuation in the caudal aspect. The additional right upper lobe nodules are new as is the extensive abnormality in the right lower lobe.MEDIASTINUM AND HILA: Linear intracardiac calcification in the posterior aspect of the left ventricle near the medial and caudal aspect of the mitral valve annulus. Atherosclerotic calcifications of the aorta and its branches. Debris in the trachea. Mild lymphadenopathy along the right upper lobe bronchus, 8mm (3/40), not normally seen in this area. Several small, nonenlarged lymph nodes in the noted in the lower right paratracheal region. Coronary artery calcifications noted. No pericardial fluid. Overall heart size is normal.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. Thick-walled cavitary mass in the right upper lobe increased in size compared to the previous examination, now contains fluid as well as adjacent small nodules and new nodules within the same lobe. Although worsening over one month is suggestive of active atypical infection such as MTB or atypical mycobacteria, wall thickness greater than 5-mm more often indicates malignancy which cannot be excluded. Correlation with tissue and cultures suggested unless otherwise done at the outside institution.2. Interval development of bibasal consolidation, right greater than left and extensive irregularly thickened and nodular intralobular septal thickening in the right lower lobe with at least one area of internal cavitation seen in the consolidated lung. Again, development over a relatively short time interval would suggest infection. The coarse and nodular appearance of the lung interstitium may be secondary to severe underlying emphysema however differentiation between lymphangitic spread of tumor and infection is difficult. 3. Small subpulmonic pleural fluid collection on the right.4. Mild right superior lobar level lymphadenopathy. |
Generate impression based on findings. | 79-year-old female. Fall, hit head. Evaluate for SDH, intracranial injury status post fall. There is unchanged periventricular and subcortical white matter hypoattenuation that is most compatible with moderate small vessel ischemic disease of indeterminate age. A small focus of hypodensity within the left external capsule likely represents a lacunar infarct of indeterminate age, but also appears unchanged. There is no acute intracranial hemorrhage, mass effect, or edema. There is no abnormal enhancement. The ventricles are stable in size and configuration with minimal evidence of brain parenchymal volume loss. The mastoid air cells are clear. There is a small right sphenoid sinus retention cyst. The osseous structures and extracranial soft tissues are unremarkable. | 1. No evidence of acute intracranial hemorrhage, mass effect, or edema.2. Unchanged moderate small vessel ischemic disease of indeterminate age and left external capsule hypodensity that likely represents a lacunar infarct of indeterminate age. |
Generate impression based on findings. | Reason: carcinoid tumor History: carcinoid tumor s/p sleeve resection CHEST:LUNGS AND PLEURA: Scattered calcified pulmonary micronodules/granulomas are unchanged. Minimal dependent subsegmental atelectasis bilaterally. No pleural effusion no pneumothorax. Post surgical changes in the left lung are unchanged. No new focal nodules or masses.MEDIASTINUM AND HILA: Calcified a supraclavicular lymph node is unchanged. Mild interval decrease in size of left AP window lymph node measuring 8 mm (series 3, image 33), previously 7 mm. No new significant mediastinal or hilar lymphadenopathy.Heart size is normal. No pericardial effusion.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No evidence of recurrent or metastatic disease in the chest or upper abdomen. |
Generate impression based on findings. | LCH of mandible on therapy. There has been interval resolution of the the soft tissue mass arising from the right body of the mandible and healing of the vast majority of the associated lytic defect with a residual lucent focus with sclerotic margins lateral to the roots of ADA 31 that measures up to 10 mm and residual thinning the the buccal cortex of the mandible with a 2 mm defect. The right inferior alveolar canal is intact. There is no evidence of pathological fracture. The imaged paranasal sinuses and mastoid air cells are clear. The imaged portions of the orbits and intracranial structures are unremarkable. | Interval resolution of the the soft tissue mass arising from the right body of the mandible and healing of the vast majority of the associated lytic defect with a residual lucent focus with sclerotic margins lateral to the roots of ADA 31 that measures up to 10 mm and residual thinning the the buccal cortex of the mandible with a 2 mm defect. |
Generate impression based on findings. | Male 18 years old; Reason: Please evaluate the sizes of the kidneys. History: H/O ADPKD ABDOMEN: The absence of intravenous and oral contrast limits evaluation of the solid organs and of the bowels. Given these limitations, the following observations were made:LUNGS BASES: Numerous hypoattenuating lesions are noted throughout the liver, likely cysts. This is compatible with patient's known history ADPKD.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: Numerous hyper and hypoattenuating lesions noted throughout the kidneys, likely simple and complex cysts. The largest cyst measures 5.9 x 7.0 cm in the inferior pole left kidney. The right kidney measures 5.4 x 12.3 X 5.4 cm, the left kidney measures 6.7 x 15 x 6.8 cm. No hydronephrosis or perinephric stranding detected.Some lesions are too small to reliably characterize, and lack of IV contrast limits evaluation for solid masses.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.Limited evaluation of the kidneys given lack of IV contrast. Numerous simple and complex hemorrhagic cyst in bilateral kidneys with measurements as provided. |
Generate impression based on findings. | Reason: hx asbestosis--change from earlier CT loaded into system? History: cough LUNGS AND PLEURA: Micronodule in the left upper lobe is unchanged (series 5, image 94). Scattered areas of pleural thickening with calcified plaques bilaterally not significantly changed from prior exam. Small amount of fluid tracking along the left major fissure with mild basilar atelectasis. Small right basilar dependent atelectasis.New nodular scarring measuring 10 x 5 mm (series 5, image 196) in the peripheral right upper lobe.Right lower lobe nodule measures 7 mm (series 5, image 242) previously measuring 7 mm is unchanged.Bilateral, predominantly basilar reticular opacities without significant change compared to prior exam. Bilateral curvilinear subpleural bands. Mild traction bronchiectasis.MEDIASTINUM AND HILA: Mildly enlarged and partially calcified mediastinal lymph nodes. For reference para-aortic lymph node measures 8 mm (series 3, image 36) remains unchanged. Mild interval increase in nodule located in the mediastinal fat now measuring 9 mm (series 80221, image 69) previously measuring 7 mm.Heart size is normal. No pericardial effusions. Moderate to severe atherosclerotic coronary calcifications.CHEST WALL: Degenerative changes to the thoracic spine. Interval increase in lower cervical lymph nodes.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Spleen is absent. Soft tissue mass in the expected location of the spleen is unchanged from prior exam and likely represents a splenule. Multiple punctate calcifications throughout the liver likely represent granulomata. Status post cholecystectomy. Mildly enlarged mediastinal and porta hepatis lymph nodes appear slightly decreased in size. | 1.Bilateral, predominantly basilar, reticular opacities with mild traction bronchiectasis and curvilinear subpleural bands consistent with asbestosis not significantly changed from prior exam.2.Scattered areas of pleural thickening with calcified plaques bilaterally not significantly changed from prior exam.3.New peripherally located right upper lobe nodular scarring. |
Generate impression based on findings. | 47-year-old female with with history of tonsillar neoplasm, CRT, reevaluate. Limited intracranial views are unremarkable. Mild mucosal thickening of the right maxillary sinus, otherwise the visualized paranasal sinuses are clear. The mastoid air cells are clear.Diffuse fat stranding and reticulation compatible with posttherapy changes. Similar to the prior, there is effacement of the left piriform sinus due to asymmetric adjacent mucosal thickening associated with the thickening of the mucosal lining of the aryepiglottic fold. No discrete, enhancing measurable lesion is present. Asymmetric deviation of the right vocal cord laterally and enlargement of the right piriform sinus, unchanged. Increased enhancement of the nasopharyngeal mucosal lining compatible with posttherapy changes.Mild increased enhancement of the parotid glands and submandibular glands compatible with posttherapy changes without focal lesions. The thyroid gland is within normal limits.No pathologic lymphadenopathy by CT size criteria. No soft tissue masses are present in the neck. The cervical vasculature is patent bilaterally.Necrotic appearing left paratracheal superior mediastinal lymph node. The visualized lung apices are clear. Please see dedicated chest CT report from today's date for further details.No suspicious osseous lesions are identified. | 1. No significant interval change in asymmetric mucosal thickening within the left aryepiglottic fold resulting in effacement of the left piriform sinus. Given the stability of this finding, it is most likely posttreatment related.2. No cervical lymphadenopathy by CT size criteria. |
Generate impression based on findings. | 59 year old female patient with history of metastatic cholangiocarcinoma status post 3 cycles of chemotherapy. Compared to prior examination. CHEST:LUNGS AND PLEURA: Stable scattered miconodules and nodules bilaterally. Reference left lower lobe nodule measures 3 mm (series 4 image 76), previously 4 mm. MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Right chest wall port with catheter tip in the superior vena cava.ABDOMEN:LIVER, BILIARY TRACT: Nodular liver morphology, consistent with pseudocirrhosis. Patent portal vein. Numerous ill-defined liver metastases appear stable compared to prior examination. Reference lesion in the liver dome measures 2.4 x 2.4 cm (series 3 image 89), previously 2.1 x 2.3 cm and appears grossly stable. No definite new lesion identified.Status post cholecystectomy.SPLEEN: Splenomegaly, stable. Redemonstration of multiple collateral vessels in the splenic hilum.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal hypodensities are too small to characterize and are stable compared to prior examination. RETROPERITONEUM, LYMPH NODES: Stable upper retroperitoneal lymphadenopathy. Reference portacaval lymph node measures 1.8 x 1.3 cm (series 3 image 115], previously 1.6 x 2.1 cm.BOWEL, MESENTERY: Stable mild peritoneal nodularity, which is suspicious for peritoneal carcinomatosis.BONES, SOFT TISSUES: Multiple sclerotic bone lesions, stable.OTHER: Minimal interval decrease 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: Multiple stable sclerotic and lytic bone lesions.Interval decrease in soft tissue density nodule in the right lower abdominal subcutaneous tissue (series 3 image 168).Right femur hardware redemonstrated.OTHER: Stable moderate pelvic ascites. | No significant interval change in metastatic disease compared to prior examination. |
Generate impression based on findings. | 18 year-old male with history of autosomal dominant polycystic kidney disease, evaluate size of kidneys. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Multiple hypoattenuating lesions, likely representing cysts.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral enlarged kidneys with innumerable cysts many of which are hyperdense likely representing complex cysts, although they are incomplete evaluated on this noncontrast exam.The right kidney measures 14.4 x 7.3 cm. The left kidney measures 15.7 x 7.1 cm.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 | Multicystic enlarged kidneys and hepatic cysts, compatible with the history of autosomal dominant polycystic kidney disease. |
Generate impression based on findings. | 43-year-old male with a history of buccal cancer, reevaluate Limited intracranial views are unremarkable. Bilateral mucosal thickening of the maxillary sinuses. The visualized mastoid air cells are clear.Within the preepiglottic space, there is a primarily cystic lesion with some enhancing solid components which measures approximately 1.4 x 1.9 cm (series 6 image 33) and has not significantly changed in size or appearance since the prior examination. The oral cavity, oro/nasopharynx and subglottic airways are unremarkable/patent. The vallecula, piriform sinuses, and vocal cords are normal. The parotid, submandibular, and thyroid glands are unremarkable. No lymphadenopathy by CT criteria. The carotid arteries and jugular veins are patent. No suspicious osseous lesions identified.Redemonstration of the patient's right upper lung ground glass nodule. Please see dedicated chest CT from today's date for further details. | 1. Primarily cystic partially solid preepiglottic space lesion which has not significantly changed in size or appearance from the prior examination and may represent a mucous retention cyst, cystic neoplasm or thyroglossal duct cyst. Recommend clinical correlation and direct visualization for further characterization.2. Redemonstration of the patient's right upper lung ground glass nodule. Please see dedicated chest CT from today's date for further details. |
Generate impression based on findings. | Lung C. A. doing well CHEST:LUNGS AND PLEURA: Mass in the left upper lobe containing both groundglass and solid components measures 3.6 x 4.8 cm, previously 3.3 x 4.6 cm. The solid component in its inferior aspect is not significantly changed. Multiple subcentimeter nodules also noted in the left upper lobe, some of which have increased in size.Bilobed and part solid nodule in the left lower lobe also increased in size, though the increase is difficult to appreciate on the reference level image. Largest transaxial dimensions are 20 x 32 mm compared to 17 x 26 mm (4/75). The solid part of the lesion has increased from 14 x 19 mm to 17 x 20 mm (4/74).Right pneumonectomy cavity unchanged in appearance.MEDIASTINUM AND HILA: Rightward mediastinal shift. Atherosclerotic calcification of the thoracic aorta and its branches. Small mediastinal lymph nodes noted on the left, one of which has been slowly increasing in size over the last two studies (3/56). Coronary artery calcifications. No pericardial fluid.CHEST WALL: Right subclavian vein is markedly narrowed where it crosses the first rib.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Nodular thickening in the medial limb of the left adrenal gland unchanged compared to recent studies. This does not have imaging characteristics of an adenoma, but was not reported to be FDG avid on prior PET scan.KIDNEYS, URETERS: Renal cortical cysts. Additional lesions in the kidneys too small to accurately characterize.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Severe atherosclerotic calcification of the abdominal aorta with focal infrarenal narrowing of the lumen to 11 by 9-mm (3/29). The superior mesenteric artery also contains calcification and intramural thrombus with focal stenosis noted (3/116). The celiac access appears to be stenotic shortly after its origin with areas of distal beaded dilatation (3/107) measuring up to 12-mm in size. Proximal extent of an aortic bypass graft is incompletely imaged.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. Slight increase in size of left upper and lower lobe lesions.2. Multiple nonindex pulmonary nodules in the left lung have increased in size.3. Subtle enlargement of a non-index subcentimeter mediastinal lymph node.4. Extensive vascular disease detailed in the body of the report. |
Generate impression based on findings. | 69-year-old male with metastatic renal cell cancer, evaluate for growth. CHEST:LUNGS AND PLEURA: Few scattered micronodules some of which are calcified, likely representing prior granulomatous disease.MEDIASTINUM AND HILA: Severe atherosclerotic changes of the coronary arteries. The heart size is normal. No mediastinal or hilar lymphadenopathy.CHEST WALL: Cortical thickening in a right rib. No lytic lesions.ABDOMEN:LIVER, BILIARY TRACT: Enhancing (hyperdense) lesion along the left hepatic dome. Cholelithiasis without evidence of cholecystitis. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Cortical thinning in the right lower pole kidney likely represent scarring. Status post left nephrectomy.RETROPERITONEUM, LYMPH NODES: Status post left nephrectomy with multiple enhancing soft tissue masses in the nephrectomy bed and left retroperitoneum, increased in size and number from the prior study. Mass also infiltrates the left psoas muscle. Reference left retroperitoneal mass measures 1.9 x 2.1 cm and previously measured 1.9 x 2.1 cm (image 144, series 4). A second more inferior reference lesion measures 2.6 x 2.7 cm and previously measured 2.2 x 2.4 cm (image 161, series 4).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Reference left posterior chest wall mass measures 1.5 x 1.1 cm and previously measured 1.6 x 1.3 cm (image 115, series 4). Additional enhancing focus in the left posterior paraspinal musculature appears unchanged. Nonspecific focus of skin thickening along the left anterior abdominal wall (image 168, series 4). 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: Degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality noted | Interval progression of disease with new and enlarging soft tissue masses in the nephrectomy bed. |
Generate impression based on findings. | Male 57 years old; Reason: Pt s/p duodenal perf with pancreatitis s/p duodenojejunostomy, panc debridement 10/24 - please evaulate resolution of pancreatitis and fluid collections History: Pancreatitis ABDOMEN:LUNG BASES: Bilateral pleural effusions with compressive atelectasis are stable.LIVER, BILIARY TRACT: No focal hepatic lesions. Pneumobilia is again noted. A biliary stent is unchanged in position, extending to the duodenum. Air is again noted within the gallbladder.SPLEEN: No significant abnormality notedPANCREAS: Loculated fluid collection containing gas abutting the uncinate process of the pancreas contains a drain and has decreased in size and now measures 1.9 x 6.1, previously 2.6 x 8.3 cm (image 70, series 3). The inferior extension of this collection along the paracolic gutter measures 1.3 x 2.0 cm, previously 1.8 x 2.4cm (image 107, series 3). The heterogeneously attenuating collection superior to the drain abutting the inferior surface of the liver is is stable. Interval placement of a pigtail catheter is noted. Foci of gas and substantial amount of high density material that is most suggestive of contained hemorrhage within the collection.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left simple cyst is again noted. Moderate right hydronephrosis similar to the prior study likely related to partial ureteral obstruction from adjacent inflammatory fluid collection. Extensive perinephric fluid collections are stable when compared to previous, with loculated fluid collections along the posterior aspect of the right kidney measuring 2.8 x 1.4cm. Symmetric renal cortical enhancementRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Interval placement of an NG tube with stable positioning of an enteric tube in the jejunum. Postsurgical change duodenojejunostomy.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. Mild interval decrease in size in right perinephric fluid collection with stable placement of percutaneous drain.2. Stable size of the heterogeneous collection superior to the drain, and inferior to the liver/gallbladder containing hemorrhage and foci of gas, with interval placement of new pigtail catheter. |
Generate impression based on findings. | 66 year old female. Uterine carcinosarcoma. Reason: assess for etiology severe left flank pain 2 months s/p left radical nephrectomy. ABDOMEN:LUNG BASES: Scattered granulomas. Ill-defined soft tissue nodule anteriorly at the right lung base (image 3; series 5) measures 0.8 x 0.6 cm is stable. New left pleural effusion and lower lobe atelectasis. LIVER, BILIARY TRACT: Hepatomegaly with overall length of 21 cm. STOMACH: Sutures noted along the lesser curvature from prior partial gastrectomy.SPLEEN: Numerous splenic calcifications are probably old granulomata. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post left nephrectomy. Probable recurrent masses in left nephrectomy bed. RETROPERITONEUM, LYMPH NODES: New left sided upper quadrant posterior masses are new. The largest is 5 x 7.5 cm and second mass is 3 cm in diameter at image 22 of series 6. The lesions extend craniocaudally for 12 cm and are contiguous with the nephrectomy bed. Retroperitoneal adenopathy persists. For reference, 2 x 2.2 cm node at image 61 series 6. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multiple focal sclerotic foci in the lumbosacral spine and pelvis. OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy. Ovaries not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable sclerotic lesions in the pelvis and lumbosacral spine. OTHER: No significant abnormality noted. | Status post left nephrectomy and hysterectomy. New left upper quadrant masses extend to the nephrectomy bed, suspicious for recurrence. New left pleural effusion and lower lobe volume loss. Ill-defined subcentimeter pulmonary nodule at the right lung base is stable.Stable sclerotic bone lesions. Stable retroperitoneal lymphadenopathy. |
Generate impression based on findings. | Malignant neoplasm of tonsil status post CRT. CHEST:LUNGS AND PLEURA: Left lower lobe nodule inseparable from the inferior pulmonary ligament no longer measurable in the long axis but significantly decreased in size, 3-mm in thickness compared to 10-11 mm previously (5/68). The second nodule in the left lower lobe at a slightly lower level is adherent to the mediastinal pleural surface and has also decreased in size, 10-mm compared to 17-mm previously (5/24).Additional micronodules unchanged compared to previous studies.MEDIASTINUM AND HILA: Lymph node in the right cardiophrenic angle adjacent to the suprahepatic IVC measures 6 mm, previously 8-mm (3/73). 11 mm lymph node also adjacent to the suprahepatic IVC (3/75) measures 11-mm compared to 12-mm on the prior study (3/75).Newly enlarged left hilar lymph node(3/45). New centrally necrotic peripherally enhancing upper left paratracheal lymph node 9-mm (3/24), 1 to 2-mm previously. Interval slight enlargement of an adjacent retrotracheal lymph node (3/25).Other subcentimeter mediastinal lymph nodes unchanged. Normal heart size. Physiologic volume of pericardial fluid.CHEST WALL: Very small lymph nodes in the right internal mammary chain are noted, not typically seen. ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Bilateral adrenal gland nodules are unchanged in size and reportedly not FDG avid.KIDNEYS, URETERS: Exophytic cyst right kidney. Lower pole cyst left kidney.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant change in upper abdominal lymphadenopathyBOWEL, 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. | Mixed response with interval decrease in size of pulmonary nodules and some of it previously measured lymph nodes. However, new lymph node enlargement in the left hilum, right internal mammary chain and mediastinum are consistent with new nodal metastases. Unchanged appearance of adrenal gland nodules and upper abdominal lymphadenopathy. |
Generate impression based on findings. | 64-year-old male with of bladder cancer. Undifferentiated carcinoma involving liver. Reason: cholangiocarcinoma s/p chemo then SBRT (done 9-9-13 40Gy). Please evaluate interval change with liver protocol. CHEST:LUNGS AND PLEURA: Stable small nodular density in the right upper lobe on image 35 series 15, unchanged from the prior study.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Port in the right chest with catheter tip in the superior vena cava.ABDOMEN:LIVER, BILIARY TRACT: The predominantly low-attenuation (on non-contrast images) mass with perhaps peripheral enhancement seen on prior CT and MRI exams has been treated since the prior exam and appears stable. Small hepatic cyst is unchanged. Cholelithiasis. There are multiple metallic clips in the central right hepatic lobe. Several new masses were identified in the pericaval region of the hepatic dome. These include one arterial enhancing mass 1.4 x 3.1 cm at image 10 of series 14. Several adjacent smaller discrete masses are new.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Atrophic kidneys. Right kidney somewhat smaller than the left. Left renal cyst is present.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Vascular calcification.PELVIS:PROSTATE, SEMINAL VESICLES: Post cystoprostatectomy.BLADDER: Post cystoprostatectomy. No masses. The neobladder is stable.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Small pulmonary nodule which is stable.The large hepatic mass is stable when compared to recent MRI.New masses have developed at the hepatic dome with arterial enhancement. Recommend follow-up. May be due to treatment effect vs. recurrent tumor. |
Generate impression based on findings. | SDH. There are right frontal and parietal burrs holes for decompression of a right cerebral convexity subdural hematoma. There is a residual low to intermediate attenuation right cerebral convexity subdural fluid collection that measures up to 10 mm in width, which is unchanged. There is unchanged associated 3 mm of midline shift to the left. There is unchanged mild nonspecific cerebral white matter hypoattenuation that may represent microangiopathy. There is no evidence of acute intracranial hemorrhage, mass, or cerebral edema. The ventricles are stable in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. There is a small amount of residual right frontoparietal subgaleal fluid. | No significant interval change in the subacute right cerebral convexity subdural hematoma and associated mild midline shift. |
Generate impression based on findings. | T2N2b SCC L BOT p16+ s/p TFHX and radiation completed in 2/2013. There is considerable streak artifact related to dental amalgam. Within these limitations, there no discernable residual mass within the left tongue base. There is no significant residual cervical lymphadenopathy. For example, a left level 2 lymph node measures 7 x 6 mm, previously 7 x 6 mm. The mild persistent supraglottic mucosal edema and a trace retropharyngeal effusion are consistent with radiation therapy. There is no significant narrowing of the airways. The salivary glands and thyroid are unremarkable. The major cervical vessels are patent. The osseous structures are unremarkable, aside from unchanged degenerative spondylosis. The imaged intracranial contents are otherwise unremarkable. There is a partially imaged lobulated fluid attenuation lesion in the left lateral subscapular fossa. | 1. No evidence of locoregional tumor recurrence in the left tongue base and no residual significant cervical lymphadenopathy2. A partially imaged lobulated fluid attenuation lesion in the left lateral subscapular fossa, which may represent a distended bursa or ganglion cyst, for example. This can be further evaluated via a dedicated shoulder MRI, if clinically indicated and there are no contraindications. |
Generate impression based on findings. | 75 year old female. Reason: History of bladder cancer s/p cystectomy, please evaluate for recurrent or metastatic disease. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality noted. Status post cholecystectomy. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Omental fat herniated in peristomal region at right lower quadrant iliac loop ostomy site. PELVIS:UTERUS, ADNEXA: Status post hysterectomy. BLADDER: Status post cystectomy. LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No evidence of recurrence. No measurable metastatic disease. |
Generate impression based on findings. | 47-year-old female. Reason: 47 yo female with renal txp, abdominal pain, pls evaluate for free air. ABDOMEN:LUNG BASES: Cardiomegaly, similar to the prior exam.LIVER, BILIARY TRACT: Few scattered subcentimeter hypoattenuating foci in the liver, which are too small to characterize though likely representing cysts.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: The previously measured left adrenal nodule is not well visualized on this study.KIDNEYS, URETERS: Atrophic native kidneys. Right iliac fossa transplant kidney, without hydronephrosis.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Evaluation of the bowel is limited by lack of oral contrast. No evidence of bowel obstruction. No pneumatosis.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Leiomyomatous uterus is large. Multiple calcified fibroids. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Large stool load. Constipation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Pelvic free fluid may be physiologic. | 1. Gaseous distension of bowel, but no free air. 2. Large stool load. Constipation. No evidence of bowel obstruction. |
Generate impression based on findings. | Pituitary adenoma diagnosed in 2005, partial removal in 2006, and gamma knife ablation in July 2013. Left facial pain and burning provoked with facial movement and pressure. There are postoperative findings related to transsphenoidal surgery and probable dacryorhinocystostomy. There is lytic lesion in the right clivus, sella, and cavernous sinus that measures approximately 25 AP x 20 RL x 20 SI mm, although lack of contrast administration limits precise assessment. There is another lytic focus involving the left clivus with possible extension into the left cavernous sinus that measures approximately 10 AP x 10 RL x 12 SI mm. There is expansion of the sella with constriction of the sphenoid sinuses and linear opacification along the sphenoidotomy. There is a 4 mm osteoma within the right ethmoid sinuses. The paranasal sinuses are otherwise clear. The orbits are grossly unremarkable. There is periodontal lucency surrounding ADA 3, which contains dental amalgam. | A residual focus of invasive pituitary adenoma involving the right clivus, sella, and cavernous sinus measures approximately 25 mm. An additional lytic lesions involving the left clivus with possible extension into the left cavernous sinus that measures up to approximately 12 mm may also represent recurrent pituitary adenoma and/or mucocele, although assessment is limited by lack of intravenous contrast. MRI with contrast may be useful for further delineation. |
Generate impression based on findings. | Reason: evaluate for progression of lung nodule History: none CHEST:LUNGS AND PLEURA: Basilar subsegmental atelectasis.The previous dominant pulmonary nodule within the anterior basal segment of the right lower lobe is no longer present. However, several clustered solid pulmonary nodules remain. There is one new peripheral nodule (series 3 image 91 that measures 4 x 4 millimeters. The findings are suspicious for postinflammatory origin, continued follow-up to assure resolution is recommended.There is an ill-defined ground glass nodule within the superior segment of the right lower lobe which was not included in the previous field of view on the abdominal CT (series 6 image 44). This measures 10 x 10 mm. Given the clustered pulmonary lower lobe nodules, this may be inflammatory. The differential consideration includes indolent adenocarcinoma. This should be evaluated on subsequent examination.MEDIASTINUM AND HILA: There is a calcified lymph node right of the superior esophagus causing mild leftward shift (series 4 image 17).The heart size is normal. No pericardial effusion. No mediastinal or hilar lymphadenopathy. CHEST WALL: No axillary lymphadenopathy. Posterior chest wall lipomaABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Hepatomegaly measuring 19.4 cm in craniocaudal dimension. Status post cholecystectomy. Left hepatic lobe cyst is unchanged. Minimal intrahepatic biliary ductal dilatation. The common bile duct is dilated measuring 1.6 cm in diameter, similar to the prior exam. SPLEEN: Stable partially calcified splenic artery aneurysm.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: Prominent main pancreatic duct.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Ileal conduit at right lower quadrant.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | The previous dominant pulmonary nodule within the anterior basal segment of the right lower lobe is no longer present. Several clustered solid pulmonary nodules remain. There is one new peripheral nodule. In suspicious for postinflammatory origin, continued follow-up to assure resolution is recommended.Ill-defined ground glass nodule within the superior segment of the right lower lobe which was not included in the previous field of view on the abdominal CT measures 10 x 10 mm. Given the clustered pulmonary lower lobe nodules, this may be inflammatory. The differential consideration includes indolent adenocarcinoma. This should be evaluated on subsequent examination. |
Generate impression based on findings. | 57 year-old male with altered mental status. There appears mild to moderate enlargement of the lateral ventricles (posterior more than anterior) with undulating borders. There appear scattered hypodensity in the periventricular white matter. The third and fourth ventricles, sulci, and cisterns are symmetric and unremarkable. The corpus callosum appears present.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. Limited view of the skull base shows shortened, defected clivus. | 1. No mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. 2. Findings are suggestive of periventricular leukomalacia. Hydrocephalus is also considered but felt less likely. |
Generate impression based on findings. | Right upper lobe solitary nodule. Remote history of the buccal mucosa neoplasm. LUNGS AND PLEURA: Right lobe groundglass nodule measures 17 mm, unchanged in size (9/78). On the high resolution sequence, there is a very small focus of soft tissue (9/78). This lesion is consistent with a minimally invasive adenocarcinoma or possibly an adenocarcinoma in situ. 6-mm groundglass nodule left lower lobe (9/193) also unchanged. This may represent an area of atypical adenomatous hyperplasia but should continue to be monitored to exclude a small AIS/MIA.Incomplete left major fissure, normal anatomic variant.MEDIASTINUM AND HILA: Mildly enlarged left low cervical lymph node, 7-mm (8/7), not present previously. High riding superior pericardial recess. Normal heart size.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. Slight interval enlargement of a 2.8-cm hypoattenuating lesion in the left hepatic lobe, previously 2.4-cm (8/94). There is a single focus of peripheral nodular enhancement noted along the cranial margin. | 1. Right upper lobe groundglass nodule is most consistent with adenocarcinoma in situ or minimally invasive adenocarcinoma. 2. Left lower lobe groundglass density nodule may reflect a benign area of atypical adenomatous hyperplasia but should continue to be monitored to exclude growth from AIS/MIA. This lesion may be followed by CT in one year.3. Small low cervical lymph node on the left, please refer to separately dictated neck CT for significance.4. Lesion left hepatic lobe is incompletely assessed but could the possibly represent a hemangioma. Given history of malignancy, a baseline dedicated CT or MR of the liver is suggested for further characterization. |
Generate impression based on findings. | Esophageal cancer status post chemo/RT and surgery 3 months ago. CHEST:LUNGS AND PLEURA: Very mild paramediastinal fibrosis likely the result of RT. Linear atelectasis in the right middle lobe terminates in a peripheral area of consolidation, nonspecific. No suspicious pulmonary nodules or masses. Small right pleural fluid collection is unchanged compared to the most recent previous scan.MEDIASTINUM AND HILA: Distal esophagectomy with pull up. No signs of localized recurrence within either the pull up or the remaining native esophagus.No significant lymphadenopathy. Normal heart size. Trace pericardial fluid. Coronary artery calcifications. Ascending aorta 4.7-cm in AP dimension. The sinuses of Valsalva are slightly prominent but this could be secondary to healing should plane with the scanner. It is unchanged compared to previous. Chest port tip at the SVC.CHEST WALL: Peripherally enhancing fluid collection in the right subscapular space measures 17 x 80 mm in transaxial dimensions and approximately 35-mm craniocaudally. This collection appears to communicate with the extrapleural fat between the right fifth/sixth rib interspace where there is a 1.7-cm gap between the surgical fracture fragments. There is minimal displacement and osseus nonunion of the surgical fracture of the right fifth rib laterally. No intercostal or axillary lymphadenopathy is identified.Right chest port.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic disease of the abdominal aorta.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Right subscapular fluid collection with a thin hyperattenuating rim could represent hematoma or seroma. This is seen to communicate with the right extrapleural space via a distracted surgical fracture of the right sixth rib. Lack of intercostal or axillary lymphadenopathy makes an abscess less likely but infection should be excluded on a clinical basis as it may appear radiographically similar.2. No signs of localized recurrence, pulmonary metastases or lymphadenopathy.3. Mild ectasia of the ascending aorta. |
Generate impression based on findings. | Male, 64 years old, seizures. A large region of encephalomalacia is demonstrated within the right MCA distribution involving the right parietal and right temporal lobes compatible with a remote infarct.No CT evidence of acute territorial ischemia is seen. No mass lesion or mass effect is demonstrated. No evidence of intracranial hemorrhage or any other abnormal fluid collection is demonstrated. The lateral ventricles are patent and within normal limits for size.The osseous structures are intact. The paranasal sinuses and mastoid air cells are normally aerated. | 1. Large chronic right MCA stroke.2. No acute intracranial abnormality or other specific findings to account for the patient's symptoms. |
Generate impression based on findings. | 52-year-old male with history of metastatic melanoma CHEST:LUNGS AND PLEURA: No pulmonary nodules or masses.MEDIASTINUM AND HILA: No 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: Hypoattenuating left renal lesion with internal complexity, likely a complex cyst.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: Right external iliac adenopathy measuring 3.5 x 2.2 cm (image 199, series 3).BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Surgical clips are noted in the right inguinal soft tissues. There is soft tissue infiltration along the vessels of the right proximal lower extremity.OTHER: No significant abnormality noted | Right pelvic adenopathy consistent with metastatic disease. |
Generate impression based on findings. | Female 59 years old; Reason: history of metastatic lung cancer to brain, new lung lesion, SUPER D PROTOCOL History: none. LUNGS AND PLEURA: Scattered pulmonary micronodules and scarring. No suspicious nodules.MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. No cardiomegaly or pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Bilateral adrenal nodules are present. Hepatic cyst-like hypodensity. | Lungs unremarkable without evidence of a lung primary cancer. Bilateral adrenal nodules, non-specific. |
Generate impression based on findings. | 49-year-old female patient with history of increased white blood cell count, tachycardia, pneumonia on multiple antibiotics. Assess progression of lung infection. CHEST:LUNGS AND PLEURA: Numerous bilateral, diffusely distributed pulmonary nodules, stable compared to prior examination. Interval decrease in left-sided pleural effusion and associated atelectasis risk consolidation. Persistent right sided consolidation involving the majority of the right middle lobe and partially involving the right lower lobe and right upper lobe.MEDIASTINUM AND HILA: Mediastinal lymphadenopathy, similar to CT chest 10/12/2013. Enlarged right paratracheal lymph node measures 1.4 x 1.7 cm (series 3 image 16).Subclavian central line with catheter tip terminating in the superior vena cava.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Hypoattenuating lesion in the left lobe of the liver is stable compared to prior examination. Perihepatic carcinomatosis stable compared to prior examination. Gallbladder is collapsed.SPLEEN: Wedge-shaped hypoattenuating lesion in the spleen is stable compared to prior examination.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Large, partially calcified retroperitoneal lymph node measures 1.5 x 1.6 cm (series 3 image 29).BOWEL, MESENTERY: Interval decrease in abdominal ascites. Diffuse calcified peritoneal carcinomatosis is stable compared to prior examinations. Distorted bowel with nonspecific bowel wall thickening, which is suggestive of metastatic serosal involvement. Interval resolution of loculated fluid in the right lower quadrant.BONES, SOFT TISSUES: Large ventral abdominal and pelvic wall defect.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy and oophorectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Interval decrease in abdominal ascites. Diffuse calcified peritoneal carcinomatosis is stable compared to prior examinations. Distorted bowel with nonspecific bowel wall thickening, which is suggestive of metastatic serosal involvement. Interval resolution of loculated fluid in the right lower quadrant.Ostomy noted in the right lower quadrant. Residual rectum filled with fluid and anastomosis with residual colon.BONES, SOFT TISSUES: Large ventral abdominal and pelvic wall defect.OTHER: No significant abnormality noted. | 1.Persistent right lung consolidation.2.Interval resolution of pelvic fluid collection.3.Interval decrease in abdominal ascites.4.Calcified peritoneal carcinomatosis is stable compared to prior examination and consistent with treated/partially treated disease. |
Generate impression based on findings. | Female 82 years old; Reason: history of metastatic lung cancer of LUL to the chest wall, reimaging after radiation treatment in August History: pain. CHEST:LUNGS AND PLEURA: Moderate apical centrilobular and paraseptal emphysema. Prior left lower lobectomy.Interval reduction in the size of the posterior left upper lobe chest wall mass with erosion of the adjacent rib, which now measures 2.9 cm x 2.9 cm (series 3 and image 76), compared to 4.3 x 4.6 cm previously. Interval reduction in the size of the left upper lobe subpleural nodule which now measures 0.8 x 1.7 cm (series 5 and image 39) are as previously and CT PET the lesion measured 1.4 x 1.7 cm. MEDIASTINUM AND HILA: Cardiomegaly or pericardial effusion. Coronary artery calcifications are noted. No significant mediastinal lymphadenopathy. Bilateral hilar lymphadenopathy. Reference left hilar lymph node measures 1.3 cm (series 3, image 53), previously measured 1.0 cm on the previous PET/CT.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Status post cholecystectomy with mild intrahepatic and extrahepatic biliary ductal dilatation. The common bile duct measures up to 1.3 cm in diameter.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Aortobiiliac atherosclerosis. There is aneurysmal dilation of the abdominal aorta measuring up to 3.1 cm in the transverse dimension (series 3, image 23) and is unchanged compared to previous exam. Note is made of thrombus in the anterior wall of the aneurysm.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Degenerative changes of the spine are seen.OTHER: No significant abnormality noted. | 1.Interval reduction in the biopsy proven left upper lobe chest wall mass and left upper lobe subpleural nodule status post radiation treatment. 2.Bilateral hilar lymphadenopathy again seen with interval slight increase in the size of the left hilar lymph node. |
Generate impression based on findings. | Hodgkin's lymphoma status post autologous transplant. 6 month follow up. CHEST:LUNGS AND PLEURA: Minimal scarring at the right lung apex. Unchanged non-specific micronodules. No new nodules or masses. No pleural effusion.MEDIASTINUM AND HILA: Interval reduction in the size of the anterior mediastinal soft tissue mass, now 3.4 x 1.3 cm (series 401, image 43), previously 3.8 x 1.7 cm. The reference right hilar lymph node is unchanged at 10 mm (series 401, image 41). No new enlarged lymph nodes. Normal sized heart without pericardial effusion.CHEST WALL: No axillary lymphadenopathy. Interval removal of the right central venous catheter.ABDOMEN:LIVER, BILIARY TRACT: Normal in appearance, without focal lesions or ductal dilatation.SPLEEN: Normal in appearance and size.PANCREAS: Normal in appearance, without focal lesions.ADRENAL GLANDS: Normal in appearance.KIDNEYS, URETERS: Normal symmetric size and perfusion, without pelvocaliceal dilatation or focal lesions.RETROPERITONEUM, LYMPH NODES: No retroperitoneal or mesenteric lymphadenopathy.BOWEL, MESENTERY: Nondilated loops of bowel without wall thickening, associated mesentery stranding, or fluid collections.BONES, SOFT TISSUES: No osseous abnormalities. No soft tissue abnormalities.OTHER: No ascites.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: Nondilated loops of bowel without wall thickening, associated mesentery stranding, or fluid collections.BONES, SOFT TISSUES: No osseous abnormalities. No soft tissue abnormalities.OTHER: No ascites. | 1.Continued reduction in size of the anterior mediastinal mass.2.Unchanged right hilar lymph node3.No new sites of disease in the chest, abdomen, or pelvis. |
Generate impression based on findings. | 68-year-old male with prostate cancer and rising PSA. ABDOMEN:LUNG BASES: Aortic valvular and coronary arterial calcifications. No pulmonary nodules or masses.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: Atherosclerotic calcification of the abdominal aorta and its branches. No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild sclerosis along the lateral aspect of a left lower thoracic rib may represent subtle metastatic disease.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Radiodense beads are noted within the prostate.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerosis of the L4 vertebral body which may relate to metastatic disease.OTHER: No significant abnormality noted | Findings suggestive of osseous metastatic disease involving the lumbar spine and ribs, correlate with bone scan. |
Generate impression based on findings. | Reason: h/o HNC, CRT, compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: Right lower lobe calcified granuloma.No sign of pulmonary or pleural metastases.MEDIASTINUM AND HILA: Evidence of healed granulomatous disease, and an upper normal size node may be present now in the AP window region, but more likely is fluid in a pericardial recess..Residual thymic tissue appears prominent, possibly rebound hyperplasia.CHEST WALL: Prior chest wall port has been removed.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Small hypodensity unchanged, likely a hemangioma.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Unchanged dilated gonadal veins. BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No reliable evidence of metastases, although there is some mediastinal nodal prominence and as well as rebound thymic hyperplasia. |
Generate impression based on findings. | Reason: 78 yo M w/ T2 N0 RUL lung cancer treated with SBRT in 3/2013. Please evaluate for interval change History: lung cancer post-treatment surveillance CHEST:LUNGS AND PLEURA: Severe centrilobular and paraseptal emphysema with apical predominance.Right upper lobe nodule and previously measuring 12 x 16 mm now measures 10 x 16 mm (series 4, image 27). Increased surrounding nodularity of the cranial aspect falls within the radiation field and is probably post therapeutic. Bronchial narrowing of the posterior segment of the right upper lobe may also be from radiation.Previously noted micronodules are no longer visible. Stable bibasilar reticular opacities at the lung bases with mild bronchial wall thickening and bronchiectasis.No pleural effusions or pneumothorax.No new suspicious focal nodules or masses.MEDIASTINUM AND HILA: Coronary artery stents and ascending aortic graft.Moderate to severe coronary artery calcifications.No significant mediastinal or hilar lymphadenopathy.Heart size is normal. No pericardial effusions.CHEST WALL: New filling defect within upper trachea at the level of the cricoid may be debris.Surgical hardware is again noted.ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted. Collapsed or absent gallbladder.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral hypodense lesions not significantly changed since prior exam.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.Diverticulosis of the ascending, transverse, and descending colon without evidence of diverticulitis.BONES, SOFT TISSUES: Degenerative changes of the lumbar spine with vacuum disk phenomenon.OTHER: No significant abnormality noted. | 1.Stable to mild interval decrease in size of right upper lobe nodule.2.Expected progression of post radiation changes to the right upper lobe.3.Probable debris within the trachea. |
Generate impression based on findings. | Mesothelioma with new onset of pulmonary pneumonitis from chemotherapy. Patient is status post two weeks of steroids. LUNGS AND PLEURA: Near complete resolution of parenchymal ground glass opacities previously seen in the right lung. Minimal residual groundglass opacity is noted in the right lower lobe (5/45) compared to the prior outside study. Circumferential pleural thickening and fluid consistent provided history of mesothelioma is seen on the right with subjective increase since previous study. This will be detailed at the time of the patient's neck staging exam. MEDIASTINUM AND HILA: Mediastinal lymphadenopathy similar to recent outside CT, slightly increased compared to the 10/2/13 exam. Leftward mediastinal shift. Tumor is inseparable from the epicardial fat on the right and causes narrowing of the suprahepatic IVC.CHEST WALL: Tumor extends through the chest wall anteriorly, posteriorly and laterally on Series 3 Image 67, noted previously. Additional small foci of ipsilateral chest wall involvement are seen caudal to this level. Invasion of subpleural and paravertebral fat noted on the right. A mild right intercostal lymphadenopathy.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Ascites. Peritoneal caking from abdominal involvement by tumor, incompletely included on this scanning range but increased compared to previous study in the left upper quadrant (3/98). | Improved groundglass opacities consistent with response to steroid therapy. Minimal residual opacity is seen in the right lung base. Subjective slight worsening of thoracic and abdominal disease which will be quantified on the patient's neck staging study. |
Generate impression based on findings. | Reason: mediastinal mass History: mediastinal mass LUNGS AND PLEURA: Scattered benign appearing micro-nodules, some calcified, but no significant pulmonary or pleural abnormality. MEDIASTINUM AND HILA: Residual soft tissue along the right paraesophageal region is unchanged, where earlier there had been a cystlike abnormality likely an esophageal duplication cyst or bronchogenic cyst. There has been no recent change, and there is no evidence of cyst redevelopment.There is no significant 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. Cholecystectomy clips. | No evidence of a mediastinal lesion recurrence, or other significant abnormality. |
Generate impression based on findings. | Female 77 years old; Reason: please characterize cervical and axillary lymphadenopathy for possible malignancy History: cervical and axillary lymphadenopathy seen on neck CT could LUNGS AND PLEURA: Centrilobular emphysema is seen. Bibasilar dependent atelectasis. Scattered bilateral pulmonary micronodules. No suspicious nodules. No pleural effusions.MEDIASTINUM AND HILA: Left-sided predominately hyperattenuating thyroid nodule with calcifications measures 3.2 x 4.2 cm (series 3, image 17). This appears unchanged compared to previous exam. A right fluid attenuating thyroid lesion demonstrates interval reduction in size and measures 2.7 x 3.1 cm (series 3, image 11), whereas previously it measured 4.3 x 3.7 cm. No change in the right supraclavicular lymph node which measures 1.0 x 1.5 cm (series 3, image 9). Mild subcentimeter axillary lymphadenopathy especially on the right, unchanged from previous exam. No significant change in the right paraesophageal lymph node which measures 1.1 x 1.2 cm (series 3, image 74), previously measured 1.1 x 1.1 cm. No hilar lymphadenopathy. Right atrial enlargement. No pericardial effusion. Focal eventration of the right hemidiaphragm.CHEST WALL: Degenerative changes noted of the thoracic spine most severe at T11-T12 where there is bone-on-bone apposition of the endplates and endplate sclerosis.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Segment 7 hypoattenuating lesion compatible with a hemangioma (series 3 image 31). Additional small subcentimeter hypoattenuating foci are too small to characterize. Calcified splenic granulomas. | 1.Interval reduction in the size of the cystic appearing fluid attenuating right thyroid lesion, status post fine needle aspiration.2.No change in size of the large left predominately hyperattenuating thyroid nodule with peripheral calcification.3.No significant change in the right supraclavicular, axillary, and right paraesophageal lymphadenopathy. |
Generate impression based on findings. | Reason: 48 y/o malae with HNC s/p March 2013, Completed 7 cycles of CRT History: as above CHEST:LUNGS AND PLEURA: No evidence of pulmonary or pleural metastases.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Mild degenerative abnormalities affect the thoracic spine.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Small accessory splenules noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Scattered small renal cystlike hypodensities are stable.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No sign of metastases, or other significant abnormality. |
Generate impression based on findings. | 85 year old female with Reason: unintentional weight loss, fatigue. evaluate for cancer. Increased bloating / belching. History: weight loss CHEST:LUNGS AND PLEURA: There is mild diffuse emphysematous change. No concerning parenchymal nodular masses were identified.MEDIASTINUM AND HILA: Few tiny hilar and mediastinal lymph nodes are seen. No enlarged hilar or mediastinal lymph nodes are identified. Small hiatal hernia.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY: Dependent gallstone in the gallbladder is stable.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable cysts are present in both kidneys.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: A calcified fibroid is seen in the pelvis. Atrophic uterus. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diffuse scattered colonic diverticulosis. Normal appendix in the right lower quadrant. BONES, SOFT TISSUES: Sclerotic focus in right sacrum is noted. Fat containing subcutaneous nodules in right buttock may be old injection sites. OTHER: No significant abnormality noted. | 1) Stable examination since 2009.2) Diffuse emphysematous changes seen in the lung. 3) Colonic diverticulosis.4) No specific abnormality to explain weight loss. |
Generate impression based on findings. | 42-year-old female patient with history of soft tissue sarcoma with new abnormality in the liver. Please evaluate for metastases. CHEST:LUNGS AND PLEURA: Reconstruction of right upper lobe lung nodule (series 11 image 48), stable.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Status-post cholecystectomy. Hypoattenuating, nonenhancing lesion in segment 6 of the liver measures 1.8 x 3.3 cm (series 12 image 96), measures fluid density and likely represents a cyst. Segment 3 subcentimeter hypoattenuating lesion is nonenhancing, is too small to characterize and likely represents a cyst.SPLEEN: No significant abnormality noted.PANCREAS: Subcentimeter focus of fat attenuation in the body of the pancreas likely represents fatty infiltration versus tiny lipoma (series 12 image 88).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Right sacroiliitis.OTHER: No significant abnormality noted. | Two hypoattenuating, nonenhancing lesions in the liver most likely represent cysts. |
Generate impression based on findings. | Reason: evaluate ILD History: soboe LUNGS AND PLEURA: Apical scar like abnormalities unchanged.Lower lung zone predominant moderate to severe interstitial lung disease, not significantly changed, characterized by subpleural reticular opacities, honeycombing, scattered regions of traction bronchiectasis but no significant groundglass disease.Expiration series fail to reveal air trapping. MEDIASTINUM AND HILA: Scattered mediastinal lymph nodes are consistent with interstitial lung disease.Mild coronary artery calcifications are present.Apparent lucency in the region of the left atrial appendage could be a thrombus, but without contrast more likely is an artifact of adjacent fat.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. Moderate interstitial lung disease. Although there is apical fibrosis this may be a separate process as often seen in the apices, rendering this a UIP pattern.2. Questionable left atrial appendage hypodensity/thrombus, for which a cardiac echo is recommended. This is unchanged since 9/17/2013, however. |
Generate impression based on findings. | Left pneumonectomy and right upper lobectomy for lung cancer. LUNGS AND PLEURA: Left pneumonectomy. The right upper lobe is present. Numerous ground glass density lesions in the right lung.Mixed density lesion in the right upper lobe (4/51) contains internal solid components, currently measuring 17 x 16 mm, previously 16 x 13mm in 2012 and 12 x 12 mm in 2011. This lesion is compatible with an indolent adenocarcinoma.Lesion near the right apex measures 18-mm in length and also appears to contain some solid components (4/15). This previously measured 16mm in 2012 hand 14-mm in 2011, also suspicious for malignancy.10-mm groundglass nodule in right apex (5/31) previously measured 7-mm in 2012 and 6-mm in 2011. This lesion is indeterminate and could reflect an area of atypical adenomatous hyperplasia, adenocarcinoma in situ or possibly a minimally invasive adenocarcinoma.The multiple additional groundglass lesions are less than 1cm in size and could reflect atypical adenomatous hyperplasia or small adenocarcinomas; these could be followed by yearly CT for growth.MEDIASTINUM AND HILA: Severe leftward mediastinal shift. Massive enlargement of the right atrium and its appendage. Mild to moderate mediastinal lymphadenopathy with a subtle increase compared to remote earlier studies. For reference, a lymph node in the left paraesophageal region and measures 6-mm (3/21) .CHEST WALL: Interval development of small subpleural soft tissue nodules in the extrapleural fat near the apex (3/21) given the architectural distortion these probably represent intercostal lymph nodes. Rib crowding due to pneumonectomy on the left.Probable left lateral meningocele at the level of T9UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Elevation of the left hemidiaphragm with herniation of the stomach adjacent to the left cardiac border, correlate for history of pull up. | 1. Two mixed density nodules (groundglass with semi-solid to solid components) in the right upper lobe are compatible with indolent adenocarcinoma such as minimally invasive or invasive adenocarcinoma.2. Lymphadenopathy in the mediastinum and left chest wall is mild but now suspicious for nodal metastases given growth compared to earlier exams.3. Indeterminate one cm lesion in the right apex increased in size compared with last exams. Although this could reflect atypical adenomatous hyperplasia, AIS/MIA cannot be excluded.4. Recommend yearly CT follow-up for additional groundglass lesions in the right lung.5. The patient's right upper lobe has not been resected. |
Generate impression based on findings. | 49-year-old male with vocal cord cancer status post 7 cycles CRT. Brain:Redemonstration of a 7-mm extra-axial enhancing mass in the left frontal region, unchanged. Favor a benign meningioma over metastatic disease. Elsewhere, no suspicious enhancing parenchymal or extra-axial lesions are identified. No focal edema or mass effect. The bones of the calvarium and skull base are intact. Normal opacification of anterior left ethmoid air cells, otherwise the paranasal sinuses and mastoid air cells are clear.Neck:Interval decrease in hyperemia at the tongue base mucosa. Interval decrease in epiglottic and aryepiglottic fold thickening and enhancement. The preepiglottic space is preserved. Mild anatomic distortion of the glottis and supraglottic tissues is similar to the prior examination. Erosive change of the anteromedial thyroid cartilage is stable. The left arytenoid cartilage is also slightly sclerotic similar to prior. An ill-defined enhancing region at the right tongue base is again identified and measures 1.3 x 1.0 cm (series 80490 image 54), previously measured 1.3 x 1.0 cm.No definite pathologic enhancement is seen elsewhere throughout the aerodigestive tract. No pathologic adenopathy by CT size criteria. Salivary glands and thyroid are free of focal lesions. The cervical vasculature remains patent.No significant interval change in the well-defined round lucency within the left lateral mass of C1. No new or concerning focally destructive osseous lesions are present. The visualized lung apices are clear. | 1. Interval decrease in thickening and hyperemia at the base of the tongue as well as the epiglottis and aryepiglottic folds. Distortion of the glottic and supraglottic space is unchanged.2. No evidence of pathologic adenopathy in the neck.3. Stable small left frontal enhancing lesion which is likely an incidental meningioma. No convincing evidence of intracranial metastases. |
Generate impression based on findings. | 72-year-old male with history of CLL on treatment CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: . Marked interval decrease in mediastinal lymphadenopathy. Reference subcarinal lymph node measures 3.7 x 1.1 cm and previously measured 3.7 x 2.4 cm (image 54, series 3). Multiple additional lymph nodes are decreased in size. Severe atherosclerotic calcification of the coronary arteries.CHEST WALL: Interval resolution of axillary lymphadenopathy.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: The spleen measures 12.4 cm.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Unchanged bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Reference mesenteric lymph node measures 1.4 x 1.1 cm and previously measured 1.7 x 1.5 cm (image 101, series 3). Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: . No decrease in pelvic lymphadenopathy. Reference left-sided external iliac lymph node measures 2.6 x 0.7 cm and previously measured 4.9 x 1.9 cm (image 205, series 3).BOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Status post L4 laminectomy. Degenerative changes of the lower lumbar spine. Focal atrophy of the right gluteal muscle with scattered calcifications.OTHER: No significant abnormality noted | Marked interval decrease in lymphadenopathy and all reference lesions as detailed above |
Generate impression based on findings. | Male 56 years old; Reason: uncontrollable cough History: uncontrollable cough. LUNGS AND PLEURA: No focal opacities, pleural effusions or pneumothorax. Dependent atelectasis in the lung bases. Central airways are clear. Right lung base predominant bronchial wall thickening is present. Scattered pulmonary micronodules. No suspicious nodules.MEDIASTINUM AND HILA: No cardiomegaly or pericardial effusion. Moderate coronary artery calcifications. Scattered subcentimeter mediastinal lymph nodes. No hilar lymphadenopathy.CHEST WALL: Mild degenerative changes are noted in the thoracic spine with anterior osteophyte formation.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Simple appearing low attenuating hepatic cyst in the left lobe of the liver is unchanged in size compared to the previous exam and likely represents a benign hepatic cyst. | Basilar bronchial wall thickening, suggest of chronic aspiration or other cause of inflammation. |
Generate impression based on findings. | Malignant fibrous histiocytoma metastatic to lung with left upper lobe resection. Presented with infected port, persistent bacteremia, but worsening productive cough. Evaluate for pneumonia, septic emboli or other pathology. LUNGS AND PLEURA: Small pleural fluid collections. Left hilar mass smaller, approximately 3.7 x 3.2 cm, previously 3.8 x 4.5 cm. Left upper lobe segmental atelectasis is new and probably secondary to an obstructing bronchial lesion seen on series 3 image 34. Pleural thickening and nodularity on the left incompletely assessed without IV contrast but mildly suspicious for pleural metastases or empyema.Peribronchial ground glass opacities right upper lobe suspicious for infection. These are seen to a lesser extent elsewhere in the right lung. Focal ground glass opacity in the aerated portion of the left lower lobe posteriorly is also new.MEDIASTINUM AND HILA: Thrombosis of the right jugular vein with peripheral enhancement suspicious for infected thrombus. The clot extends caudally to the confluence of the brachiocephalic vein to the superior vena cava (3/22) and also extends into the right subclavian vein for a short distance.Left hilar and interlobar lymphadenopathy slightly larger, 23-mm compared to 14-mm previously (3/37). Mediastinal lymphadenopathy elsewhere unchanged. Lymphadenopathy in the right hilum slightly more prominent. CHEST WALL: Right chest port pocket filled with air and debris but no drainable fluid collection.8-mm centrally lucent nodule with rim enhancement (series 3 image 3) anterior to the left sternocleidomastoid muscle with surrounding inflammatory change new from previous but of unclear etiology. This could possibly reflect enhancement of small vessels with volume averaging however a small metastatic infectious lesion cannot be entirely excluded.Numerous small left-sided intercostal lymph nodes are present, not normally visible. .UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. Diffuse peribronchial and groundglass opacities consistent with pneumonia. No specific signs of septic emboli at this time.2. Thrombosis of the right jugular vein with clot extending into the superior vena cava and right subclavian vein. Peripheral enhancement may be a sign of infected thrombus.3. Interval development of left upper lobe segmental atelectasis probably secondary to an obstructing mass lesion.4. Worsening lymphadenopathy in the thorax and left chest wall.5. Subtle pleural thickening and nodularity on the left is too mild to accurately characterize but could be an early manifestation of metastatic disease or infection of the pleural space. |
Generate impression based on findings. | Male, 57 years old, base of tongue tumor, with dysphagia. No mass effect, focal edema or suspicious enhancement is seen to suggest brain parenchymal metastatic disease. The bones of the calvarium and skull base are intact. Fluid levels and mucosal thickening are demonstrated in the bilateral maxillary sinuses.Asymmetric enhancing and thickened soft tissue is seen along the left glossotonsillar sulcus. The abnormal region measures 2.3 x 1.7 cm (image 32 series 7). The remainder of the aerodigestive mucosa is unremarkable.Two pathologically enlarged left level 2 lymph nodes are identified. For reference, the more inferior of these nodes measures 2.0 x 1.4 cm (image 37 series 7). No definite additional pathologic adenopathy is seen in the left neck. No contralateral adenopathy is detected.The salivary glands and thyroid are free of focal lesions. The cervical vessels are patent with evidence of some atherosclerotic calcification at the level of the carotid bifurcations. Lung apices are remarkable for paraseptal emphysema. No worrisome osseous lesions are detected. | Left base of tongue/tonsillar tumor with left level 2 adenopathy. |
Generate impression based on findings. | 72-year-old male with history of CLL on treatment, evaluate Limited intracranial views are unremarkable. Mild mucosal thickening of the left maxillary sinus and anterior right ethmoid air cells, the remainder of the visualized paranasal sinuses are clear. The mastoid air cells are clear.Interval resolution of cervical lymphadenopathy. Small scattered lymph nodes are identified throughout the neck. Several of the reference lymph nodes are no longer identified. Reference node anterior to the right SCM (station two) measures 5 mm (series 7 image 38), previously measured 14 mm. A second reference node at the left mandibular angle (station two) measures 4 mm (series 7 image 36), previously measured 11 mm. Interval decrease in the previously identified prominent lymphoid tissue at the base of the tongue.No soft tissue masses are identified in the neck. The parotid and submandibular glands are free of focal lesions. Small hypoattenuating nodule in the left thyroid lobe. No exophytic masses or focal effacement of the aerodigestive tract. The cervical vasculature is patent. Mild atherosclerotic calcifications at the carotid bifurcations.Prominent superior mediastinal lymph nodes. The visualized lung apices are clear. Please see dedicated chest CT from today's date for further details.Severe multilevel degenerative disease of the mid cervical spine similar to the prior without suspicious osseous lesions. | 1. Interval resolution of cervical lymphadenopathy by CT size criteria.2. Prominent superior mediastinal lymph nodes. Please see dedicated chest CT from today's date for further details. |
Generate impression based on findings. | Male 79 years old; Reason: Hx of Relapsed Large Cell NHL History: s/p 5 cycles of chemotherapy CHEST:LUNGS AND PLEURA: The previously seen ground-glass opacities involving the upper lobes and lower lobes have resolved. No focal consolidation. There is mild lower lobe bronchiectasis. No parenchymal volume loss or fibrosis. No nodule or mass detected.MEDIASTINUM AND HILA: Heart size is normal. Coronary artery calcifications. Small mediastinal lymph nodes are unchanged in size and not enlarged by CT criteria.Right chest wall port terminates at the caval atrial junction.CHEST WALL: Multiple thyroid nodules some of which are calcified.OTHER: ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesions. Status post cholecystectomy.SPLEEN: The spleen is normal in size.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Upper abdominal retroperitoneal lymph node measures 0.6 x 0.8 cm (series 3 image 104) previously 0.9 x 0.7 cm.Severe calcific arteriosclerotic diseaseBOWEL, 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 pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Sclerotic foci in the left ilium are unchanged and may represent bone islands.The soft tissue nodule in the left subcutaneous fat adjacent to the gluteus maximus muscle has decreased in size.OTHER: No significant abnormality noted | 1.Decrease in the size of the upper abdominal retroperitoneal lymph node. No new lymphadenopathy.2.Resolution of the previously noted ground glass pulmonary opacities. |
Generate impression based on findings. | Male 52 years old; Reason: metastatic/recurrent head and neck ca, on therapy, eval for progression with measurements History: as above CHEST:LUNGS AND PLEURA: Postoperative changes from a right middle lobectomy and right lower lobe wedge resection. There are multiple metastasis to the lungs and pleura, many of which are either new or increased in size. In the base of the left lung is a 3.1 x 4.4 cm soft tissue density mass (series 6, image 59) that has increased in size since previous exam where it measured 2.2 x 3.3 cm. there is also been interval development of a unilateral left sided pleural effusion. Additionally the right lung base parenchymal and subpleural nodules have also increased in size. MEDIASTINUM AND HILA: Several mediastinal lymph nodes are slightly larger. A right inferior lobar lymph node is new and measures 1.2 cm (series 5, image 49).. Mild cardiomegaly with small pericardial effusion.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Concentrically calcified large gallstone in the gallbladder.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Again seen is an infiltrative left renal metastasis extending from the apex of the kidney to the renal hilum and encasing the left renal vasculature. The collecting system and proximal ureter are of abnormal attenuation, suspicious for tumor infiltration. The mass measures 4.1 x 5.6 centimeters (series 5, image 85), whereas previously it measured 3.9 x 4.7 cm. PANCREAS: Atrophic pancreas again seen.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Increasing size and number of the pulmonary and pleural metastases. Left renal lesion measures larger. |
Generate impression based on findings. | T2N0 laryngeal squamous cell carcinoma treated with 70 Gy to the larynx and 56 Gy to the cervical nodes through January 2009. The cancer recurred, and hemilaryngectomy was performed in September 2009 followed by total laryngectomy in February 2010 for another recurrence. In August 2010 he was found to have a 4.7 x 4.7 x 3.9 cm mass in the right pharyngeal space that encased the right external carotid. He was also found to have lesions at T10 and T12 concerning for metastatic disease. He then had 3 cycles of cetuximab, carboplatin, and paclitaxel followed by 5 cycles of TFHX, completing in April 2011. The patient also developed metastases elsewhere and is on MK-3475 protocol. Head: There is no mass effect, edema, or abnormal intracranial enhancement. The ventricles are stable in size and configuration. There is mild mucosal thickening within the bilateral maxillary sinuses. The mastoid air cells are clear. The orbits and osseous structures are unremarkable. Neck: There are post-treatment findings related to total laryngectomy with tracheostomy, neck dissection, and radiation therapy with persistent extensive mucosal edema in the neopharynx and oropharynx. There is no discrete mass lesion to suggest tumor recurrence. There is no significant cervical lymphadenopathy. For example, a left level 1B lymph node measures 5 x 8 mm and a pretracheal lymph node measures 5 x 6 mm, which are unchanged. The right internal jugular vein appear to be absent, but the remaining major vessels in the neck are patent. The salivary glands and remaining portions of the thyroid gland are unchanged. There are multiple dental carries. The imaged portions of the airway and lung apices are clear. Also refer to the separate chest CT for additions findings. | Extensive post-treatment findings without definite evidence of locoregional tumor recurrence or significant cervical lymphadenopathy. |
Generate impression based on findings. | Female 70 years old; Reason: Left lower quadrant abdominal pain History: Pain for 3 weeks ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: A few too small to characterize lesions in the kidneys. No hydronephrosis or perinephric fluid collections 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:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is mild distention of the small bowel with mottled appearance of stool within the small bowel. Mesenteric stranding (series 3 image 96) is noted in the small bowel mesentery. Numerous diverticula are seen in the colon without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Dilated serpiginous venous structures in the pelvis are noted, correlate for pelvic congestion syndrome.. | 1.Mild distention of the small bowel with small bowel feces sign and mesenteric stranding, correlate for chronic low-grade obstruction.2.Findings compatible with pelvic congestion syndrome |
Generate impression based on findings. | Female, 45 years old, with right ear canal stenosis, right ear infection. The cerebral and cerebellar hemispheres and brainstem are normal in attenuation and morphology. No intracranial hemorrhage or abnormal extra-axial fluid collection is seen. There is no evidence of mass effect or midline shift. The ventricles and basal cisterns are patent and normal in size. Minimal opacification of the left ethmoid air cells is seen. The remaining paranasal sinuses are well pneumatized.The right external auditory canal shows no evidence of bony stenosis. However, there is soft tissue thickening within the canal which may be occlusive or nearly occlusive. There is also soft tissue thickening deeper within the canal at the level of the tympanic membrane. The middle ear cavity seems to be normally aerated on this non-dedicated examination. The mastoid air cells are grossly pneumatized.The bones of the calvarium and skull base are intact. | 1. No intracranial abnormalities.2. Nonspecific soft tissue thickening along the right external auditory canal is demonstrated. The right middle ear cavity is normally aerated as visualized on this nondedicated exam. |
Generate impression based on findings. | Reason: Left Tonsil SCCA, pretreatment scan History: Left Tonsil SCCA CHEST:LUNGS AND PLEURA: Multiple small calcified granulomas and few micronodules bilaterally. No suspicious focal nodules or masses. No pleural effusion or pneumothorax. Mild paraseptal emphysema with apical predominance.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusions. Moderate to severe atherosclerotic calcifications of the aorta and coronary arteries.No significant mediastinal or hilar lymphadenopathy.CHEST WALL: Degenerative changes to the thoracic spine.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Multiple calcified granulomas.ADRENAL GLANDS: Bilateral adrenal nodules, right greater left.KIDNEYS, URETERS: Bilateral multiple hypodense lesions most likely cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Severe atherosclerotic calcification of the abdominal aorta and bilateral iliac arteries.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.Mild apical predominant paraseptal emphysema.2.No focal suspicious pulmonary nodules or masses.3.Bilateral, right greater than left, adrenal nodules. |
Generate impression based on findings. | 34 year old female, pre kidney transplant surveillance. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Extremely dense breast tissue with multiple soft tissue masses and several coarse calcifications incompletely characterized by CT.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: Atrophic native kidneys, and right iliac fossa renal transplant.RETROPERITONEUM, LYMPH NODES: No significant atherosclerotic calcifications of the abdominal aorta or its branches.BOWEL, MESENTERY: Note is made of a small gastric diverticulum projecting near the left adrenal gland.BONES, SOFT TISSUES: Peritoneal dialysis catheter extends along the inferior aspect of the right hepatic lobe.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: Trace pelvic ascites. | Atrophic native kidneys and right iliac fossa transplant kidney. No significant atherosclerotic calcification of the abdominal aorta or its branches. |
Generate impression based on findings. | Female, 57 years old, right mandibular swelling. The soft tissues of the right mandibular region are unremarkable. In particular, no evidence of skin thickening, subcutaneous infiltration or fluid collection is seen. The parotid and submandibular glands are normal. The musculature of the masticator space is unremarkable.No fractures or focal destructive lesions are seen within the mandible. No concerning abnormalities are detected elsewhere in the maxillofacial region. The paranasal sinuses are clear. The nasal septum is intact. | No specific findings are seen to account for the patient's symptoms. |
Generate impression based on findings. | Head and neck cancer status post CRT CHEST:LUNGS AND PLEURA: Majority of the pulmonary nodules in micronodules are unchanged. New small nodular focus of consolidation with extension to the pleural surface in the left lower lobe measuring 9-mm in thickness could reflect a small subsegmental infarct or postinflammatory lesion.No pleural fluid or pneumothorax.MEDIASTINUM AND HILA: Right chest port tip in the right atrium. Normal heart size. Stable small right cardiophrenic lymph nodes. Cluster of mildly enlarged right paracardiac lymph node seen anterior to the suprahepatic IVC appear relatively flat on the coronal images and are probably unchanged in size compared to the prior study allowing for differences in scan variability. Tracheostomy tube tip above the carina. Small lymph nodes in the thoracic inlet are unchanged. The distal esophagus is mildly thickened, unchanged.CHEST WALL: Right chest port. Small lymph node near the origin of the left pectoralis minor (6/2), about the same.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: New 15 x 18 mm hypoattenuating lesion in the left hepatic lobe incompletely assessed but suspicious for metastasis. Numerous additional hypoattenuating lesions in the liver have a density suggestive of fluid, likely cysts.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Renal cortical scarring.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. New 18-mm lesion in the right hepatic lobe suspicious for a metastasis. Recommend correlation CT for further characterization.2. New nodular focus of consolidation in the left lower lobe unlikely to represent a metastasis given its configuration but could reflect a small subsegmental infarct or a postinflammatory lesion. This could be followed by CT in 6 weeks if clinically warranted.3. Nonspecific thickening of the distal esophagus. |
Generate impression based on findings. | Female 68 years old; Reason: on an OSH CT scan of teh abd/pelcis, pt was found to a 2 mm RLL nodule; needs a dedicated chest CT; h/o smoking History: none. LUNGS AND PLEURA: Apical predominant emphysema is noted. There are multiple bilateral pulmonary micronodules most prominent in the lung bases. Reference right lower lobe micronodule measures 3 x 3 mm (series 5, image 67). Outside study is not available for comparison at this time. The nodules are all located within the area that was atelectatic/consolidated in 2006 MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. No supraclavicular or axillary lymphadenopathy. Moderate coronary artery calcification. Atherosclerotic calcification of the ascending aorta. No cardiomegaly or pericardial effusion.CHEST WALL: Degenerative changes of the spine are noted especially prominent at T7-T8. No suspicious lesions.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Calcific density in the right dome of the liver, likely calcified granuloma. | Multiple bilateral pulmonary micronodules, predominately in the lung bases. These are nonspecific and OSH imaging is not available for comparison at this time. Follow-up is CT recommended in 3 months given the patients age, distrubution and lack of signs of granulomatous disease to exclude metastatic lesions from an occult primary, though postinflammatory lesions are equally as likely. If the referring clinical service can obtain and submit outside previous study to prove stability, an addendum can be provided. |
Generate impression based on findings. | Metastatic follicular thyroid carcinoma. CHEST:LUNGS AND PLEURA: Numerous pulmonary nodules consistent with metastases. Postobstructive consolidation in the right lower lobe suspicious for infection. Index metastatic lesions as follows:Index lesion in the left upper lobe centrally cavitary and less dense compared to the previous examination, currently measuring 7 x 7 mm, previously 8 x 8 mmsome of the additional non-index lesions are smaller or more tense..MEDIASTINUM AND HILA: Moderate mediastinal lymphadenopathy appears slightly improved, though the index right paratracheal lymph node is not significantly changed and 25-mm compared to 26-mm previously (3/34).No pericardial fluid. Normal heart size.Extrinsic compression of the right descending pulmonary artery again noted (3/49).CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Significant motion artifact degrades image quality.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: The the left iliac vein is compressed as it passes between the vertebral column and the common iliac artery. 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. Overall improvement in size and density of pulmonary metastases. 2. New area of postobstructive consolidation in the right lower lobe could represent pneumonia; pulmonary infarction secondary to extrinsic compression of the pulmonary artery is considered less likely based on the appearance the cannot be entirely excluded.3. Slight improvement in lymphadenopathy.4. Signs of May Thurner syndrome, correlate for clinical symptoms (left leg swelling with standing) |
Generate impression based on findings. | Male 59 years old; Reason: Head and neck screening evaluation. History: as above. CHEST:LUNGS AND PLEURA: Scattered bilateral pulmonary micronodules. No suspicious nodules. MEDIASTINUM AND HILA: Few mildly enlarged lymph nodes are seen in the lower mediastinum. No cardiomegaly or pericardial effusion.CHEST WALL: Right-sided chest terminates in the distal superior vena cava. Multilevel degenerative changes of the thoracic spine with age indeterminate anterior compression fracture of the T7 vertebral body.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple water attenuating cystic lesions are seen the kidneys likely representing benign renal cysts.PANCREAS: No significant abnormality noted.ARETROPERITONEUM, LYMPH NODES: Aortobiiliac atherosclerosisBOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Multilevel thoracolumbar degenerative disease.OTHER: No significant abnormality noted. | No specific evidence of metastasis. Mildly enlarged lower mediastinal lymph nodes should be monitored on subsequent exams but are atypical in distribution for nodal metastases without more cranially located lesions. |
Generate impression based on findings. | 23-year-old female with right-sided abdominal pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No focal hepatic lesions. The gallbladder appears unremarkable.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of right lower quadrant inflammation. The appendix appears normal. The terminal ileum appears normal.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Physiologic-appearing uterus and adnexa for age.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No evidence of right lower quadrant inflammation. The appendix appears normal.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted. | No specific findings to account for the patient's symptoms. |
Generate impression based on findings. | Reason: evaluate lung mass History: cough LUNGS AND PLEURA: New large right upper lobe a solid appearing mass with spiculated margins measuring 28 x 23 mm (series 4, image 30). Portions of the mass stretch out to the pleura. There is a large bulla medial to this lesion.Ground glass opacity in the posterior left upper lobe has increased in size from prior exam (series 5, image 29). Ground glass opacity in the superior segment left lower lobe has increased in size from prior exam (series 4, image 34).Left anterior upper lobe paraseptal emphysema with architectural distortion.No pleural effusions. No pneumothorax.Bilateral calcification of the segmental and subsegmental bronchi.MEDIASTINUM AND HILA: Moderate cardiomegaly. Small pericardial effusion. AICD with leads noted. Severe coronary artery calcifications.Hilar lymphadenopathy. Mediastinal lymphadenopathy is obscured by pericardial effusions.CHEST WALL: Mild degenerative changes to the upper thoracic spine. Superior endplate depression of L2 vertebral body.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Hypodense lesion in the spleen is nonspecific. | 1.Right upper lobe solid appearing mass with spiculated margins highly suspicious for malignancy.2.Few groundglass opacities in the left lung with interval growth as noted above may also represent malignancy.. |
Generate impression based on findings. | 37-year-old female with dyspnea, evaluate for soft tissue swelling. The visualized intracranial contents are unremarkable. The visualized paranasal sinuses and mastoid air cells are clear. The visualized orbits are unremarkable.The airway is patent. The epiglottis is within normal limits. No exophytic mass or focal effacement of the aerodigestive tract is present. Asymmetry of the piriform sinuses, right greater than left. No soft tissue masses are present in the neck. No CT evidence of cervical lymphadenopathy. Hypodense thyroid nodules. The submandibular glands and parotid glands are free of focal lesions.The cervical vasculature is patent.The visualized lung apices are clear. No suspicious osseous lesions are identified. | No specific CT findings to account for the patient's presenting symptoms. |
Generate impression based on findings. | Metastatic thyroid cancer on treatment. HEAD: There is no mass, edema, midline shift, acute hemorrhage, or abnormal contrast enhancement. The ventricles, sulci, and cisterns are stable in size and configuration. The skull and regional extracranial soft tissues are unremarkable. NECK: There are postoperative findings related to total thyroidectomy. There is no discrete mass in the resection bed. There is no significant cervical lymphadenopathy. Hypodense foci within the right palatine tonsil are unchanged and likely represent prominent tonsillar crypts. The oral cavity, pharynx, larynx, and subglottic airways are patent. The epiglottis, vallecula, piriform sinuses, and vocal cords are unremarkable. The parotid and submandibular glands are unremarkable. The carotid arteries and jugular veins are patent. There are no destructive osseous lesions. There is unchanged multilevel degenerative changes with loss of the normal cervical lordosis. There are partially imaged nodules in the left lung apex and partially imaged prominent mediastinal lymph nodes. | 1.Stable postsurgical findings related to total thyroidectomy without evidence of locoregional tumor recurrence.2.No pathologically enlarged cervical lymph nodes.3.No evidence of intracranial metastases.4.Please refer to the separately dictated CT chest report regarding mediastinal adenopathy and pulmonary metastases. |
Generate impression based on findings. | T1N2b SCC left tonsil, p16+, enrolled in clinical trial (IRB 10-069) with IC cis/paclitaxel/cetux. Head: There is no evidence of abnormal intracranial enhancement or mass lesions. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. Neck: There has been interval resolution of the left palatine tonsil mass without discernable residual tumor. There has also been interval decrease in size of cervical lymphadenopathy. For example, a left level 2 lymph node measures 10 x 16 mm, previously 21 x 30 mm and a left level 3 lymph node measures 13 x 16 mm, previously 20 x 28 mm. The thyroid gland and major salivary glands are unremarkable. The airways are patent. There is a right internal jugular venous catheter in position. The major cervical vessels are patent. The osseous structures are unremarkable, aside from mild degenerative cervical spondylosis. The imaged portions of the lungs are clear. | Interval resolution of the left palatine tonsil squamous cell carcinoma without residual measurable disease and interval decrease in the cervical lymphadenopathy. |
Generate impression based on findings. | Benign neoplasm of cerebral meninges The patient has undergone right-sided craniotomy for removal of a right sided extra-axial mass. There is now a CSF space where the mass was adjacent to the right frontal lobe. There is associated intracranial air and a soft tissue swelling superficial to the craniotomy sitePeriventricular and subcortical white matter hypodensities of a moderate degree are present.The lateral ventricles are fairly large but stable.The visualized portions of the paranasal sinuses demonstrate minor mucous retention cysts. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin. There is a scleral band present along the right eyeball | 1.The patient is status post right-sided craniotomy with removal of a previously noted extra-axial mass. There are attendant and expected postsurgical changes present Please note that CT is less sensitive in detecting residual tumor than MRI with contrast.2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. |
Generate impression based on findings. | 1mm slices - history of malignant meningioma, now with recurrence including bony involvement - 1mm slices for preop planning for cranial implantSigns and Symptoms: radiographic progression The patient has undergone left-sided craniotomy previously. On the prior MRI there are foci of enhancement along the cortical surface of the left lobe which are not readily visible on the current exam no associated vasogenic edema is visible and unchanged.The craniotomy flap itself is somewhat irregular along its inner table and has multiple lucent defects along its inferior aspect. There is a pre-operative MRI from 11/14/2011 which seems to indicate that the calvarium adjacent to the tumor was invaded at that time. This irregularity may represent invasion from that time.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.The patient is status post left-sided craniotomy. Previously identified enhancing lesion in the left frontal lobe cannot be identified on the current exam most likely because of the decrease sensitivity of CT relative to contrast enhanced MRI. The extent of vasogenic edema however is similar to the prior MRI exam.2.Although the craniotomy flap there is a somewhat irregular and this may represent bony involvement, it is not clear that this represents bony involvement on the basis of this exam alone. A comparison to a prior CT exam would be helpful to further assess this. There is a pre-operative MRI from 11/14/2011 which seems to indicate that the calvarium adjacent to the tumor was invaded at that time. This irregularity may represent preoperative tumoral invasion. |
Generate impression based on findings. | Large cell non-Hodgkin's lymphoma status post 5 cycles of chemotherapy. The palatine tonsils appear unchanged and not significantly enlarged. The cervical lymph nodes are stable to slightly decrease in size. A reference left level 2 lymph node measures 4 x 5 mm (image 41, series 6), previously 5 x 6 mm. A right level 2 lymph node measures 4 x 7 mm (image 37, series 4), previously 4 x 7 mm. There is no significant cervical lymphadenopathy by size criteria. The salivary glands are unremarkable. The left lobe of the thyroid is enlarged and heterogeneous with scattered calcifications, which is unchanged. There are atherosclerotic calcifications at the level of the carotid bifurcations. The major cervical vessels are otherwise unremarkable. There is unchanged degenerative spondylosis without evidence focal lytic or blastic lesions. The imaged portions of the lungs are clear. | Stable size and appearance of the palatine tonsils and stable to slightly decreased cervical lymph nodes without significant cervical lymphadenopathy by size criteria. |
Generate impression based on findings. | Male, 55 years old, left base of tongue squamous cell carcinoma. No mass effect, focal edema or suspicious enhancement is seen to suggest brain parenchymal metastatic disease. The bones of the calvarium and skull base are intact. Mucosal thickening at the base of the tongue which projects into the vallecula is less conspicuous than on the prior examination, but remains nonspecific. The aerodigestive mucosa is otherwise unremarkable.A left level 2 reference node has significantly decreased in size, now measuring 1.9 x 0.8 cm (image 23 series 4), previously 3.3 x 1.9 cm. No pathologic adenopathy is identified elsewhere in the neck.Salivary glands and thyroid are free of focal lesions. Cervical vessels remain patent. Lung apices are unremarkable. No concerning osseous lesions are detected. | Response to therapy with reduction in size of a left level 2 lymph node. Nonspecific mucosal thickening at the tongue base has also improved. No evidence of intracranial disease. |
Generate impression based on findings. | Male, 79 years old, altered mental status. Images are degraded by motion artifact. Within this limitation, the following observations are made.No definite evidence of acute territorial ischemia is seen by CT. No acute intracranial hemorrhage or abnormal extra-axial fluid collections are detected.Ventricles and sulci remain prominent compatible with parenchymal volume loss. No parenchymal edema or mass effect is detected.The osseous structures are intact. The paranasal sinuses and mastoid air cells are clear. | No definite acute abnormalities or other specific findings to account for the patient's symptoms. |
Generate impression based on findings. | 74-year-old male with history of right-sided chest pain and previous history of right lung adenocarcinoma. PULMONARY ARTERIES: Technically adequate study with no evidence of pulmonary embolism to the subsegmental level. The main pulmonary artery is unremarkable and there is no evidence of right heart strain.LUNGS AND PLEURA: There is debris in the trachea and left mainstem bronchus suggesting aspiration. The pleural spaces are unremarkable.There is severe upper lobe predominant centrilobular and paraseptal emphysema.The previously described lesion in the lateral segment of the right middle lobe (series 10, image 77) has not significantly changed in size with a solid component measuring 8 x 7 mm, previously 8 x 8 mm. However, in correlation with prior PET imaging this nodule remains suspicious for indolent malignancy. There is surrounding bronchiolitis and groundglass opacity which appears somewhat more prominent than prior study and favor inflammatory process.A right lower lobe nodule (series 10, image 91) appears smaller than prior study and likely represents resolving inflammation.There are linear opacities at the left lung base which likely represent subsegmental atelectasis. MEDIASTINUM AND HILA: There is mild left ventricular dilatation with mild cardiomegaly. The pericardium is unremarkable. There is mild calcification of the aortic arch, coronary arteries, and descending aorta and there is stable mild enlargement of the ascending aorta, although this is suboptimally evaluated on this noncontrast study.There is a right paratracheal node (series 7, image 36) which is mildly enlarged by CT size criteria, has increased in size from prior study, and measures 10 mm in short axis. A right hilar lymph node has also increased in size measuring 12 mm, previously 10 mm. There is no other significant hilar or mediastinal lymphadenopathy. There is a small hiatal hernia.CHEST WALL: There is dextroscoliosis of the thoracic spine and mild degenerative disease of the thoracic spine with anterior osteophyte formation, otherwise no significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. There is a 4 x 3 cm hypoattenuating lesion of the liver which is unchanged from prior. | 1.No evidence of pulmonary embolus.2.Unchanged right middle lobe nodule which remains suspicious for indolent malignancy.3.Increased groundglass opacity surrounding right middle lobe nodule with airway debris, findings which suggest aspiration.4.Mildly enlarged right paratracheal and right hilar lymph nodes. |
Generate impression based on findings. | 56-year-old male patient with tense abdomen and abdominal pain. Evaluate for perforation. ABDOMEN:LUNG BASES: Redemonstration of marked emphysematous changes with bulla in the bilateral lung fields.LIVER, BILIARY TRACT: Hyperattenuating material layering in the gallbladder consistent with sludge. No ductal dilatation or pericholecystic fluid. SPLEEN: No significant abnormality noted.PANCREAS: Again noted is a small hypoattenuating lesion in the pancreatic tail (series 3 image 33 and coronal series 80217 image 102), which is suboptimally evaluated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of bowel obstruction. No pneumatosis or pneumoperitoneum. Colonic diverticulosis without CT evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.No pneumoperitoneum or evidence of bowel obstruction.2.Redemonstration of hypoattenuating lesion in the tail of the pancreas, which may represent an IPMN. |
Generate impression based on findings. | Dizziness and giddiness No evidence of intracranial hemorrhage or extra-axial fluid collection. Extensive periventricular and subcortical white matter, cerebellar, and basal ganglia hypodensities compatible with small vessel ischemic disease of indeterminate age. Vague hyperdensity along the anterior midbrain/pons junction is nonspecific. Parenchymal volume loss is likely age related. The ventricles and sulci are symmetric without evidence of hydrocephalus. No mass-effect, midline shift or basal cistern effacement. The visualized paranasal sinuses and mastoid air cells are clear. The calvarium is intact. Vascular calcifications. | 1.No evidence of an acute intracranial abnormality, although CT is not sensitive for the detection of acute nonhemorrhagic ischemia.2.Vague hyperdensity along the anterior midbrain/pons junction is nonspecific and would be better evaluated by MRI if clinically warranted.3.Extensive small vessel ischemic disease. |
Generate impression based on findings. | Abnormal coagulation profile, evaluate for intracranial hemorrhage No evidence of intracranial hemorrhage or extra-axial fluid collection. The ventricles and sulci appear normal in size and configuration. No mass-effect, midline shift or basal cistern effacement. The visualized paranasal sinuses and mastoid air cells are clear. The calvarium is intact. | No evidence of an acute intracranial abnormality, although CT is not sensitive for the detection of acute nonhemorrhagic ischemia. |
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