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Generate impression based on findings. | 28 year-old female patient with abdominal distention. Evaluate for lymph node burden and ascites. ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Numerous subcentimeter hypoattenuating lesions in the both lobes of the liver are redemonstrated and consistent with microabscess pattern. Hepatomegaly is stable. Patent hepatic vasculature.SPLEEN: Multiple hypoattenuating lesions in the spleen consistent with microabscess pattern and are stable compared to prior examination.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Redemonstration of extensive bulky retroperitoneal lymphadenopathy and mesenteric lymphadenopathy, burden is stable compared to prior. There are slightly more partially necrotic and necrotic lymph nodes compared prior examination.BOWEL, MESENTERY: Mild mucosal fold thickening at the small bowel is consistent with MAI enteritis.BONES, SOFT TISSUES: Lucent lesions in the sacrum, L5, L2 and T9 vertebral bodies. Interval increase in L5 lesion size.OTHER: Small amount of ascites, stable. | 1.Stable retroperitoneal lymph node burden with scattered necrotic lymph nodes.2.Mucosal fold thickening of the small intestines consistent with MAI enteritis.3.Interval increase in L5 vertebral body lucent lesion. |
Generate impression based on findings. | Reason: assess for ischemic changes/bleed History: L sided paresthesia No evidence of intracranial hemorrhage or extra-axial fluid collection. The ventricles are normal in size and configuration. Slight asymmetric lobular tissue along the superior margin of the body of the left lateral ventricle is nonspecific. No mass-effect, midline shift or basal cistern effacement. The visualized paranasal sinuses and mastoid air cells are clear. The calvarium is intact. | 1.No evidence of an acute intracranial abnormality, although CT is not sensitive for the detection of acute nonhemorrhagic ischemia.2.Nonspecific lobular tissue adjacent to the left lateral ventricle may represent a focus of heterotopic grey matter, and would be better evaluated by MRI if clinically warranted. |
Generate impression based on findings. | Male, 75 years old, history of hypopharyngeal carcinoma in 1993, now with proven squamous cell carcinoma in the head and neck. Please note comparison is made to a nondiagnostic quality noncontrast CT PET from 2011, as well as the same day CT PET.Extensive postoperative change is demonstrated compatible with left neck surgery and flap reconstruction. The overall morphology of this surgical change appears similar to the prior exam.Although accurate comparison is difficult as indicated above, there does appear to be progressive soft tissue thickening with subtle ill-defined enhancement involving the base of tongue and vallecula, particularly on the left (see image 38 of series 7). It is difficult to separate this tissue from the base of the epiglottis which is also thickened and enhancing. The left aspect of the hyoid bone seems to have been resected. Enhancing tissue extends to the preepiglottic space. The aryepiglottic folds are thick but not necessarily enhancing and this appearance is not significantly changed from the prior study.Subtle mucosal irregularity is also evident along the pharyngeal mucosa, left side more than right. Pooling debris is evident within the hypopharynx and left piriform sinus.Small lymph nodes are evident in both sides of the neck, none of which actually reaches imaging criteria for pathologic enlargement. Two hypermetabolic nodes seen on the same day PET exam are identified at level 2 on the right. Both of these nodes demonstrate ill-defined margins which is a suspicious finding. The more anterior of these two nodes measures 1.0 x 0.9 cm (image 30 of series 7). The more posterior node is slightly smaller and can be seen on the same slice.The right parotid gland is unremarkable. The left parotid gland contains several small nonspecific lymph nodes. The right submandibular gland is unremarkable. The left submandibular gland is absent. The thyroid is unremarkable.Scattered pulmonary micronodules and biapical scarring are demonstrated. A dedicated chest CT will be dictated separately.The left IJ vein is not visualized. Cervical vasculature is otherwise unremarkable.No worrisome or focally destructive osseous lesions are seen. | 1. Thickened ill-defined enhancing tissue at the left tongue base involving the vallecula, the preepiglottic space and perhaps the base of the epiglottis seems to be a new finding when compared to the prior examination of 2011 and is concerning for recurrent tumor.2. Vague thickening and irregularity of the pharyngeal mucosa, more so on the left, is a nonspecific finding but also somewhat suspicious for infiltrative tumor.3. No pathologically enlarged lymph nodes are demonstrated by size criteria. Two of the right level 2 lymph nodes seen as hypermetabolic on PET are identified and demonstrate suspicious ill-defined margins. |
Generate impression based on findings. | Reason: r/o mass/ bleed History: new onset intermittent twitching of left arm No evidence of intracranial hemorrhage or extra-axial fluid collection. Focal hypodensity in right parietal lobe adjacent to the falx is nonspecific but may represent a focus of edema, mass lesion, or less likely ischemia. The ventricles and sulci appear normal in size and configuration. No significant mass-effect, midline shift or basal cistern effacement. The visualized paranasal sinuses and mastoid air cells are clear. The calvarium is intact. | Nonspecific focal hypodensity in the right parietal lobe may represent a focus of edema, mass lesion, or less likely, ischemia and would be better evaluated by MRI.Findings discussed with Dr. Derani at on 11/9/2013 at 10:45 a.m. |
Generate impression based on findings. | 72-year-old male with history of parotid cancer. CHEST:LUNGS AND PLEURA: The tracheobronchial tree is unremarkable. There are innumerable bilateral pulmonary nodules, the largest of which is in the right upper lobe (series 5 Image 50) and measures 19 x 13 mm. There is also a small calcified nodule in the right lung base. There is biapical pleural-parenchymal scarring.MEDIASTINUM AND HILA: There are multiple enlarged right hilar lymph nodes, some of which are calcified. There are also multiple calcified subcarinal lymph nodes. The heart is unremarkable. There is mild calcification of the coronary arteries and the aorta along with mural plaque in the mid descending aorta.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: There are multiple hypoattenuating lesions in the right lobe of the liver which are too small to characterize accurately, otherwise no significant abnormality.SPLEEN: There are punctate calcifications suggestive of prior granulomatous disease.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There are large nonenhancing hypoattenuating exophytic lesions of the posterior superior pole of the right kidney with small septation which may represent two abutting cysts. This finding can be followed on subsequent imaging. There are also nonenhancing hypoattenuating peripelvic cysts bilaterally. 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.There is a gastric tube with balloon which appears outside of the gastric lumen abutting the gastric serosa.BONES, SOFT TISSUES: There is mild degenerative change of the thoracic spine.OTHER: No significant abnormality noted. | 1.Innumerable bilateral pulmonary nodules consistent with metastases, the largest of which is a right upper lobe nodule measuring 19 x 13 mm.2.Subcarinal and right hilar lymphadenopathy, some of which is calcified and likely represents prior granulomatous disease.3.Gastric tube with balloon which appears outside of the gastric lumen abutting the gastric serosa. This finding was relayed to Dr. Herman by phone at 11:15 on 11/9/13. |
Generate impression based on findings. | 69-year-old female patient with abdominal pain and nausea. Evaluate for obstruction. Note that the lack of intravenous contrast limits evaluation of vasculature, lymph nodes and solid viscera.ABDOMEN:LUNG BASES: Bilateral ground-glass opacities, consistent with pulmonary edema. Cardiomegaly with pacemaker in place.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Areas of focal fatty infiltration.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Atherosclerotic changes in the abdominal aorta and iliac arteries.BOWEL, MESENTERY: Diverticulosis in the sigmoid and descending colon without CT evidence of diverticulitis. The bowel is normal in caliber without CT evidence of obstruction.Small, fat-containing umbilical hernia.BONES, SOFT TISSUES: Mild multilevel degenerative changes in the thoracic and lumbar spine.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Calcifications within the uterus likely secondary to leiomyomatous uterus.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diverticulosis in the sigmoid and descending colon without CT evidence of diverticulitis. The bowel is normal in caliber without evidence of obstruction.Small, fat-containing umbilical hernia.BONES, SOFT TISSUES: Mild multilevel degenerative changes in the thoracic and lumbar spine.OTHER: No significant abnormality noted | 1.Bowel is normal in caliber without evidence of obstruction.2.Fat-containing umbilical hernia. |
Generate impression based on findings. | Reason: eval for intracranial lesion, normal pressure hydrocephalus History: AMS, jerking No evidence of intracranial hemorrhage or extra-axial fluid collection. Extensive periventricular white matter hypodensity compatible with small vessel ischemic disease of indeterminate age. Focal hypodensity in the right cerebellar hemisphere is also age-indetrminate but most likely reflects old prior infarction. The ventricles and sulci are prominent consistent with parenchymal volume loss, likely age related. No mass-effect, midline shift or basal cistern effacement. Mucosal thickening of the right frontal sinus and ethmoid air cells. The mastoid air cells are clear. The calvarium is intact. | 1.No evidence of an acute intracranial abnormality, although CT is not sensitive for the detection of acute nonhemorrhagic ischemia.2.Ventricles and sulci are prominent, consistent with parenchymal volume loss, which complicates the evaluation of hydrocephalus. MRI can be performed as clinically warranted.3.Extensive small vessel ischemic disease, age indeterminate. Again, MRI may be helpful to exclude acute ischemia. |
Generate impression based on findings. | 66-year-old female patient with abdominal pain, nausea, vomiting and history of small bowel obstruction on 7/2013. Evaluate for small bowel obstruction. Note that the lack of intravenous contrast limits evaluation of vasculature, lymph nodes and solid viscera.ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter hyperattenuating focus in the left renal cortex is stable compared to prior examination. Hypoattenuating lesion left inferior pole likely represents a renal cyst and is stable compared to prior examination.RETROPERITONEUM, LYMPH NODES: Atherosclerotic changes in the abdominal aorta and iliac arteries.BOWEL, MESENTERY: Diffuse small bowel dilatation with air-fluid levels, slightly decreased compared to prior examination. Transition point noted adjacent to the suture margin in the right lower abdomen (series 3 image 91).Left lower quadrant colostomy is redemonstrated.Ventral hernia containing loop of small bowel without evidence of strangulation.BONES, SOFT TISSUES: Orthopedic spinal hardware involving L5 and L4.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: Diffuse small bowel dilatation with air-fluid levels. Transition point noted adjacent to the suture margin in the right lower abdomen (series 3 image 91).Left lower quadrant colostomy is redemonstrated.Ventral hernia containing loop of small bowel without evidence of strangulation.BONES, SOFT TISSUES: Orthopedic spinal hardware involving L5 and L4.OTHER: No significant abnormality noted. | Findings consistent with chronic partial small bowel obstruction, possibly secondary to adhesions in the right lower abdomen. |
Generate impression based on findings. | Reason: migraines. patient with uterine mass with mets to lungs. please evaluate for metastatic disease History: migraines No intracranial mass or abnormal enhancement. No mass-effect, midline shift or basal cistern effacement. The ventricles and sulci appear normal in size and configuration. The visualized paranasal sinuses and mastoid air cells are clear. The calvarium is intact. | No intracranial mass or abnormal enhancement. |
Generate impression based on findings. | Female, 84 years old, altered mental status. Subarachnoid hemorrhage. The left temporal parenchymal hematoma has diminished in size and density compatible with interval evolution/resorption. The degree of mass effect is stable to slightly improved.Subarachnoid extension involving the left frontoparietal and left occipital sulci as well as the left sylvian fissure is diminished in density. Subarachnoid blood products seen previously within the right sylvian fissure is no longer clearly identified.Bilateral hemispheric low density subdural collections are again seen perhaps representing hygromas. These are slightly more prominent than on the prior examination by 1 or 2 mm.No new blood products are seen. No new parenchymal abnormalities, focal edema or mass effect is detected. The ventricles are stable and normal in size.Bilateral facial hematomas are redemonstrated and similar to the prior exam. | Continued expected evolution of left temporal parenchymal and subarachnoid blood product. No evidence of new bleeding is seen.Very mild expansion of bilateral low density subdural hemispheric collections compatible with hygromas. |
Generate impression based on findings. | Motor vehicle collision. Diffuse abdominal tenderness. Lumbar spine pain. ABDOMEN:LUNG BASES: No focal air space opacities or pleural effusions.LIVER, BILIARY TRACT: Normal-appearing liver, without focal lesions or evidence of traumatic injury. Normal appearing gallbladder, without ductal dilatation.SPLEEN: Normal-appearing spleen, without evidence of traumatic injury.PANCREAS: Normal-appearing pancreas.ADRENAL GLANDS: Normal in appearance.KIDNEYS, URETERS: Uniform symmetric enhancement of the kidneys, without focal lesions or evidence of traumatic injury.RETROPERITONEUM, LYMPH NODES: No intra-abdominal lymphadenopathy.BOWEL, MESENTERY: Nondilated loops of bowel, without associated mesenteric stranding or fluid collections to suggest injury.BONES, SOFT TISSUES: No osseous abnormality. No soft tissue abnormality.OTHER: No ascites.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: Nondilated loops of bowel, without associated mesenteric stranding or fluid collections to suggest injury.BONES, SOFT TISSUES: No osseous abnormality. No soft tissue abnormality.OTHER: No ascites. | Normal examination. No evidence of traumatic injury. |
Generate impression based on findings. | Male 49 years old; Reason: eval rectus sheath hematoma, possibly suprainfected and right psoas hematoma History: purulent discharge ABDOMEN:LUNGS BASES: Bibasilar subsegmental atelectasis and small trace effusions.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: IVC filter with hypodense clot inferior to the filter. Right psoas muscle thickening represents a hematoma which has decreased in size measuring 6.4 x 4.5 cm (image 113/series 3) previously, 6.9 x 5.7 cm. BOWEL, MESENTERY: Percutaneous gastrostomy catheter terminates within the stomach lumen . Via the indwelling catheter a second catheter has been inserted with terminates about the ligament of Treitz.BONES, SOFT TISSUES: Body wall collection that extends in the gastrostomy catheter with gas and fluid. It measures at least 7.0 x 3.4 cm and has a percutaneous catheter within it. 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.Status post drain placement in the left body wall/rectus abscess. With stable slight decrease in the size of the abscess.2.Right psoas muscle hematoma, decreased in size. |
Generate impression based on findings. | Reason: hemorrhage History: hemorrhage CT head:Large left parenchymal hematoma involving the basal ganglia, insula, and inferior left frontal lobe with intraventricular extension evidenced by blood layering in the occipital horns. There is modest surrounding edema and local mass effect without evidence of herniation. Scattered and diffuse subarachnoid hemorrhage is present. No midline shift or basal cistern effacement. The ventricles and sulci appear normal in size and configuration for a patient of this age. The visualized paranasal sinuses and mastoid air cells are clear. The calvarium is intact. Brain CTA: An enlarged venous structure courses along the medial edge of the left frontal hematoma, coursing inferiorly into the basal vein to join the vein of Galen. This vein demonstrates a CT density more similar to an artery and therefore some degree of arteriovenous shunting is suspected. A small presumed artery arises from the region of the anterior communicating artery and courses immediately adjacent to the abnormal venous structure and may communicate with it. No aneurysms or high grade vascular stenoses. Bilateral fetal origin of the PCAs and dominant right vertebral artery are noted. | 1.Large left parenchymal hematoma with intraventricular extension and moderate local mass effect.2.Along the medial margin of the hematoma is an enlarged venous structure, which by virtue of its CT density, reflects some degree of arteriovenous shunting. There is an unusual artery arising from the anterior communicating artery coursing adjacent to the venous structure. An underlying vascular abnormality is suspected. Differential considerations include arteriovenous malformation or an arteriovenous fistula.Findings discussed with Dr. Christopher Allen, ICU resident, at 8:30 a.m. Findings discussed with Dr. Ashley Ralston, neurosurgery resident, at 10:00 a.m. |
Generate impression based on findings. | 56 year old female patient with abdominal pain. Evaluate for appendicitis. ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Hypoattenuating lesion with peripheral nodular enhancement at the hepatic dome likely represents a hemangioma. There is a subcentimeter hypoattenuating lesion in the right hepatic lobe that is too small to characterize and is stable compared to prior examination.Cholelithiasis and distended gallbladder, stable compared to prior examination. No pericholecystic fluid.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: Dilated appendix is stable and measures 16 mm in diameter (series 3 image 120). No adjacent fat stranding or inflammatory changes.Bowel is normal caliber without evidence of obstruction.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumbar spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Fluid density left adnexal lesion measures 5.4 x 2.8 cm (series 3 image 105), stable compared to prior examination and may represent an abscess versus postoperative stroma.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Dilated appendix is stable and measures 16 mm in diameter (series 3 image 120). No adjacent fat stranding or inflammatory changes.Bowel is normal caliber without evidence of obstruction.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumbar spine.OTHER: No significant abnormality noted | 1.Dilated, fluid-filled appendix without adjacent inflammatory changes, consistent with a mucocele. The appendix is enlarged compared to examination in 2009. Cannot rule out underlying neoplasia in the mucocele.2.Stable left adnexal lesion. |
Generate impression based on findings. | Female 27 years old; Reason: assess edema , inflammation, obstruction History: recurrent gut cramping in setting of GVH 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: Patchy striated enhancement of the kidneys suggests pyelonephritis. No abscess formation or perinephric fluid collections. The ureters are normal in caliber. No nephrolithiasis allowing for the phase of imaging post contrast.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Small bowel is normal in caliber. Mild thickening of the distal colon/rectum which is nonspecific. Mild thickening of the terminal ileum.BONES, SOFT TISSUES: Gas in the subcutaneous abdominal tissues possibly due to subcutaneous injections.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: Please see aboveBONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace pelvic ascites. | 1.Patchy enhancement of the kidneys most suggestive of an infectious process such as pyelonephritis. No abscess or hydronephrosis.2.Nonspecific thickening of the terminal ileum, distal colon and rectum. |
Generate impression based on findings. | 55-year-old male with history of head and neck cancer. CHEST:LUNGS AND PLEURA: There is a small right tracheal diverticulum at the thoracic inlet, otherwise the tracheobronchial tree is unremarkable. The pleura are unremarkable. There is a stable right middle lobe micronodule. There is nonspecific bronchial wall thickening and mild basilar atelectasis.MEDIASTINUM AND HILA: There is an AICD with lead in the right atrium and ventricular lead which appears to extend outside of the apical wall into the epicardial fat. There is no pericardial thickening or effusion and the position of this lead appears unchanged from study on 9/13. There is septal hypertrophy which is disproportionate to the left lateral ventricular wall suggestive of hypertrophic cardiomyopathy. There is a common origin of the innominate and left common carotid artery; the great vessels are unremarkable.There is no hilar or mediastinal lymphadenopathy.CHEST WALL: There is a left AICD generator.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: The liver, gallbladder, and biliary tract are unremarkable.SPLEEN: There is a small anterior accessory splenule, otherwise the spleen is unremarkable.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 metastatic disease. |
Generate impression based on findings. | Female 56 years old; Reason: pancreatitis, masses on left ABDOMEN:LUNGS BASES: Left talar parenchymal opacities, trace pleural effusion and calcified pleural plaque.LIVER, BILIARY TRACT: Subcentimeter hypoattenuating lesion in segment 7 of the liver (image 19/series 3 is too small to characterize. No evident biliary ductal dictation.SPLEEN: Spleen is normal in size. PANCREAS: Pancreatic duct is dilated to the head of the pancreas. This is suboptimally evaluated without contrast. No large fluid collections surrounding the pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mild wall wall thickening of the transverse portion of the duodenum.BONES, SOFT TISSUES: Sclerotic left lower rib lesions with adjacent soft tissue thickening.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: Small bowel is normal in caliber. The appendix is normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Suboptimal exam without contrast. Findings of neoplastic disease in the chest involving the ribs.2.Hypodense hepatic lesion too small to characterize without contrast.3.Pancreatic ductal dilatation of unclear etiology. Consider M.R.C.P. when able. |
Generate impression based on findings. | Female 40 years old; Reason: Acute RUQ abdominal pain with hx of pancreatitis. Evaluate for cholecystis or pancreatitis. History: RUQ abdominal pain and tenderness ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. Gallbladder contains several calcified stones with mild peri-cholecystic inflammatory changes. No evident gallbladder wall thickening or biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes of unclear etiology. A left para-aortic node measures 1.3 x 1.0 cm (image 106/series 3). BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Findings of early cholecystitis with pericholecystic inflammation and gallstones. No evident gallbladder wall thickening, necrosis or fluid collections. |
Generate impression based on findings. | 61-year-old male with history of multiple myeloma prior to stem cell transplant and right mid lung opacity seen on recent radiograph. LUNGS AND PLEURA: There is a focus of apical segment right upper lobe scarring and bronchial wall thickening. There are nodular fissural densities which likely represent intrapulmonary lymph nodes and multiple pleural based micronodules. There are additional scattered pulmonary micronodules and mild basilar atelectasis.The opacity seen on chest radiograph from 11/8 is not seen on CT images, and most likely represented resolved atelectasis.MEDIASTINUM AND HILA: Lack of intravenous contrast limits evaluation of the mediastinum. There is a right PICC line with catheter tip in the right atrium. There is mild coronary calcification, otherwise the heart and pericardium are unremarkable. The great vessels are unremarkable. There are an increased number of small mediastinal lymph nodes with mild enlargement of right hilar nodes.There is a hypoattenuating soft tissue mass measuring 5.4 x 3 cm (series 3, image 6) which appears to arise from the left lobe of the thyroid gland. This mass deviates the trachea rightward, however there is no airway compromise.CHEST WALL: There are heterogeneous appearance with mixed lytic and sclerotic lesions of the vertebral bodies, sternum, and ribs, suggestive of marrow infiltrative process. There is mild degenerative disease of the thoracic spine. No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. The partially visualized liver, spleen, pancreas, adrenals, and kidneys are unremarkable. | The opacity seen on prior chest radiograph is not seen on CT images and most likely represented resolved atelectasis. There is no evidence of acute pulmonary process or masses.Diffuse heterogeneous bone marrow appearance consistent with patient's known multiple myeloma.Incidentally noted goiter in the left lobe of the thyroid. Further evaluation with ultrasound can be considered in the appropriate clinical scenario. |
Generate impression based on findings. | Reason: mets? bleed? History: metastatic pancreatic ca, vertigo, falls No evidence of intracranial hemorrhage or extra-axial fluid collection. Evaluation of metastatic disease is limited in the absence of intravenous contrast. 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. | 1.No evidence of an acute intracranial abnormality, although CT is not sensitive for the detection of acute nonhemorrhagic ischemia.2.Evaluation for metastatic disease is limited in the absence of intravenous contrast. |
Generate impression based on findings. | 75-year-old male with history of head and neck cancer. LUNGS AND PLEURA: The tracheobronchial tree is unremarkable. The pleura are unremarkable.There are multifocal dependent pulmonary masses with central fat and an irregular rim of soft tissue and centrilobular nodules in the bilateral lower lobes and right middle lobe. These findings are consistent with lipoid pneumonia. There are additional pulmonary micronodules, without any suspicious nodules or masses. There is bilateral apical scarring consistent with postradiation changes.MEDIASTINUM AND HILA: There is mild cardiomegaly, otherwise the heart and pericardium are unremarkable. There is mild calcification of the aorta.There is an enlarged right lower paratracheal node (series 4, image 44) measuring 25 x 14 mm axial dimension which correlates with hypermetabolic focus seen on PET from 11/6/2013. There is also left hilar lymphadenopathy with a large left hilar lymph node (series 8038, image 40) measuring 21 x 15 mm in coronal dimension and mildly enlarged prevascular lymph nodes.There is a small hiatal hernia.CHEST WALL: There is no significant axillary or subpectoral lymphadenopathy. There is degenerative disease of the thoracic spine with prominent osteophyte at the right T6 costovertebral angle. No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. There is a small hypodense lesion of the left lobe the liver which likely represents cyst or hemangioma. There are multiple choleliths in the gallbladder. The pancreas is unremarkable. There are punctate calcifications of the spleen consistent with prior granulomatous disease. There is mild nodular thickening of bilateral adrenal glands. The partially visualized kidneys are unremarkable. There are mildly enlarged gastrohepatic, periportal, and peripancreatic lymph nodes, the largest of which measures 13 mm in short axis (series 4, image 99). | 1.Bilateral lipoid pneumonia.2.Enlarged prevascular, right paratracheal, left hilar lymph, and intra-abdominal lymph nodes. |
Generate impression based on findings. | Female 42 years old; Reason: Source of abd pain History: RUQ, RLQ, LLQ abd pain 10 days after EGD and colonoscopy ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver contour is smooth. No suspicious hepatic lesions. Hepatic and portal veins are patent. Status post cholecystectomy. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas is normal morphology without peripancreatic inflammatory changes or ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Jejunal jejunal intussusception in the left upper abdomen without bowel obstruction. The appendix is in the right lower abdomen and is fluid filled. No surrounding inflammatory changes. However, the appendix is suboptimally evaluated due to the lack of enteric contrast in the cecum limiting resolution of the appendix from adjacent non opacified bowel.BONES, SOFT TISSUES: Number hernia containing portion of omentum.OTHER: No free air or ascites.PELVIS:UTERUS, ADNEXA: Mild thickening or fluid within the endometrial cavity.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Please see aboveBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Status post cholecystectomy without biliary ductal dilatation or pancreatitis. 2.No free air or free fluid.3.No bowel obstruction. |
Generate impression based on findings. | 81 year old female with history of head and neck cancer, intubated and with stridor. LUNGS AND PLEURA: The patient is intubated, otherwise the tracheobronchial tree is unremarkable. There are scattered pulmonary micronodules, some of which are calcified. There is pleural-parenchymal scarring at the apices and mild apical-predominant centrilobular emphysema.There is a new nodular opacity in the right middle lobe and resolution of the previously seen cavitary nodular opacities, likely representing evolving inflammation from aspiration or infection. There is also bronchial wall thickening, bronchiolectasis and tree-in-bud opacities suggesting bronchiolitis.Dense consolidation at the right lung base persists and there is new consolidation in the left lower lobe compatible with bilateral atelectasis, aspiration, and possible aspiration pneumonia in the appropriate clinical setting.MEDIASTINUM AND HILA: There is moderate to severe calcification of the coronary arteries and the aortic valve, otherwise the heart and pericardium are unremarkable. There is moderate calcification of the aorta and its branches.There is no significant mediastinal or hilar lymphadenopathy.CHEST WALL: There is a right chest port with catheter tip in the SVC. There is no significant axillary, internal mammary, or subpectoral lymphadenopathy. There is degenerative disease of thoracic spine with multilevel anterior osteophytes.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. There is an NG tube in place with tip in the gastric body. There are partially visualized surgical clips from prior cholecystectomy. There is mild biliary dilatation which appears slightly decreased from prior study. There is stable nodular thickening of the left adrenal gland. | Increasing consolidation at the right lung base with new consolidation in the left lung base compatible with bilateral atelectasis, suspected aspiration pneumonia. |
Generate impression based on findings. | Female 74 years old; Reason: 74 yo female with multiple myeloma with left hip pain History: hip pain CHEST:LUNGS AND PLEURA: Right lower lobe lung mass extending along the major fissure to the lateral pleural surface measures 4.7 x 3.4 cm (image 61/series 5) . The lesion is mildly hypermetabolic on the corresponding PET CT. The lesion has some central calcifications.Scattered calcified granulomata in both lungs. The pleural spaces are clear.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Calcific arteriosclerotic disease affects the aorta.BOWEL, MESENTERY: Left lower abdominal colostomy without obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Stub changes in the: In the pelvis.BONES, SOFT TISSUES: Soft tissue in the presacral space presumably residual rectum.OTHER: Degenerative changes affect the lumbar spine with grade 1 anterolisthesis of L4 and L5. No discrete myelomatous lesions are evident. | Right lower lobe lung mass differential considerations include primary lung malignancy. Infectious etiology are a possibility given the calcifications. However lung malignancy must be excluded. |
Generate impression based on findings. | Reason: new leukemia diagnosis, ataxia, LE weakness, syncope History: ataxia, LE weakness, syncope Images are severely degraded by motion artifact. No evidence of large intracranial hematoma or large extra-axial fluid collection. The ventricles and sulci are prominent, compatible with age-related parenchymal loss. No significant mass effect. Air-fluid level in the right sphenoid sinus. The calvarium is intact. | 1.Images degraded by motion artifact. Within this limitation, there is no evidence of an acute intracranial abnormality, although CT is not sensitive for the detection of acute nonhemorrhagic ischemia.2.Sphenoid sinusitis. |
Generate impression based on findings. | 52-year-old male with history of tonsillar cancer and right neck mass. LUNGS AND PLEURA: The tracheobronchial tree is unremarkable. There is apical pleural parenchymal scarring. There are new linear opacities in the inferior lingula which represent scarring and early rounded atelectasis.MEDIASTINUM AND HILA: There is evidence of prior CABG, otherwise the heart and pericardium are unremarkable. There is mild calcification of the aortic arch.There is no significant mediastinal or hilar lymphadenopathy. The thyroid gland has multiple nodules, right greater than left, which has not significantly changed from prior study.CHEST WALL: There is no significant axillary or subpectoral lymphadenopathy. There is evidence of prior median sternotomy with wires intact. There is mild degenerative disease of the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. The spleen is surgically absent and there are multiple surgical clips in the left upper quadrant. There is a well-circumscribed soft tissue mass near the tail of the pancreas (series 3, image 91) measuring 17 x 14 mm which likely represents a residual splenule. There is an unchanged fat attenuating adenoma of the lateral limb of the right adrenal gland. There is an unchanged small enhancing hemangioma in the dome of the liver. The gallbladder, pancreas, and visualized portions of the kidneys are unremarkable. | 1.No evidence of metastatic disease.2.Stable multinodular thyroid. |
Generate impression based on findings. | 69-year-old male with history of gastric cancer and now with acute onset shortness of breath. PULMONARY ARTERIES: This study is somewhat limited by respiratory motion but demonstrates embolus the right main pulmonary artery at the bifurcation extending into the truncus anterior and interlobar artery. There are multiple emboli in the lobar and segmental pulmonary arteries of the right upper, middle and lower lobes. The main pulmonary artery measures at the upper limits of normal diameter however there is no evidence of right ventricular strain.LUNGS AND PLEURA: The tracheobronchial tree is unremarkable. There is a large right and moderate left pleural effusion. There is adjacent near complete atelectasis of the right lobe and significant atelectasis of the left lower lobe. There is a calcified pleural based micronodule in the left apex which likely represents prior granulomatous disease. There is no evidence of infarcted lung parenchyma, although evaluation of the atelectatic lung is limited.MEDIASTINUM AND HILA: There is mild calcification of the coronary arteries and the aorta, the heart and pericardium are otherwise unremarkable.There is mild right paratracheal, internal mammary, and cardiophrenic lymphadenopathy with a left internal mammary lymph node measuring 10mm (series 8, image 168).There is non-specific thickening of the proximal esophagus which may be post-inflammatory change from recent enteric tube which has been removed since prior study.CHEST WALL: There is mild degenerative change of the thoracic spine. No significant axillary or subpectoral lymphadenopathy.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. There is extensive soft tissue mass in the anterior epigastrium involving the stomach antrum and peritoneum. There are multiple enlarged gastrohepatic and subdiaphragmatic lymph nodes. A focus of hyperdense material is seen at the anterior margin of the intraluminal stomach contents but is incompletely visualized.There is a hypoattenuating lesion in the left lobe liver which is too small to accurately characterize. | 1.Right main pulmonary artery emboli with multiple right-sided lobar, segmental and subsegmental emboli. These findings were relayed to Dr Patel by phone at 11:55 on 11/9/13.2.Bilateral pleural effusions, right greater than left with adjacent atelectasis.3.Soft tissue mass in the anterior epigastrium with mediastinal and abdominal lymphadenopathy. 4.Nonspecific proximal esophageal wall thickening. 5.Incompletely visualized high density material in the stomach lumen. |
Generate impression based on findings. | Male 45 years old; Reason: Hx of Hodgkin's Disease History: Evaluate extent of disease CHEST:LUNGS AND PLEURA: Nodule along the right minor fissure is unchanged and most likely represents an intrapulmonary lymph node. Minimal middle lobe atelectasis.Subtle ground-glass parenchymal opacities worse in the upper lobes without a solid mass is new. This may represent either medication related toxicity or possibly hypersensitivity.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. Small mediastinal lymph nodes persist. The pretracheal lymph node measures 1.1 x 0.7 cm (image 34/series 4) and is unchangedCHEST WALL: Reference right axillary lymph node measures 1.8 x 0.9 cm (image 21/series 4). OTHER: ABDOMEN:LIVER, BILIARY TRACT: Liver has a smooth contour without suspicious hepatic lesions. Cholelithiasis. No biliary ductal dilatation.SPLEEN: Spleen remains mildly enlarged.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes persist.BOWEL, MESENTERY: Widemouthed ventral hernia containing transverse colon and small bowel.BONES, SOFT TISSUES: Large ventral herniaOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Left external iliac lymph node measures 1.8 x 1.3 cm (image 184/series 4) , unchanged.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.No change in the small lymph nodes in the chest, abdomen and pelvis |
Generate impression based on findings. | Female 53 years old; Reason: adrenal nodule, pls assess for changes History: adrenal nodule ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver contour is smooth. Well marginated hypodense liver lesion in segment 6 measures 11 mm and is unchanged. There is fatty infiltration of the liver.Hepatic and portal veins are patent. Cholelithiasis without biliary ductal dilatation or gallbladder distention.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: 8mm left lateral limb adrenal gland nodule is unchanged. It measures less than 10 Hounsfield units on the noncontrast CT and most likely represents an adenoma and image 47/series 80528.Right adrenal gland is normal in morphology.KIDNEYS, URETERS: Bilateral renal cysts. Calcifications along the posterior wall of the right upper pole cyst. No hydronephrosis in either kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Post operative changes from appendectomy. No bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Please see aboveBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.8mm left adrenal lesion most likely an adenoma, unchanged.2.Cholelithiasis.3.Stable right hepatic lobe 11 mm lesion likely representing a cyst.4.Hepatic steatosis |
Generate impression based on findings. | Male, 68 years old, left-sided weakness. No definite CT evidence of acute territorial ischemia. Extensive periventricular hypoattenuation compatible with advanced age indeterminate small vessel ischemic disease.No focal edema or mass effect. No intracranial hemorrhage or abnormal fluid collections. The ventricular system is patent and within normal limits for size.Osseous structures are intact. Paranasal sinuses are clear. | Advanced age indeterminate small vessel ischemic disease. No definite acute intracranial abnormalities are detected. However, if clinical concern persists, follow-up with MRI would be appropriate. |
Generate impression based on findings. | Female 53 years old; Reason: assess for abscess, ruptured bladder History: ams, recent Foley catheterization, firm abd, hypotensive ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver is normal in contour. Hyperdense material in than the gallbladder suggests either bile or stones.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Kidney contour is nodular. Underlying masses are not excluded on the basis of a noncontrast CT. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Multiple small retroperitoneal lymph nodes.BOWEL, MESENTERY: No bowel obstruction is evident.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Probable injection changes in the anterior subcutaneous abdominal tissues.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Suprapubic catheter terminates within the bladder. There is scattered gas within the urinary bladder and possibly in the wall.LYMPH NODES: Small pelvic lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes affect the lumbar spine.OTHER: Right femoral vascular catheter. | 1.No CT evidence intraperitoneal or retroperitoneal hematoma.2.Gas in the bladder and possibly in the wall. Correlate for infection or recent instrumentation.3.Nodular bilateral renal contours, unchanged but further evaluation is suggested.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Male 60 years old; Reason: IRB 10-666 Re-evaluate disease status following additional systemic therapy; compare to previous and provide bi-dimensional measurements History: stage IV metastatic melanoma CHEST:LUNGS AND PLEURA: Subcentimeter left lower lobe pulmonary nodule, unchanged. No dominant lung lesion. The pleural spaces are clear.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. No new mediastinal lymphadenopathy.CHEST WALL: Postoperative changes from a right axillary lymph node dissection. No recurrent lymphadenopathy.OTHER: ABDOMEN:LIVER, BILIARY TRACT: Liver has a smooth contour. No suspicious hepatic lesions. Cholelithiasis within a nondistended gallbladder.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Calcific arthrosclerotic disease of the aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Stable exam without recurrent lymphadenopathy. |
Generate impression based on findings. | Female 79 years old; Reason: history of microscopic hematuria, please evaluate with CT urogram delayed imaging. History: microscopic hematuria ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Age related fatty atrophy of the pancreas . No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mild cortical atrophy of both kidneys. No nephrolithiasis. No focal enhancing renal masses.Ureters are normal in caliber. No evident masses. Left kidney lobe old peripelvic cysts.RETROPERITONEUM, LYMPH NODES: Calcific arteriosclerotic disease of the aorta and branch vessels. Moderate to severe narrowing at the origin of the celiac and SMA.BOWEL, MESENTERY: Small bowel is normal in caliber. Colonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No distal ureter or bladder calculi.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Scattered colonic diverticula.BONES, SOFT TISSUES: Degenerative changes affect the lumbar spine. Grade 2 anterolisthesis of L4 and L5 due to bilateral pars defects.OTHER: No significant abnormality noted. | 1.Mild renal cortical atrophy. No nephrolithiasis, or focal mass to explain the patient's symptoms. |
Generate impression based on findings. | Female 46 years old; Reason: RLQ pain, h/o NSAID use r/o colitis, chololithiasis. History: Intermittent RLQ pain ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Renal cysts. No hydronephrosis. Poorly defined partially cystic lesion at the upper pole of the right kidney suspicious for a complex cystic renal lesion. Similar right lower pole subcentimeter lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Post operative changes of gastric bypass. No obstruction is evident.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Heterogeneous enhancement of the endometrium.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.No colitis or cholelithiasis as clinically questioned.2.Complex right renal lesions. Follow-up renal MRI is suggested. |
Generate impression based on findings. | Male, 57 years old, hydrocephalus, hemiplegia. Interval removal of the right frontal approach ventriculostomy catheter. Procedure related air demonstrated in the ventricles. Small calcific fragment along the shunt tract may reflect small bony fragment from the burr hole. Ventricular caliber is not substantially changed from prior.Right thalamic hematoma is smaller measuring 2.4 x 1.3 centimeters, previously 2.8 x 1.8 cm. Moderate surrounding parenchymal edema is similar. Regional mass-effect is slightly improved with partial reexpansion of the third ventricle. Small amount of layering blood persists in occipital horns. Minimal persistent subarachnoid blood and neck regions. Minimal scattered subarachnoid blood seen elsewhere on prior exams is difficult to discern on the present study. No new hemorrhage is seen. | 1. Continued resolution of right thalamic/basal ganglia hematoma.2. Interval removal of the right frontal approach into the shunt catheter with stable size of ventricles.3. No new hemorrhage is seen. |
Generate impression based on findings. | Male 54 years old; Reason: Eval for renal/ureteral stones - history of gross hematuria History: gross hematuria, h/o episode of right groin pain ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: The liver has a smooth contour. The lack of intravenous contrast limits evaluation of the hepatic right lung. Probable fatty infiltration of the liver. No calcified stones are evident within the gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No contour deforming masses. No nephrolithiasis or hydronephrosis.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 distal ureteral or bladder calculi.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.No evident nephrolithiasis or hydronephrosis. Study is suboptimal to evaluate for solid renal or collecting system masses. |
Generate impression based on findings. | Male 30 years old; Reason: r/o obstruction History: Crohn's s/p ileocecectomy, questionable appendicitis ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Post operative changes in the cecum and distal ileum. The proximal bowel loops are dilated up to 3.1-cm. There is mucosal hyperenhancement of a distal loop of bowel in the right lower abdomen which is narrowed suggesting possible stricturing.There is fluid-filled loops of bowel distal to this extending up to the cecum. There is mild surrounding fluid. There is mesentery is hypervascular.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No free air or drainable fluid collections.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Please see aboveBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Findings of slow transit (partial bowel obstruction) involving the ileum most likely due to active Crohn disease and possible stricturing.2.Surrounding small amount of mesenteric ascites and mesentery hypervascularity indicate active inflammation. Ascites may be due to obstruction as well. |
Generate impression based on findings. | Male, 57 years old, status-post EVD placement. Right thalamic/basal ganglia hematoma is similar to the immediate prior exam and smaller than on more remote exams. Parenchymal edema and mass effect are similar to prior. Minimal persistent layering blood in the occipital horns. No new hemorrhage detected. Minimal persistent subarachnoid blood product in the occipital regions.Slight interval decrease in the quantity of intraventricular air from shunt removal. Small calcific fragment along the shunt tract again seen. Interval development of a thin subgaleal fluid collection with persistent subgaleal/subcutaneous air. Ventricular caliber is unchanged. | 1. Right basal ganglia/thalamic hematoma similar to immediate prior but reduced when compared to more remote studies.2. No new hemorrhage detected.3. Findings subsequent to removal of the right frontal approach ventricular catheter. Intraventricular air is slightly reduced. There is a developing thin subgaleal fluid collection and persistent subcutaneous air along prior subcutaneous shunt tract. |
Generate impression based on findings. | 61-year-old female with abnormal chest radiograph. LUNGS AND PLEURA: The tracheobronchial tree is unremarkable. There are moderate bilateral pleural effusions, right greater than left. There is significant bilateral lower lobe consolidation along with smaller areas of nodular consolidation in the bilateral upper lobes. These findings are consistent with pneumonia, possibly of fungal origin.There is moderate apical predominant centrilobular emphysema.There is diffuse septal thickening suggestive of pulmonary edema.MEDIASTINUM AND HILA: There is a mild pericardial effusion and biatrial enlargement. There is hypoattenuation of the blood pool suggestive of anemia. There is severe coronary artery calcification.There a number of enlarged paratracheal and AP window lymph nodes measuring up to 15 mm in short axis (series 5, images 28, 30, and 32).CHEST WALL: There is soft tissue edema with asymmetric enlargement of the left lateral breast tissue which may be due to dependent swelling, although these finding should be correlated on physical exam as cellulitis or infiltrative malignancy cannot be excluded.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. There is mild ascites and effacement of the intra-abdominal fat planes. There is nodular thickening of the left adrenal gland. | 1.Bilateral lower lobe consolidation along with multifocal upper lobe nodular consolidation suggestive of multifocal pneumonia, possibly fungal in origin.2.Pulmonary edema, ascites, soft tissue swelling, and biatrial enlargement suggestive of fluid overload.3.Asymmetric swelling of the left lateral breast soft tissues which may be due to dependent edema, although this finding should be correlated on physical exam. |
Generate impression based on findings. | Male 84 years old; Reason: assess for systemic malignancy History: weight loss, progressive polyneuropathy CHEST:LUNGS AND PLEURA: Small bilateral pulmonary micronodules. No dominant lung lesion. The pleural spaces are clear.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. Extensive coronary artery calcifications.CHEST WALL: Multiple punctate nodules in the thyroid gland.OTHER: ABDOMEN:LIVER, BILIARY TRACT: Multiple well marginated subcentimeter hypodense lesions throughout the liver most suggestive of small biliary hamartomas or cysts.SPLEEN: No significant abnormality notedPANCREAS: Pancreatic cystic lesions involving the body tail junction; the largest measuring 1.9-cm (image 104/series 3) may represent a side branch type IPMN.Global pancreatic atrophy without ductal dilatationADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Scarring at the upper pole of the right kidney. Small lateral probable renal cysts. No evident renal mass.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No bowel obstruction. No colonic obstruction.Scattered diverticula.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: As aboveBONES, SOFT TISSUES: Degenerative changes affect the lumbar spine.OTHER: No significant abnormality noted | 1.1.9-cm cystic mass in the pancreas most likely representing a side branch type IPMN. This may be further evaluated with M.R.C.P.2.Renal parenchymal scarring.3.Probable biliary hamartomas in the liver. |
Generate impression based on findings. | Male, 60 years old, history of tongue cancer, also with lung cancer, status post CRT. Patchy white matter hypodensities are redemonstrated most likely indicative of small vessel ischemic disease. 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. Frothy debris evident in the right maxillary sinus.Treatment related changes are redemonstrated in the neck. No evidence of recurrent tumor or pathologic adenopathy.Salivary glands and thyroid are free of suspicious lesions. Vessels remain patent. Lungs will be assessed separately. No concerning osseous lesions. | 1. No evidence of active disease in the neck.2. No intracranial metastatic disease. |
Generate impression based on findings. | Male, 35 years old, syncope, intoxication. Evaluate for fracture/dislocation/intracranial abnormality. The cerebral and cerebellar hemispheres and brainstem are normal in attenuation and morphology. No intracranial hemorrhage or abnormal extra-axial fluid collection is seen. There is no evidence of mass effect or midline shift. The ventricles and basal cisterns are patent and normal in size. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.The bones of the calvarium and skull base are intact. Small sebaceous cyst noted in the left cheek.No cervical spine fracture or dislocation. Vertebral body heights and morphology are normal. Prevertebral soft tissues are unremarkable. | 1. No acute intracranial abnormality.2. No cervical spine fracture or dislocation. |
Generate impression based on findings. | Female, 84 years old, severe headache. Hypertensive urgency. Mild scattered white matter hypodensities are seen, a nonspecific finding which likely reflects age indeterminate small vessel ischemic disease. No intracranial hemorrhage or abnormal extra-axial fluid collection is seen. There is no evidence of mass effect or midline shift. The ventricles and basal cisterns are patent and normal in size. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. The bones of the calvarium and skull base are intact. | No acute intracranial abnormality. |
Generate impression based on findings. | Female 81 years old; Reason: pe? History: cp, elevated d-dimer. PULMONARY ARTERIES: No pulmonary emboli. Normal caliber to the pulmonary arteryLUNGS AND PLEURA: Moderate apical predominant emphysema. Diffuse nodular pleural thickening in the apical area of the left hemithorax, and to a lesser extent at the left base. The left pleural effusion is improved. Atelectasis is again seen overlying the effusion.Calcified micronodule right lower lobe compatible with previous infection.MEDIASTINUM AND HILA: Extensive atherosclerotic calcification of the thoracic aorta. Moderate calcification of the coronary arteries. Mild cardiomegaly. Small pericardial effusion. No significant hilar lymphadenopathy. Enlarged precardiac lymph node measuring 1.2 cm (series 7, image 208), unchanged.CHEST WALL: Degenerative disease in the medial clavicles, greater on the right, but no sign of a destructive lesion. Scoliosis and degenerative disease in the spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Multiple small hypodensities in the liver, most compatible with cysts. Focal fatty infiltration adjacent to the falciform ligament.Mild enlarged medial limb of the left adrenal gland which is nonspecific but more likely benign than malignant.Moderate atherosclerosis of the abdominal aorta and its major branches | 1.No pulmonary emboli.2.Significant improvement in the left-sided pleural effusion.3.Again seen is diffuse pleural thickening in the apical and left medial posterior aspect of the pleura, suspicious for neoplasm.4.Precardiac lymphadenopathy, unchanged. |
Generate impression based on findings. | Female, 60 years old, numbness in fingers. The cerebral and cerebellar hemispheres and brainstem are normal in attenuation and morphology. No intracranial hemorrhage or abnormal extra-axial fluid collection is seen. There is no evidence of mass effect or midline shift. The ventricles and basal cisterns are patent and normal in size. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.The bones of the calvarium and skull base are intact. | Unremarkable evaluation. |
Generate impression based on findings. | Female, 23 years old, adult of treatment, head trauma, evaluate for bleed or fracture. Head:The cerebral and cerebellar hemispheres and brainstem are normal in attenuation and morphology. No intracranial hemorrhage or abnormal extra-axial fluid collection is seen. There is no evidence of mass effect or midline shift. The ventricles and basal cisterns are patent and normal in size. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.The bones of the calvarium and skull base are intact. Orbits:Mild soft tissue swelling is seen along the forehead and in the left periorbital region. The bony orbits are intact. The globes are round and symmetric. The lenses are normally positioned. The extraocular muscles and optic nerves demonstrate normal CT appearance. | 1. No acute intracranial abnormality.2. Mild soft tissue swelling of the forehead and left periorbital region. No orbital fractures. No injury to the orbital contents. |
Generate impression based on findings. | Male 53 years old; Reason: please eval R heart mass, pancreas for complications of pancreatitis History: abn cxr, pancreatitis, prior pseudocyst v. abscess CHEST:LUNGS AND PLEURA: Subpleural blebs in the left upper lobe anterior subsegmental. Scattered subsegmental atelectasis.The pleural spaces are clear. No focal consolidation .MEDIASTINUM AND HILA: Coronary artery calcification in a triple vessel distribution.CHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Moderate peripancreatic inflammatory changes. Hypodense lesion in the pancreatic uncinate process measures 2.5 x 2.1 cm suspicious for a cystic or solid neoplasm. Given the pancreatitis, pseudocyst is on the differential.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Punctate calcifications in the renal hilum possibly vascular. ThisRETROPERITONEUM, LYMPH NODES: Calcific arteriosclerotic disease of the aorta and branch vessels. Inflammation extends along the retroperitoneum into the paracolic gutters.BOWEL, MESENTERY: No loculated intraperitoneal fluid collection. No bowel obstruction. Pancreatic inflammation extends to the transverse portion of the duodenum.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Diffuse prostate calcifications.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Findings compatible with pancreatitis.2.Hypodense pancreatic uncinate process lesion recommend follow-up contrast enhanced MRI for further characterization as pancreatic neoplasm is not excluded.3.No drainable fluid collections. |
Generate impression based on findings. | Female 52 years old; Reason: s/p roux en y gastric bypass with persistent nausea and emesis History: nausea and emesis CHEST:LUNGS AND PLEURA: Calcified left lower pulmonary granulomata and basilar linear atelectasis. No pleural effusions. No pneumothorax.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. Post operative changes of median sternotomy. Hypodense focus adjacent to the left superior pulmonary vein (image 35 series 3) most likely represents a artifact or volume averaging.CHEST WALL: Median sternotomy.ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesions. Hypodensity about the hepatic hilum is nonspecific and may represent focal fatty infiltration.SPLEEN: The spleen is normal in size.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts and possible nonobstructive bilateral renal calculi.RETROPERITONEUM, LYMPH NODES: Calcific arteriosclerotic disease affects the aorta. No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Post operative changes from Roux-en-Y gastric bypass with an antecolic limb. There is probable edema at the distal stenosis causing a bowel obstruction. The proximal bowel loops are dilated up to 4 cm with a distal bowel loops partly collapsed. Contrast has reached the cecum either from this exam or the prior upper GI. No mesenteric fluid collections. There is some mesenteric edema.No pneumatosis, free intraperitoneal air or fluid collections.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: Please see aboveBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Bowel obstruction probably due to edema at the distal anastomotic site in the jejunum. The proximal loops are dilated up to 4 cm with distal loops collapsed. Follow up is suggested. |
Generate impression based on findings. | Male 79 years old; Reason: stone History: hematuria and back pain ABDOMEN:LUNGS BASES: Emphysema with areas of atelectasis. Probable blebs involving the right lung base. No pleural effusions.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: Well-circumscribed hypodense lesions in both kidneys may represent small cysts. No hydronephrosis or nephrolithiasis.RETROPERITONEUM, LYMPH NODES: Severe calcific arteriosclerotic disease of the aorta. Small nonspecific retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: The prostate is enlarged.BLADDER: No distal ureter or bladder calculi are evident.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Compression fracture of the L4 vertebral body which is age indeterminate. There is approximately 30% height loss involving the superior end plate.OTHER: No significant abnormality noted. | 1.No nephrolithiasis or hydronephrosis as clinically questioned.2.Compression fracture of the L4 vertebral body. |
Generate impression based on findings. | Female, 68 years old, 10 out of 10 headache status post fall with blunt head trauma to the right occiput. Moderate periventricular and subcortical white matter hypoattenuation is seen, a nonspecific finding which likely reflects age indeterminate small vessel ischemic disease. 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. There is a right parietal region subgaleal hematoma with diffuse scalp swelling involving the right side more than the left with extension to the right face and periorbital regions. | 1. No acute intracranial abnormality.2. Right parietal subgaleal hematoma and fairly diffuse soft tissue swelling involving the scalp and right face. |
Generate impression based on findings. | Female 21 years old; Reason: r/o stone, assess for ovarian cyst History: LLQ pain ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No nephrolithiasis or hydronephrosis in either kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small bowel is normal in caliber. Appendix is unremarkable in the right lower abdomen.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Bilateral ovarian cysts possibly physiologic.BLADDER: No distal ureteral bladder calculi.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.No distal ureteral or bladder calculi.2.Bilaterally ovarian cysts, possibly physiologic. If patient's symptoms persist, consider pelvic sonography. |
Generate impression based on findings. | Male 43 years old; Reason: inflammatory bowel disease, continued abdominal pain History: severe abdominal pain after colonoscopy ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic duct is dilated measuring up to 4-mm. No definite mass is identified at the level of the ampulla to account for these changes. Compared to the prior exam, the findings are stable.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic disease of the aorta. Small retroperitoneal lymph nodes.BOWEL, MESENTERY: Post operative changes from a right hemicolectomy. There is ileocolonic anastomosis in the mid abdomen. The proximal colonic portion (transverse colon) has wall thickening, mucosal hyperenhancement with submucosal edema and mild pericolonic inflammation.No free air or intraperitoneal loculated fluid collections.No bowel obstruction is evident.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: Please see above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Right hemicolectomy and ileo-colonic anastomosis in the right midabdomen with mucosal edema and wall thickening involving the colon (transverse colon) without evident findings of perforation or abscess formation.Differential considerations include inflammation from inflammatory bowel disease, infection. Ischemia is considered less likely given patency of the mesenteric vessels.2. Dilated pancreatic duct. M.R.C.P. is suggested. |
Generate impression based on findings. | Female 40 years old; Reason: ?etiology of sob History: active cancer. PULMONARY ARTERIES: No pulmonary emboli. Normal caliber of the main pulmonary artery. No right heart strain.LUNGS AND PLEURA: Interval development of a small right pleural effusion with overlying atelectasis. Stable left apical nodule which measures 0.7 x 0.9 cm (series 9 and image 14), previously 0.8 x 1.1 cm. Again seen is left anterior pleural thickening, predominately in the apex. The nodular focus at the level of the lingula measures 0.6 x 1.7 cm (series 9 and image 66), previously 2.7 x 1.5 cm and is not significantly changed. Persistent ground glass opacities again are seen in the right upper lobe. In a bronchial thickening and tree and blood opacities are again seen in the anterior right lobe (series 9, image 42) not significantly changed and likely post-inflammatory. Bilateral anterior subpleural reticulation is again identified, consistent with prior radiation exposure.MEDIASTINUM AND HILA: Again seen is increasing mediastinal and left hilar lymphadenopathy. Reference AP window node measures 1.3 cm (series 8, image 80) on increased from 1.1 cm. The left hilar lymph node measures 1.4 cm (series 8, image 88), previously 1.1 cm. No cardiomegaly or pericardial effusion. Left-sided chest port terminates at the superior cavoatrial junction.CHEST WALL: Postsurgical changes from prior bilateral mastectomies. A left posterior supraclavicular lymph node a stable at 0.9 cm. Stable left axillary fluid collection which measures and 1.7 x 1.9 cm (series 8, image 122), previously by 1.8 x 2.1 cm. Stable second more inferior axillary fluid collection measures 2.3 x 6.6 cm (Series 8, image 167), previously measured 2.5 x 6.4 cm. Interval increased in the size of the small right chest wall fluid collection from 1.4 x 1.8 cm (series 8, image 132), previously 0.9 x 1.5 cm. In addition there is increased surrounding stranding of the soft tissues and fat in this region.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Cholelithiasis without cholecystitis. | 1.No pulmonary emboli.2.Interval development of a small right pleural effusion with overlying atelectasis.3.Stable pulmonary nodules and pleural thickening. 4.Continued interval increase in the mediastinal and left hilar lymphadenopathy.5.Interval increase in the size of the small right chest wall fluid collection with increased reticular fat stranding and soft tissue thickening in this region. Although there is no clear rind circumscribing the fluid collection, Infection/early abscess cannot be ruled out. |
Generate impression based on findings. | Female 87 years old; Reason: Hemothorax - assess vascular etiology History: Hemothorax - assess vascular etiology CHEST:LUNGS AND PLEURA: The right middle pulmonary nodule has resolved. Moderate emphysematous changes and right dependent pulmonary consolidation.Left basilar and right paramediastinal upper lobe atelectatic changes.There is a small loculated pneumothorax at the left lung base.A left chest tube terminates adjacent to the eighth rib.MEDIASTINUM AND HILA: Heart size is globally enlarged. There is right atrial dilatation. Small pericardial effusion.Ascending aorta measures 4.0-cm in AP dimension while the descending aorta measures 1.9-cm. No aortic dissection is evident.Calcific arteriosclerotic disease affects the aorta and branch vessels.No active bleeding is identified to account for the left hemothorax.CHEST WALL: Subcutaneous gas in the left chest. Small amount of probable hematoma in the intercostal muscles at the site of chest tube placement. Other: Hypodense hepatic lesions presumably cysts. Left renal cyst. | 1.Chronic lung changes without evident source for a hemothorax. |
Generate impression based on findings. | Female 20 years old; Reason: infiltrate History: fever, cough, sob, abnormal cxr. LUNGS AND PLEURA: Multiple scattered bilateral pulmonary micronodules. Left lingular consolidation consistent with pneumonia.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Mild cardiomegaly without pericardial effusion.CHEST WALL: Thoracic dextroscoliosis.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Incompletely visualized areas of relatively low attenuation lesions (20 to 30 Hounsfield units) noted in the expected regions of the adrenal glands are of uncertain etiology. | 1.Left lingular consolidation consistent with pneumonia.2.Incompletely visualized soft tissue or high fluid attenuation masses in the expected regions of the adrenal glands of uncertain etiology. Abdominal CT or ultrasound may be considered for further evaluation. |
Generate impression based on findings. | Cellulitis, check for abscess Exam limited without intravenous or bowel contrast. Within this limitation, the lower pelvis and contents are unremarkable and symmetric.Starting soft tissues of the pelvis and upper limbs demonstrate a focal area of induration and possible small focus of fluid subcutaneously overlying the right hip (image 45 series 3). This focus measures 2.5 x 1.9 cm in correlation with physical exam and/or possibly ultrasound would be helpful to confirm. A small abscess cannot entirely be excluded. No abnormality of the deep soft tissues or muscular bundles. Osseous structures are unremarkable throughout | Small questionable subcutaneous focal fluid collection and/or changes representing a questionable early abscess overlying the right hip anteriorly. Please correlate with physical exam and consider ultrasound imaging |
Generate impression based on findings. | Female 64 years old; Reason: Evaluate for renal or bladder mass or nephrolithiasis as source of painless hematuria History: Hematuria ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver has a smooth contour. Status post cholecystectomy. No intra-or extrahepatic biliary ductal dilatation. The hepatic vasculature are patent. No suspicious hepatic lesions.SPLEEN: Nonspecific hypodense foci in the spleen. Spleen is normal in size.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Kidneys are normal in size and morphology. No hydronephrosis, nephrolithiasis or focal enhancing renal mass. Duplication of the left renal collecting system up to the level of the pelvis. Single right renal collecting system.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Severe degenerative changes affect the hips. Nonspecific sclerotic focus involving the right ilium. It has features suggesting a bone island.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Uterus is atrophic. Pelvic varices with dilatation of the left gonadal vein.BLADDER: No distal ureteral or bladder calculi.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.No nephrolithiasis or hydronephrosis.2.No evident focal renal mass or collecting system mass.3.Duplication of the left renal collecting system up to the level of the pelvis where there is a single entry into the bladder. No hydronephrosis or obstruction. While this is a normal variant, it may account for the patient's hematuria. 4.Follow-up is suggested possibly with a triphasic CT in 12 months to evaluate for currently occult lesions. |
Generate impression based on findings. | Male 73 years old; Reason: Cirrhosis, liver masses reported on CT 8/2013. reported negative on biopsy, but persistent RUQ pain. Evaluate for HCC History: RUQ pain, anorexia CHEST:LUNGS AND PLEURA: Minimal atelectasis at the lung bases. The pleural space are clear. No dominant lesion.MEDIASTINUM AND HILA: Heart size is normal. No mediastinal lymphadenopathy.CHEST WALL: Well-defined lytic lesion involving the posterior vertebral body of T5 . Differential considerations the lesion include metastatic disease or other vertebral body lesions including hemangiomas.OTHER: ABDOMEN:LIVER, BILIARY TRACT: Liver is enlarged and diffusely fatty infiltrated. Large hypodense segment 8 lesion with ill-defined margins measures at least 5.1 x 4.0 cm (image 75/series 10). There is focal biliary ductal dilatation adjacent to the mass.Small hyper vascular lesions in the left hepatic lobe with subsequent washout suspicious for small foci HCCThere are innumerable other right hepatic lobe lesions and there is diffuse disease of the right lobe. Focal gallbladder wall nodule seen along its anteromedial aspect.The hepatic fissures are slightly widened and the liver has a nodular contour.The main portal vein and intrahepatic portal venous branches are patent. Hepatic veins are patent.SPLEEN: No significant abnormality notedPANCREAS: Prominence of the pancreatic duct. No focal pancreatic lesion.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Mild nodularity of the right adrenal gland. Left adrenal gland is unremarkable.RETROPERITONEUM, LYMPH NODES: Extensive upper abdominal and retroperitoneal lymphadenopathy. A large, conglomerate lymph node mass adjacent to the celiac artery axis measures 3.8 x 2.4 cm (image 93/series 10). There are peripancreatic and portacaval lymph nodesBOWEL, MESENTERY: Small bowel is normal in caliber. No obstructive colonic mass. No enhancing lesion involving the transverse colon as seen on image 66 series 13 is nonspecific but may represent a colonic primary. Stomach is decompressed limiting evaluation. Scattered upper abdominal ascites suggests mesenteric involvement with disease.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: Decompressed colon.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Pelvic ascites. | 1.Extensive hepatic metastases with almost entire replacement of the right hepatic lobe with tumor. The dominant tumor size is provided.2.Extensive peripancreatic and periceliac lymphadenopathy.3.The findings are compatible with a metastatic process of unknown primary. Given the cirrhosis, primary hepatocellular carcinoma, cholangiocarcinoma and cholangio hepatoma, are high on the differential. Other considerations include metastatic melanoma (gallbladder lesion), metastatic colon cancer (transverse colon lesion).4.Peritoneal carcinomatosis is likely given the ascites and subtle peritoneal nodularity.5.Cirrhosis.6.See discussion above for the T5 vertebral body.7.Consider ultrasound guided biopsy of the liver with cytopathology confirmation. |
Generate impression based on findings. | Female, 48 years old, fever of unknown origin. The maxillary sinuses are small and completely opacified. The medial sinus walls are very thin to almost imperceptible and they seem to be retracting laterally. The ostiomeatal units are obstructed.There is compensatory expansion of the nasal cavity which is otherwise unremarkable with the exception of minimal secretions. The nasal septum is intact with a rightward deviation and a rightward projecting bony spur.The right frontal sinus and frontoethmoidal recess are opacified. The left frontal sinus and frontoethmoidal recesses are clear. There is a paucity of ethmoid air cells on the right which may be congenital or secondary to surgery. The ethmoid air cells are not significantly opacified. The sphenoid sinuses and sphenoethmoidal recesses are clear. | Opacified and apparently involuting maxillary sinuses compatible with long-standing outlet obstruction (silent sinus syndrome). Opacification of the right frontal sinus is also demonstrated. |
Generate impression based on findings. | Decreased range of motion and skin breakdown. Check for soft tissue infection versus osteomyelitis. Left ankle: Mild to moderate diffuse soft tissue swelling with questionable shallow ulceration along the medial aspect of the ankle. No discrete abnormal fluid collections or other findings to suggest deep soft tissue infection, specifically no subcutaneous gas. Mild scattered atherosclerotic changes.The underlying osseous structures are otherwise intact. Severely no findings of destruction fracture or malalignment. Underlying tendons appear grossly intactRight ankle: Similar mild to moderate diffuse soft tissue swelling with involving the lateral and medial aspects of the ankle. No discrete abnormal fluid collections or other findings to suggest deep soft tissue infection, specifically no subcutaneous gas. Mild scattered atherosclerotic changes.The underlying osseous structures are otherwise intact. Severely no findings of destruction fracture or malalignment. Underlying tendons appear grossly intact | Bilateral mild to moderate soft tissue changes suggesting diffuse induration and questionable shallow ulceration more pronounced the left. No underlying osseous abnormalities suggesting osteomyelitis or discrete abscess. |
Generate impression based on findings. | Male, 69 years old, paralysis agitans, status post deep brain stimulator placement with altered mental status. Assess for hemorrhage. Bilateral parietal approach deep brain stimulator leads are identified in stable position. Postoperative pneumocephalus has almost completely resolved.No evidence of acute intracranial hemorrhage or abnormal extra-axial fluid collection is seen. Brain parenchymal morphology and attenuation are unchanged and unremarkable with stable mild prominence of the ventricles and sulci.There is a small amount of edema or fluid in the right parietal subgaleal space along the stimulator leads. | Expected postoperative findings status post deep brain stimulator placement. No acute abnormalities are seen. |
Generate impression based on findings. | Female, 86 years old, shortness of breath, wheezing, deviation of the trachea consistent with a large right-sided goiter. There is a homogeneous, soft tissue attenuation mass in the right paratracheal upper mediastinum measuring 4.8 x 4.0 cm transaxial and slightly greater than 5 cm craniocaudal. This lesion displaces the trachea leftwards and causes a moderate transverse narrowing to a caliber of approximately 7 mm (normal tracheal caliber above the mass is approximately 14 mm).The source of the above mass is not entirely clear. It may be originating from the thyroid as it does contact the lower aspect of the right thyroid lobe. However, the majority of the right lobe and the left lobe of the thyroid are normal in size and imaging characteristics.Elsewhere in the neck, and without the benefit of contrast, no definite concerning mass lesions or pathologic lymph nodes are detected. The palatine and lingual tonsils are prominent for age but this can be reactive. Salivary glands are unremarkable. Lung apices are notable for a scarlike opacity in the right apex.The bony cortices of the skull base are thickened and sclerotic and demonstrate a pagetoid morphology. There is extensive degenerative disease in the cervical spine with flowing anterior osteophytes. | Large homogeneous soft tissue mass occupying the anterior and middle compartments of the upper mediastinum on the right. This results in leftward deviation and narrowing of the trachea.The lesion is in contact with the lower margin of the right thyroid lobe and may therefore be thyroid in origin. Other possible etiologies include a parathyroid lesion, thymic lesion or lymphadenopathy.The visualized bones of the skull base demonstrate a fairly typical pagetoid appearance. If the diagnosis is in question, radiographs of the pelvis and long bones may be helpful in demonstrating other characteristic sites of disease. Metastatic disease does, however, remain in the differential. |
Generate impression based on findings. | Male 42 years old; Reason: 11/7 CXR c/f ascending thoracic aorta ectasia/dilation, recommended CT Thorax History: no chest pain or SOB, possibly increasing dilation in CXR, no prior CTs in Epic CHEST:LUNGS AND PLEURA: Ground glass opacities in the apical posterior segment of the right upper lobe and scattered ground glass opacities in the lower lobes. These may pertain to infection, inflammation or possible areas of infarction given the patient's history of sickle cell. No pleural effusions. Central airways are patent.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. Ascending aorta measures 3.2-cm at the level of the MPA while the descending aorta measures 1.8-cm ; no dissection is evident. Coronary arteries are patent at the origin.No filling defects in the pulmonary arteries to suggest emboli.CHEST WALL: No significant abnormality notedOTHER: Imaged portion of the liver, spleen, kidneys adrenal glands and pancreas are unremarkable | 1.No aortic aneurysm as clinically questioned.2.Groundglass opacities possibly due to infectious, inflammatory or related to sickle cell. |
Generate impression based on findings. | Female, 63 years old, non-Hodgkin's lymphoma, now neutropenic with fever. Evaluate for infectious source. The visualized intracranial contents are unremarkable. The soft tissues of the maxillofacial region are free of infiltration, pathologic enhancement and fluid collections.There is mild soft tissue fullness in the left orbital apex which seems to reflect extra soft tissue situated in the space bounded by the medial rectus, optic nerve and superior rectus. The orbits are otherwise unremarkable. Peripheral mucosal thickening is evident within the left maxillary sinus.The outflow pathway is narrowed but may be minimally patent. The right maxillary sinus is clear and the outflow pathway is patent. The remaining paranasal sinuses are free. The mastoid air cells and middle ear cavities are normally pneumatized. | 1. Vague soft tissue fullness is noted within the left orbital apex. This may be artifactual. However, further evaluation with dedicated orbital MRI is suggested.2. Relatively mild peripheral mucosal thickening is evident within the left maxillary sinus. There are no fluid levels or frothy debris to suggest an active infection, though infection cannot be completely excluded. The remaining paranasal sinuses are unremarkable. |
Generate impression based on findings. | Female 63 years old; Reason: assess for infxn vs disease recurrence History: hx oh nhl, now neutropenic CHEST:LUNGS AND PLEURA: Subpleural reticulations and mild pleural thickening and nodularity. The subcentimeter pulmonary nodule has resolved. Scattered pulmonary micronodules for example, image 47/series 4 involving the left upper lobe.MEDIASTINUM AND HILA: Heart size is normal ; no pericardial effusion. No mediastinal lymphadenopathy. Reference pretracheal lymph node measures 0.8 x 0.7 cm (image 29/series 3) previously, 0.7 x 0.7 cm.CHEST WALL: Right axillary lymph node measures 0.5 x 0.5 cm (image 16/series 3) previously, 0.5 x 0.4 cm.Healing left rib fracture.ABDOMEN:LIVER, BILIARY TRACT: Liver has a smooth contour. No suspicious hepatic lesions. Prominence of the right hepatic lobe possibly a Riedel's lobe. Hepatic vasculature are patent. Multiple gallstones within a collapsed gallbladder.SPLEEN: Spleen is normal in size.PANCREAS: Hypoattenuating lesion in the tail of the pancreas measures 0.8 x 0.7 cm (image 105/series 3) previously, 1.0 x 0.6 cm. No distal pancreatic atrophy or ductal dilatation. The lesion most likely represents a side branch type IPMN.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy. Perinephric node measures 0.6 x 0.6 cm (image 97/series 3) previously, 0.8 x 0.8 cm.Left aortocaval lymph node measures 0.8 x 0.5 cm (image 111/series 3) previously, 0.6 x 0.6 cm.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 pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Stable exam without recurrent lymphadenopathy in the chest, abdomen or pelvis. |
Generate impression based on findings. | Female 38 years old; Reason: intraabd abn? History: writhing in pain, tympanic to percussion on L abd, TTP on RUQ/RLQ ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver has a smooth contour. No suspicious hepatic lesions. Hepatic and portal veins are patent. Status post cholecystectomy. Biliary tree is normal in caliber.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: Post operative changes from gastric resection. There is a suture margin involving the proximal duodenum. There is a suture margin at the mid jejunum and a anastomosis with the biliary alimentary limb at the distal jejunum. The biliary limb is dilated with fluid measuring up to the 3.2-cm. The alimentary limb is dilated up to 4.4-cm. The distal bowel loops past the distal anastomosis are completely collapsed.Small amount of fecal matter within the ascending colon. The remainder of the colon is collapsed.No definite free intraperitoneal air. There is scattered upper abdominal ascites.No pneumatosis.Enteric tube terminates in the proximal alimentary limb.BONES, SOFT TISSUES: Healed scar at midline.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Uterine fibroids.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Please see aboveBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Configuration suggests a duodenal switch procedure. Dilatation of the biliary limb and alimentary limb to the level of the distal anastomosis where there is a complete small bowel obstruction. Ascites indicates the obstruction is severe.2.Findings discussed with surgery team in person. |
Generate impression based on findings. | Male 69 years old; Reason: diverticulitis? History: intermittent LLQ pain ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver contour is smooth. Nonspecific subcentimeter hypodense hepatic lesions. Hepatic and portal veins are patent. No biliary ductal dilatation is evident.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right kidney enhances homogeneously. No hydronephrosis or nephrolithiasis.Delay in the left nephrogram and mild dilatation of the left ureter up to the left ureterovesical junction where there is a partially obstructive 3 mm calculus.There is mild left perinephric inflammation.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small bowel is normal in caliber. Colon is not distended. Small amounts of perinephric fluid extend into the left paracolic gutter.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: Prostate is enlarged.BLADDER: Three to 5-mm partially obstructing left UVJ calculus.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes affect the lumbar spine, pubic symphysis and hips.OTHER: Small amount of abdominal ascites. | 1.3 mm calculus at the left UVJ with mild left hydronephrosis.2.Pelvic ascites possibly due to the ureteral stone. Follow up is suggested. |
Generate impression based on findings. | Female 32 years old; Reason: work up for sarcoidosis due to MRI brain findings History: left arm twitching and numbness CHEST:LUNGS AND PLEURA: No suspicious pulmonary lesions. The pleural spaces are clear. Minimal left basilar atelectasis. Possible atelectasis in the lingula..MEDIASTINUM AND HILA: Heart is severely enlarged. No mediastinal lymphadenopathy. No pericardial effusion.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Liver has a smooth contour. Hepatic and portal veins are patent. Right hepatic lobe is enlarged measuring 20 cm in craniocaudal dimension. No definite hepatic lesions.SPLEEN: Spleen is normal in size.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes.BOWEL, MESENTERY: Small bowel is normal in caliber. Scattered colonic diverticula.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Adnexal cyst, possibly physiologic.Probable uterine fibroids involving the posterior uterine body.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Severe cardiomegaly.2.Findings suggestive of hepatomegaly.3.No specific findings of sarcoid. |
Generate impression based on findings. | Male 57 years old; Reason: metastatic melanoma, on dacarbazine, please eval for progression History: melanoma CHEST:LUNGS AND PLEURA: Bilateral pulmonary metastatic deposits. Right lower lobe pulmonary lesion measures 1.2 x 1.0 cm (image 86/series 5) previously, 1.0 x 0.9 cm.Left lung base lesion measures 0.6 x 0.6 cm (image 71/series 5) previously, 0.7 x 0.6 cm.Pleural spaces are clear. Minimal ground glass opacities in the right upper lobe is new. No definite new solid lesions.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Chronic right rib fractures. Small left axillary lymph nodes.OTHER: ABDOMEN:LIVER, BILIARY TRACT: Reference segment 7 lesion measures 1.2 x 0.8 cm (image 100/series 3) previously, 1.2 x 0.9 cm.Reference segment 3 lesion measures 2.0 x 1.4 cm (image 135/series 3) previously, 2.4 x 1.7 cm.Other hepatic lesions are unchanged.The hepatic and portal veins are patent. No biliary ductal dilatation.SPLEEN: Hypervascular splenic lesion is unchanged.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Pelvic lymph nodes are unchanged. Index left distal external iliac lymph node measures 1.6 x 0.9 cm (image 193/series 3) previously, 1.8 x 0.8 cm.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Near stable size measurements of the reference lesions. No definite new lesions. |
Generate impression based on findings. | Male, 57 years old, status-post EVD placement. Postop change demonstrated consistent with placement and removal of a right frontal approach ventricular shunt. Procedure-related air within the ventricles persists with some redistribution. Air within the right parietal subcutaneous space is reduced and there is a small amount of extracranial scalp fluid noted along the tract. Small calcific fragment along the right frontal lobe shunt tract again seen.No significant interval change in the size of a right basal ganglia/thalamic hematoma. Stable surrounding parenchymal edema and stable mass effect. Hemorrhage layering within the occipital horns is more difficult to see on today's exam. Minimal persistent subarachnoid blood product in the occipital regions. Lateral ventricular caliber has increased very slightly, on the order of 1 to 2 mm. | 1. Right basal ganglia/thalamic hematoma appearing similar in size to the prior exam.2. No new hemorrhage is detected.3. Very slight interval increase in the caliber of the lateral ventricles. |
Generate impression based on findings. | Male, 57 years old, history of metastatic melanoma. 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. Stable left maxillary sinus mucous retention cyst.Aerodigestive tract is unremarkable. No soft tissue masses or pathologic adenopathy is detected. The salivary glands and thyroid are free of focal lesions. Cervical vessels are patent. Lung apices notable for nonspecific vague opacities and a right apex micronodule. Dedicated chest CT will be interpreted separately. No concerning osseous lesions are seen. | No evidence of active disease in the neck. |
Generate impression based on findings. | Female 57 years old; Reason: baseline study for new leukemia patient History: new leukemia diagnosis. LUNGS AND PLEURA: Apical centrilobular emphysema. Bilateral streaky opacities in the dependent distribution represent atelectasis. No focal consolidation or pleural effusion.MEDIASTINUM AND HILA: Right-sided central venous catheter terminates at the superior cavoatrial junction. No mediastinal or hilar lymphadenopathy. No cardiomegaly or pericardial effusion. CHEST WALL: Small bilateral thyroid nodules.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | No lymphadenopathy, suspicious lesions or evidence of metastasis. |
Generate impression based on findings. | Male 72 years old; Reason: 72yo M with pulmonary fibrosis, persistent pneumothorax s/p chest tube, eval prior to endobronchial valve placement History: persistent pneumothorax. LUNGS AND PLEURA: Again seen is a moderate right pneumothorax and known chest tube, unchanged in position. Underlying diffuse groundglass opacities are seen throughout the lungs bilaterally with septal thickening which could represent edema in a peribronchial distribution. Focal consolidation in the right lower lobe with air bronchograms remains of concern for possible infection or postprocedural. These changes are superimposed on a background of chronic appearing interstitial opacities with predominantly basilar lung base bronchiectasis and fibrosis. No discrete pleural effusions.MEDIASTINUM AND HILA: Moderate to severe cardiomegaly. No pericardial effusion yet severe coronary artery calcifications. Left-sided pacemaker with leads unchanged. No lymphadenopathy.CHEST WALL: Severe right-sided subcutaneous emphysematous changes of the soft tissues status post placement of a right-sided chest tube.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Large calcified gallstone. Nonspecific thickening in the left adrenal gland. Ill-defined left renal hypodensity, partially seen and incompletely characterized on noncontrast exam. | 1.Right-sided pneumothorax and severe subcutaneous emphysema status post right-sided chest tube placement.2.Acute edema or atypical infection superimposed on chronic interstitial and fibrotic lung changes. |
Generate impression based on findings. | Female, 68 years old, status post fall. Headache. Neck pain. Straightening of the cervical lordosis is likely positional. No acute malalignment seen.There is degenerative type loss of vertebral body height secondary to endplate irregularity and Schmorl's node deformities. No evidence of traumatic fracture is seen.Disk space narrowing is evident with posterior disk osteophyte complexes at C3-4, C4-5 and C5-6. The disk osteophyte complex at C4-5 is large and probably results in some degree of spinal canal stenosis. The neural foramina are patent. | 1. No cervical spine fracture or acute malalignment.2. Fairly extensive degenerative disk disease, most severe at C4-5 where there is a large posterior disk-osteophyte complex likely resulting in spinal canal stenosis. |
Generate impression based on findings. | Male, 74 years old, status-post fall. The cerebral and cerebellar hemispheres and brainstem are normal in attenuation and morphology. No intracranial hemorrhage or abnormal extra-axial fluid collection is seen. There is no evidence of mass effect or midline shift. The ventricles and basal cisterns are patent and normal in size. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.The bones of the calvarium and skull base are intact. | No acute intracranial abnormality. |
Generate impression based on findings. | Male, 11 years old, history of head trauma presenting with worsening headache for the last month. The cerebral and cerebellar hemispheres and brainstem are normal in attenuation and morphology. No intracranial hemorrhage or abnormal extra-axial fluid collection is seen. There is no evidence of mass effect or midline shift. The ventricles and basal cisterns are patent and normal in size. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.The bones of the calvarium and skull base are intact. | Unremarkable evaluation. |
Generate impression based on findings. | Female 86 years old; Reason: Assess for tracheal narrowing. History: Wheezing, shortness of breath, deviation of the trachea the thoracic inlet level consistent with a large right-sided goiter. LUNGS AND PLEURA: No focal consolidation, pleural effusion or pneumothorax. Small left pleural effusion and atelectasis is noted in the left lung base. In the right upper mediastinum is a well-defined, round, 3.9 x 4.4 cm mass, which causes leftward deviation of the trachea by 2-3 cm. The mass is exerting mass effect on the trachea resulting in approximately 50% compression.CHEST WALL: Multilevel degenerative changes of the spine are noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Large left nonobstructive renal stone. | Right upper mediastinal soft tissue mass causing leftward deviation of the trachea but no significant narrowing.MEDIASTINUM AND HILA: Within the right upper mediastinum is a well-defined trauma rounded, 3.9 x 4.4 cm mass which causes leftward deviation of the trachea and esophagus by 22 cm. The left mass diameter is is causing compression of the trachea, the lumen of which is reduced by 50%. CHEST WALL: Multilevel degenerative changes of the spine are noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. 1.1 cm left nonobstructive renal stone, partially visualized. |
Generate impression based on findings. | to eval if any acute change from previous stroke There is redemonstration of a left sided intraparenchymal hematoma involving the left caudate nucleus and adjacent basal ganglia and internal capsule measuring approximately 38 x 32 mm axial dimensions which is unchanged since prior exams and associated with a mild to midline shift. There is associated intraventricular blood and subarachnoid blood.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.Stable left basal ganglia and adjacent to white matter hematoma associated with intraventricular and subarachnoid blood. The lateral ventricle size and the mass effect are stable. |
Generate impression based on findings. | to eval if any acute change from previous stroke There is redemonstration of a left sided intraparenchymal hematoma involving the left caudate nucleus and adjacent basal ganglia and internal capsule measuring approximately 38 x 32 mm axial dimensions which is unchanged since prior exams and associated with a mild to midline shift. There is associated intraventricular blood and subarachnoid blood.The lateral ventricles remain stable in size. There is contrast in now present within the cerebral vasculature.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.Stable left basal ganglia and adjacent to white matter hematoma associated with intraventricular and subarachnoid blood. The lateral ventricle size and the mass effect are stable. |
Generate impression based on findings. | 41 year old female patient with right flank pain and history of kidney stones. Evaluate for renal calculi. Note that the lack of intravenous contrast limits evaluation of vasculature, lymph nodes and solid viscera.ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Hepatomegaly, measuring 22 cm in craniocaudal dimension. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate, nonobstructing renal calculi in the superior poles bilaterally. Right kidney with mild hydronephrosis, subtle perinephric fat stranding and dilatation of the proximal two thirds of the ureter, measuring 8 mm on coronal images. There is a punctate calcification in the region of the right urterovesicular junction (series 3 image 133) that measures 4 mm and is suspicious for a renal calculus. It is unclear whether this is an obstructing calculus versus a phlebolith. The right ureter is not clearly visualized and is likely collapsed in this area.RETROPERITONEUM, 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.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Enlarged uterus, likely secondary to fibroids.BLADDER: Collapsed without bladder calculi.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.OTHER: No significant abnormality noted. | Mild right hydronephrosis with dilatation of the proximal two thirds of the right ureter. 4 mm calcification in the area of the right UVJ suspicious for renal calculus versus phlebolith. |
Generate impression based on findings. | Reason: known UE DVT, please assess for PE History: hypoxia PULMONARY ARTERIES: Technically adequate examination. New equivocal filling defect in segmental right pulmonary artery extending into the proximal upper lobe pulmonary artery (image 80/308) which may represent an embolus versus a web. It does appear new versus prior study. The clinical significance of such a finding is unknown. LUNGS AND PLEURA: New complete left lower lobe atelectasis with presumed mucus plugging of the left lower lobe bronchus. Surrounding moderate pleural effusion. Persistent diffuse bronchial wall thickening. Patchy multifocal ground glass opacity throughout the left upper lobe.Surgical changes in the right hemithorax with right lung wedge resection and resection of the posterior chest wall is again seen. Interval increase in fluid collection with multiple air foci in the right upper pleural space tracking into the subcutaneous tissues around the scapula in the right posterolateral chest wall. No cortical destruction in the right scapula is evident. Right apical consolidation with hydropneumothorax is again seen without significant change. Slight decrease in loculated right pleural effusion. Persistent foci of air in the superior segment of the right lobe.MEDIASTINUM AND HILA: Tracheostomy tube noted. Heart size is normal. Mild atherosclerotic calcification of the coronary arteries and aorta. Enlarged hilar lymph nodes are nonspecific and may be reactive in nature. Occlusion of the SVC.CHEST WALL: Post surgical changes in the posterolateral right chest wall. As noted above, interval increase in fluid and gas in the soft tissues surrounding the right scapula. Multiple chest wall collaterals. Right axillary lymphadenopathy likely reactive. Drainage catheter coursing to the right lateral and posterior subcutaneous soft tissues is unchanged in position.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Interval resolution of pneumoperitoneum. Ulcerative atherosclerotic plaques of the abdominal aorta. | 1.New equivocal filling defect in segmental right pulmonary artery extending into the proximal upper lobe pulmonary artery which may represent an embolus versus a web. It does appear new versus prior study. The clinical significance of such a finding is unknown. 2.New complete left lower lobe atelectasis with presumed mucus plugging of the left lower lobe bronchus.3.Interval increase in fluid and air collection in the right chest with extension into the subcutaneous tissue of the right posterior chest wall.Findings discussed with ICU resident at 1030 on 11/11/13 by Dr. Alexander. |
Generate impression based on findings. | 51 old female with history of tachycardia and tachypnea with hypoxemia, evaluate for PE. PULMONARY ARTERIES: No pulmonary embolus.LUNGS AND PLEURA: Diffuse, sharply demarcated areas of groundglass opacities are seen in all lobes in a predominantly central distribution with sparing of the CP angles. No pleural effusions, with a few septal lines at the bases.MEDIASTINUM AND HILA: The esophagus is patulous and several minimally enlarged lymph nodes are seen about the hilum and mediastinum.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Fatty infiltration of the liver. | 1.No pulmonary embolus.2.Parenchymal findings are nonspecific but may represent acute noncardiogenic pulmonary edema secondary to an acute drug or transfusion reaction. Atypical infection or pulmonary hemorrhage are considered less likely given the distribution and clinical context. |
Generate impression based on findings. | 68 year-old male with hemorrhagic stroke A right parenchymal hemorrhage has slightly decreased in size over the interim. Residual subarachnoid hemorrhage remains similar to prior study although there has been some redistribution. Blood within the occipital horns is stable. The ventricular system remain within normal size and unchanged. Midline structures are maintained. There are no findings of interval new hemorrhage. | 1.No interval new hemorrhage.2.Slight decrease in size of right hemispheric hemorrhagic stroke.3.Essentially stable intraventricular and subarachnoid hemorrhage given some interval redistribution.4.Stable normal size of ventricular system. |
Generate impression based on findings. | 62-year-old male with sharp pain in back and site of CT guided biopsy. History of a metastatic urothelial carcinoma with sarcomatoid differentiation. CHEST:LUNGS AND PLEURA: Interval development of large loculated fluid collections involving the left lung pleura. Multiple left pleural and pulmonary nodules are also identified. Innumerable right pulmonary nodules are consistent with metastatic disease. For future reference one right upper lobe nodule measures 6 x 6 mm (image 26, series 4).MEDIASTINUM AND HILA: No mediastinal lymphadenopathy.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Hypodense segment 4 lesion measures 1.5 x 1.9 cm. (image 108, series 3). Additional hypodensity in the left hepatic lobe (image 95, series 3) is unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Right adrenal myelolipoma.KIDNEYS, URETERS: Moderate left hydronephrosis and hydroureter with narrowing of the distal left ureter near the anastomosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Right lower quadrant ileostomy.BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine. OTHER: Fluid collection adjacent to the right external iliac vessels measures 5.8 x 1.1 cm and previously measured 4.8 x 1.9 cm (image 27, series 3).PELVIS:PROSTATE, SEMINAL VESICLES: Cystoprostatectomy.BLADDER: Cystoprostatectomy.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine. OTHER: Residual fluid collection in the deep pelvis measures 4.8 x 2.4 cm and previously measured 6.1 x 3.0 cm (image 203, series 3). | 1. Interval development of multiple loculated fluid collections involving the left lung/pleura suspicious for empyema, correlate for fever and white blood cell count.2. Interval decrease in pelvic and lower abdominal fluid collections.3. Redemonstration of diffuse metastatic pulmonary and pleural disease.4. Unchanged pelvic lymphadenopathy and hypodense hepatic lesions. |
Generate impression based on findings. | Abdominal pain and vomiting. Evaluate for appendicitis. ABDOMEN:LUNG BASES: No air space opacities or pleural effusions.LIVER, BILIARY TRACT: Normal appearance of the liver, without focal lesions or ductal dilatation. Normal appearance of the gallbladder.SPLEEN: Normal in appearance.PANCREAS: Normal in appearance.ADRENAL GLANDS: Normal in appearance.KIDNEYS, URETERS: 5-mm stone in the distal right ureter, with mild proximal hydroureter and hydronephrosis. Several additional bilateral non-obstructing renal stones bilaterally. No focal renal lesions.RETROPERITONEUM, LYMPH NODES: No intra-abdominal lymphadenopathy.BOWEL, MESENTERY: Normal-appearing loops of bowel. Normal appendix.BONES, SOFT TISSUES: No osseous abnormality. Increased body mass index and peritoneal fat.OTHER: No ascites. PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: Normal-appearing loops of bowel.BONES, SOFT TISSUES: No osseous abnormality. Increased body mass index and peritoneal fat.OTHER: Trace pelvic free fluid, likely physiologic. | 5-mm obstructing stone in the distal right ureter, with mild hydroureter and hydronephrosis. |
Generate impression based on findings. | Fall. There is no evidence of acute 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 appears unremarkable, without evidence of displaced fracture. There is a small left frontal scalp hematoma. | Small left frontal scalp hematoma, but no evidence of intracranial hemorrhage or displaced calvarial fracture. |
Generate impression based on findings. | Right cheek melanoma. Left cheek biopsy: Solar damaged skin with rare reactive changes, no melanocytic lesion. Right cheek biopsy: solar elastosis, no melanocytic lesion, and cavernous hemangioma in the dermis. Head: There is no evidence of abnormal intracranial enhancement, mass, intracranial hemorrhage, or cerebral edema. There is mild diffuse brain parenchymal volume loss and nonspecific cerebral white matter hypoattenuation. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. There is a non-expansile lucent focus in the occipital bone to the right of the occipital protuberance that measures 10 x 14 mm with ground glass consistency, which likely represents a fibroosseous lesion or hemangioma.Neck: There are multiple foci of right cheek skin thickening. There are also two foci of soft tissue attenuation that measure up to 3 mm in the subcutaneous tissues overlying the parotid gland and a subcutaneous soft tissue attenuation focus that measures up to 5 mm in thickness anterior to the tragus. There is also diffuse mild left cheek skin thickening associated with a linear soft tissue attenuation focus that extends into the subcutaneous tissues, which likely represents a biopsy track. There is a mildly prominent right occipital lymph node that measures 5 x 5 mm with a preserved fatty hilum. There is otherwise no evidence of significant cervical lymphadenopathy. The thyroid gland and major salivary glands are unremarkable. The airways are patent. There is mild mixed-attenuation plaque at the bilateral carotid bifurcations. There is multilevel degenerative spondylosis. | Multiple bilateral cheek skin lesions with associated biopsy changes. Otherwise, no deep neck space masses or significant cervical lymphadenopathy. |
Generate impression based on findings. | Reason: 59-year-old male with history of head and neck cancer status post CRT 2/2011;developed lung primary and is now s/p right lower lobectomy for a T1aN0M0 stage IA adenocarcinoma History: as above CHEST:LUNGS AND PLEURA: Post op change on the right. Stable scarring and scattered micronodules which are presumably post inflammatory. No evidence of metastatic disease.MEDIASTINUM AND HILA: Scattered subcentimeter nodes are unchanged.CHEST WALL: New subacute rib fracture of right anterior sixth rib (image 62/154) with some callus formation.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Scattered punctate nonobstructive calcified stones, unchanged.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Scattered small subcentimeter lymph nodes with some nonspecific haziness to the mesentery are unchanged.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Colonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No evidence of metastatic disease. |
Generate impression based on findings. | HCC last TACE 9/2012. Evaluate interval change from 1/2013, right upper quadrant pain Limited study, intravenous contrast was not administered. This limits the sensitivity to detect small lesions in solid organs and bowel.Suboptimal study due to breathing artifact.CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Multiple small lymph nodes not enlarged by CT criteria.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology of the liver noted. Previously described arterially enhancing left lobe mass appears to be seen is a slightly high attenuating lobulated lesion that has increased in size with a contour bulge, approximately measuring 10.6 x 8 cm on this noncontrast study (image 95, 3), previously measured 4.6 x 7.3 cm on a postcontrast study.Hypoattenuating right hepatic lesion segment 8 measures 1.9 x 1.1 cm (image 95, 3), unchanged from prior study, when it measured 2 x 1.1 cm.Previously hypoattenuating now more iso-attenuating left lobe of liver lesion measures 4.9 x 4 .8 cm, previously measured 4.9 x 5.1 cm (image 111, 3), mostly unchanged from prior study.Previously seen lesion in the caudate lobe and other arterially enhancing bilobar lesions are not definitely identified on this noncontrast study.Out of the previously noted new 4 arterially enhancing lesions within the left lobe one lesion at the tip of the left lobe in ( image 121, 3), appears increased from prior study, now measures 2.1 x 2 cm. Other 3 lesions are definitely seen.SPLEEN: No significant abnormality notedPANCREAS: Coils placement in the GDAADRENAL GLANDS: Stable nodularity of the adrenal glands.KIDNEYS, URETERS: Nonobstructing right renal calculusRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mild increased haziness of the mesentery part of it could be due to breathing artifact. No measurable disease.BONES, SOFT TISSUES: Multiple degenerative changes.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Multiple diverticula involving the descending and sigmoid colon without diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Minimal fluid noted in the pelvis, new from prior study. | Limited study due to lack of IV contrast and breathing artifact in mid abdomen.Cirrhotic morphology of the liver. Interval increase in left hepatic dome lesions.New minimal fluid within the pelvis. |
Generate impression based on findings. | 36 year old female with history of painful respiration, tachycardia, shortness of breath, lupus and recent estrogen. PULMONARY ARTERIES: No pulmonary embolus to the segmental level.LUNGS AND PLEURA: Bibasilar atelectasis/scarring, with a mild bronchiolar wall thickening. The previously described right lower lobe nodule is no longer seen. No appreciable pleural effusion.MEDIASTINUM AND HILA: Several markedly enlarged lymph nodes are noted about the hilum and mediastinum bilaterally, with one focus of lymphoid tissue in the right hilum measuring approximately up to 2 cm in diameter. This is nonspecific but most consistent with sarcoidosis.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Cholecystectomy clips are noted. | 1.No pulmonary embolus.2.Marked mediastinal and hilar lymphadenopathy, nonspecific, but in this age group most commonly due to sarcoidosis.3.Bibasilar atelectasis or scarring with mild bronchial wall thickening. |
Generate impression based on findings. | Reason: pt with lung ca s/p multiple chemo/rt History: Lung cancer-questionable disease CHEST:LUNGS AND PLEURA: Reference right apex/paratracheal mass measures 3.5 x 2.4 cm on image 37/150, slightly decreased versus 3.9 x 2.7 cm on prior. Small right pleural effusion as grossly stable. There is extensive pleural thickening, unchanged. Multiple small pleural pleural based nodules on the right, for instance images 77 and 87/150) are unchanged. Extensive right sided consolidation presumably related to prior radiation therapy with cavitary changes in the right apex, has increased with decreased aeration of the right base.The left lung shows extensive emphysema and interval increase in centrilobular nodular and tree in bud opacity. However, the reference left lower lobe nodule has decreased to 17 x 14 mm on image 88/111, 22 x 13 mm on prior. There is associated bronchial wall thickening.Incidental note is made of acentric hypodensity involving the posterior aspect of the right main pulmonary artery which is likely due to chronic PE or possibly prior radiation therapy to this area. No evidence of acute PE given limits of technique. MEDIASTINUM AND HILA: Lymphadenopathy stable. Right hilar encasement of tumor is unchanged. Atherosclerotic calcification of the aorta and its branches. Coronary calcification.CHEST WALL: Subcentimeter hypodensity in right hepatic lobe is unchanged and presumably a cyst.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Hypodensity in segment 4 is unchanged. Well-circumscribed hypodensity in right posterior segment (image 98/150) unchanged and presumably benign.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Nonspecific right adrenal nodule is unchanged.KIDNEYS, URETERS: Interval right nephrectomy.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the aorta and its branches. Small upper abdominal nodes are unchanged.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Reference left lower lobe nodule has decreased, though surrounding nodularity throughout the left lung has increased. The appearance and distribution of the nodule is nonspecific but more typical of bronchiolitis than metastases. Endobronchial spread of tumor can appear similarly, however, and continued follow up is recommended.2. Reference right paratracheal/mediastinal mass is stable.3. Presumed pleural metastases are stable.4. New findings involving right main pulmonary artery likely due to chronic PE or possibly prior radiation therapy. No evidence of acute PE given limits of technique. |
Generate impression based on findings. | 49-year-old male status post orthotopic heart transplant ABDOMEN: Exam is limited in the evaluation of solid organ pathology and vasculature due to lack of IV contrast.LUNG BASES: Small pleural effusions with associated atelectasis.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral hypodense lesions are incompletely evaluated, and may represent cysts. Several hyperdense lesions are suggestive of complex cysts. Punctate calcification in the right kidney. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diffuse ascites and multiple small mesenteric lymph nodes of unclear etiology. Normal appendix.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: Diffuse ascites and multiple small mesenteric lymph nodes of unclear etiology. Normal appendix.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Diffuse abdominal and pelvic ascites and multiple small prominent mesenteric lymph nodes which may be reactive in etiology. Carcinomatosis would be unlikely but cannot be excluded, correlate clinically.2. Normal appendix. |
Generate impression based on findings. | 22-year-old male needs CT of left wrist prior to surgery this a.m. Left wrist pain. TENDONS: No significant abnormality noted within the limitations of CT technique.BONES: Note is made of an impacted comminuted distal radius fracture with intra-articular extension involving the radiocarpal joint and dorsal displacement of the distal fracture fragments. There is soft tissue swelling noted in the surrounding area. There is a small ossific density consistent with an ulnar styloid fracture. No additional fractures are identified.ADDITIONAL | Comminuted distal radial and ulnar styloid fractures. |
Generate impression based on findings. | 57 years old male status-post EVD placement. Postop change demonstrated consistent with removal of a right frontal approach ventricular shunt. Procedure-related air within the ventricles has been less. Air within the right parietal subcutaneous space is reduced and there is a small amount of extracranial scalp fluid noted along the tract. Small calcific fragment along the right frontal lobe shunt tract again seen.No significant interval change in the size of a right basal ganglia/thalamic hematoma. Stable surrounding parenchymal edema and stable mass effect. Hemorrhage layering within the occipital horns is more difficult to see on today's exam. Minimal persistent subarachnoid blood product in the occipital regions. Lateral ventricular caliber has been stable in size. | 1. Right basal ganglia/thalamic hematoma appearing similar in size to the prior exam.2. No new hemorrhage is detected.3. Stable ventricular size. |
Generate impression based on findings. | 19 year-old female with right lower quadrant tenderness, evaluate for appendicitis ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Cholelithiasis. No focal hepatic lesionsSPLEEN: 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: Normal appearing appendix. The bowel is normal in caliber. No right lower quadrant inflammation.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Surgical clip is noted in the left lower quadrant. Normal appendix and normal caliber bowel.BONES, SOFT TISSUES: Nonspecific sclerotic focus in the right ilium.OTHER: No significant abnormality noted | 1. No specific findings to account for patient's symptoms.2. Cholelithiasis without evidence of cholecystitis. |
Generate impression based on findings. | 36-year-old male patient with history of type 2 diabetes, hypertriglyceridemia with recurrent pancreatitis. Please evaluate for pseudocysts, abscess or necrosis. ABDOMEN:LUNG BASES: Bilateral dependent atelectasis versus scarring.LIVER, BILIARY TRACT: Hypoattenuating liver parenchyma is consistent with fatty infiltration.SPLEEN: Mild splenomegaly, measuring 14 cm in craniocaudal dimension.PANCREAS: Extensive peripancreatic fat stranding and fluid extending into the mesentery. Fluid and fat stranding extends caudally anterior to the right psoas muscle to the level of the pelvic inlet and extends cranially to the transverse colon and the small bowel mesenteric root. Right pericolic fluid is present. There is attenuation of the proximal SMV and portosplenic confluence without evidence of thrombosis.The head and neck of the pancreas are relatively hypoenhancing without evidence of necrosis. No pseudocyst, abscess, pseudoaneurysm or hyperattenuation to suggest hemorrhage.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple subcentimeter, hypoattenuating lesions in the bilateral kidneys are too small to characterize and likely represent cysts.RETROPERITONEUM, LYMPH NODES: Peripancreatic fat stranding, as above.BOWEL, MESENTERY: Colonic diverticulosis without CT evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis without CT evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Extensive peripancreatic fat stranding and fluid without evidence of pseudocyst, pseudoaneurysm, abscess or necrosis. |
Generate impression based on findings. | Reason: h/o recurrent larynx cancer History: r/o chest mets LUNGS AND PLEURA: New 46 x 25 mm mass in right lower lobe (image 48/96). Emphysema. Bronchial wall thickening.MEDIASTINUM AND HILA: New right hilar lymphadenopathy. Right paratracheal lymph nodes are stable. Atherosclerotic calcification of the aorta and its branches. Coronary calcification.Postop change involving the neck.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Nonspecific left adrenal nodule is incompletely visualized but the visualized portions are unchanged in size and appearance. Small calcified splenic artery aneurysm unchanged. | Lower lobe mass with right hilar lymphadenopathy highly suggestive of malignancy. The appearance is more typical of primary lung carcinoma than metastatic disease. |
Generate impression based on findings. | AML, neutropenic fever. r/o sinusitis vs. left upper molar dental infection. There is dental amalgam within multiple teeth, including the left maxillary molars. There is periodontal lucency surrounding ADA 13. There is also periodontal lucency surrounding ADA 28, which also contains dental amalgam. There is moderate mucosal thickening and retention cyst formation within alveolar recess of the left maxillary sinus, which is new since September 2013. There is minimal mucosal thickening within the right maxillary sinus and posterior ethmoid air cells. The sphenoid and frontal sinuses are clear. There is partial opacification of bilateral mastoid air cells, right greater than left. The portions of the facial soft tissues that are not obscured by dental amalgam streak artifact appear unremarkable without evidence of residual preseptal stranding. There are moderate degenerative changes of the bilateral temporomandibular joint. The imaged portions of the orbits and intracranial structures are grossly unremarkable. | 1. Periodontal lucency surrounding ADA 13 and 28, which contain dental amalgam. 2. Moderate retention cyst formation within the left maxillary sinus, which is new since September 2013. |
Generate impression based on findings. | Reason: 68 female with relapsed AML, neutropenic fever. r/o infiltrate History: Neutropenic fever LUNGS AND PLEURA: New bilateral pleural effusions with mild compressive basal atelectasis. New faint upper lobe predominant patchy ground glass opacities which are nonspecific but can be seen with pneumonia or edema. New 17-mm nodule in right lower lobe (image 46/103) suggestive of infection.MEDIASTINUM AND HILA: Large heterogeneous thyroid mass with calcification unchanged to slightly larger.Calcified mediastinal and right hilar lymph nodes are likely the result of healed granulomatous disease.Left PICC terminates at the SVC/RA junction level.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Hepatic and splenic granulomas. | New bilateral pleural effusions with new ground glass opacities and right lower lobe nodule suggestive of infection, possibly fungal. There may be associated pulmonary edema.Findings communicated to Dr. King via text paging tool at the time of report. |
Generate impression based on findings. | Reason: 54 male with AML in remission receiving consolidation chemotherapy. Recurrent fevers with prior probable fungal pneumonia per CT, has been on treatment. Assess for interval change. History: AML with fever LUNGS AND PLEURA: Widespread multifocal bilateral nodular opacities highly suggestive of fungal pneumonia. Overall the majority of the opacities show no significant change. A larger area of opacity in the superior segment of the right lower lobe (image 43/106) and medial left upper lobe (image 36) are smaller though a small subcentimeter nodule in the superior left lower lobe (image 51/106) is equivocally new, but definitely increased.Emphysema.MEDIASTINUM AND HILA: Atherosclerotic calcification of the coronary arteries.CHEST WALL: Small subcutaneous nodule in right back is unchanged and presumably a small sebaceous cyst. Degenerative change involving the spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Status post cholecystectomy. | Widespread multifocal bilateral nodular opacities highly suggestive of fungal pneumonia. Overall the majority of the opacities show no significant change. While the two largest areas have decreased in size, a small subcentimeter nodule in the superior left lower lobe is equivocally new, but definitely increased. |
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