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Generate impression based on findings. | 68 year-old male with possible consolidation on chest radiograph. LUNGS AND PLEURA: Moderate upper lobe predominant centrilobular emphysema. Lower lobe bronchiectasis and bronchial wall thickening, with improvement of previously seen mucous plugging in basilar consolidation. There is complete collapse of the right middle lobe. No obstructing lesion is identified.New 4-mm pleural based nodular opacity adjacent to cysts in right upper lobe (series 4, image 33). Several other calcified lung nodules compatible with prior granulomatous infection.MEDIASTINUM AND HILA: No significant change in multiple mildly enlarged mediastinal and hilar lymph nodes, which may be reactive in nature. The heart is normal in size without pericardial effusion. Moderate coronary artery calcifications.Enlarged pulmonary artery suggestive of pulmonary arterial hypertension.CHEST WALL: Status post median sternotomy. No axillary lymphadenopathy.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Multiple liver and renal cysts consistent with polycystic kidney disease. | 1.Complete collapse of right middle lobe, which may be related to mucous plugging. No evidence of underlying obstructing lesion. Considerations include MAI.2.Lower lobe bronchial wall thickening and bronchiectasis, with interval improvement of previously seen basilar consolidation and mucous plugging. 3.New pleural based ill-defined opacity in the right upper lobe measures 4 mm; follow up in 6 to 12 months is recommended.4.Findings compatible with polycystic kidney disease. |
Generate impression based on findings. | 84-year-old female with history of renal cell carcinoma CHEST:Bilateral, new, subpleural predominantly groundglass opacity lesions, more prominent on the right side compared to the left. Their etiology is unknown and there present atypical infection versus thrive reaction.Previously measured left paratracheal necrotic lymph node now measures 1.4 by 0.9-cm on image number 37, series number 4, smaller compared to previous study.ABDOMEN:LIVER, BILIARY TRACT: Nonspecific, subcentimeter hypodense liver lesions are unchanged compared to previous study.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post left nephrectomy. Subcentimeter right renal lesions are unchanged and likely represent cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Leiomyomatous uterus.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Interval decrease in the size of the necrotic mediastinal adenopathy.Interval development of bilateral subpleural groundglass opacities. There etiology is unknown but may represent atypical infection versus drug reaction. |
Generate impression based on findings. | Reason: advanced NSCLC s/p chemoRT for stage III disease with recurrence treated with carboplatin/pem and pem maintenance now on observation-only with progressive symptoms History: malaise, R sided pleuritic pain CHEST:LUNGS AND PLEURA: Marked interval increase in size and number of multiple pulmonary nodules compatible with progressive primary lung malignancy. Increased confluence of pulmonary nodules in the periphery. Multiple nodules demonstrate cavitations which was only minimal on prior CT. For reference, left apical nodule previously measuring 8 x 10 mm currently measures 16 x 18 mm (series 6, image 24).Mild narrowing of the left upper and lower lobe bronchi.Postsurgical changes to right upper lobe and left hilum.MEDIASTINUM AND HILA: Interval increase in mediastinal and hilar lymphadenopathy. For reference, right hilar lymph node previously measuring 13 mm currently measures 20 mm (series 4, image 41).Heart size is normal. No pericardial effusions. Moderate to severe atherosclerotic calcifications of the coronary arteries.CHEST WALL: Enlarged, necrotic lower cervical lymph nodes, left greater than right. For reference, left lower cervical node measures 25 mm in diameter (series 4, image 5).Fixation devices along the left sixth and seventh ribs. Evidence of multiple old left rib fractures. Sclerotic lesions T12 are and L3 vertebral bodies.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis without evidence of cholecystitis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Right nodular adrenal gland, new from prior exam.KIDNEYS, URETERS: Bilateral mildly atrophic but symmetric kidneys. Bilateral perirenal fat stranding. Calcified focus in the left kidney may represent nonobstructing stone or vascular calcification.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Severe atherosclerotic disease of the descending aorta and bilateral iliac arteries. Aneurysmal dilation of the infrarenal aorta measuring 4.6 x 4.3 centimeters (series 4, image 146) and questionable extension to the iliac arteries. Mural thrombus is noted within the dilated portion.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Mild wedge deformity and endplate depression of the T12 vertebral body grossly unchanged from prior CT. Sclerotic lesions of the L3 vertebral body concerning for metastatic disease.OTHER: No significant abnormality noted. | 1.Marked interval increase in size and number of multiple pulmonary nodules and lower cervical, mediastinal, and hilar lymphadenopathy compatible with progressive metastatic primary lung malignancy.2.Aneurysmal dilation of the infrarenal aorta. |
Generate impression based on findings. | 82 year-old female with dyspnea on exertion and dysphagia. Assess size of substernal goiter. LUNGS AND PLEURA: Punctate micronodule located along right minor fissure, unchanged and likely benign (series 5, image 57). No new or suspicious nodules. No consolidation or pleural effusions.MEDIASTINUM AND HILA: Large, heterogeneous right lobe of the thyroid extending into mediastinum measures 5.2 x 5.6 cm in maximal dimension, increased in size since 2007. The goiter compresses the brachiocephalic veins, with associated collateral vessels seen in the anterior mediastinum and chest wall. There is rightward mass effect on the right subclavian artery and left heart mass effect on the trachea, however, both are remain patent.No mediastinal lymphadenopathy. Heart is normal in size without pericardial effusion. Moderate coronary artery calcifications.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Hypodense lesions in right lobe of liver is unchanged, compatible with cysts. | Intrathoracic goiter causing compression of central venous structures. |
Generate impression based on findings. | 66-year-old male of pancreatic cancer -- restaging CHEST:LUNGS AND PLEURA: No chest examination for comparison. Scattered nonspecific micronodules -- Dense calcified right lower lobe nodule is seen typical of prior granulomatous disease and the micronodules are certainly consistent with prior granulomatous disease.Since prior examination is right lower lobe pleural-based air space consolidation with slightly infiltrating margins -- the location and appearance, while nonspecific may suggest potential vascular disease (infarct or embolic phenomenon.). It does not have an appearance typically associated with metastasis.No pleural disease identified.MEDIASTINUM AND HILA: Calcified lymph nodes from prior granulomatous disease -- no other abnormality seen to suggest lymphadenopathy.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Mild hepatomegaly again seen with edema. Contracted gallbladder with gallstone and mild wall thickening again seen. No intrahepatic or extrahepatic biliary duct dilatation is seen. Small irregularly shaped, but well defined, hypoattenuating lesions seen in the dome liver, most likely benign and unchanged.No other abnormalities.SPLEEN: No significant abnormality notedPANCREAS: Hypoattenuating mass in body of pancreas again seen (series 3, image 107) measuring 4.6 x 4 .3 cm, minimally changed from prior report of 4.9 x 4.6 cm. More proximal pancreas and the tail is atrophic with pancreatic duct dilatation.Celiac axis and splenic artery again showed tumoral encasement unchanged. The superior mesenteric vein first jejunal branch is again encased -- no change in the appearance in this region is seen. The portal vein does not appear narrowed, although the tumor does abut confluence with splenic vein and mesenteric vein and occlusion of the splenic vein is again seen.. ADRENAL GLANDS: Left adrenal gland is again diffusely enlarged with maximal dimension of 3.7 x 2.7 cm (series 3 come image 104) unchanged from prior examination. Right adrenal gland appears normal.KIDNEYS, URETERS: No significant abnormality noted -- benign cysts again seen, unchanged. No other abnormalities.RETROPERITONEUM, LYMPH NODES: No lymph nodes exceeding 1 cm short axis diameter seen, although the clusters of small lymph nodes are seen adjacent to the origin of the celiac artery, unchanged.BOWEL, MESENTERY: No significant abnormality noted. No evidence of free peritoneal fluid or a peritoneal metastases.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. Minimal change in pancreatic body tumor mass with encasement of adjacent celiac axis and occlusion of the splenic vein. 2. Nonspecific pulmonary parenchyma micronodules, most likely associated with prior granulomatous disease. 3. New right paravertebrally pleural-based air space consolidation -- does not have an appearance typical of metastases and most likely relates to either prior inflammatory disease or vascular disease. |
Generate impression based on findings. | 49-year-old male patient with rectus sheath hematoma. Evaluate for change. ABDOMEN:LUNG BASES: Bibasalar atelectasis, improved compared to prior examination. Interval resolution of left pleural effusion with interval decrease in trace right pleural effusion.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: There is redemonstration of a hyperdense clot inferior to be IVC filter.Right psoas muscle hematoma is slightly decreased compared to prior examination and measures 5.9 x 4.7 cm (series 3 image 106), previously 6.4 x 4.5 cm.BOWEL, MESENTERY: Percutaneous gastrostomy tube with catheter terminating in the proximal jejunum.BONES, SOFT TISSUES: Body wall collection in the rectus sheath that extends from the gastrostomy catheter contains fluid and a small amount of gas. Percutaneous catheter remains in place. Collection size is stable compared to prior examination.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: Focal distention and enhancement of the wall of the right femoral vein is suggestive of thrombus (series 3 image 153) and is stable compared to prior examination. | 1.Stable size of rectus sheath hematoma with percutaneous drain.2.Slight interval decrease in size of right psoas hematoma. |
Generate impression based on findings. | Male 43 years old; Reason: History metastatic testicular cancer, assess for recurrence History: none CHEST:LUNGS AND PLEURA: Postoperative changes in the left lung base with a surgical staple line. Left upper and right upper lobe micronodules (images 45, 43 of series 6) are unchanged. Pleural spaces clear.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post right nephrectomy. Cyst at the upper pole of the left kidney is unchanged.RETROPERITONEUM, LYMPH NODES: Postoperative changes in the retroperitoneum with multiple clips. No new lymphadenopathy.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 pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Post operative changes in the right inguinal canal.OTHER: No significant abnormality noted | 1.Stable pulmonary micronodules. 2.No new retroperitoneal or pelvic lymphadenopathy. |
Generate impression based on findings. | 71-year-old male with prostate cancer and renal cancer, presents with dyspnea. PULMONARY ARTERIES: Diagnostic quality exam without evidence of pulmonary embolus.LUNGS AND PLEURA: Mild basilar atelectasis. Scattered punctate micronodules, likely benign in nature. No consolidation or pleural effusions.MEDIASTINUM AND HILA: Multiple prominent mediastinal lymph nodes not significantly changed. Stable moderate cardiomegaly. No pericardial effusion. Moderate coronary artery calcifications. Hypodense nodule in right lobe of thyroid gland, new since 2008.CHEST WALL: Extensive degenerative changes in the thoracic spine with multiple bridging anterior osteophytes. Vertebral body heights are preserved.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.Diagnostic quality exam without evidence of pulmonary embolus or other acute abnormality to account for patient's symptoms.. 2.Scattered lung micronodules, all measuring less than 4 mm, likely benign in etiology. |
Generate impression based on findings. | Female 78 years old; Reason: 78yo woman with flank pain and hematuria - evaluate for renal stone. History: flank pain, hematuria ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver has a smooth contour. There are multiple well marginated hypodense masses that cannot be further characterize without contrast. A reference segment 7/8 mass measures 5.2 x 7.0 cm (image 32/series 3) . The lesions are not cysts.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right lower pole calix calculus measures 1.6-cm. No hydronephrosis.. However, there is adjacent cortical atrophy. Probable cyst at the upper pole of right kidney.No hydronephrosis in either kidney. No left renal calculiRETROPERITONEUM, LYMPH NODES: Calcifications adjacent to the left psoas muscle likely in the left gonadal vein.Calcific or sclerotic disease affects the aorta. No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No distal ureteral or bladder calculi.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative this disease of the lumbar spine.OTHER: No significant abnormality noted. | 1.Right lower pole calix calcification.2.Probable phleboliths along the course of the left ureter.3.Multiple hypodense hepatic lesions, further characterization with a MRI is recommended.4.Findings discussed with resident for Dr. Rossi for further evaluation with MRI of the liver. |
Generate impression based on findings. | 23 year old male with abdominal discomfort. Mesothelioma workup. LUNGS AND PLEURA: Mild, slightly nodular thickening of major and minor fissures on the right. Ill-defined peripheral opacity in the superior aspect of the right lower lobe, which may be postinflammatory in nature or focal bronchiectasis.No consolidation or pleural effusions.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Ascites fluid in upper abdomen. | 1.Mild, somewhat nodular thickening of pleural fissures on the right, suggestive of fluid with small nodular component. 2.Ascites; please refer to abdominal/pelvis CT report for detailed findings. |
Generate impression based on findings. | Malignant neoplasm of connective tissues of thorax CHEST:LUNGS AND PLEURA: Stable right posterior calcified pleural based mass best seen on image 69 of series 9 measuring 4.2 x 1.4 cm.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Left anterior chest wall postoperative findings.ABDOMEN:LIVER, BILIARY TRACT: Stable right lobe cystsSPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Stable examination |
Generate impression based on findings. | Male 61 years old; Reason: please evaluate liver lesion previously seen on CT chest History: 61M s/p OHT adm with T1RF, now recovered, though with hypodense lesions seen previous CT chest ABDOMEN:LUNGS BASES: Lower lobe ground glass pulmonary opacities have improved. Trace bilateral effusions and left pleural thickening. Segment IVb lesion measures 1.5 x 1.4 cm (image 32/series 3) previously, 2.1 x 1.4 cm.LIVER, BILIARY TRACT: Liver contour is normal. Status post cholecystectomy. Hepatic and portal veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cortical atrophy.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Hypodense segment IVb lesion is unchanged. It is located adjacent to the gallbladder fossa in the area of prior inflammation and surgery. It may represent sequelae of prior surgery although the imaging features are not entirely specific. Recommend 6 month follow up MRI or CT. |
Generate impression based on findings. | 23-year-old male with abdominal distention. Mesothelioma ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Orally administered contrast progresses rapidly through normal-appearing stomach, small bowel, and through the proximal colon without abnormality intrinsic to the bowel. Marked ascites is seen diffusely throughout.Diffuse infiltration in a reticulonodular pattern is seen throughout the omentum, greatest in the right abdomen, anterior to liver and hepatic flexure and in the left anterior abdomen extending into the pelvis. These do not show increased radiopharmaceutical uptake on the PET examination. More confluent aggregate nodule is seen in the left pelvis anteriorly (series 41, image 105) measuring 1.5 x 2.0 cm and a smaller right pelvic anterior omental nodule (series 4, image 3 to 4) measuring 1.3 x 1.1 cm, both of which do show markedly increased in radiopharmaceutical uptake on today's PET examination. In the inferior pelvis. Dependent presacral space, the peritoneum shows thick wall and enhancing around the ascites anterior to the rectum (series 4, image 362). This area does show increased radiopharmaceutical activity on the PET examination and indicates active peritoneal 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: Orally administered contrast progresses rapidly through normal-appearing and there is an in a chest, the small bowel, and through the proximal colon without abnormality intrinsic to the bowel. Marked ascites is seen diffusely throughout.Diffuse infiltration in a reticulonodular pattern is seen throughout the omentum, greatest in the right abdomen, anterior to liver and hepatic flexure and in the left anterior abdomen extending into the pelvis. These do not show increased radiopharmaceutical uptake on the PET examination. More confluent aggregate nodule is seen in the left pelvis anteriorly (series 41, image 105) measuring 1.5 x 2.0 cm and a smaller right pelvic anterior omental nodule (series 4, image 3 to 4) measuring 1.3 x 1.1 cm, both of which do show markedly increased in radiopharmaceutical uptake on today's PET examination. In the inferior pelvis, dependent presacral space, the peritoneum shows thick wall and enhancing around the ascites anterior to the rectum (series 4, image 362). This area does show increased radiopharmaceutical activity on the PET examination and indicates active peritoneal disease.BONES, SOFT TISSUES: Soft tissue nodule in the lower right inguinal region (series 4 come image 4, 14) cephalad to the right testicle shows increased radiopharmaceutical activity on the PET examination and most likely represents a right inguinal hernia with peritoneal disease.Slightly enlarged left inguinal lymph node (series 4, image 344) measures 1.5 x 1.1 cm, and shows slightly increased radiopharmaceutical activity on the PET examinationOTHER: No significant abnormality noted | 1. Two nodular foci of peritoneal measurable disease in anterior pelvis correlating with increased PET activity. 2. Large ascites. 3. Peritoneal thickening in the dependent pelvis posteriorly, consistent with peritoneal mesothelioma. 4. Reticulonodular infiltration of the omentum diffusely -- this does not correlate with increased radiopharmaceutical activity on PET examination. 5. Small left inguinal lymph node -- inflammatory versus metastatic disease. |
Generate impression based on findings. | Colon carcinoma CHEST:LUNGS AND PLEURA: No significant change in numerous bilateral pulmonary nodules. Reference peripheral left lower lobe nodule best seen on image 74 series 5 measures 1.6 x 1.3 cm. Focal left pleural thickening unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Stable bilobar low attenuation foci.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Stable reference mesenteric lymph node is seen on image 124 series 3 measuring 0.7 cmBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Stable examination |
Generate impression based on findings. | Clinical question: cerebellar lesion. Signs and symptoms: Ataxia. Nonenhanced head CT:There is no detectable acute intracranial process CT however is in sensitive for early detection of acute non-hemorrhagic ischemic strokes.There are subtle subcortical and periventricular foci of low-attenuation which are nonspecific however often represent age indeterminate small vessel ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces as well as the gray -- white matter differentiation.Correlate with history and patient's risk factors and consider follow-up with an MRI exam.Unremarkable calvarium and soft tissues of the scalp.Unremarkable paranasal sinuses and mastoid air cells.Images through the orbits demonstrate a chronic blowout fracture of left lamina papyracea and unremarkable otherwise. | 1.No acute intracranial findings.2.Suspected mild age indeterminate small vessel ischemic strokes.3.Chronic left lamina papyracea blowout fracture. |
Generate impression based on findings. | Clinical question: Stroke? Signs and symptoms: Weakness. Nonenhanced head CT:No detectable acute intracranial process. CT however is insensitive for early detection of acute ischemic strokes.There are moderate to advanced periventricular and subcortical low attenuation of white matter consistent with aging determinate small vessel ischemic strokes.Cerebral cortex is unremarkable.Cortical sulci, ventricular system and CSF spaces are unremarkable.Heavy bilateral cavernous carotid vascular calcification is noted.Unremarkable calvarium and soft tissues of the scalp.Unremarkable orbits, paranasal sinuses and mastoid air cells with the exception of small retention cyst in the right maxillary sinus. | Moderate to advanced age indeterminate small vessel ischemic strokes. |
Generate impression based on findings. | Clinical question: Fat Signs and symptoms: Hemorrhage Nonenhanced head CT:No detectable acute intracranial process. CT however is insensitive for early detection of acute ischemic strokes.Mild-to-moderate periventricular and subcortical low attenuation of white matter considering patient's age likely representing age indeterminate small vessel ischemic strokes. There is mild prominence of ventricular system and cerebral cortical sulci which may be still within normal range for patient stated age however possibility of some underlying parenchymal volume loss secondary to small vessel ischemic stroke cannot be excluded.Unremarkable calvarium and soft tissues of the scalp.Unremarkable paranasal sinuses, mastoid air cells and orbits. | Moderate age indeterminate small vessel ischemic strokes. A |
Generate impression based on findings. | Clinical question: Rule out acute ischemic event. Signs and symptoms: Gait imbalance. Nonenhanced head CT:No detectable acute intracranial process. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.There is a tiny focus of calcification in the pons.Examination demonstrates fairly extensive subcortical and periventricular as well as bilateral basal ganglia and right thalamic foci of low-attenuation consistent with age indeterminate small vessel ischemic strokes. There is ex vacuo dilatation of right lateral ventricle secondary to extend strokes. No detectable cerebral cortical abnormalities.No convincing evidence of abnormality of the cerebellum.Unremarkable calvarium and soft tissues of the scalp.Unremarkable orbits, paranasal sinuses and mastoid air cells. | Extensive age indeterminate small vessel ischemic strokes. |
Generate impression based on findings. | Reason: assess for PE History: hypoxia, tachypnea PULMONARY ARTERIES: Technically adequate examination. No evidence of pulmonary embolism. Main pulmonary artery caliber is high-normal.LUNGS AND PLEURA: Progression of right lobe opacity now with consolidation and architectural distortion may represent atelectasis or aspiration pneumonia with underlying fibrosis. Small left lower lobe opacity likely represents atelectasis. Moderate central lobular emphysema. Calcified granulomas in the left lung are unchanged.MEDIASTINUM AND HILA: Type B aortic dissection beginning just distal to the origin of the left subclavian artery is again noted without interval change. Mildly enlarged mediastinal lymph nodes unchanged from prior exam. Mild cardiomegaly. Mild pericardial effusion. Left-sided dual lead AICD.CHEST WALL: Sclerotic lesions in the right scapula appearing unchanged. Subchondral cysts in the right humeral head.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Multiple hypodense liver lesions are seen in the partially visualized liver, unchanged. Small hypodense lesion in the spleen, unchanged. Nodularity of bilateral adrenal glands, left greater than right. Left renal cysts in a partially visualized kidney, unchanged. Distended loops of large bowel. | 1.No evidence of pulmonary embolism.2.Persistent basilar atelectasis and/or aspiration on the posterior right lung base. |
Generate impression based on findings. | Clinical question: Concern for stroke and hemorrhage. Signs and symptoms: Left-sided weakness and numbness. Unenhanced head CT:No detectable acute intracranial process. CT however is insensitive for detection of acute nonhemorrhagic ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation.Calvarium and soft tissues of the scalp are unremarkable.Unremarkable bilateral orbits.Well pneumatized visualized paranasal sinuses, mastoid air cells and middle ear cavities. | No acute intracranial process. |
Generate impression based on findings. | 69-year-old female patient with history of CLL presents with neutropenia, fever and LFT abnormalities. Evaluate for lung or liver pathology. ABDOMEN:LUNG BASES: Small bilateral pleural effusions with associated atelectasis, right greater than left and new compared to prior examination.There is a round lesion along the fissure in the left lung base and may represent rounded atelectasis, fluid in the fissure or less likely a new lesion (series 4 image 4).LIVER, BILIARY TRACT: Two ill-defined hypoattenuating lesions within the liver parenchyma. Lesion in the right dome of the liver measures 1.4 x 1.1 cm (series 3 image 116) and second lesion is in the right liver adjacent to the falciform ligament (series 3 image 43).SPLEEN: 12 cm in craniocaudal dimension. The spleen has decreased in size since the 7/2013 outside CT exam. Multiple hypoattenuating lesions within the splenic parenchyma, new compared to prior examination. There is a wedge-shaped hypoattenuating focus in the posterior superior spleen that may represent an infarct versus lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Hypoattenuating lesion in the inferior pole of the right kidney is too small characterize and likely represents a cyst.RETROPERITONEUM, LYMPH NODES: Scattered subcentimeter retroperitoneal lymph nodes are decreased in size and number compared to prior examination. On the 7/2013 exam, there was extensive retroperitoneal adenopathy, now resolved. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Height loss of the L3 and L4 vertebral bodies consistent with osteoporotic compression fractures. There is interval increase in invagination of the superior endplates of the L2 and L5 vertebral bodies.OTHER: Trace abdominal ascites in the right lower abdomen, increased compared to prior examination.PELVIS:UTERUS, ADNEXA: Atrophic.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Height loss of the L3 and L4 vertebral bodies consistent with osteoporotic compression fractures. There is interval increase in invagination of the superior endplates of the L2 and L5 vertebral bodies. These compression deformities are new since 7/2013. OTHER: Trace abdominal ascites in the right lower abdomen, increased compared to prior examination. | 1.New hypoattenuating lesions within the liver and spleen, suspicious for malignancy.2.Left lower lobe rounded lesion may represent round atelectasis, fluid in fissure or less likely a new solid lesion.3.Interval resolution of retroperitoneal lymphadenopathy.4.Bilateral pleural effusions.5.Height loss in the L3 and L4 vertebral bodies consistent with osteoporotic compression fractures. |
Generate impression based on findings. | Female 63 years old; Reason: Metastatic endometrial cancer receiving chemotherapy with rising tumor marker. Restaging evaluation. History: Rising tumor marker. CHEST:LUNGS AND PLEURA: Small right pleural effusion is stable. Scattered micronodules in the right lung. No dominant lung lesion.MEDIASTINUM AND HILA: . Chest wall port terminates at the cavoatrial junction. No mediastinal lymphadenopathy. Esophagus remains dilated.Small para cardiac nodes.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Subtle nodularity along the hepatic capsule persists. Too small to characterize right hepatic lobe subcentimeter hypodense nodule. No dominant liver lesion and no change.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 nodesBOWEL, MESENTERY: Ascites has resolved. Peritoneal carcinomatosis persists but is less prominent in the current exam compared to prior.BONES, SOFT TISSUES: Injection granulomas in the abdomenOTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Enlarged uterus with fibroids and masses.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. | Stable right pleural effusion. Resolution of ascites. Regression of peritoneal carcinomatosis. |
Generate impression based on findings. | 61 year old male with chest pain, vomiting, evaluate for aneurysm or dissection. CHEST:LUNGS AND PLEURA: Mild basilar atelectasis.MEDIASTINUM AND HILA: Few atherosclerotic calcifications of the thoracic aorta. No evidence of aneurysm or dissection. Moderate atherosclerotic calcification of the coronary arteries. Left ventricular hypertrophy. Patulous esophagus.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Hypoattenuating splenic lesion is nonspecific.PANCREAS: Prominence of the pancreatic duct.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Atrophic native kidneys with multiple hypoattenuating lesions, many of which are too small to characterize, but likely represent cysts.RETROPERITONEUM, LYMPH NODES: Atherosclerotic plaque of the abdominal aorta and its branches. No evidence of aneurysm, dissection, or occlusion.BOWEL, MESENTERY: The stomach is poorly distended. The small bowel is normal in caliber.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. No evidence for aneurysm or dissection. Moderate atherosclerotic calcification of the abdominal aorta and its branches. 2. Left ventricular hypertrophy. Coronary artery calcification, especially the LAD. 3. Mildly patulous esophagus. |
Generate impression based on findings. | Victim of domestic abuse. Left sided orbital swelling, bruising, one minute loss of consciousness. Head: There is no acute intracranial hemorrhage. The ventricles are normal size and morphology. There is no mass-effect or midline shift. There is no depressed skull fracture. Maxillofacial: There is a minimally displaced fracture through the anterior wall of the left maxillary sinus which extends through the inferior orbital rim and orbital floor across the infraorbital canal and into the superior aspect of the lateral wall of the maxillary sinus. There is also appears to be a subtle lucency of the left zygomatic arch separate from the suture, which may represent a fracture. In addition, there is a 2 mm displaced fracture of the left frontal process of the maxilla and right nasal bone anteriorly. There is a subcutaneous fat stranding in the nose, left periorbital region, and left cheek, suggestive of contusions. The globes appear to be intact, without evidence of retrobulbar hemorrhage. There is diffuse mild left maxillary sinus mucosal thickening without air-fluid levels. The mandible and temporomandibular joints appear intact. | 1.Minimally depressed fractures of the anterior and lateral walls of the left maxillary sinus and inferior orbital rim and floor, traversing the infraorbital canal, as well as possibly a non-displaced fracture of the left zygomatic arch. The constellation of fractures indicates a zygomaticomaxillary complex fracture2.Mildly displaced right nasal bone and left frontal process of the maxilla fractures.3.No evidence of acute intracranial hemorrhage. 4.Discussed with Dr. Hogan at 10:00 AM on 11/13/13.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Female, 82 years old, large substernal goiter, assess for progression in size and compression. Limited intracranial views are remarkable for periventricular hypoattenuation likely indicating age indeterminate small vessel ischemic disease.A large, heterogeneous goiter of the right thyroid lobe is reidentified. The lesion contains scattered areas of calcification and sheet-like areas of low density similar to prior. Lesion size has increased from the prior examination. The most accurate measurements are likely to be obtained on sagittal imaging where the lesion measures 13.5 x 6.4 cm (image 53 of series 80397), previously 11.4 x 5.4 cm.The lesion extends superiorly to the level of the submandibular space and inferiorly to the level of the aortic arch. The brachiocephalic and left common carotid arteries are splayed around the lesion but they remain patent. The right carotid and jugular vessels are displaced laterally in the neck but they too remain patent. The superior vena cava is difficult to distinguish, and the azygos and internal mammary venous systems seem to be compensatorily prominent. No pathologic adenopathy is detected. The salivary glands are free of focal lesions. Lung apices are unremarkable. No concerning osseous lesions are demonstrated. | Mild interval increase in size of a large right thyroid goiter. |
Generate impression based on findings. | Clinical question: Recent IVH Signs and symptoms: Monitoring change from prior exam. Nonenhanced head CT:The examination redemonstrates an acute well-demarcated hematoma in the left basal ganglion without convincing evidence of any change in its size, morphology, extent and associated subtle mass effect.Similar to prior exam there is no appreciable surrounding vasogenic edema. Acute blood in the dependent portion of bilateral occipital horns remain also very similar to prior exam.Ventricular system remains within normal size and midline is maintained.There are scattered subarachnoid hemorrhage throughout bilateral hemispheric over more prominent on the left and in particular in the left posterior temporal -- occipital region. No convincing evidence of any new hemorrhage. | 1.No convincing evidence of any acute new finding since prior study.2.Stable acute dissecting no basal ganglia hematoma since prior study.3.Stable acute blood in the dependent portion of bilateral occipital horns and scattered subarachnoid hemorrhage since prior exam.4.Stable normal size of ventricular system and maintained midline. |
Generate impression based on findings. | 60 year-old male with hematuria. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Nonobstructive bilateral nephrolithiasis. No hydronephrosis or ureteral stones. Small left renal cyst. Normal filling of the left renal pelvis and ureter on delayed images. The right ureter is only filled proximally and the distal right ureter is not well evaluated.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: There is a 3.9 x 2.3 cm enhancing mass arising from the right wall of the bladder with several additional soft tissue adjacent nodules.LYMPH NODES: Prominent subcentimeter inguinal lymph nodes.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Mass arising from the right wall of the bladder, highly suspicious for primary malignancy. No evidence of metastatic disease.2. Nonobstructive bilateral nephrolithiasis. |
Generate impression based on findings. | 44-year-old female patient with left lower quadrant pain. Evaluate for diverticulitis. ABDOMEN:LUNG BASES: Bilateral dependent atelectasis, left greater than right.LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left superior pole exophytic subcentimeter hypoattenuating lesion is too small to characterize and likely represents a cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Fluid noted within the endometrial cavity. Noncalcified masses within the uterus likely representing fibroids. Small cystic lesion in the right ovary.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Scattered colonic diverticula without CT evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.No CT evidence of diverticulitis.2.Right adnexal cyst, likely physiologic.3.Fibroid uterus. |
Generate impression based on findings. | Reason: r/o PE History: unexplained DOE, SOB, chest pain PULMONARY ARTERIES: Technically adequate examination. No evidence of pulmonary embolism. Main pulmonary artery caliber is within normal limits.LUNGS AND PLEURA: Bilateral band-like streaky changes consistent with atelectasis and/or scarring. Moderate emphysema.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusions. No evidence of right heart strain.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material and acquisition of images in a different phase of contrast markedly limits sensitivity for abdominal pathology. Hypodense lesion in the peripheral left lobe of the liver probably represents a hepatic cyst. Mildly nodular adrenal glands bilaterally. | 1.No evidence of pulmonary embolism.2.Mildly nodular adrenal glands bilaterally. |
Generate impression based on findings. | Pain over lumbar and coccygeal region. There is maintenance of the overall lumbar lordosis with grade 1 spondylolisthesis at the L3-4 (4 mm) and L4-5 (7 mm) levels on the basis of significant degenerative change. There is sclerotic change of the S1 vertebral body which is also likely related to degeneration. There is loss of intravertebral disk height at the L4-5 and L5-S1 levels with preservation of vertebral body height throughout the lumbar spine. There is degenerative change including vacuum phenomena and osteophytes within the SI joints bilaterally.T12-L1: No disk bulge or significant degenerative change. Spinal canal and neural foramina are patent.L1-2: No disk bulge or significant degenerative change. Spinal canal and neural foramina are patent.L2-3: Mild bilateral facet arthropathy without significant disk pathology. No neural foraminal or spinal stenosis.L3-4: Bilateral facet arthropathy without significant disk pathology. No neural foraminal or spinal stenosis.L4-5: Extensive bilateral degenerative facet change including vacuum phenomena and ligament hypertrophy with grade 1 spondylolisthesis resulting in uncovering of the disk. There is no significant spinal stenosis. Mild neural foraminal stenosis bilaterally.L5-S1: Extensive bilateral degenerative facet change including vacuum phenomena and ligament hypertrophy with grade 1 spondylolisthesis resulting in uncovering of the disk. There is no significant spinal stenosis. Mild neural foraminal stenosis bilaterally.Incidental note is made of atherosclerotic calcification within aortoiliac arterial vasculature. The is mild linear density most likely representing subsegmental atelectasis at the right lung base. | Multilevel degenerative change most prominent within the posterior elements at the L4-5 and L5-S1 levels. No spinal stenosis with mild bilateral neural foraminal stenosis at L4-5 and L5-S1. |
Generate impression based on findings. | 65-year-old female patient with abdominal pain. Evaluate for small bowel obstruction. Note that lack of intravenous contrast limits evaluation of vasculature, lymph nodes and solid viscera.ABDOMEN:LUNG BASES: Trace bilateral dependent atelectasis.LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: Mild peri-splenic ascites.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Right adrenal gland surgically resected. Left adrenal gland not visualized.KIDNEYS, URETERS: Left inferior pole cyst is stable in size compared to prior examination with a slight increase in internal density. Left renal cortex slightly atrophic compared to right kidney.RETROPERITONEUM, LYMPH NODES: Moderate atherosclerotic changes in the abdominal aorta and iliac arteries.BOWEL, MESENTERY: Duodenal diverticulum in the second portion of the duodenum, stable. Prior partial colon resection. Bowel is normal in caliber without evidence of obstruction.BONES, SOFT TISSUES: Partially visualized left breast implant appears partially collapsed. Subcutaneous soft tissue density in the left breast may be secondary to postsurgical change.Multilevel degenerative changes in the thoracic and lumbar spine.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Prior partial colon resection. Bowel is normal in caliber without evidence of obstruction.BONES, SOFT TISSUES: 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.Subcutaneous soft tissue density in left breast was not included in the field-of-view on the prior examination and may be secondary to postsurgical changes. |
Generate impression based on findings. | Headache with SDH. There are right frontal and parietal burr holes for decompression of a right cerebral convexity subdural hematoma. There is a residual low to intermediate attenuation right cerebral convexity subdural fluid collection that measures up to 10 mm in width, which is unchanged. However, there is a newly apparent punctate hyperdense focus within the collection. There is unchanged associated 3 mm of midline shift to the left. There is unchanged mild nonspecific cerebral white matter hypoattenuation that may represent microangiopathy. There is no evidence of acute intracranial hemorrhage, mass, or cerebral edema. The ventricles are stable in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. There is a small amount of residual right frontoparietal subgaleal fluid. | New punctate hyperdense focus of acute hemorrhage within the subacute right cerebral convexity subdural hematoma, which is otherwise unchanged in overall size. Likewise, the degree of midline shift remains approximately 3 mm to the left.Discussed with Dr. Burnet at 9:15 AM on 11/13/13. |
Generate impression based on findings. | Clinical question: Rule-out intracranial process. Signs and symptoms: Worsening right-sided facial droop, dysmetria and dysarthria, abnormal gait. Hemorrhage Unenhanced head CT:Examination demonstrates minimal interval increase in the focus of high density in the right paramedian pons since prior exam and likely representing small hemorrhage. The findings are current study measures approximately 4 mm in its transaxial dimensions.No convincing evidence of any additional interval change since prior study. CT is insensitive for early detection of acute non-hemorrhagic ischemic strokes. Prior brain MRI from 11 -- 12 -- 13 demonstrated acute ischemic strokes as detailed in prior study.Extensive periventricular and subcortical low attenuation white matter and ex factor dilatation of right lateral ventricle remains grossly similar to prior study. | 1.Tiny focus of increased density in the right paramedian pons demonstrate minimal interval increase in its size to 4mm on current exam and likely representing small focus of hemorrhage.2.Stable exam otherwise as detailed. |
Generate impression based on findings. | Female 40 years old. Reason: PTCL s/p auto stem cell transplant 1/2013. Compare to prior studies. CHEST:LUNGS AND PLEURA: Scattered calcified and noncalcified micronodules are unchanged since the previous examMEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. No cardiomegaly or pericardial effusion. CHEST WALL: Interval removal of the right-sided chest port.ABDOMEN:LIVER, BILIARY TRACT: Normal size and appearance of the liver.SPLEEN: No splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Multiple small retroperitoneal lymph nodes, unchanged in appearance. Reference left para-aortic lymph node measures 0.6 x 1.0 cm (series 3, image 109) is not significantly changed.BOWEL, MESENTERY: Nonobstructive bowel pattern.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Bilateral adnexal surgical clips and bilateral Essure devices are present. BLADDER: No significant abnormality noted.LYMPH NODES: Bilateral small iliac chain lymph nodes, left greater than right, are stable.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Stable examination. No new lesions identified. |
Generate impression based on findings. | 60-year-old female with shortness of breath, COPD, and lung nodule. LUNGS AND PLEURA: Severe upper lobe predominant emphysema. Right upper lobe ill-defined nodular opacity is slightly decreased in size and may represent scarring/post inflammatory in nature (series 4, image 28). Several other punctate micronodules are unchanged and most likely benign in nature. No new or suspicious nodules.No consolidation or pleural effusions.MEDIASTINUM AND HILA: Heart is normal in size. No pericardial effusion. Mild to moderate coronary artery calcifications. No mediastinal lymphadenopathy. Again noted aberrant right subclavian artery.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.Decrease in size of right upper lobe nodular opacity, which may be postinflammatory in nature. No new or suspicious nodules.2.Severe emphysema without superimposed acute abnormality. |
Generate impression based on findings. | peripheral T-cell lymphoma, stage IVA, status post stem cell transplant. There is no significant interval change in size of the cervical lymph nodes. For example, the right paratracheal lymph node measures 11 x 5 mm, previously 11 x 8 mm. Likewise, a left level 2A lymph node measures 6 x 5 mm, previously also 6 x 5 mm, and a right level 5A lymph node measures 5 x 4 mm, previously also 5 x 4 mm. There are no significantly enlarged lymph nodes by size criteria. The Waldeyer ring structures are unremarkable. There are several 2 to 3 mm hypoattenuating nodules in the thyroid gland. The airways are patent. There is mild degenerative change of the right temporomandibular joint. There are also unchanged posterior disc-osteophyte complexes at C4 through C7 with apparent effacement of the anterior thecal CSF and possible mild indentation of the spinal cord. The osseous structures are unremarkable. The imaged paranasal sinuses and mastoid air cells are clear. The imaged portions of the intracranial structures and orbits are unremarkable. The imaged portions of the lungs are clear. | Unchanged cervical lymph nodes, without significant lymphadenopathy by size criteria. |
Generate impression based on findings. | 17 year-old female patient with right adnexal pain. Evaluate for TOA. ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No evidence of adnexal abscesses or fluid collection.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. | No evidence of tubo-ovarian abscess. If continued clinical concern, suggest dedicated pelvic ultrasound. |
Generate impression based on findings. | 47-year-old male with recurrent head and neck cancer. CHEST:LUNGS AND PLEURA: Right middle lobe atelectasis, unchanged. Stable appearance of left lower lobe nodules, likely intrapulmonary lymph nodes. No new or suspicious nodules. MEDIASTINUM AND HILA: Tracheostomy in place. Left PICC terminates in SVC. No mediastinal adenopathy. The heart is normal in size without pericardial effusion. Mild calcifications in aorta and coronary arteries. Eccentric plaque in proximal descending aorta appears unchanged.CHEST WALL: Stable mildly enlarged axillary lymph nodes; reference right axillary node is unchanged, measuring 9 mm, previously measured 9 mm (series 3, image 36). Degenerative endplate changes again noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications in aorta and its branches. No retroperitoneal adenopathy noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted. Gastrostomy tube in place.BONES, SOFT TISSUES: Degenerative changes in the spine, with mild loss of height anteriorly of L4 vertebral body.OTHER: No significant abnormality noted. | Stable mildly enlarged axillary lymph nodes. No evidence of intrathoracic or intra-abdominal metastatic disease. |
Generate impression based on findings. | 82 year old female with pulmonary sarcoidosis, now with progressive shortness of breath. LUNGS AND PLEURA: Severe upper lobe predominant chronic interstitial disease again noted, with associated focal areas of atelectasis/consolidation, traction bronchiectasis, pleural thickening, and architectural distortion; not significantly changed. Increased left lower lobe ground glass opacity (series 5, image 50). Previously seen ground glass opacities in the right lower lobe are improved. MEDIASTINUM AND HILA: Severe coronary artery calcifications. The heart is normal in size without pericardial effusion. Numerous calcified lymph nodes.CHEST WALL: Healing right lateral rib fracture (sagittal series image 126).UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.New left lower lobe ground glass opacities are unclear etiology but may represent mild residual hemorrhage from prior pulmonary emboli. Atypical infection, aspiration, or progression of pulmonary sarcoidosis are also considerations. 2.Extensive chronic interstitial lung disease compatible with sarcoidosis, not significantly changed. |
Generate impression based on findings. | 29-year-old male with history of Wilms tumor status post left nephrectomy and chemoradiation. Follow-up evaluation. CHEST:LUNGS AND PLEURA: No suspicious pulmonary masses are identified. Calcified granuloma right upper lobe. No pleural effusions.MEDIASTINUM AND HILA: A well-defined hypoattenuating mass is again noted in the subcarinal region which measures up to 6.0 x 3.4 cm (series 2, image 51). This mass is not significantly changed compared to prior examination and likely represents a duplication or bronchogenic cyst rather than lymphadenopathy. No new mediastinal or lymphadenopathy is identified.The heart size is normal. No pericardial effusion is present.CHEST WALL: Right gynecomastia unchanged.ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size and attenuation. No focal hepatic lesions are identified. The gallbladder appears normal. There is no intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: The spleen is normal in size and attenuation.PANCREAS: The pancreas appears normal.ADRENAL GLANDS: The adrenal glands are symmetric in size and attenuation.KIDNEYS, URETERS: Postoperative changes of left nephrectomy are again noted. There is no evidence of recurrent or residual tumor.Numerous exophytic right renal cysts are again noted which are not significantly changed since the prior examination and may represent nephroblastomatosis.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy is present.BOWEL, MESENTERY: No bowel obstruction is present. The appendix is located in the right lower quadrant and appears normal.BONES, SOFT TISSUES: No fracture or focal osseous lesions.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No evidence of recurrent or metastatic disease. No significant interval change since the prior examination from April 15, 2013. |
Generate impression based on findings. | 44-year-old male with new diagnosis of esophageal cancer. CHEST:LUNGS AND PLEURA: Mild basilar atelectasis and scarring. Punctate micronodules in lingula and right middle lobe likely represents intrapulmonary lymph nodes (series 5, images 50, 45). No suspicious nodules or masses.MEDIASTINUM AND HILA: Significant thickening of the midesophagus with soft tissue infiltration of surrounding mediastinal fat, compatible with known esophageal neoplasm. A centrally hypoattenuating lesion abutting left aspect of the mid esophagus, possibly representing necrotic lymph node, measures 2.1 x 2.5 cm (series 3, image 32). Multiple adjacent enlarged mediastinal lymph nodes. For reference, high right paratracheal node measures 1.1 x 1.1 cm (series 3, image 20).The heart is normal in size without pericardial effusion. Mild coronary artery calcifications.CHEST WALL: Several healing fractures of the lateral left ribs (coronal series image 50).ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Mid-esophageal mass with infiltration of surrounding mediastinal fat, compatible with known esophageal carcinoma.2.Multiple enlarged mediastinal lymph nodes.3.Two punctate lung micronodules, which have morphology suggestive of intrapulmonary lymph nodes; however, given patient's known cancer, continued follow-up is recommended. |
Generate impression based on findings. | 67-year-old male with shortness of breath and abnormal chest x-ray. LUNGS AND PLEURA: Small bilateral pleural effusions, right more than left. Basilar atelectasis/consolidation as well as basilar scarring. The scattered areas of ground glass opacity in the right upper and right lower lobes, nonspecific but may represent edema.Several lung nodules are identified (series 5, image 61, 71). Left lower lobe nodule measures 6 mm (series 5, image 71). Ill-defined groundglass, nodular opacity in right lower lobe measures 11 mm (series 5, image 46).MEDIASTINUM AND HILA: Multiple enlarged mediastinal lymph nodes; precarinal node measures 12 mm in short axis (series 3, image 39).Moderate cardiomegaly. Trace pericardial effusion. Moderate coronary artery calcifications.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Thickening of adrenal glands bilaterally. Partially visualized right kidney contains several hypodensities, incompletely evaluated but likely representing cysts. | 1.Multiple pulmonary lung nodules, largest located in the left lower lobe and measuring 6 mm.2.Ill-defined, partially solid nodular opacity in right lower lobe measures 11 mm; while nonspecific and could be inflammatory in nature, adenomatous hyperplasia or minimally invasive adenocarcinoma is also in differential. Follow-up in 3 to 6 months is recommended.3.Multiple enlarged mediastinal lymph nodes. 4.Small bilateral pleural effusions are associated with ground glass opacities, suspected to be due to pulmonary edema. |
Generate impression based on findings. | Clinical question: Evaluate sinuses. Signs and symptoms: 72-year-old male with history of multiple myeloma. Status post CT and pulmonary aspergillosis who has chronic sinusitis symptoms. Maxillofacial CT:Frontal sinuses demonstrate minimal mucosal thickening at their base and with occluded ostia.Ethmoid sinuses demonstrate mild chronic sinusitis (R>L).Sphenoid sinus demonstrate near complete opacification of the right chamber with evidence of uniform diffuse bony thickening and subtle high density of the sinus contents consistent with chronic long-standing sinus disease. The right sphenoethmoidal recess however remain still patent. Minimal mucosal thickening on the left chamber of the sphenoid sinus and with occluded sphenoethmoidal recess.Maxillary sinuses bilaterally demonstrate mild diffuse mucosal thickening with occluded right ostiomeatal unit and patent left.Nasal cavity demonstrate significant nasal septum deviation to the left.Bilateral mastoid air cells and th middle ear cavities are well pneumatized. Unremarkable images through the orbits. | Mild chronic pansinusitis which is worse in the right chamber of the sphenoid sinus as detailed. Occluded left sphenoethmoidal recess and left ostiomeatal unit. Significant leftward nasal septum deviation. |
Generate impression based on findings. | 23-year-old female with metastatic osteosarcoma. Off therapy. LUNGS AND PLEURA: Post-surgical changes at the left lower lobe, with scarring. No nodules are seen. No focal airspace opacities or pleural effusions.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Normal sized heart without pericardial effusion.CHEST WALL: Post surgical changes at the left posterior chest wall. No axillary lymphadenopathy. Central venous catheter has been removed.UPPER ABDOMEN: No significant abnormality noted. | Post-surgical scarring at the left lower lobe, without new nodules seen. |
Generate impression based on findings. | Male, 47 years old, history of tongue cancer, on therapy. 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. Extensive postsurgical and posttreatment findings are demonstrated in the neck including total glossectomy with flap reconstruction, neck dissection, and extensive subcutaneous/fascial infiltration.Ulceration of the right neck, just below the parotid gland at the level of the tongue flap pedicle, is redemonstrated. Ill-defined enhancing tissue is seen surrounding the ulceration and extending to some degree superiorly into the right parotid space. This tissue appears slightly bulkier than on the prior examination. Accurate measurement is very difficult, but as a rough approximation, coronal dimensions are 2.5 x 1.7 cm (image 43 series 80445), previously 1.8 x 1.2 cm. Very mild erosion of the adjacent angle of the mandible is suspected.The mucosal spaces are free of suspicious lesions. There is a small air and fluid collection tracking along the pterygoid musculature on the left (see image 34 series 5), which may reflect communication with the oral cavity however a discrete point of communication is not visualized. This finding has been stable over multiple prior exams.Anatomy of the neck is distorted from prior treatment with loss of volume and significant effacement of fascial planes. Within this background, no pathologic adenopathy is detected. A tracheostomy is in place. The divided thyroid gland is unremarkable. Cervical vessels are patent. Lung apices are unremarkable. Except as above, no concerning osseous lesions are demonstrated. | 1. Redemonstration of extensive postsurgical and posttreatment findings in the neck.2. Ulcerated ill-defined enhancing tissue within the right neck, at the level of the tongue flap pedicle, is again seen, highly suspicious for active disease. Accurate measurement of this tissue is very difficult, but it does appear to be slightly bulkier when compared to the prior exam.3. No evidence of intracranial metastases. |
Generate impression based on findings. | 70 year-old male patient with history of bladder cancer. Evaluate for recurrence. CHEST:LUNGS AND PLEURA: Redemonstration of scattered bilateral pulmonary micronodules, most of which are calcified.MEDIASTINUM AND HILA: Calcified mediastinal and hilar lymph nodes, consistent with prior granulomatous disease.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Scattered punctate calcifications, consistent with prior granulomatous disease.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cyst in the intrapolar region and inferior pole are stable compared to prior examination and represent simple cysts. Bilateral subcentimeter renal hypoattenuating lesions are too small to characterize and likely represent cysts.Bilateral nonobstructive renal calculi.Mild hydronephrosis, expected and stable compared to prior examination.Delayed images show proximal filling of the ureters only, likely secondary to timing.RETROPERITONEUM, LYMPH NODES: Atherosclerotic changes in the abdominal aorta and iliac arteries. No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Dextroscoliosis of the lumbar spine. Multilevel degenerative changes in the thoracic and lumbar spine.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Postoperative changes from cystoprostatectomy.BLADDER: Stable postoperative changes from cystoprostatectomy with neobladder.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: Colonic diverticulosis without CT evidence of diverticulitis.BONES, SOFT TISSUES: Dextroscoliosis of the lumbar spine. Multilevel degenerative changes in the thoracic and lumbar spine.OTHER: No significant abnormality noted. | Stable postoperative changes from cystoprostatectomy and neobladder reconstruction. No lymphadenopathy or evidence of recurrent disease. |
Generate impression based on findings. | Reason: eval for esophageal cancer History: eval for esophageal cancer CHEST:LUNGS AND PLEURA: Bibasilar groundglass opacities compatible with atelectasis. Mild perihilar ground glass opacities may represent edema. These findings may also represent early NSIP.MEDIASTINUM AND HILA: Large hiatal hernia. Eccentric thickening of the distal esophagus measuring 15 mm (series 3, image 52), suspicious for underlying mass though diffucult to differentiate from prominent folds due to hernia. Mild mediastinal lymphadenopathy. For reference, right superior paratracheal lymph node measures 16 mm (series 3, image 15).Mild cardiomegaly. No pericardial effusions. Moderate atherosclerotic ossifications of the coronary arteries.Distal paraesophageal lymph node on the left measures 10 mm (series 3, image 61). Additional small paraesophageal and subcarinal lymph nodes noted.Subtle bulge of the cranial aspect of the left ventricle suspicious for pericardial defect.CHEST WALL: Sclerotic focus in the posterior left 10th rib. Mild degenerative changes to the thoracic spine.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis without evidence of cholecystitis. No intrahepatic or extrahepatic biliary ductal dilatation. No focal lesions.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Right adrenal nodule.KIDNEYS, URETERS: Bilateral mildly atrophic kidneys. Punctate calcification in the left kidney may represent a vascular calcification or nonobstructing kidney stone.PANCREAS: Hypodense lesion in the uncinate process of the pancreas may represent a sidebranch IPMN, too small to accurately characterize.RETROPERITONEUM, LYMPH NODES: Mild para -aortic and mesenteric lymph adenopathy. BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.BONES, SOFT TISSUES: Mild degenerative changes of the lumbar spine.OTHER: No significant abnormality noted. | Distal esophageal wall thickening with mild adjacent lymphadenopathy. Recommend correlation with PET or endoscopy to exclude neoplasm. Groundglass opacities are suspicious for mild NSIP, |
Generate impression based on findings. | 68-year-old male postop day #1 following transphenoidal hypophysectomy for macroadenoma. There are postoperative changes including a bony defect at the floor of the sella, surgical packing within the sphenoid sinus and loculated air within the sella representing postoperative pneumocephalus. There has been decrease in size of the intrasellar component of the mass. There is hyperdense material within the suprasellar region partially effacing the suprasellar cistern which could represent blood products or residual tumor.There is partial opacification of ethmoid sinuses. Mastoid air cells and orbits are normal. There is patchy hypoattenuation within white matter most likely representing sequela of chronic small vessel ischemic disease. There is no hydrocephalus or CT evidence of ischemia. The midline is intact. | Postoperative changes related to recent transphenoidal hypophysectomy including debulked intrasellar component of a previously the described macroadenoma with hyperdense material in the suprasellar region. This could represent blood products and/or residual tumor an MRI is recommended to further evaluate this mass and mass effect on the chiasm. |
Generate impression based on findings. | 52-year-old male with esophageal cancer status post two cycles of chemotherapy. CHEST:LUNGS AND PLEURA: New paramediastinal linear opacities and consolidation, most compatible with postradiation change. No suspicious nodules or masses.MEDIASTINUM AND HILA: No pathologically enlarged mediastinal lymph nodes. Thickening of the distal esophageal wall; lack of intraluminal contrast makes evaluation for discrete lesion difficult (series 3, image 56). Large hiatal hernia.Heart is normal size without pericardial effusion. CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Hypodense lesions in both kidneys, some of which are too small to characterize, unchanged and most compatible with benign cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.New paramediastinal opacities most compatible with post radiation change.2.No evidence of metastatic disease.3.Thickening of the distal esophagus, most compatible with known esophageal neoplasm. |
Generate impression based on findings. | 65-year-old male with history of lung cancer status post right lower lobectomy. CHEST:LUNGS AND PLEURA: Status post right lower lobectomy. Stable pleural thickening and scarring in the right base. No evidence of recurrence, suspicious nodules or masses. Moderate emphysema.MEDIASTINUM AND HILA: Status post gastric pull up with air fluid level in neoesophagus, unchanged. No pathologically enlarged mediastinal lymph nodes. Heart is normal in size without pericardial effusion. Mild to moderate coronary artery calcifications noted. Right port catheter tip in upper right atrium. CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Left lobe cyst unchanged.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Post surgical changes in the left upper quadrant.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Status post right lower lobectomy without evidence of recurrence or metastatic disease. |
Generate impression based on findings. | 21-year-old female with headaches and seizures. Near resolution of the previously identified tubular enhancing structure along the left frontal scalp. No abnormal intracranial enhancement is present. Similar to the prior examinations, scattered lucencies are present in the left frontotemporal calvarium.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No gross intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1. Near resolution of the previously identified tubular enhancing structure along the left frontal scalp. This most likely represents a venous structure such as a varix.2. No abnormal intracranial enhancement, mass, mass effect, edema or midline shift. |
Generate impression based on findings. | 73-year-old male with pulmonary aspergillosis. LUNGS AND PLEURA: Severe emphysema. Stable appearing scarlike opacities in the right upper lobe.Lobulated mass with several surrounding smaller nodules in right lower lobe measuring approximately 3.8 cm, unchanged (series 4, image 58). Several other micronodules in both lungs are unchanged. No new nodules, consolidation or pleural effusions.MEDIASTINUM AND HILA: Several small mediastinal lymph nodes are unchanged. Heart is normal in size without pericardial effusion. Severe coronary artery calcifications. Left port catheter tip in SVC.CHEST WALL: Status post median sternotomy. Unchanged heterogeneous appearance of bone marrow most compatible with osteoporosis.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Again seen scattered pancreatic calcifications. | No significant change in right lower lobe mass, consistent with known aspergillus infection. No new nodules or opacities. |
Generate impression based on findings. | 71-year-old male with right upper lobe opacity. LUNGS AND PLEURA: Severe emphysema.New spiculated nodule in the right upper lobe measures 12 x 9 mm, highly suspicious for primary lung neoplasm (series 5, image 23). New punctate micronodule in right middle lobe adjacent to fissure measures 3 mm, most consistent with pulmonary lymph node (series 5, image 48).Previously seen right upper lobe scar like opacity with nodular components not significantly changed, measuring 10 x 9 mm, previously measured 10 x 8 mm (series 5, image 25). The more anteriorly located, paramediastinal opacity also appears unchanged, measuring approximately 18 mm in maximal AP dimension, previously measured 18 mm (series 5, image 30).MEDIASTINUM AND HILA: Prominent subcarinal node measures 10 mm in short axis, not significantly changed (series 3, image 52). The heart is normal in size. Unchanged mild pericardial thickening. CHEST WALL: Old fractures in several right lateral ribs. UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Status post cholecystectomy. | 1.New spiculated right upper lobe nodule measuring 12 mm, highly suspicious for primary lung neoplasm.2.New nodule in right middle lobe measuring 3 mm, most consistent with intrapulmonary lymph node given morphology and location.3.Two previously seen scarlike opacities in right upper lobe not significantly changed.4.Stable prominent subcarinal lymph node. |
Generate impression based on findings. | 36 year old female with abdominal pain, status post multiple hernia repairs ABDOMEN:LUNG BASES: In the right lower lobe is an incompletely imaged density which may be vascular however a nodule cannot be excluded (image 1 series 4).LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Wall thickening and narrowing of the mid transverse colon, extending to the splenic flexure appears somewhat similar to the prior study and may be post infectious/inflammatory in etiology. No evidence of bowel obstruction. No loculated fluid collections.BONES, SOFT TISSUES: Surgical changes of the abdominal wall without evidence of recurrent hernia.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Surgical changes of the abdominal wall without evidence of recurrent hernia.2. Mild chronic narrowing and wall thickening of the transverse colon extending to the splenic flexure, which may be post inflammatory/infectious.3. Incompletely imaged density in the right lower lobe, consider chest CT for further evaluation if clinically warranted. |
Generate impression based on findings. | Clinical question: Evaluate for occlusion, posterior. Signs and symptoms: Dysphagia and hoarseness. Nonenhanced head CT:There is no convincing evidence of any new acute findings since prior study of earlier this date.Stable tiny focus of increased density in the right paramedian pons since prior study.Extensive findings of age indeterminate small vessel ischemic strokes remain grossly similar to prior exam. The findings on the right are more extensive and with resultant ex vacuo dilatation of right lateral ventricle.No evidence of hemorrhage, mass effect, midline shift or hydrocephalus.Brain CTA:Examination demonstrates moderate vascular lumen compromise of distal left MCA due to a short segmental smooth plaque. No convincing evidence of any additional significant vascular lumen compromise of intracranial vasculature is identified. Examination demonstrate mild bilateral cavernous carotid vascular calcification without vascular lumen compromise. Unremarkable bilateral anterior and middle cerebral arteries.Unremarkable bilateral intracranial vertebral arteries, basilar artery and its distal branches. Mild vascular calcification of dominant right vertebral artery is noted. Very tiny bilateral posterior communicating arteries are identified.Neck CTA:Unremarkable visualized aortic arch and the origins of major branches. Unremarkable break a cephalic and bilateral subclavian arteries.Unremarkable bilateral common carotid arteries and including their origins.There are heavy bilateral vascular calcification of internal carotid artery origins without any significant vascular lumen compromise. Unremarkable internal carotid arteries otherwise through the cervical region and across to skull base.Unremarkable bilateral external carotid arteries.Unremarkable bilateral vertebral arteries and including their origins. There is a tiny focus of vascular calcification at the origin of the right dominant vertebral artery. | 1.Nonenhanced head CT demonstrate no convincing evidence of any new acute finding since prior exam. Stable punctate focus of increased density in the right paramedian pons and suspicious for tiny hemorrhage. Extensive supratentorial (right greater than left) small vessel ischemic strokes.2.Intracranial CTA demonstrate short segmental moderate vascular lumen compromise of left distal M1 segment of middle cerebral artery and no evidence of any additional significant vascular lumen compromise or stenosis. All major intracranial vessels are widely patent. Mild bilateral cavernous carotid and minimal right dominant vertebral artery vascular calcification is noted.3.CTA of neck demonstrate no significant vascular lumen compromise or any vascular occlusion. Heavy vascular calcification of bilateral internal carotid artery origins without any significant vascular lumen compromise. |
Generate impression based on findings. | 55-year-old male with cough and lung nodule. LUNGS AND PLEURA: Linear, scarlike opacities and rounded, subsegmental atelectasis in right midlung and both bases with associated pleural thickening, unchanged since 4/2013 but new since 7/2004. No suspicious nodules or masses.MEDIASTINUM AND HILA: No pathologically enlarged lymph nodes. Heart normal in size without pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Cirrhotic liver morphology with moderate amount of ascites fluid in abdomen. Status post cholecystectomy. | 1.Right lung predominant scarlike opacities and rounded atelectasis, without evidence of suspicious nodules or masses.2.Cirrhosis with ascites fluid. |
Generate impression based on findings. | Malignant neoplasm of the lung, restaging CHEST:LUNGS AND PLEURA: Postsurgical changes including a right upper lobectomy are unchanged and with associated volume loss and mediastinal shift. No suspicious pulmonary nodules or masses. Scattered small micronodules unchanged. Specifically the previously described narrow and lunate shaped trachea suggestive of obstructive airways disease is again observedMEDIASTINUM AND HILA: No lymphadenopathyProminent central pulmonary arteries again suggests possible hypertension. Severe coronary calcifications. Relative right sided enlargement with aortic valve calcifications. Pericardium unremarkableCHEST WALL: Scattered degenerative changes without suspicious lytic or blastic lesions. Mild scoliosisABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Stable appearing inferior right lobe area of hyper attenuating tissue, possibly incompletely assessed due to phase of contrast. No suspicious new foci or abnormal lesions. Cholecystectomy.SPLEEN: Splenule without suspicious abnormalityADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Extensive atherosclerotic changes throughout the aorta and branchesBOWEL, 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.No findings of recurrent malignancy. 2.Nonspecific focal hepatic hyper attenuation also unchanged |
Generate impression based on findings. | History of desmoid tumor. Assess for progression of disease. CHEST:LUNGS AND PLEURA: Previously described nodular structure on the posterior segment of the right lung base is not visualized in this examination.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Stable left paraspinal and right inferolateral, intercoastal mass, taking in account the differences in technique. Reidentification of multiple punctate calcifications located at the paraspinal muscles and right soft tissues of the chest wall. The lower part of the right chest wall mass compresses and displaced medially the liver. Some bone remodeling from the 7th up to the 10th right ribs is noted on the region in which the wall mass is abutting the osseous structures.ABDOMEN:LIVER, BILIARY TRACT: Liver is slightly displaced and compressed by the right-sided chest wall mass, however looks otherwise normal.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Stable multiple left paraspinal and right sided inferolateral chest wall mass. |
Generate impression based on findings. | Male, 4 years old, status post head trauma 12 hours before, loss of consciousness, mom says patient still confused. 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. | Mesothelioma post 3 doses of immunotherapy. CHEST:LUNGS AND PLEURA: Right hydropneumothorax with increase in volume of pleural fluid since the previous examination. Two possible areas of fistulous communication with the pleural space on the right are identified on series 4 and images 58 and 64. Interval increase in size and number of pleural nodules in the right hemithorax. Reference level near the main PA bifurcation (3/60) 20-mm at the 4 o'clock position, previously 1 mm. 0 mm at the 7 and 9 o'clock positions. Tumor elsewhere at this level is new.Level of the aortic root (3/64) 0 mm 4 o'clock, unchanged. 0 mm at the 6 and 8 o'clock positions unchanged however there is new tumor elsewhere at this level. Level immediately superior to the right hemidiaphragm (3/77) 0 mm at 4 o'clock unchanged, 26-mm at 6 o'clock, previously 2-mm. 29-mm at 7 o'clock, previously 2-mm.New semi-spherical area of soft tissue opacity at the left costophrenic angle (4/87) indeterminate. This is atypical in appearance for atelectatic lung and suspicious for a contralateral lesion.MEDIASTINUM AND HILA: Tumor along the right heart border has increased with narrowing of the right superior pulmonary vein it between the right pulmonary artery and adjacent pleural mass (3/65). The adjacent to the superior vena cava, tumor extends through the mediastinal pleural surface to invade the adjacent mediastinal fat anterior to the aortic root (3/62). New small right cardiophrenic nodule (3/83).CHEST WALL: Tumor in the right paravertebral fat near the apex (3/24) and now extends to the cortical surface of the adjacent vertebral body. Left chest port. Rib fracture deformities. Right lateral chest wall musculature haziness unchanged.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Enhancing lesions in the spleen could reflect a hemangioma.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: Pancreatic atrophy and fatty replacement with an area of focal sparing in the neck region (3/112) unchanged, this should continue to be monitored to exclude an underlying isoattenuating soft tissue lesion.RETROPERITONEUM, LYMPH NODES: Atherosclerotic disease.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Right diaphragmatic graft.OTHER: No significant abnormality noted. | Interval increase in the size and number of pleural masses in the right hemithorax. New right pleural fluid collection with chronic right pneumothorax presumably due to bronchopleural fistula. Given presence of pleural fluid on the current examination, two possible areas of communication are identified in the anterior lung. Unable to exclude contralateral pleural tumor. |
Generate impression based on findings. | Mesothelioma, follow-up LUNGS AND PLEURA: Postsurgical right pneumonectomy and diaphragmatic graft placement with a large amount of fluid throughout the hemithorax unchanged. Moderate right to left mediastinal shift again observed. Previously described thickening along the inferior right pleura and posterior costophrenic angle not well visualized previously is again unchanged when compared to multiple earlier exams; specifically comparison to 7/23/13 was performed.Lungs remain clear other than scattered nonspecific micronodules unchanged. New left pleural effusion or thickening.MEDIASTINUM AND HILA: No suspicious lymphadenopathy. The reference left hilar node (image 44 series 3) remains 12 mm when measured in a similar fashion.The cardiac and pericardium are grossly normal yet compressed moderately. Atrial septal defect repairCHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Please correlate with dedicated abdomen and pelvis CT interpreted separately | Postsurgical right pneumonectomy with extensive retained fluid throughout the hemithorax. No evidence of local recurrence or new metastatic disease. |
Generate impression based on findings. | Malignant mesothelioma, follow-up CHEST:LUNGS AND PLEURA: Interval enlargement and increased nodular pleural thickening on the left compatible with progression of known underlying mesothelioma. Associated volume loss and increase changes in the lobe left lung base are again observed. Reference measurements are as follows:1. At the level of the anterior descending coronary artery (image 43 series 3), the 11 o'clock lesion currently measures 1.9 cm from a prior measurement of 1.4 cm when measured as similarly2. At the level of the aortic root (image 56 and 61, series 3, respectively) the "1 o'clock" (more like 3 o'clock) measures 4 mm, previously 2 mm; and 11 o'clock measures 9 mm raw prior measurement of 7 mm3. At the level of the left ventricle (image 64 series 3), the tachycardia clock position measures 10 mm or prior measurement of 9 mm. The 12 o'clock measurement is not observed currently.The small nodular density located within the left major fissure has increased to 10 mm were prior measurement of 7 mm (image 43 series 3). Lungs demonstrate diffuse moderate emphysematous changes with areas of scarring, otherwise unchangedMEDIASTINUM AND HILA: No lymphadenopathy.Increased pleural and pericardial thickening (image 48 series 3) along with similar interval increase in thickening noted more inferiorly involving the anterior and left lateral aspect of the pericardium. Additionally a new soft tissue focal nodular density is observed in the anterior mediastinum, currently measuring 1.9 x 1.8 cm (image 36 series 3).Marked coronary calcifications.Small hiatal herniaCHEST WALL: Postoperative changes in thickening soft tissue stranding involve the left lateral chest wall essentially unchanged (image 57 series 3).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 renal cysts without interval changePANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic changes of aorta and branchesBOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Scattered marked degenerative changes more pronounced lower thoracic and lumbar spineOTHER: No significant abnormality noted. | Interval progression of known mesothelioma with reference measurements above. Changes include enlargement of existing disease with also additional new foci |
Generate impression based on findings. | Question change in size of nodule. History of latent tuberculosis infection LUNGS AND PLEURA: Numerous groundglass pulmonary nodules measuring from 4 -7mm in size similar to previous. Biapical scarring. Mild bronchiectasis is unchanged.Spiculated nodule in the right lower lobe not conclusively changed in either size or density compared to the most recent previous. This measures 11 x 7 x 14 mm on both the current and most recent previous exams when remeasured.MEDIASTINUM AND HILA: Main pulmonary artery enlarged measuring 35-mm in transverse dimension. Dual chamber ICD in place.CHEST WALL: Left subcutaneous pacemaking device. Surgical clips in the right paratracheal area.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Cholecystectomy clips. Hyperattenuating cortical lesions in the visualized portion of the left kidney may be hemorrhagic or proteinaceous cysts but are incompletely assessed. | 1. No conclusive change in dominant right lower lobe nodule since the previous examination. The lesion remains indeterminate for malignancy. Additional follow-up CT in 6 months is recommended.2. Unchanged numerous groundglass density nodules which may reflect sequela of pulmonary involvement by Crohn's disease though not specific. Nodules should continue to be monitored yearly to exclude growth due to small areas of adenocarcinoma in situ or a minimally invasive adenocarcinoma.3. Signs of pulmonary hypertension. |
Generate impression based on findings. | Mesothelioma, follow-up CHEST:LUNGS AND PLEURA: Left sided hemithorax by them loss with pleural thickening and fluid anteriorly, unchanged. Changes associated with pleurectomy and decortication with associated osseous abnormalities. Small loculated fluid within hyperattenuating rim persists along the anterior aspect, unchanged. Reference measurements:1. At the level of the AP window (image 31 series 3) anterior loculated small fluid collection at 12 o'clock remains 10 mm. The 6 o'clock measurement remains 0 mm2. At the level of the aortic root (image 50 series 3) the 12 o'clock measurement remains 11 mm and the 6 o'clock position 0 mm unchanged3. The right costophrenic angle measurement posteriorly (image E4 series 3) the 6 o'clock measurement remains 1.7 cm unchangedMEDIASTINUM AND HILA: No lymphadenopathyMild to moderate cardiac enlargement with coronary calcifications.CHEST WALL: Old healed left rib fractures. Old biopsy changes unchangedABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis without additional hepatic abnormalitySPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Probable yet stable simple renal cystsPANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic changes of the descending aorta and branchesBOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Scoliosis and degenerative changes with questionable benign-appearing cystic lesion in L3OTHER: No significant abnormality noted. | Residual stable pleural thickening and fluid, reference measurements provided |
Generate impression based on findings. | 54-year-old patient with persistent back pain. History includes multilevel surgical laminectomies. There are postoperative changes including L4 -- laminectomy and partial fusion of posterior elements with bulky bony material (right greater than left) resulting in fusion of L3-4. There is maintenance of vertebral body height, though sclerotic changes related to degeneration are demonstrated at L4, L5 and S1. There is mild retrolisthesis of L2 on 3 on the basis of degenerative change. There is loss of intervertebral disk space at L3-4, L4-5 and L5-S1 in addition to vacuum phenomena at L4-5. The conus medullaris is demonstrated at the T12 level. There is no clumping or displacement of nerve roots. There is mild impression on the right posterolateral aspect of the thecal sac the L5-S1 level. L1-2: There is no disk bulge or significant degenerative change. There is no spinal or neural foraminal stenosis.L2-3: There is a disk bulge and ligamentum flavum hypertrophy which results in moderate spinal canal stenosis (8 mm) without neural foraminal stenosis.L3-4: There is near complete obliteration of the disk space without any obvious disk bulge. There are degenerative facet changes without canal or neural foraminal stenosis.L4-5: There is loss of disk height and vacuum phenomenon with a disk bulge, though the canal is decompressed posteriorly. The neural foramen demonstrate moderate narrowing bilaterally. L5-S1: There is a mild disk bulge which does not significantly efface the thecal sac. There are degenerative changes which result in moderate neural foraminal stenosis bilaterally. | 1.Postoperative changes including L4-5 laminectomy with partial fusion of posterior elements.2.Multilevel degenerative change resulting in moderate canal stenosis at L2-3 and bilateral moderate neuroforaminal stenosis at L4-5 and L5-S1. |
Generate impression based on findings. | Female 68 years old; Reason: Evaluate for progression of metastatic disease; compare to previous scan. CHEST:LUNGS AND PLEURA: Bilateral and pulmonary and pleural based masses. Reference left lower lobe mass measures 6.1 x 3 .9 cm, previously 5.8 x 3.3 cm (image 67, series 5). Reference right lower lobe lesion measures 5.4 x 5 .4 cm, previously 5.3 x 4.7 cm (image 71, series 5). There are no new pulmonary nodules seen. The previously noted nodules along the left major fissure are not seen on this exam . Stable right pleural thickening noted.MEDIASTINUM AND HILA: There is mediastinal and hilar adenopathy. Reference left paratracheal lymph node measures 1.1 x 1.7cm, previously 1.5 x 1.8 cm (image 22, series 3). Reference low right paratracheal lymph node measures 1.4 x 1.6cm, previously 2.2 x 1.5 cm (image 35, series 3). CHEST WALL: Status post right mastectomy. Surgical clips in the right axilla. Compression deformity of T8 vertebral body is unchanged from the prior exam. ABDOMEN:LIVER, BILIARY TRACT: Cholecystectomy clips.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: 1.9 x 2.4 cm contour deforming hypoattenuating lesion is noted in the lower pole left kidney which measures 78 Hounsfield units. This lesion has not changed since the previous exam, however when compared to 2009, this lesion has markedly increased in size. This is incompletely characterized given only single phase of contrast. Other hypodense subcentimeter lesions in the kidneys are unchanged from the prior exams but still too small to characterize. RETROPERITONEUM, LYMPH NODES: Slight increase in size of retroperitoneal lymphadenopathy. Reference gastrohepatic lymph node measures 1.6 x 0 .8 cm, previously 1.8 x 0.9 cm (image 86, series 3). BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Unchanged compression deformity of T8 vertebral bodyOTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Right femoral rod. OTHER: No significant abnormality noted. | 1. Very minimal increase in size of the pulmonary and pleural based metastatic masses. No new lung lesions detected.2. Stable size of mediastinal and retroperitoneal adenopathy. 3. Indeterminant renal lesion that has grown since 2009 worrisome for metastatic disease. Although primary neoplastic process can be similar, correlate.4. Unchanged compression deformity of T8 vertebral body. No new metastatic lesions detected. |
Generate impression based on findings. | Intracerebral hemorrhage. There is no significant interval change in the evolving hematoma centered in the right thalamus with associated vasogenic edema and effacement of the third ventricle. There is also no significant interval change in the appearance of the lateral ventricles, although these appear to have slightly decreased in size since 11/12/13. The brain parenchymal appears unchanged, include a prior right transfrontal ventricular shunt track. The skull and extracranial soft tissues are unchanged. | No significant interval change in the evolving hematoma centered in the right thalamus with associated vasogenic edema and effacement of the third ventricle and no significant interval change in the appearance of the lateral ventricles, although these appear slightly less dilated since 11/12/13. |
Generate impression based on findings. | Lung cancer LUNGS AND PLEURA: Right upper lobectomy with resection volume loss. No evidence of interval focal recurrence. No effusions. Mildly dependent posterior and lower lung patchy nonspecific ground glass and tree in bud deformity, possible aspiration. Largely paraseptal emphysematous changes unchangedMEDIASTINUM AND HILA: Left small hypoattenuating thyroid nodule.No lymphadenopathyMild left to right mediastinal shift unchanged. Coronary calcifications without additional cardiac or pericardial abnormalityModerate hiatal hernia with associated surrounding fatCHEST WALL: Old healing left and right rib fracture, presumably postsurgicalUPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Stable hypoattenuating left lobe hepatic lobe cyst and left kidney. No additional upper abdominal abnormality this limited evaluation. | Postsurgical changes of right upper lobectomy without evidence recurrence or metastatic disease |
Generate impression based on findings. | Malignant neoplasm of the uterus. Carcinosarcoma. Vaginal bleeding. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Minimal nodularity along the omentum (e.g., image 93; series 3) should be followed.PELVIS:UTERUS, ADNEXA: Uterus is enlarged and heterogeneous measuring 12.3 x 13.6 cm (image 140; series 3). Ovaries not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: Multiple small pelvic lymph nodes. For reference purposes, a right common femoral node measures 2.1 x 1.0 cm (image 154; series 3).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Enlarged heterogeneous uterus. Small pelvic lymph nodes. No definite evidence of remote disease. |
Generate impression based on findings. | Reason: Lung nodule size. Need for follow-up CT. History: COPD. MAI infection now on treatment. LUNGS AND PLEURA: Severe diffuse centrilobular emphysema.Scarring with surgical staples in the right upper lobe.Flat right upper lobe nodule measuring 8 x 9 mm in cross-section but decreased in thickness on coronal images.New partial atelectasis of the left lower lobe with focal consolidation, moderate bronchiectasis and mucoid impaction.Extensive mucus impaction in the right bronchus intermedius, as well as the right middle lobe and right lower lobe segmental bronchi.MEDIASTINUM AND HILA: No significant lymphadenopathy.Moderately severe coronary artery calcification, with extensive aortic and bronchial calcification.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Small left Bochdalek hernia. | 1. Stable right upper lobe nodule, slightly decreased in 6/19/2013, compatible with an infectious etiology.2. New partial consolidation and atelectasis in the left lower lobe with associated bronchiectasis and diffuse emphysema. 3. Extensive mucoid impaction in the central airways on the right. |
Generate impression based on findings. | Thyroid cancer with persistent thyroglobulin and 3 stable subcentimeter lung nodules. LUNGS AND PLEURA: No pleural fluid or pneumothorax.4-mm nodule in the right middle lobe (4/47) may contain internal lipid contents (-69HU on the source images).1 to 2-mm right lower lobe nodule (4/46). Subpleural 1 to 2-mm micronodule left upper lobe (4/39).Additional micronodule densities are too small to accurately characterize, some of which may be endobronchial debris..MEDIASTINUM AND HILA: In the region of the thymus, there is a soft tissue and lipid containing lesion having convex lateral borders (3/27) at the midportion of this lesion there is focal enhancement which may be due to vascularity (3/29). This may reflect residual or hyperplastic thymus however the convexity of the upper margins is mildly suspicious for an underlying lesion. This measures 12 x 17 mm in transaxial dimensions (3/27).Small hiatal hernia. No lymphadenopathy. Surgical clips in thyroid bed.CHEST WALL: Subtle area of lucency T12 vertebral bodies the left of midline (3/84) should be correlated with nuclear scintigraphy, mildly suspicious for a skeletal metastasis.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. Mildly dilated fluid filled loop of bowel in the left upper quadrant (3/88) nonspecific in appearance, correlate for symptoms. | 1. Subtle spherical lucency in the T12 vertebral body suspicious for a metastasis. Recommend correlation with nuclear scintigraphy for confirmation.2. Nonspecific pulmonary micronodules for which 3 month CT follow-up is recommended. Largest nodule measures 4-mm in size but appears to contain internal lipid content which would be atypical for a metastasis.3. Soft tissue in the thymic bed may reflect residual or hyperplastic thymus however convex borders along its superior margin should be monitored to exclude an occult lesion. Nuclear scintigraphy may also be of use to assess for uptake at this level. |
Generate impression based on findings. | Esophageal neoplasm, evaluate LUNGS AND PLEURA: The discrete well-defined nodule in the left lower lobe (image 63 series 4) remains unchanged at 5 mm. The semisolid nodular densities in the left upper lobe (image 31 series 4) is also unchanged measuring 8 x 7 mm. the referenced right lower lobe semisolid nodule or density is also unchanged 9 x 6 mm (image 65 series 4). Other scattered nodular densities and scarlike opacities mostly posteriorly are all unchanged. No distinct effusions, however mild posterior right pleural thickening is unchangedMEDIASTINUM AND HILA: No lymphadenopathyThe cardiac and pericardial appearance remains unchanged with a questionable small effusion, moderate coronary calcifications and a mitral valve prosthesis.Gastric pull up unchanged with associated moderate retained contentsCHEST WALL: Left mastectomy with axillary dissection scattered surgical clipsUPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Incomplete visualization of a suspected moderate-sized left renal cyst observed on the last image. Consider dedicated imaging but grossly unchanged when compared to prior. Splenic artery aneurysm is unchanged | Stable part solid nodule in the right lower and left upper lobes. Appearance again suspicious for indolent adenocarcinoma. Reference measurements are provided |
Generate impression based on findings. | New onset psychosis/AMS. There is diffuse volume loss, more so in the cerebellum than cerebral hemispheres. There is vascular calcification which is advanced for the patient's age demonstrated within the right vertebral artery and the bilateral internal carotid arteries. The calvarium is slightly thickened. There are no acute abnormalities including intracranial mass or hemorrhage. Ventricles and cisterns demonstrate normal size and morphology. There is no mass-effect including midline shift. The orbits are unremarkable the mastoid air cells are clear. There is partially visualized soft tissue attenuation within the inferior aspect of the maxillary sinuses most likely representing sequela of inflammatory sinus disease as demonstrated on prior exams. | No acute intracranial normality demonstrated. Diffuse volume loss more so in the cerebellum than cerebral hemispheres and large vessel vascular calcification as described. |
Generate impression based on findings. | Benign neoplasm of the thymus CHEST:LUNGS AND PLEURA: Stable multiple pleural and subpleural soft tissue nodules noted in the left. Suspected metastatic disease grossly unchanged, with the reference lesions measured similarly. The large lesion along the posterior left lower lung remains 5.5 cm (image 70 series 3) and the more medial discrete component is unchanged at 1.9 cm (image 69 series 3). Another reference lesion anteriorly remains 1.2 cm in short axis (image 67 series 3) and adjacent to the left ventricular apex. And suspicious tumor is also in observed and unchanged along the left major fissureScattered nonsuspicious micronodules are unchanged. No effusions. Mild bilateral paramediastinal radiation fibrotic changesMEDIASTINUM AND HILA: Stable anterior mediastinal changes and soft tissue/fluid attenuation anterior to the aortic arch. No distinct new lymphadenopathy.The cardiac and pericardium are also unchanged with a small hypodensity adjacent to the distal tip of the SVC catheter representing possible thrombus. The previously described questionable left ventricular isointense to a lesion is inseparable from the ventricle wall is stable in appearance and again raises concern of questionable myocardial invasion (image 52 series 3).Note is again made of the eccentric mural thrombus or focal fluid adjacent to the proximal left common carotid artery unchanged (image 12 series 3), measuring 9 mm.Moderate hiatal hernia.CHEST WALL: Right chest port. Sternotomy changesABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mild descending aorta and branch atherosclerotic diseaseBOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Stable appearing left hemithorax pleural and extrapleural metastatic disease with reference measurements provided. Again noted is questionable invasion of left hemidiaphragm and questionable involvement of the left apical myocardium. |
Generate impression based on findings. | Mesothelioma, follow-up CHEST:LUNGS AND PLEURA: Post operative left pleurectomy changes with volume loss and diaphragmatic mesh all unchanged. A small focus of increased pleural fluid anteriorly and adjacent to the left upper lobe and mediastinal contour is unchanged in appearance. No suspicious new masses or focal areas of pleural thickening to suggest recurrence.Moderate fluid is again noted adjacent to the diaphragmatic mesh without a discrete effusion. Persistent mild basilar minimal consolidation and/or atelectasis/scarring.MEDIASTINUM AND HILA: No lymphadenopathy.Small hiatal hernia. The cardiac and paracardial remain within normal limits other than extensive coronary calcificationsCHEST WALL: Right chest port and old healed rib deformities on the leftABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Scattered persistent suspected hepatic cysts.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Renal cysts unchangedPANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Diverticular diseaseBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Postoperative left pleurectomy without evidence of recurrence |
Generate impression based on findings. | Female 63 years old; Reason: 63 yr old female with h/o aplastic anemia, pre stem cell transplant evaluation. LUNGS AND PLEURA: Scattered bilateral pulmonary micronodules. No suspicious nodules. Mild dependent basilar atelectasis/scarring. No focal consolidation or pleural effusion.MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. Mild cardiomegaly. No pericardial effusion. Atherosclerotic calcifications of the thoracic aorta. Calcific nodules within the right perihilar and subcarinal regions, likely from prior granulomatous disease.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Atherosclerotic calcifications of the abdominal aorta. | No evidence of active infection in the chest.Numerous calcified nodules are consistent with healed granulomas. |
Generate impression based on findings. | Male 66 years old; Reason: Reason: stage IV neuroendocrine small call carcinoma. Please perform a triple phase study. History: pain CHEST:LUNGS AND PLEURA: Stable nonspecific 5 mm right upper lobe pulmonary nodule (series 12, image 34). No new suspicious pulmonary nodules or masses. No pleural effusions.MEDIASTINUM AND HILA: Nodular thyroid is unchanged. No mediastinal or hilar adenopathy. Heart size is normal. No pericardial effusion. Coronary artery calcifications.CHEST WALL: No axillary lymphadenopathy.ABDOMEN:LIVER, BILIARY TRACT: Hepatic metastases are smaller in size. Reference right hepatic lesion measures 1.2. x 1.1 cm previously 1.3 x 1.1 cm (series 12, image 87). Reference left hepatic lobe lesion measures 0.8 X 0.5 cm, previously 1.0 x 0.8 cm (series 14, image 79).SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple appearing renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Reference anterior peritoneal soft tissue nodule measures 1 x 0.8cm previously 1.2 x 0.9 cm (series 14, image 80).BONES, SOFT TISSUES: Diffuse skeletal sclerotic lesions compatible with metastases, stable from prior exam. Reference left anterior abdominal wall soft tissue nodule has resolved in the interim, previously 0.9 x 0.5 cm (series 14, image 127).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: Punctate focus in the right anterior subcutaneous soft tissues is unchanged.OTHER: No significant abnormality noted. | 1. Relatively stable diffuse sclerotic skeletal metastases. 2. Decrease in size of reference lesions. |
Generate impression based on findings. | 66-year-old female with mesothelioma status post recent chemo, evaluate and compare prior ABDOMEN: Limited exam in the evaluation of solid organ pathology and vasculature due to the lack of IV contrast.LUNG BASES: See chest CT report.LIVER, BILIARY TRACT: Mild distortion of the hepatic parenchyma from adjacent soft tissue mass. No focal hepatic lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Multiple prominent periaortic lymph nodes are again noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Infiltrative soft tissue mass involving the right anterolateral abdominal wall measures 8.9 x 4.7 cm (image 66, series 8) and previously measured 9.7 x 4.1 cm. Perihepatic soft tissue mass measures 1.8 cm in thickness and previously measured 2.0 cm (image 48, series 8).OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Fibroid uterus.BLADDER: No significant abnormality notedLYMPH NODES: Index right femoral lymph node measures 1.4 x 1.7 cm and previously measured 1.2 x 1.8 cm (image 102, series 8).BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Pelvic ascites. | Anterior abdominal wall soft tissue mass with intra-abdominal extension and abdominal lymphadenopathy, not significantly changed. |
Generate impression based on findings. | 70-year-old male patient with metastatic prostate cancer. Evaluate for progression. CHEST:LUNGS AND PLEURA: Redemonstration of bilateral upper lobe predominant centrilobular emphysematous changes.No suspicious pulmonary lesions.MEDIASTINUM AND HILA: No significant abnormality noted.Index left paratracheal node measures 3.3 x 2.3 cm (series 3 image 11), stable.Index subcarinal mass measures 3.9 x 3.2 cm (series 3 image 49), previously 4.0 x 3.3 cm.CHEST WALL: Bilateral gynecomastia, stable.ABDOMEN:LIVER, BILIARY TRACT: Pneumobilia, stable.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Minimal bilateral hydronephrosis, slightly increased compared to prior examination.RETROPERITONEUM, LYMPH NODES: Extensive retroperitoneal lymphadenopathy is stable compared to prior examination and continues to encase the aorta and IVC. Conglomerate of lymph nodes in the left periaortic region measures 7.1 x 6.8 cm (series 3 image 115), stable.BOWEL, MESENTERY: Scattered mesenteric lymphadenopathy is minimally increased in size compared to prior examination.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumbar spine. T12 vertebral body hemangioma.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Index pelvic lymph node measures at 5.5 x 4.3 cm (series 3 image 178), stable.BOWEL, MESENTERY: Scattered mesenteric lymphadenopathy is minimally increased in size compared to prior examination.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumbar spine. T12 vertebral body hemangioma.OTHER: No significant abnormality noted. | Stable lymphadenopathy in the retroperitoneum and chest. Minimal interval increase in mesenteric lymphadenopathy. No new lesions. |
Generate impression based on findings. | Female 52 years old; Reason: follow up lung cancer History: cough. CHEST:LUNGS AND PLEURA: Apical predominant centrilobular and paraseptal emphysema. Again seen is left hemithorax volume loss with extensive pleural thickening. Reference nodular thickening of the pleura measures 1.2 cm (series 3, image 50). Note that this area of pleural thickening has more of a triangular appearance which could suggest atelectasis or prior infarct. Redemonstration of a confluent pleural based focus of consolidation in the left lower lobe which measures 1.4 cm (series 3, image 66) and has appearance suggestive of included rounded atelectasis. The difference in size likely reflects previous measurement of the pleura along with the consolidation. This consolidation has decreased in size compared to previous which measured 2.2 cm.Again seen are multiple metastatic nodules throughout the right lung which are stable to slightly decreased. Reference right lower lobe nodule measures 5.0 x 0.6 cm (series 4, image 59), previously measured 0.6 x 0.9 cm.MEDIASTINUM AND HILA: Epicardial extension of tumor has not significantly changed. Heart size is normal. No pericardial effusion. Prevascular, right hilar, and subcarinal lymphadenopathy has not significantly changed. Reference right hilar lymph node is slightly smaller measuring 1.5 cm (series 3, image 46) , previously measuring 1.7 cm. CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Right anterior abdominal wall subcutaneous soft tissue nodules are compatible with injection sites. A new nodule measures 2.0 x 4.0 cm (series 3, image 112) but probably also represents an injection site.OTHER: No significant abnormality noted. | 1.No significant interval change in the left pleural disease. Area of rounded atelectasis/tumor in the left lower lobe is decreased.2.Stable to decreased size in the right pulmonary nodules. |
Generate impression based on findings. | Status post lingulectomy and right upper lobectomy for lung CA CHEST:LUNGS AND PLEURA: Postsurgical changes consistent with right upper lobectomy and lingulectomy. No pleural fluid or pneumothorax.There is an approximately 1.5-cm region of nodular and serpiginous neovascularity within the right middle lobe adjacent to the major fissure which is consistent with a vascular malformation. This is supplied by right fourth intercostal artery and drained by a branch of the right inferior pulmonary vein. The right superior pulmonary vein appears to have been ligated.Groundglass density nodule in the right lower lobe anteriorly (5/56) unchanged, measuring 8mm in long axis.MEDIASTINUM AND HILA: Thyroid gland is enlarged and heterogeneous in appearance, consistent with a multinodular goiter. Please note that thyroid lesions are nonspecific by CT.13-mm anterior mediastinal soft tissue nodule appears chronic and unchanged. No visible hilar or mediastinal lymphadenopathy elsewhere.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Granulomas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Solid 2.6-cm nodule in the inferior pole of the left kidney not included within the scanning range of the previous examination but increased compared to the the exam of 7/20/12 where it measured 17 x 18 mm. This remains highly suspicious for a renal cell carcinoma and should be considered such until proven otherwise. Case discussed with Madison Paschal P.A.(3478) at the time of dictation.Numerous the additional fluid attenuating lesions in the kidneys bilaterally were previously demonstrated to be cysts by renal ultrasound.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Small fat-containing ventral hernia.OTHER: No significant abnormality noted. | 1. 2.6-cm solid nodule posterior aspect of the lower pole of the left kidney continues to enlarge. This remains highly suspicious for a primary renal cell carcinoma and should be considered such until proven otherwise.2. No signs of localized tumor recurrence.3. Unchanged 8mm groundglass nodule in the right lower lobe, one year CT follow-up is recommended.4. Arterial venous malformation in the right middle lobe not significantly changed. |
Generate impression based on findings. | Reason: He is status post chemoradiation for a T1N2b left tongue base cancer completed in 02/2012. Please re-eval for dz and compare History: as above CHEST:LUNGS AND PLEURA: Multiple calcified and noncalcified pulmonary micronodules consist with previous infection.Bronchial thickening with tree in bud opacity in the left lower lobe, increased from previous, consistent with recurrent microaspiration.No suspicious nodules or pleural effusions.MEDIASTINUM AND HILA: Enlarged lymph nodes throughout the mediastinum and hila, unchanged.A lower right paratracheal node measures 15 mm in short axis, not significantly changed from previous. An enlarged right hilar node is also unchanged.CHEST WALL: Mild degenerative disease in several vertebral hemangiomas, unchanged.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mildly enlarged retroperitoneal lymph nodes, unchanged.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Vertebral hemangioma at L2.OTHER: No significant abnormality noted. | Stable nonspecific mediastinal and hilar lymphadenopathy, most likely benign. |
Generate impression based on findings. | Clinical question: Bleed expansion? Hydrocephalus? Nonenhanced head CT:Previously noted acute hemorrhage in the left basal ganglia is no longer identified and presumed resorbed. Examination demonstrate no detectable acute intracranial process in particular no evidence of hemorrhage. CT however is insensitive for early detection of acute non-hemorrhagic ischemic strokes.Examination demonstrates moderate periventricular and subcortical low attenuation of white matter although nonspecific and are often result of aging determinate small associated strokes. Although difficult to compare the findings remains grossly similar to prior exam. There is prominence of cortical sulci for patient's stated age. Ventricular system however remain within normal range and midline is maintained.Calvarium and soft tissues of the scalp are unremarkable.Unremarkable images through the orbits.Paranasal sinuses demonstrate bilateral posterior ethmoid sinus disease and unremarkable otherwise. | 1.Interval complete resolution of previously noted acute left basal ganglia hematoma.2.Moderate age indeterminate small vessel ischemic strokes. |
Generate impression based on findings. | 56 year-old female with abdominal pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Status post cholecystectomy. No hepatic parenchymal lesions. Patent hepatic vasculature.SPLEEN: No significant abnormality notedPANCREAS: The pancreas enhances homogeneously. Several tiny hypoattenuating lesions in the pancreatic tail may represent small lipomas, cysts and/or invaginating fat.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Small hypoattenuating lesions, likely representing cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No specific findings to account for the patient's abdominal pain. |
Generate impression based on findings. | aplastic anemia, pre stem cell transplant evaluation. The paranasal sinuses and nasal cavity are clear. The ethmoid roofs are symmetric and intact. The carotid grooves and optic canals are covered by bone. There are prominent probable arachnoid granulations in the left middle cranial fossa with apparent focal dehiscence of the skull. The imaged intracranial structures are otherwise grossly unremarkable. There appear to be surgical staples in the bilateral temporal subcutaneous tissues. There is a left canal wall down mastoidectomy with a clear mastoid bowl. | No evidence of sinusitis. |
Generate impression based on findings. | 5 year old male with history of neuroblastoma status post therapy CHEST:LUNGS AND PLEURA: Dependent subsegmental atelectasis. No distinct pulmonary nodules identified. MEDIASTINUM AND HILA: No cardiomegaly or pericardial effusion. No significant mediastinal, hilar or axillary lymphadenopathy. Soft tissue surrounding the right heart border anteriorly presumably represents rebound thymic tissue. Nonenlarged partially calcified retrocrural lymph nodes.CHEST WALL: Left-sided central line tip in the superior vena cava. No axillary lymphadenopathy.ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size without focal lesions. The liver measures approximately 14 cm in craniocaudal dimension, similar to prior. No radiopaque gallstones. No intrahepatic or extrahepatic biliary duct dilatation.SPLEEN: Normal in size. Again seen is focal hypoattenuation along the right splenic border adjacent to the surgical bed.PANCREAS: Normal in appearance.ADRENAL GLANDS: Normal right adrenal gland. Post surgical changes from the prior left adrenal gland resection. The soft tissue in the surgical bed with multiple clips and calcifications is unchanged in size at 2.2 x 2.5 cm (series 5, image 66).KIDNEYS, URETERS: Normal enhancement of the right kidney, without focal lesions or hydronephrosis. The subcentimeter hypodense lesion in the left upper pole is too small to characterize, though unchanged. Normal enhancement of the left kidney otherwise.RETROPERITONEUM, LYMPH NODES: Postsurgical changes from a previous retroperitoneal lymph node dissection. The reference prominent calcified retroperitoneal lymph node measures 6 mm in short axis (series 5, image 75), previously 7 mm.BOWEL, MESENTERY: Non-distended loops of bowel without wall thickening, mesenteric stranding, or fluid collections.BONES, SOFT TISSUES: Unchanged mixed sclerotic and lytic bony lesions throughout the thoracolumbar spine, pelvis and visualized femurs.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Non-distended loops of bowel without wall thickening, mesenteric stranding, or fluid collections.BONES, SOFT TISSUES: Unchanged mixed sclerotic and lytic bony lesions throughout the thoracolumbar spine, pelvis and visualized femurs. | 1.Left adrenal surgical bed soft tissue without significant interval change.2.Unchanged retroperitoneal lymphadenopathy.3.Unchanged appearance of the osseous metastasis. |
Generate impression based on findings. | Left pleural effusion and wheezing LUNGS AND PLEURA: Moderate bilateral pleural fluid collections, left greater than right with associated atelectasis. No suspicious pulmonary nodules or masses. No areas of bronchial narrowing or obstruction to the segmental level. There are a few scattered areas of the distal bronchiolar impaction in the right upper lobe, with scattered 2 to 3-mm subpleural nodules in the upper lobes bilaterally, some of which represents debris in the distal airways. This is very mild in degree.Subtle subpleural reticulation in the left upper lobe is suggestive of fibrosis related to chest wall radiation therapy, correlate with history.MEDIASTINUM AND HILA: Dual chamber ICD. Severe calcification within the native coronary arteries. Normal heart size. No pericardial effusion. No significant lymphadenopathy.CHEST WALL: Subcutaneous pacemaker generator on the left. Degenerative changes of the spine. Axillary dissection clips on the left. Asymmetric skin thickening of the left breast with subcutaneous fat stranding. A scarlike lesion extends from the deep breast to the anterior skin surface which is retracted. It is unclear whether this represents scarring or is a non-benign process by CT. A small right deep breast nodule posteriorly measures 8mm in length (3/34).The soft tissues of the breasts and chest wall are incompletely included within the field of view.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. Severe atherosclerotic calcifications. | 1. Appearance of the left anterior chest wall and adjacent lung is suggestive of prior radiation therapy; skin thickening may be post therapeutic related however tumor could not be excluded without comparison to prior studies. 2. Single 8mm soft tissue nodule in the deep posterior left breast is of unclear etiology; this could represent an intramammary lymph node or a benign or malignant lesion.3. Moderate volume of pleural fluid bilaterally with adjacent atelectasis but no specific evidence of infection or visible metastases by unenhanced technique.4. No intrathoracic lymphadenopathy or visible endobronchial lesions. |
Generate impression based on findings. | Clinical question: 34-year-old female with history of ALL, pre stem cell transplant eveluation. Signs and symptoms: Evaluate for Maxillofacial CT:There is no evidence of acute or chronic sinus disease.Bilateral ostiomeatal units and the sphenoethmoidal recesses remain patent. There is mild rightward nasal septum deviation.All mastoid air cells and the bilateral middle ear cavities remain well pneumatized. | No evidence of sinusitis. |
Generate impression based on findings. | Male 79 years old; Reason: pt with pleural biphasic mesothelioma History: undergoing 3 cycles of chemo any changes since last CT scan. Compare and comment. CHEST:LUNGS AND PLEURA: Mild interval enlargement of the extensive nodular left pleural thickening with associated left hemithorax volume loss. Reference measurements are as follows:1.At the level of the carina (series 4, image 39), the 5 o'clock position, measures 4.3 cm previously 3.7 cm.2.At the base of the heart (series 4, image 71) the 12 o'clock position measuring 5.9 x 8.3 cm previously 7.4 x 5.3 cmThe right lung is again normal other than mild hyperexapnsion. No right pleural effusions and the loculated left collection is essentially unchanged.MEDIASTINUM AND HILA: Multiple partially calcified hypodense lesions in the thyroid, unchanged. Near complete embolic occlusion of proximal left subclavian artery, unchanged. No mediastinal lymphadenopathy. No cardiomegaly or pericardial effusion with severe coronary artery calcifications. The pericardium is abutted by the pleural mass at the cardiac apex and again pericardial extension of the tumor cannot be excluded. Large hiatal hernia again seen.CHEST WALL: Chest wall involvement by the tumor with destruction of these left seventh, eighth, and eleventh ribs, grossly unchanged. The intramuscular lipoma in the superior aspect of the right pectoralis major muscle.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Increasing size of numerous heterogeneous masses throughout the liver compatible with advancing metastatic disease. Enlargement of the right reference hepatic lobe currently measuring 5.5 x 4.6 cm (series 4, image 75) previously 4.9 x 4.0 cm. Increased confluence and the most inferior hepatic (image 120 series 4) have increased in size currently 6.0 x 4.3 previously 4.6 x 3.4 cm. Additional multiple large hepatic cysts are unchanged.SPLEEN: Extensive enhancing soft tissue masses in the left hemiabdomen encasing and invading the spleen measures 17.1 cm in greatest craniocaudal dimension (coronal image 33), previously 16.5 centimeters.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cyst. Abnormally low right kidney with multiple cysts, unchanged compared to previous PET/CT.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerosis of the abdominal aorta. Reference enlarged left para-aortic lymph node measures 15 mm (series 4, image 108), previously 11 mm.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. | Moderate interval enlargement of both the thoracic and hepatic lesions. Reference measurements above |
Generate impression based on findings. | Status post chemoradiation for a T1N2b left tongue base cancer completed 02/2012. Please re-evaluate for IJV clot. There is non-opacification of the right internal jugular vein, which displays a very narrow caliber essentially throughout and development of venous collateral in the right neck, compatible with sequela of chronic thrombosis. The remainder of the major cervical vessels are patent. There are stable post-treatment findings in the oropharynx without evidence of locoregional tumor recurrence. There is no significant cervical lymphadenopathy. However, there are partially imaged prominent upper mediastinal lymph nodes. The major salivary glands and thyroid gland are unchanged. The airways are patent. The osseous structures are unremarkable. The imaged paranasal sinuses and mastoid air cells are clear. The imaged intracranial structures are grossly unremarkable. The imaged portions of the lungs are clear. | 1. Chronic right internal jugular vein thrombosis with development of venous collaterals.2. No evidence of locoregional tumor recurrence or significant cervical lymphadenopathy. However, there are partially imaged prominent upper mediastinal lymph nodes. Please refer to the separate chest CT report for additional details. |
Generate impression based on findings. | 63 year-old female with weakness and slurred speech. The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. | No acute intracranial abnormality. |
Generate impression based on findings. | 53-year-old male. Evaluate for small bowel intussusception. Reason: Pt with hx of BOT Ca; s/p CRT. Please re-eval for recurrent dz CHEST:LUNGS AND PLEURA: Interval resolution of patchy ground glass opacities in the right upper and right lower lobes.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Slight interval decrease in bilateral gynecomastia.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. The small bowel intussusception seen on the prior CT scan has resolved. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No evidence of intussusception. |
Generate impression based on findings. | Male, 58 years old, adenoid cystic cancer of the submandibular gland. Postop findings are redemonstrated consistent with resection of the left parotid gland. Atrophy/absence of the anterior belly of the left digastric muscle may also be surgical. No evidence of recurrent disease is seen in the resection bed. No pathologic adenopathy is detected.The remaining salivary glands and the thyroid are free of focal lesions. Cervical vessels are patent. Lung apices are unremarkable. No concerning osseous lesions are detected. Subtle sclerosis of the left mandible is unchanged and of doubtful significance. | Stable post surgical/treatment findings with no evidence of recurrent disease. |
Generate impression based on findings. | 53 year-old male with history of base of the tongue cancer and status post CRT. The orbits are unremarkable. Mild mucosal thickening noted in the right maxillary sinus. Otherwise, paranasal sinuses and mastoid air cells unremarkable. Limited view of the intracranial structure is unremarkable. Again seen are post treatment changes in the neck, appearing unchanged. The aerodigestive tract appears unremarkable, without evidence of focal effacement or exophytic mass. Again seen is asymmetry at the level of tongue base, unchanged. Airway is patent. Atrophy of the submandibular glands. Parotid and thyroid glands unremarkable. The right internal jugular vein is not visualized in the upper neck, however, this is unchanged. Otherwise, cervical vasculature unremarkable. Visualized lung apices unremarkable. Degenerative changes in cervical spine, worst at C5-6 with posterior disk osteophyte complex at this level, unchanged. | Post-treatment changes without evidence of disease recurrence or pathologic lymphadenopathy. |
Generate impression based on findings. | Fell and hit head, anticoagulated. There is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. | No evidence of intracranial hemorrhage, mass, or cerebral edema. |
Generate impression based on findings. | Alteration of consciousness. There is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is partially imaged right ethmoid air cells opacification. The imaged mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable, including a partially imaged incomplete posterior arch of C1. | No evidence of intracranial hemorrhage, mass, or cerebral edema. However, non-contrast CT is relatively insensitive for the detection of small mass lesions and non-hemorrhagic infarct. MRI with contrast may be performed for further evaluation, if clinically warranted. |
Generate impression based on findings. | 69-year-old female, follow up for PTLD. Reason: follow-up for PTLD History: six months post-chemotherapy for PTLD; restaging CHEST:LUNGS AND PLEURA: Interval resolution of bilateral pleural effusions and atelectasis/consolidation.MEDIASTINUM AND HILA: Marked narrowing of the left innominate vein with multiple collateral vessels noted in the thoracic wall. Interval resolution of mediastinal lymphadenopathy. Scattered atherosclerotic calcifications of the thoracic aorta and coronary arteries.CHEST WALL: Interval resolution of axillary adenopathy. Lytic and sclerotic lesions diffusely involving the manubrium appear mildly progressed from the prior PET/CT.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without evidence of cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the abdominal aorta and its branches. Scattered small retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Resolution of thoracic adenopathy and pleural effusions compared with prior CT. 2. Mixed lytic/sclerotic lesions diffusely involving the manubrium.3. High-grade stenosis of the left innominate vein with thoracic wall collateralization. |
Generate impression based on findings. | Episodic dizziness and headaches ongoing for 5 years becoming increasingly severe and prolonged. There is always a sense of fullness in the right ear and sense of pressure at the right skull base. On the right, the external auditory canal is patent and clear. The middle ear and mastoid air cells are well-pneumatized and clear. The ossicular chain is intact. The facial nerve describes a normal course, although there appears to be dehiscence along the tympanic segment. The inner ear structures are unremarkable, without evidence of semicircular canal dehiscence.On the left, the external auditory canal is patent and clear. The middle ear and mastoid air cells are well-pneumatized and clear. The ossicular chain is intact. The facial nerve describes a normal course, although there appears to be dehiscence along the tympanic segment. The inner ear structures are unremarkable, without evidence of semicircular canal dehiscence. | No evidence of perilymphatic fistula. |
Generate impression based on findings. | 59-year-old female patient with history of lymphoma status post 4 cycles of BR therapy. Please restage. CHEST:LUNGS AND PLEURA: Trace bilateral dependent atelectasis.MEDIASTINUM AND HILA: Scattered subcentimeter mediastinal lymph nodes, seen on prior examination. Index node adjacent to the left pulmonary artery measures 5 x 5 mm (series 401 image 34), previously 8 x 5 mm.CHEST WALL: 3-mm nodule in the posterior aspect of the right thyroid lobe is stable compared to prior examination.ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Retrocaval nodal conglomerate seen on prior examination currently measures 4 mm (series 401 image 103), previously 1.5 x 2.2 cm.Right retrocrural node measures 9 x 9 mm (series 4 and are one image 67), stable.Left para-aortic node measures 5 x 7 mm (series 401 image 91), previously 9 x 6 mm.Left abdominal mesenteric node is decreased in size and measures 9 x 3 mm (series 401 image 111), previously 1.7 x 0.5 cm.Mid abdominal mesenteric node measures 1.0 x 0.6 cm (series 401 image 136), previously 1.0 x 0.8 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild multilevel degenerative changes in the lumbar spine. Sclerotic changes in the T9 vertebral body are stable compared to prior examination.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: Left pelvic sidewall soft tissue density measures 1.5 x 0.9 cm (series 401 image 172), previously 1.6 x 0.9 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild multilevel degenerative changes in the lumbar spine. Sclerotic changes in the T9 vertebral body are stable compared to prior examination.OTHER: No significant abnormality noted. | Minimal to significant interval decrease in index lymph nodes. |
Generate impression based on findings. | Chronic sinusitis. There is complete opacification of the right maxillary sinus and infundibulum. There is moderate mucosal thickening within the left maxillary sinus with an air-fluid level, which appears new since 9/30/13. There is also opacification of the left infundibulum. There is diffuse thickening and sclerosis of the right maxillary sinus walls. There is also partially imaged periodontal lucency affecting ADA 2 and 3 with communication of the lucency around ADA 2 with the alveolar recess. There is mild opacification of the bilateral anterior ethmoid sinuses. The underpneumatized right frontal sinus is clear. The left frontal sinus is not pneumatized. The sphenoid sinuses are clear. The left ethmoid roof is 3 mm lower than the right. The carotid grooves and optic canals are covered by bone. There is no significant nasal septal deviation. The imaged intracranial structures are grossly unremarkable. | 1. An air-fluid level within the right maxillary sinusitis suggests acute sinusitis.2. Chronic right maxillary sinusitis, which may be odontogenic in origin, given the presence of periodontal disease affecting ADA 2 and 3. |
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