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Generate impression based on findings. | Resected stage 3 melanoma of tight cheek and ear. There are postoperative findings related to right parotidectomy and neck dissection. Skin thickening and subcutaneous stranding at the incision site likely represent scar tissue formation. There is no discrete mass evident in the region of the surgical bed. There is no significant cervical lymphadenopathy. The thyroid and remaining major salivary glands are unremarkable. The major cervical vessels are intact. The imaged intracranial structures and orbits are unremarkable. There is partial opacification of the right mastoid air cells. There is an os odontoideum. The imaged paranasal sinuses are virtually clear. unremarkable. The imaged portions of the lungs are clear. | Postoperative findings related to right parotidectomy and neck dissection, without definite evidence of locoregional tumor recurrence of significant cervical lymphadenopathy. |
Generate impression based on findings. | 57-year-old female patient with urothelial cancer status post resection in 2010. Please restage. Note that the lack of intravenous contrast limits evaluation of vasculature, lymph nodes and solid viscera.CHEST:LUNGS AND PLEURA: Scattered bilateral pulmonary micronodules, some of which are calcified and consistent with prior granulomatous disease.MEDIASTINUM AND HILA: Scattered subcentimeter mediastinal lymph nodes, stable.CHEST WALL: Left breast soft tissue density measures 1.0 x 1.9 cm (series 9 image 36), previously 1.8 x 2.4 cm on 11/13/2012.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: Bilateral severe hydronephrosis with atrophic right kidney, stable. RETROPERITONEUM, LYMPH NODES: Scattered retroperitoneal lymph nodes, stable to slightly decreased.BOWEL, MESENTERY: Right lower quadrant ileostomy for urinary diversion.Status post resection of right colon.Fat-containing umbilical hernia. Large ventral hernia containing loop of transverse colon is stable compared prior examination.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: Status post cystectomy.LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: Right lower quadrant ileostomy for urinary diversion.Status post resection of right colon.Fat-containing umbilical hernia. Large ventral hernia containing loop of transverse colon is stable compared prior examination.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No suspicious lymphadenopathy or evidence of recurrence. |
Generate impression based on findings. | Hit head two weeks ago, with headache and difficulty concentrating since then. 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. There is an unchanged enlarged and partially empty sella. The skull and extracranial soft tissues are otherwise unremarkable. | No evidence of intracranial hemorrhage or skull fracture. |
Generate impression based on findings. | 65-year-old female with metastatic thyroid cancer. CHEST:LUNGS AND PLEURA: No change in bilateral calcified and noncalcified nodules. No new or suspicious nodules. No consolidation or pleural effusions.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Heterogeneous sclerosis in the sternum appears unchanged.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Scattered hypoattenuating lesions in the liver are unchanged; reference right lobe lesion measures 14 by 12 mm, previously measured 14 x 12 mm (series 3, image 95). No new lesions identified.SPLEEN: Multiple calcified granulomas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Unchanged right renal cyst.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: Stable grade 1 anterolisthesis of L4 on L5. L2 lesion seen on MRI not well identified on current exam.OTHER: No significant abnormality noted. | 1.No evidence of intrathoracic metastatic disease.2.Stable hepatic and skeletal lesions. |
Generate impression based on findings. | Clinical question: Evaluate shunt placement. Signs and symptoms: Same. Nonenhanced head CT:Examination demonstrate interval placement of a high convexity right paramedian approach/burr hole for placement of ventricular catheter. The catheter is noted traversing the right frontal lobe, entering the right lateral ventricle, traversing the midline and the tip in the left frontal horn in the immediate left paramedian location. There is no intraparenchymal, subarachnoid or intraventricular hemorrhage. Minimal expected postoperative air in the subarachnoid space adjacent to the boneexpected postoperative changes of the scalp at the site of surgery. The visualized intracranial component of the catheter appears intact.There is no convincing evidence of a significant change in moderately dilated supratentorial ventricular system compared to prior brain MRI from 8 -- 23 -- 13. Minimal periventricular low-attenuation white matter is less conspicuous than the finding on prior MRI. | 1.Expected postoperative changes of right frontal paramedian approach for placement of ventricular catheter. The tip of the catheter traverses the right lateral ventricle, midline and the tip in the left frontal horn.2.No evidence of any change in moderately dilated supratentorial ventricular system. |
Generate impression based on findings. | medullary thyroid CA with mets to liver currently on clinical trial XL184/placebo. HEAD: The brain parenchyma appears unchanged without evidence of intracranial metastases. The ventricles are stable in size and configuration. The osseous structures are unremarkable. There is mild scattered paranasal sinus mucosal thickening. NECK: There are postsurgical findings related to total thyroidectomy. There is an unchanged nonspecific hyperattenuating focus in the right tracheoesophageal groove that measures 5 x 3 mm. There is no significant lymphadenopathy based on size criteria. The salivary glands are unremarkable. The carotid arteries and jugular veins are patent. The airways are patent. There are no destructive osseous lesions. There is an unchanged superior right lower lobe calcified granuloma. | 1.Stable postsurgical findings with unchanged nonspecific right paratracheal focus measuring up to 5 mm in the thyroidectomy bed, but otherwise no evidence of locoregional tumor recurrence or cervical lymphadenopathy.2.No evidence of intracranial metastases. |
Generate impression based on findings. | Gastric carcinoma with peritoneal METs 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: Stable segment 5/6 low-attenuation focus best seen on image 71 of series 3 measuring 2.4 x 1.7 cm. Previously noted subcentimeter low attenuation focus within segment 5 of the right lobe liver also stable best seen on image 87 of series 3 measuring 1 x 0.8 cm.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: Stable small gastrohepatic and portacaval lymph nodesBOWEL, MESENTERY: No change in diffuse thickening of the gastric antrum. Subtle nodularity within the omentum best seen on image 104 series 3 relatively unchangedBONES, 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. No change in gastric antral wall thickening. No change in subtle omental nodularity. |
Generate impression based on findings. | 57-year-old male with metastatic lung cancer on chemotherapy. CHEST:LUNGS AND PLEURA: Stable cystic lesion with adjacent solid component in left lower lobe (series 4, image 51). Unchanged scarring/atelectasis in lingula and right middle lobe. Punctate micronodules unchanged. No new suspicious nodules or masses.MEDIASTINUM AND HILA: No mediastinal lymphadenopathy. The heart is normal in size. Unchanged anterior pericardial thickening/effusion. Mild coronary artery calcifications. CHEST WALL: Multiple sclerotic lesion in osseous structures appear similar.ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts unchanged.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: IVC filter noted. No retroperitoneal adenopathy. Mild atherosclerotic calcifications in aorta.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Multiple sclerotic lesion in osseous structures appear similar.OTHER: No significant abnormality noted. | 1.Stable cavitary lesion in left lower lobe.2.Stable sclerotic lesions in osseous structures. |
Generate impression based on findings. | 47-year-old male patient with hepatocellular carcinoma status post resection. Follow-up. ABDOMEN:LUNG BASES: Bilateral trace atelectasis.LIVER, BILIARY TRACT: Cirrhotic liver morphology. Status post wedge resection of part of segment 6 and cholecystectomy. There is linear low-density liver parenchyma at the resection margin that likely represents devascularized tissue. There is a small fluid collection inferior to the resection margin that measures 1.5 cm with wall enhancement (series 13 image 45). No suspicious liver lesions are seen. Hepatic vasculature shows no abnormalities.SPLEEN: Splenomegaly.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: Large amount of abdominal ascites, stable. | 1.Postsurgical changes from wedge resection of liver and cholecystectomy. No suspicious hepatic lesions.2.Stable abdominal ascites. |
Generate impression based on findings. | 52 year-old female with abdominal pain, right upper quadrant. Evaluate for cyst, stone, perforation. ABDOMEN: Limits of a non-IV contrast enhanced examination, limiting evaluation of solid parenchymal organs and vascular structures, the following observations can be made:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Liver parenchyma is homogeneous without focal abnormality. Moderately distended gallbladder seen with layering high density in the dependent portion, which may represent small, punctate gallstones. Alternatively, this may represent vicarious excretion of contrast material from CT chest examination done 11/13/13. Ultrasound would be more optimal technique to diagnose gallstones. Gallbladder wall is not thickened and no pericholecystic fluid collections are seen. No intrahepatic or extrahepatic biliary duct dilatation is seen.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: High density cyst right lateral kidney measures 74, H. U. -- lesions of this high density are most often benign. Residual contrast excretion into the renal pelves and ureters bilaterally from CT examination 11/13/13. No other abnormality seen. 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: Bulbous, and large uterus, most consistent with multiple fibroids. These appear unchanged since prior CT examination.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Multiple scattered well-defined, sclerotic lesions in the iliac bones, which appear benign in etiology, unchanged. Degenerative changes in the left hip.OTHER: No significant abnormality noted | 1. High density layering material in the gallbladder which may represent small stones not seen previously or may represent vicarious excretion of contrast from 11/13/13 chest CT examination. Ultrasound would be optimal technique to detect/characterize gallbladder/ stone disease. 2. High density right kidney cyst unchanged. Most likely benign in nature. 3. Enlarged bulbous uterus, most likely leiomyomas, unchanged. 4. No other abnormalities seen. |
Generate impression based on findings. | Venous clots-right neck and upper arm. There is non-visualization of the right internal jugular vein, although there is suboptimal opacification of the veins in the neck overall. There has been interval resolution of inflammatory changed in the lower right anterior neck. The carotid arteries are patent. The major salivary glands and thyroid are unremarkable. There is no significant cervical lymphadenopathy. The imaged intracranial structures and orbits are unremarkable. | Non-visualization of the right internal jugular vein is compatible with chronic thrombosis, although there is suboptimal opacification of the veins in the neck overall. Doppler ultrasound may be useful for further evaluation. |
Generate impression based on findings. | Reason: R/o PE History: new onset hemoptysis, new onset scant hemoptysis, sinus tach, chest tightness in this patient with metastases to lung PULMONARY ARTERIES: Technically adequate examination. No evidence of pulmonary embolism. Main pulmonary artery catheter is within normal limits.LUNGS AND PLEURA: Innumerable pulmonary and pleural based nodules compatible with metastatic disease. Interval increase in size of left loculated pleural fluid collections and atelectasis. Slightly less aeration of the left lung compared to prior exam.MEDIASTINUM AND HILA: Heart size is normal. No evidence right ventricular strain. No pericardial effusions. Slight interval increase in mediastinal lymphadenopathy.CHEST WALL: Degenerative disk disease thoracic spine unchanged.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Ill-defined hypodense lesion in the left lobe of the liver is not as well visualized on the study. Hepatic segment 4 lesion is unchanged in size. | 1.No evidence of pulmonary embolism.2.Interval increase in size of loculated pleural fluid collections compatible with hemothorax. |
Generate impression based on findings. | 54 year-old female with colitis and history of nocardia. Cough, pleuritic pain. LUNGS AND PLEURA: Persistent tree in bud opacities and bronchiectasis in the right lung, worst in right middle lobe. Left lung unremarkable. No consolidation or pleural effusions.MEDIASTINUM AND HILA: Several prominent mediastinal lymph nodes are unchanged. Heart is normal in size without pericardial effusion.CHEST WALL: Stable mild degenerative changes in the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Status post cholecystectomy. | Tree in bud opacities affecting right lung, predominantly right middle lobe with associated bronchiectasis; overall stable to mildly improved since 2011 and suspicious for bronchiolitis/chronic atypical infection such as nocardia although may also be MAI. |
Generate impression based on findings. | Gross hematuria ABDOMEN:LUNG BASES: Mildly enlarged cardiophrenic lymph nodeLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Benign subcentimeter left renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Extensive prostatic calcificationsBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Negative for acute, inflammatory, or neoplastic process. Specifically, unremarkable kidneys and collecting system bilaterally. |
Generate impression based on findings. | 62-year-old male with probable pulmonary embolus based on recent neck CT. PULMONARY ARTERIES: Diagnostic quality exam without evidence of pulmonary embolus.LUNGS AND PLEURA: Linear scarlike opacities and pleural thickening in both lung bases. Trace left pleural effusion. Postsurgical changes in left base.Interval improvement in previously seen basilar opacities, which may have been due to aspiration or infection. Left lower lobe nodule unchanged (series 9, image 48). No new or suspicious nodules.MEDIASTINUM AND HILA: Reference mass posterior to trachea measures 3 cm, previously measured 3 cm (series 8, image 64). Reference paraesophageal soft tissue near the thoracic inlet is difficult to measure on current exam although likely not significant changed (series 8, image 50). Multiple enlarged mediastinal lymph nodes not significantly changed. Heart is normal in size without pericardial effusion.CHEST WALL: New destructive lesion arising from left 10th rib (series 8, image 158). Metastatic T2 vertebral body lesion with mild central compression deformity appears unchanged.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Previously seen liver lesion is only partially visualized on current exam. | 1.No evidence of pulmonary embolus.2.Laryngeal mass and mediastinal lymphadenopathy, not significantly changed; please see recent neck CT report for detailed neck findings.3.Improved basilar lung opacities, which were likely due to aspiration or infection. |
Generate impression based on findings. | Reason: s/p 7 mo after right thoracotomy, extended pleurectomy, decortication for management of T2N2 biphastic type (90% epithelioid, 10% sarcomatoid) malignant pleural mesothelioma History: f/u CHEST:LUNGS AND PLEURA: Interval decrease in a small right pneumothorax with an increase in the amount of pleural fluid, loculated anteriorly at the right apex. Right diaphragmatic graft in place.Reference measurements as follows:1. At the level of the left superior pulmonary vein (series 3 image 50): 12 o'clock position 7 mm increased from 2 mm previously. Six o'clock position 0 mm, unchanged.2. Reference measurements at the level of the right atrium, obscured by adjacent consolidation and atelectasis, but probably increased.Extensive subpleural pulmonary consolidation has developed in the lower right hemithorax particularly in the right middle lobe. Some of the subpleural opacity probably also represents pleural thickening due to recurrent disease.MEDIASTINUM AND HILA: Severely enlarged high and low right paratracheal lymph nodes, now measuring 27 mm in short axis (series 3 image 33), normal previously.Severely enlarged right hilar and subcarinal lymph nodes, markedly increased from previous. A reference lymph node in the inferior right hilum has increased from 8 mm to 13 mm.CHEST WALL: New supraclavicular lymphadenopathy on the right.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Enlarged celiac axis and retrocrural lymph nodes, markedly increased from previous.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. Increased diffuse pleural thickening and subpleural consolidation in the right hemithorax.2. New extensive lymphadenopathy in the mediastinum and upper abdomen compatible with recurrent disease. |
Generate impression based on findings. | Newly diagnosed extensive small cell CA. Evaluate for brain metastases. There is an ill-defined focus of hypoattenuation in the left occipital lobe without convincing evidence of associated enhancement. There is suggestion of this lesion on the CT from 2005, although comparison is limited by differences in technique. In addition, there appears to be corresponding hypometabolism in this area of the recent PET. The ventricles and basal cisterns are diffusely enlarged to a mild degree, reflecting cerebral volume loss. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. There is an unchanged mixed sclerotic and ground-glass focus within the superior let ethmoid sinus, which may represent an osteoma. The extracranial soft tissues are unremarkable. | An ill-defined focus of hypoattenuation in the left occipital lobe without convincing evidence of associated enhancement may represent encephalomalacia. However, MRI with contrast is more sensitive for brain metastases and would be useful for further characterization if there are no contraindications. |
Generate impression based on findings. | 76 year-old female with syncope. The ventricles, sulci, and cisterns are symmetric and prominent, representing volume loss. 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. Punctate calcification in the right orbit. There is mild right frontal scalp swelling. | No acute intracranial abnormality. CT is insensitive to early detection of CVA. MRI should be considered if clinical suspicion for CVA persists. |
Generate impression based on findings. | 74-year-old male with newly diagnosed small cell cancer in the chest. History of non-small cell lung cancer. CHEST:LUNGS AND PLEURA: Status post left pneumonectomy with expected volume loss in left hemithorax.Cluster of nodules in the right upper lobe is increased in size (series 4, image 56). Multiple new micronodules are seen in the right lung, best appreciated along the major fissure and along diaphragm (series 4, image 66, 80). MEDIASTINUM AND HILA: Bilateral thyroid nodules appear unchanged. Mild increase in size of mediastinal and hilar lymph nodes; reference right paratracheal node measures 11 mm, previously measured 10 mm (series 3, image 32). Although the previously measured right cardiophrenic node is not significantly changed in size, measuring 16 mm in short axis, previously measured 16 mm (series 3, image 80), more superiorly located cardiophrenic node has increased in size (series 3, image 62).Stable mild pericardial thickening. CHEST WALL: Healed right rib fracture.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Several new ill-defined hypoattenuating lesions in the liver (series 3, image 95, 106, 110, 118).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: Multiple mildly enlarged retroperitoneal lymph nodes, slightly increased in size since prior exam.IVC filter noted. Atherosclerotic calcifications in aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Midline ventral hernia without evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Multiple new punctate right lung nodule suspicious for metastases.2.Several new liver hypodensities suspicious for metastatic lesions.3.Interval increase in mediastinal and upper retroperitoneal adenopathy. |
Generate impression based on findings. | 60 year-old female with recurrent laryngeal cancer. CHEST:LUNGS AND PLEURA: Left base is subsegmental consolidation/atelectasis with associated volume loss and elevation of left hemidiaphragm. No suspicious nodules or masses identified.MEDIASTINUM AND HILA: Postsurgical changes in the larynx and upper trachea. No significant mediastinal lymphadenopathy. Extensive calcifications of the mitral valve. Mild to moderate coronary artery calcifications. Heart size within normal limits. Small 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: Right adrenal lesion with heterogeneous internal attenuation measures 2.2 x 3.6 cm (series 3, image 97).KIDNEYS, URETERS: Right renal cyst. Punctate calcification in left kidney most consistent with small nonobstructing stone.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.Heterogeneous thickening of gastric wall in cardia region (series 3, image 77). Small amount of free fluid in the right pericolic gutter.BONES, SOFT TISSUES: Degenerative changes in lumbar spine.OTHER: No significant abnormality noted. | 1.No evidence of intrathoracic metastatic disease.2.Nonspecific, heterogeneous right adrenal lesion is suspicious for metastatic focus.3.Apparent thickening of proximal stomach wall of unclear etiology but may represent gastric neoplasm or metastatic focus; recommended follow-up with endoscopy or PET/CT. 4.Small amount of free fluid along the right paracolic gutter of unclear etiology. |
Generate impression based on findings. | Pierre-Robin sequence with hearing loss. On the right, the external auditory canal is narrow in caliber diffusely. There is thickening of the tympanic membrane. There is also diffuse mucosal thickening along the walls of the middle ear cavity. The middle ear cavity is mildly underpneumatized and leads to an enlarged Eustachian tube canal. The epitympanum in particular is small and laterally situated. The malleus and incus are partially rotated horizontally and feature prominent marrow spaces. The inferior aspect of the head of malleus contacts and possibly fuses with the inferolateral wall of the epitympanum. The long process and lenticular process of the incus are elongated and deviated anteriorly, medially, and superiorly, articulating with a dysmorphic, elongated, possibly monopod stapes that courses posteriorly towards an atretic oval window. The mastoid air cells are underpneumatized and opacified. The vestibule and semicircular canals are dysmorphic. In particular, there is atresia of the posterior semicircular canal and bulbous superior and lateral semicircular semicircular canal crura. The cochlea is small with an underdeveloped modiolus, absence of the bony septum between the middle and apical turns. The cochlear aperture measures approximately 1.8 mm in diameter. The proximal segment of the vestibular aqueduct appears slightly prominent, but the fovea is not enlarged. The internal auditory canal displays a short and bulbous configuration. There is an abbreviated course of the tympanic segment of the facial nerve, which also appears to be dehiscent.On the left, the external auditory canal is perhaps mildly narrow in caliber. There is a tympanostomy tube in position. The middle ear cavity is perhaps slightly underpneumatized and there is a rounded opacity measuring 4 m in diameter that surrounds the handle of the malleus. The malleus and incus are partially rotated horizontally and feature prominent marrow spaces. In addition, the head of the malleus and body of the incus contact the walls of the anterior epitympanum and may be fixed. The stapes is not well delineated, although there appears to be a monopod configuration associated with an atretic oval window. The mastoid air cells are underpneumatized and partially opacified. The Eustachian tube canal appears to be enlarged. The vestibule is slightly small and dysplastic. The semicircular canals are also dysplastic. In particular, the posterior semicircular canal is partially absent. The cochlea is small with an underdeveloped modiolus, absence of the bony septum between the middle and apical turns. The cochlear aperture measures approximately 1.8 mm in diameter. The internal auditory canal displays a short and bulbous configuration. There is an abbreviated course of the tympanic segment of the facial nerve, which also appears to be dehiscent. There is a high riding jugular bulb, which abuts the prominent proximal segment of the vestibular aqueduct. There is an incompletely characterized oronasal fistula related to cleft palate. | Extensive congenital anomalies of the bilateral temporal bones and sequela of middle ear infection related to Pierre-Robin sequence, as described in the findings section. |
Generate impression based on findings. | 64-year-old male with two episodes of syncope. PULMONARY ARTERIES: Diagnostic quality exam without evidence of pulmonary embolus.LUNGS AND PLEURA: Groundglass opacities in the right upper lobe, nonspecific but may represent infection.Bilateral basilar scarring/subsegmental atelectasis. No pleural effusions.Several nodules noted, largest located in the right upper lobe and measuring 5 mm (series 10, image 51).MEDIASTINUM AND HILA: No significant lymphadenopathy. Mild coronary artery calcifications. Heart size within normal limits.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Stable left adrenal nodule. | 1.Diagnostic exam without evidence of pulmonary embolus.2.Ground glass opacities in right upper lobe suspicious for infection, less likely atypical focal edema.3.5-mm nodule in the right upper lobe; consider 6 to 12 month follow-up CT. |
Generate impression based on findings. | 46 year-old female with shortness of breath. PULMONARY ARTERIES: Limited examination due to body habitus, scanning during expiratory phase, respiratory motion, and inadequate opacification of the pulmonary arteries. Within these limitations, no defects are seen down to the lobar arteries.LUNGS AND PLEURA: Underinflated lungs with interval improvement of diffuse mosaic groundglass opacities. Bibasilar dependent atelectasis. Right upper lobe nodule is no longer visualized. Interval resolution of the subsegmental consolidation in the right upper lobe. No pleural effusions. There is mild to moderate collapse of the airways.MEDIASTINUM AND HILA: Patulous esophagus. No significant mediastinal or hilar lymphadenopathy. Moderate cardiomegaly. No pericardial effusions. Small right lateral tracheal diverticulum is again visualized.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Atrophic pancreas with fatty infiltration. | 1.Technically limited examination with no evidence of pulmonary embolism down to the lobar arteries.2.Interval improvement of the diffuse mosaic groundglass opacities consistent with air trapping consistent with small airways disease. Although in most cases from reactive airway disease, if this patient has a history of aspiration, this may represent sequelae of chronic airway irritation.3.Interval resolution of right upper lobe consolidation and small nodule.4.Signs of bronchomalacia5.Patulous thoracic esophagus with internal debris and a high air fluid level. Persistence of this finding raises question of whether this patient may have episodes of microaspiration. Consider esophageal motility study/esophagogram. |
Generate impression based on findings. | 60 year-old male with new right hilar lung mass. LUNGS AND PLEURA: Ill-defined opacity in the right upper lobe adjacent to major fissure measures approximately 1.6 x 3.1 cm (series 4, image 41). No other suspicious nodules or masses.Mild centrilobular emphysema.Mild basilar atelectasis/scarring. No pleural effusions.MEDIASTINUM AND HILA: No significant mediastinal lymphadenopathy. Coronary artery stents and calcifications noted. Mild cardiomegaly.Moderate hiatal hernia. Focal thickening of distal esophagus at approximately GE junction (series 3, image 70).CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Subcentimeter hypodensities in the liver too small to characterize but likely represent benign cysts. | 1.Ill-defined opacity in the right upper lobe abutting major fissure is of unclear etiology, especially without comparison studies, and may represent focus of infection. However, this could also be compatible with primary lung neoplasm and follow-up in 6 weeks should be considered to evaluate for resolution.2.Focal esophageal wall thickening at GE junction, may represent neoplasm; recommend follow-up with PET/CT or endoscopy for better evaluation. |
Generate impression based on findings. | eval vp shunt The patient is status-post right-sided ventriculostomy tube placement which course of the right frontal lobe into the right lateral ventricle with tip in the region of foramen of Monroe. This ventriculostomy tube is new since the prior MRI. Biventricular diameter currently is approximately 52 mm and in a similar location was a previously approximately the same. Third ventricular diameter is currently 17 mm and previously was approximately the same.A small arachnoid cyst is present in the left middle cranial fossa measuring approximately 30 x 16 mm axial dimensionsAtherosclerotic calcifications are present along the distal vertebral arteries. Atherosclerotic calcifications are present along the distal internal carotid arteries.Periventricular and subcortical white matter hypodensities of a moderate degree are present and are stable.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. The eyeball lenses are thin. | 1.The patient is status post recent ventriculostomy shunt placement. To the extent comparison possible the ventricles appear similar in size when compared to be July MRI exam2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. Other considerations include neurodegenerative disorder.3.Small arachnoid cyst in the left middle cranial fossa. |
Generate impression based on findings. | Unspecified cerebral artery occlusion with cerebral infarction The CSF spaces are appropriate for the patient's stated age with no midline shift. A hypodense focus is present in the right putamen.Periventricular and subcortical white matter hypodensities of a moderate degree are present.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Atherosclerotic calcifications are present along the distal internal carotid arteries.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. The eyeball lenses are thin. | 1.No evidence for acute intracranial hemorrhage mass effect or edema. CT is insensitive for the early detection of nonhemorrhagic CVA.2.A punctate hypodensity in the right basal ganglia is suspicious for lacunar infarct age indeterminant. Please correlate with the patient's clinical symptoms.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. |
Generate impression based on findings. | evaluate size of pontine bleed The CSF spaces are appropriate for the patient's stated age with no midline shift. A hypodense focus is present in the left centrum semiovale which has the general appearance of a mass effect which show when compared to the CT from 11/12/13 has progressedA hypodense focus is redemonstrated in the right thalamus. Additional hypodense foci are present in the basal ganglia bilaterally.There is redemonstration and no significant change in the punctate hyperdensity located in the right half of the pons. There is an MRI from 11/12/13 which indicates that her this could represent a calcification rather than acute blood.Periventricular and subcortical white matter hypodensities of a moderate degree are present.Atherosclerotic calcifications are present along the distal internal carotid arteries.. Atherosclerotic calcifications are present along the distal vertebral arteries.No abnormal mass lesions are appreciated intracranially. No 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.No evidence for acute intracranial hemorrhage . Findings suggest that there is a calcification in the right pons. This could be a result of a prior hemorrhage at please refer to recent MRI of the brain for further details2.Subacute infarction in the left centrum semiovale continues to evolve without evidence for hemorrhagic conversion.3.punctate hypodensities in the right thalamus and a right basal ganglia and left thalamus can also be identified on the recent MRI and represents a old lacunar infarcts. Note that the left centrum semiovale infarct is subacute as indicated above4.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. |
Generate impression based on findings. | 38 year-old female patient with history of Crohn's disease status post ileostomy and colectomy with retained rectum and kidney stones presents with acute left lower quadrant pain. Evaluate for Crohn's, kidney stones and ovarian cyst. 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: Right lower quadrant ileostomy. Small bowel is normal in caliber without evidence of obstruction. There is narrowing and evidence of chronic inflammation of the distal transverse colon that extends to the rectum. There is adjacent lymphadenopathy in the mesentery.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Left gonadal vein congestion. Left corpus luteum cyst.BLADDER: No significant abnormality noted.LYMPH NODES: Scattered mesenteric lymph nodes within the pelvis.BOWEL, MESENTERY: There is narrowing and evidence of chronic inflammation of the distal transverse colon that extends continuously to the rectum. There is adjacent lymphadenopathy in the mesentery.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Continuous chronic inflammatory changes in the transverse colon to the rectum. Radiographic findings are more consistent with ulcerative colitis as opposed to Crohn's disease.2.No renal calculi or hydronephrosis. |
Generate impression based on findings. | 80-year-old with critical aortic stenosis status post angioplasty. Treatment planning for AVR versus TAVR. VESSELS:The thoracic aorta is normal in size. No dissection is present.. Conventional 3 vessel arch anatomy. Moderate atherosclerotic calcification affects the aortic arch.Abdominal aorta is normal in size and contour. Multifocal atherosclerotic calcification affects the origins of the celiac axis, superior mesenteric artery, bilateral renal arteries, and the inferior mesenteric artery however there is no significant luminal narrowing except for an approximately 30% narrowing of the origin of the celiac axis. Moderate atherosclerotic calcification affects the distal abdominal aorta and iliac arterial systems.The common iliac arteries have a tortuous course, right greater than left.ANNULUS: 16.8 X 12.7 cmSINUS OF VALSALVA: 3.6 X 3.3 X 3.4 cmSINOTUBULAR JUNCTION: 2.7 X 2.7 cmASCENDING THORACIC AORTA AT LEVEL OF MAIN PULMONARY ARTERY: 3.0 X 3.0 cmASCENDING THORACIC AORTA IMMEDIATELY PROXIMAL TO THE INNOMINATE ARTERY: 2.9 X 3.1 cmPROXIMAL DESCENDING THORACIC AORTA IMMEDIATELY DISTAL TO THE LEFT SUBCLAVIAN ARTERY: 2.8 X 2.6 cmDESCENDING THORACIC AORTA AT LEVEL OF HIATUS: 2.3 X 2.2 cmINFRARENAL ABDOMINAL AORTA: 1.7 X 1.7 cmRIGHT COMMON ILIAC ARTERY: 11.0 X 6.6 mmRIGHT EXTERNAL ILIAC ARTERY: 9.0 X 9.0 mmRIGHT COMMON FEMORAL ARTERY: 8.3 X 7.5 mmLEFT COMMON ILIAC ARTERY: 8.9 X 9.4 mmLEFT EXTERNAL ILIAC ARTERY: 7.3 X 7.9 mmLEFT COMMON FEMORAL ARTERY: 7.4 X 6.3 mmCHEST:LUNGS AND PLEURA: Scattered nonspecific micronodules and granulomas.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. The heart is normal in size. There is marked aortic valve calcification. Mild circumferential calcification involves the mitral valve annulus, with a small component extending superiorly along the aortomitral fibrous skeleton. Severe 3-vessel coronary atherosclerotic calcification.CHEST WALL: Kyphosis and degenerative changes affect the thoracic spine.ABDOMEN:The lack of oral contrast limits evaluation of the bowel. The phase of intravenous contrast limits evaluation of the abdominal solid organs. Exam was protocoled for evaluation of the arterial system.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Nonspecific left adrenal thickening.KIDNEYS, URETERS: Subcentimeter hypodensities in the right kidney are too small to fully characterize but statistically most likely represent benign renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small foci of subcutaneous emphysema in the ventral abdominal wall without associated inflammatory changes; correlate for history of injections.OTHER: An intra-abdominal catheter is coiled in the right lower quadrant.PELVIS:PROSTATE: Moderate prostatic hypertrophy with scattered calcifications.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mild uncomplicated diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small volume of fluid within the pelvis. | 1.CT angiography demonstrating moderate to severe atherosclerotic calcification affecting the distal abdominal aorta and bilateral iliac arterial systems. The common iliac arteries are tortuous, right greater than left. Measurements as described.2.Severe aortic valve and mild mitral annular calcification. |
Generate impression based on findings. | Malignant poorly differentiated neuroendocrine carcinoma. CHEST:LUNGS AND PLEURA: Stable right lung base nodule (image 95; series 10) measuring 0.9 cm in diameterMEDIASTINUM AND HILA: Stable left thyroid noduleCHEST WALL: Stable mildly enlarged bilateral axillary lymph nodesABDOMEN:LIVER, BILIARY TRACT: Slight interval increase in size of several of the numerous bilobar hepatic metastatic lesions. Reference segment 6 right lobe lesion (image 151; series 9) measures 2.8 x 2.8 cm.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 to equivocal increase in size of multifocal omental/peritoneal metastatic deposits. Reference right omental deposit (image 157; series 9) measures 2.2 x 1.3 cm. 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: Interval increase in size of spiculated mesenteric mass (image 162; series 9) currently measuring 3.6 x 4.8 cm.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Interval progression of disease with reference measurements given above. |
Generate impression based on findings. | 50 year-old male with prior drain placement and left upper quadrant abscess. Evaluate for resolution. ABDOMEN:LUNG BASES: Significant decrease in left pleural effusion when compared to prior exam. Small amount of gas within residual fluid may be due to instrumentation. Correlate with recent history.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Post splenectomyPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Patient has had a left nephrectomy. Since the prior exam, a posterior drain has been placed in the left renal bed fluid collection. There is been almost complete resolution of fluid. There is some increased attenuation involving the left psoas muscle consistent with inflammatory changes low stranding in the adjacent fat.Small right renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Changes from injection involving subcutaneous fat of the intra-abdominal wallOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostate is enlarged.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 | Almost complete resolution of left renal bed fluid collection. See above.Small amount of left pleural effusion with several gas bubbles. |
Generate impression based on findings. | Thrombocytopenia, unspecifiedIntracerebral hemorrhage There is redemonstration of a left sided intraparenchymal hematoma involving the left caudate nucleus and adjacent basal ganglia and internal capsule measuring approximately 38 x 32 mm axial dimensions which is unchanged since prior exams and associated with a mild to midline shift. There is associated intraventricular blood and subarachnoid blood.The lateral ventricles remain stable in size. There is contrast in now present within the cerebral vasculature.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.Stable left basal ganglia and adjacent to white matter hematoma associated with intraventricular and subarachnoid blood. The lateral ventricle size and the mass effect are stable. |
Generate impression based on findings. | Male 41 years old Reason: r/o septic hip, abscess History: R hip pain, leukocytosis, immune compromised A small amount of fluid is seen layering dependently in the posterior aspect of the hip joint, but no large effusion is evident. There are no frank inflammatory changes in the surrounding soft tissues and no other findings to suggest septic arthritis. No definite soft tissue fluid collections are seen to suggest abscess. A linear density along the proximal hamstring suggests dystrophic calcification, ossification or perhaps is due to old trauma. No fracture is evident. Mild deformities of the posterior aspect of the iliac wings, left greater than right, likely represent prior bone marrow biopsy sites. Soft tissue attenuation in the proximal femoral diaphyses is nonspecific and symmetrical, and may reflect red marrow. There is a mixed lucent and sclerotic density in the left iliac wing adjacent to the anterior aspect of the sacroiliac joint. This appears unchanged compared to the prior study and is nonspecific, but we suspect it represents a small focus of bone infarction. | Small amount of fluid posteriorly within the right hip joint, but no frank joint effusion, abscess, or soft tissue inflammation is evident. |
Generate impression based on findings. | 37-year-old female with the PEG tube and prior intra-abdominal hemorrhage. Bloody return from PEG tube. Evaluate tube position. ABDOMEN:LUNG BASES: A bibasal atelectasis and small, bilateral effusions which are improved in the interim.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: There is a PEG tube present with the tip within the gastric body. There is fluid adjacent to the stomach demonstrating mass-effect on the anterior wall of the gastric antrum, which may be slightly smaller compared to prior study.. There is also free fluid in the abdomen and pelvis which is unchanged and has a density consistent with blood product.BONES, SOFT TISSUES: No significant abnormality notedOTHER: I. intervening caval filter is present with prongs extending outside the lumen.PELVIS:UTERUS, ADNEXA: Intrauterine device noted.BLADDER: Gas in the urinary bladder associated with Foley catheterLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: There is a PEG tube present with the tip within the gastric body. There is fluid adjacent to the stomach demonstrating mass-effect on the anterior wall of the gastric antrum, which may be slightly smaller compared to prior study.. There is also free fluid in the abdomen and pelvis which is unchanged and has a density consistent with blood product.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | PEG tube in the stomach.Slight improvement in perigastric hematoma.No significant change in fluid in the pelvis. |
Generate impression based on findings. | Altered mental status. There is no evidence of intracranial hemorrhage, mass, or cerebral edema. There is extensive encephalomalacia in the left MCA territory with associated Wallerian degeneration and mild midline shift to the left. There is otherwise mild scattered nonspecific cerebral white matter hypoattenuation. There is a cavum septum and vergae and ex vacuo dilatation of the left lateral ventricle, but no evidence of hydrocephalus. There is an mildly expanded, partially empty sella. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. | 1. No evidence of intracranial hemorrhage, mass, or cerebral edema.2. Large chronic infarct in the left MCA territory with associated Wallerian degeneration and mild midline shift. 3. Mild scattered nonspecific cerebral white matter hypoattenuation, which may be related to small vessel ischemic disease. |
Generate impression based on findings. | Syncope and collapse. Acute, but ill-defined, cerebrovascular disease Neck CTA: There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is mild atherosclerotic narrowing present at the carotid bifurcations bilaterally Atherosclerotic calcifications are present at the carotid bifurcations.There is occlusion of the left vertebral artery at its origin and without evidence for distal reconstitution There is a 60% stenosis at the origin of the right vertebral artery associated with atherosclerotic calcification.Multilevel degenerative changes affect the cervical spine with uncal vertebral hypertrophy. There is encroachment of the neural foramina bilaterally at C4/5, C5/6, and C6/7 with evidence of central spinal canal stenosis at these levels. There is disk space narrowing at C4/5, C5/6, and C6/7.Punctate calcifications are present along the thyroid gland along with hypodense foci.Brain CTA: There is a 50% stenosis present along the horizontal portion of the cavernous segment of the right internal carotid artery and 40% narrowing of along the horizontal portion of the cavernous segment of the left internal carotid artery.The left posterior inferior cerebellar artery opacifies. This is likely related to collateralization from the left anterior/inferior cerebellar artery.The right vertebral artery has a distal stenosis of approximately 70% intracranially at the level of the origin of the right posterior inferior cerebellar artery.There is opacification of the distal internal carotid arteries, the distal vertebral arteries and the proximal anterior middle and posterior cerebral arteries. No aneurysms or intracranial stenosis is appreciated.The anterior communicating artery and the posterior communicating arteries are identified and are intact.The anterior communicating artery is medium size. The posterior communicating arteries are tinyCT head:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Atherosclerotic calcifications are present along the distal vertebral arteries. Atherosclerotic calcifications are present along the distal internal carotid arteries.The visualized portions of the paranasal sinuses demonstrate mucosal thickening in the maxillary sinuses and ethmoid air cells. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.Significant vertebral-basilar disease with occlusion of the left vertebral artery and 70% stenosis of the right vertebral artery at the level of the origin of the right PICA with 60% RVA stenosis at its origin. Please note that this is associated with very small posterior communicating arteries. The left vertebral artery occlusion now extends from its origin whereas previously was occluded intracranially. 2.50% stenosis along the right internal carotid artery at its cavernous portion3.Multilevel degenerative changes with findings suspicious for neural foraminal encroachment of exiting nerve roots and central spinal canal stenosis. Correlate with clinical symptoms.4.No evidence for acute intracranial hemorrhage mass-effect or edema5.CT is insensitive for the early detection of nonhemorrhagic CVA6.Thyroid calcifications associated with hypodense nodules are nonspecific. Please correlate with the clinical symptoms and history. |
Generate impression based on findings. | Female, 65 years old, fall possible CVA. Mild periventricular hypoattenuation is a non-specific finding which most commonly represents age-indeterminate small vessel ischemic disease.No intracranial hemorrhage or abnormal extra-axial fluid collection is seen. There is no evidence of mass effect or midline shift. The ventricles and basal cisterns are patent and normal in size. The sphenoid sinuses are opacified. The remaining paranasal sinuses are clear.The bones of the calvarium and skull base are intact. | No acute intracranial abnormality. |
Generate impression based on findings. | History of renal stones Peery rule-out stone. This is limited secondary to lack of intravenous and oral contrast. Beyond these limitations, the following observations are made: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: Small bilateral non-obstructing renal calculi are identified. The largest calculus which was present previously at the upper pole the right kidney is no longer present. No hydronephrosis or hydroureter is identified.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Normal appendix. Evidence of prior gastric/bowel surgery in the left upper quadrant. Colonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Gynecomastia of unclear etiology.PELVIS: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 | Nonobstructive renal calculi. Colonic diverticulosis. |
Generate impression based on findings. | 40-year-old male patient with history of type B aortic dissection status post surgical repair presents with chest pain rating to the arm and neck. Evaluate for progression of dissection. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: There is a type B aortic dissection with a narrowing of the true lumen just distal to the origin of the left subclavian artery, which extends through the abdominal aorta as described below.CHEST WALL: Thrombosed axillo-femoral bypass graft.VASCULATURE: There is an aortic dissection arising distal to the left subclavian artery without involvement of any of the branches of the arch of the aorta, stable compared to prior examination. Contrast is seen in both the true and false lumen, consistent with prior fenestration of the intimal flap. The false lumen is significantly larger and posterior to the true lumen.Axillo-femoral bypass graft which does not demonstrate contrast enhancement, consistent with thrombosis.Bridging graft from the distal right femoral graft to the left femoral artery, which are widely patent.The origins of the coronary arteries demonstrate appropriate contrast enhancement.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: Abdominal aortic dissection to the level of the bifurcation as described below.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.VASCULATURE: Again seen is a type B aortic dissection arising just distal to the left subclavian artery and extending to the level of the iliac bifurcation. Contrast is seen in both the true and false lumen suggesting fenestration of the intimal flap. The false lumen is larger and more posterior than the true lumen. There is good perfusion of the true and false lumens, improved compared to prior examination. Stent within true lumen proximal to the aortic bifurcation is widely patent.There is contrast enhancement through the right common iliac; however, there is no contrast opacification of the origin of the left common iliac artery with near complete thrombosis of the proximal left common iliac artery and a mural thrombus which extends distally, stable compared to prior examination.VESSEL ORIGINS:Celiac axis: True LumenSMA: True LumenRight renal artery: True LumenLeft renal artery: False LumenIMA: True LumenPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Stable type B aortic dissection with improved flow to the celiac axis, right common iliac artery. Interval placement of stent in the true lumen proximal to the aortic bifurcation and mechanical fenestration of intimal flap.2.Right axillo-femoral bypass graft thrombosis.3.Thrombosed proximal left common iliac artery with mural thrombus involving the distal left common iliac artery, stable |
Generate impression based on findings. | 77-year-old male with history of ulcer colitis with dehydration and urethral fistula. Abdominal pain. ABDOMEN:LUNG BASES: Ovoid low attenuation area at the right lung base adjacent to the right heart is unchanged from studies dating back to March of 2013 and air present loculated fluid.LIVER, BILIARY TRACT: Left hepatic lobe cyst unchangedSPLEEN: No significant abnormality notedPANCREAS: AtrophicADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Small left renal cystRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a concentric wall thickening involving small bowel loops in the left upper quadrant. This appearance is not specific and could be inflammatory or less likely ischemic in origin. There is no gross obstruction. Right lower quadrant ostomy.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Post prostatectomy.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: There is a concentric wall thickening involving small bowel loops in the left upper quadrant. This appearance is not specific and could be inflammatory or less likely ischemic in origin. There is no gross obstruction. Right lower quadrant ostomy.BONES, SOFT TISSUES: Penile prosthesis noted with reservoir within the pelvis.OTHER: No significant abnormality noted | Thick-walled loops of small bowel.Stable abnormality right lung base. |
Generate impression based on findings. | Female, 90 years old, status post fall, left ecchymosis, evaluate for fracture. A chronic stroke of the right superior parietal lobule is demonstrated. In addition, moderate periventricular hypoattenuation is seen compatible with age indeterminate small vessel ischemic disease. There is also evidence of a lacunar infarct involving the left caudate head, probably old. 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 intact. Left periorbital soft tissue swelling is seen. No orbital fracture is demonstrated. No evidence of injury to the orbital contents is seen. Globes are round and symmetric. The lenses have been replaced. Extraocular muscles and optic nerves show normal morphology.Lucency and mild deformity of the right nasal bone could represent a minimally displaced acute fracture, particularly as there is a small amount of fluid in the underlying nasal cavity. The nasal septum is intact deviating mildly towards the left with a leftward projecting bony spur. | 1. No definite acute intracranial abnormality. There is evidence of a chronic right parietal stroke, as well as moderate age indeterminate small vessel ischemic disease.2. Left periorbital soft tissue swelling without evidence of orbital fracture or injury to the orbital contents.3. Probable minimally displaced acute fracture of the right nasal bone. |
Generate impression based on findings. | 69-year-old male with thyroid cancer. CHEST:LUNGS AND PLEURA: Bilateral basilar subsegmental atelectasis and scarring. No suspicious nodules or masses. Mild centrilobular emphysema.MEDIASTINUM AND HILA: Soft tissue attenuation in the subcutaneous fat of the lower neck and right chest wall as well as multiple surgical clips in lower neck and adjacent to thyroid gland, compatible with post treatment changes; please see dedicated neck CT report for neck findings.Multiple mildly enlarged mediastinal lymph nodes; right high paratracheal node measures 10 mm in short axis (series 5, image 15).Mild coronary artery calcifications. Heart size within normal limits.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: Right kidney has been resected. Several subcentimeter hypodensities in the left kidney most likely represent benign cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications in aorta and its branches. Multiple small retroperitoneal lymph nodes 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: Postsurgical changes in the right lower quadrant. | Soft tissue attenuation in lower neck and right chest wall as well as multiple surgical clips around the right gland; please see dedicated neck CT report for neck findings.1.Multiple mildly enlarged mediastinal lymph nodes.2.No evidence of pulmonary metastases.3.Multiple small retroperitoneal lobe nodes.4.Status post right nephrectomy. |
Generate impression based on findings. | 61-year-old male status post fall with left rib fractures, now hypotensive CHEST:LUNGS AND PLEURA: Small left pleural effusion and basilar atelectasis. High-density material in the left lower lung is suggestive of hemorrhage/contusion. Elevation of the left hemidiaphragm, which may be related to splinting. Few micronodules, some of which are calcified, compatible with prior granulomatous disease.MEDIASTINUM AND HILA: The heart size is normal. Severe atherosclerotic calcification of the coronary arteries. Status post CABG.CHEST WALL: Fractures of the lateral and posterior aspects of the left 7th through 12th thoracic ribs with mild displacement. Degenerative changes of the thoracolumbar spine. Status post median sternotomy.ABDOMEN: Evaluation of solid organ pathology and vasculature is limited due to the lack of IV contrast.LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral hypoattenuating lesions, likely representing cysts are incompletely evaluated on this exam.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine. Small ventral hernia containing fat.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality noted | 1. Mild displaced fractures of the left T7 through T12 ribs without pneumothorax. Small left pleural effusion and adjacent pulmonary opacities suggestive of hemorrhagic product/contusion.2. No acute intra-abdominal or pelvic abnormality. |
Generate impression based on findings. | Female, 56 years old, status post cranioplasty. Since the prior examination, the right pterional craniotomy defect has been replaced. The bony flap is permeated by numerous linear lucencies but is otherwise unremarkable in appearance. A small area of extra-axial fluid is evident subjacent to the craniotomy flap which seems to be contiguous with extracranial subcutaneous fluid. The overlying scalp is mildly swollen. A small amount of intracranial and subcutaneous air is seen.Evidence of a large right MCA territory stroke is redemonstrated. Encephalomalacia affects the right frontal, parietal and temporal lobes as well as the basal ganglia and insula. There is ex vacuo dilatation of the right lateral ventricle and a mild shift of midline structures towards the right. The distribution of this abnormality appears similar to the prior CT. Redemonstrated is a right parasellar surgical clip.No evidence for progressive or new territorial ischemia is seen. No acute parenchymal hemorrhage is seen. The ventricular system is somewhat deformed due to shifting brain structures as above, but given that caveat the caliber is stable to slightly smaller. | 1. Postop findings status post replacement of the right-sided craniotomy flap. There is a small amount of fluid, both intracranial and extracranial, surrounding the flap.2. Sequelae of a large right MCA distribution stroke are again seen including encephalomalacia and shift of midline structures. No evidence of progressive or new territorial ischemia is seen. |
Generate impression based on findings. | Other specified personal history presenting hazards to health. Other specified personal history presenting hazards to health Neck CTA: There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There are atherosclerotic calcifications at the origins of the vertebral arteries bilaterally with narrowing of the vertebral arteries and 70% stenosis on the right and 60% stenosis on the left. There is atherosclerotic narrowing at the origin of the left subclavian artery with approximately 70% stenosis at its origin.Atherosclerotic calcifications are present at the carotid bifurcations.There are multilevel degenerative changes present in the cervical spine with a reversal of the normal cervical curvature centered at approximately C5-6 as well as endplate and uncovertebral osteophytes worse at C4-5 and C5-6 but also present at C6-7. There is neural foramen encroachment of the exiting nerve roots at these levels.Brain CTA: There is opacification of the distal internal carotid arteries, the distal vertebral arteries and the proximal anterior middle and posterior cerebral arteries. No aneurysms or intracranial stenosis is appreciated.The anterior communicating artery and the posterior communicating arteries are identified and are intact. The left posterior communicating artery is similar in size to the left P1 segment. The right posterior communicating artery is tiny. The anterior communicating artery is a medium size. The A1 segments are similar in size. The right posterior inferior cerebellar artery has an extracranial originCT head:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.A punctate hypodensity is present in the right thalamusPeriventricular and subcortical white matter hypodensities of a moderate degree are present.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. The eyeball lenses are thin. Atherosclerotic calcifications are present along the distal internal carotid arteries. | 1.70% stenosis at the origin of the right vertebral artery.2.60% stenosis at the origin of the left vertebral artery. 3.70% stenosis at its origin of the left subclavian artery.4.A punctate hypodensity in the right thalamus likely represents lacunar infarct age indeterminate.5.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. 6.Multilevel degenerative changes are present in the cervical spine with neural foramen encroachment at C4-5, C5-6 and C6-7. |
Generate impression based on findings. | 44-year-old male with possible loculated pleural effusion. LUNGS AND PLEURA: Moderate right pleural effusion, which may have small loculated component along anterior hemithorax. Small left pleural effusion.Bilateral linear scarlike opacities and atelectasis, most prominent in right base and right middle lobe. Ground glass opacities in the left upper lobe may represent focal edema.Several nodules are identified, largest located in the left base and measuring 4 mm, likely benign in etiology.MEDIASTINUM AND HILA: Right central venous catheter terminates in distal SVC. Multiple enlarged mediastinal lymph nodes, which are nonspecific and may be reactive in nature. Heart size normal without pericardial effusion.CHEST WALL: Diffuse anasarca.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Cirrhotic liver morphology with moderate to large amount of ascites fluid in abdomen. Multiple enlarged upper retroperitoneal lymph nodes. There is wall thickening of partially visualized bowel loops, which may be related to generalized edema. TIPS stent noted. | 1.Bilateral pleural effusions, moderate on the right and small on the left, with possible small loculated component along the right anterior hemithorax. Given the cirrhosis and ascites fluid and anasarca,, pleural effusion is likely due to volume overload.Wall thickening of partially visualized bowel loops, which may be due to generalized volume overload/edema. |
Generate impression based on findings. | 32-year-old female patient with lower back pain, concern for renal calculi. Note that the lack of intravenous contrast limits evaluation of vasculature, lymph nodes and solid viscera.ABDOMEN:LUNG BASES: Linear scarring and atelectasis in bilateral lungs are stable.LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: Absent.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Scarring of the kidneys consistent with prior infarcts. No renal calculi. No hydronephrosis. No perinephric fat stranding.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Osseous changes of sickle cell disease.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Right adnexal cyst smaller than 3 cm in diameter.BLADDER: No bladder calculi.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Osseous changes of sickle cell disease, stable.OTHER: No significant abnormality noted. | No evidence of renal calculi or hydronephrosis. |
Generate impression based on findings. | Female, 56 years old, status post craniotomy. Postoperative findings are demonstrated status post replacement of the right pterional craniotomy flap. The bony flap is unchanged in morphology. Since the prior study, there has been some interval expansion of an extra-axial fluid collection subjacent to the craniotomy flap. This collection measures about 8 mm in thickness at the level of the frontal horns, previously 4 to 5 mm. The collection seems to be contiguous with fluid in the overlying scalp soft tissues which has also mildly expanded in volume. There is a small amount of subcutaneous and intracranial air similar to prior. Redemonstrated is a right parasellar surgical clip.Sequelae of a large right MCA distribution stroke are again seen. This includes encephalomalacia of the frontal, parietal and temporal lobes as well as the basal ganglia and insula. There is ex vacuo dilatation of the right lateral ventricle and shift of midline brain structures towards the right. Ventricular caliber is unchanged. No parenchymal hemorrhage is detected. | Mild interval expansion of an extra-axial fluid collection which surrounds both the intracranial and extracranial surfaces of the craniotomy flap. |
Generate impression based on findings. | 58-year-old female patient with history of sepsis. Evaluate for source of infection. ABDOMEN:LUNG BASES: Trace bilateral pleural effusions with associated atelectasis versus scarring.LIVER, BILIARY TRACT: Heterogeneous liver parenchyma with increased attenuation, consistent with cirrhosis and fatty infiltration. Gallbladder with small gallstones. No biliary dilatation.SPLEEN: Numerous small, subcentimeter hypoattenuating lesions in the splenic parenchyma, stable.PANCREAS: Atrophic native pancreas with pancreatic transplant in right lower quadrant.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diffuse mild colonic wall thickening. Mildly thick loops of small bowel adjacent to the pancreatic transplant are unchanged compared to prior examination.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumber spine. Diffuse soft tissue edema.OTHER: Abdominal ascites, stable.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Foley catheter in place.LYMPH NODES: No significant abnormality noted,BOWEL, MESENTERY: Diffuse mild colonic wall thickening. Mildly thick loops of small bowel adjacent to the pancreatic transplant are unchanged compared to prior examination.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumber spine. Diffuse soft tissue edema.OTHER: Abdominal and pelvic ascites, stable. | 1.Diffuse colitis suggestive of Clostridium difficile colitis.2.Stable abdominal ascites. |
Generate impression based on findings. | 36-year-old female patient with Crohn's disease postop day 9 status post laparoscopic ileocecectomy presents with tachycardia, nausea and vomiting. Assess for fluid collection or anastomotic leak. 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: Status post ileocecectomy. Anastomosis is intact without adjacent fluid collection or excretion of oral contrast. Bowel is normal in caliber without evidence of wall thickening.BONES, SOFT TISSUES: Surgical changes in the right lower quadrant of the abdominal wall with trace emphysema.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of free fluid in the pelvis. | Postoperative changes consistent with distal ileocecectomy without evidence of obstruction or anastomotic leak. |
Generate impression based on findings. | 62-year-old male with cholangiocarcinoma, restaging CHEST:LUNGS AND PLEURA: Numerous bilateral pulmonary nodules, overall decrease in size and number. Reference right upper lobe nodule is no longer measurable. A different right upper lobe nodule measures 7 x 8 mm (image 23 series 10221) and previously measured 10 x 7 mm (image 17, series 5).MEDIASTINUM AND HILA: Marked coronary arterial calcifications. Central venous catheter extends to the cavoatrial junction.CHEST WALL: Sclerotic osseous metastases in the spine, similar to the prior study. Right chest wall port.ABDOMEN:LIVER, BILIARY TRACT: Large hypodense reference hepatic mass measures 12.6 x 7.8 cm and previously measured 12.7 x 7.7 cm (image 93, series 3) with adjacent retraction of the capsule. Multiple additional metastatic lesions are again identified. In the posterior right hepatic lobe several large hypoattenuating lesions are increased in size from the prior study.Perihepatic carcinomatosis is reidentified.SPLEEN: Hypodense splenic lesions appear unchanged.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left renal cyst. The right kidney is absent.RETROPERITONEUM, LYMPH NODES:Reference periaortic lymph node measures a 1.2 x 2.0 cm and previously measured 1.4 x 1.9 cm (image 104, series 3).Reference aortocaval lymph node measures 1.6 x 0.9 cm and previously measured 1.9 x 1.7 cm (image 110 series 3).BOWEL, MESENTERY: Extensive omental metastatic disease with increased ascites.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Increased abdominal ascites.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Prominent iliac and inguinal lymph nodes are again identified.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Extensive osseous metastatic disease appearing similar to the prior study.OTHER: Increased ascites. | 1. Interval decrease in pulmonary metastatic disease with several enlarging hepatic lesions suggesting a mixed response, with reference lesions detailed above.2. Peritoneal carcinomatosis with interval increase in abdominal and pelvic ascites.3. Unchanged osseous metastatic lesions. |
Generate impression based on findings. | Female, 43 years old, history of tongue cancer. Treatment related findings are again seen in the neck including infiltration of the fascial planes as well as scarring and surgical clips along the bilateral carotid spaces. No evidence of recurrent mucosal tumor or pathologic adenopathy is seen.The mandible remains mildly mottled and sclerotic. Also seen is an irregular defect along the left paramedian alveolar surface. These findings have not substantially changed over multiple prior exams. They may reflect radiation related change with or without superimposed surgical deformity. No suspicious soft tissue enhancing component is seen at the site of bony defect.Small enhancing nodules within the parotid glands are stable and likely represent lymph nodes. The left IJ vein is not clearly identified, a stable finding. Vessels are otherwise unremarkable. No concerning osseous lesions are demonstrated. | No evidence of recurrent disease in the neck. |
Generate impression based on findings. | Other specified personal history presenting hazards to healthAtrial fibrillation The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.A punctate hypodensity is present in the right thalamus which is unchanged since June 2005Periventricular and subcortical white matter hypodensities of a moderate degree are present.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. The eyeball lenses are thin. Atherosclerotic calcifications are present along the distal internal carotid arteries. | 1.No evidence for acute intracranial hemorrhage mass effect or edema.2.A punctate hypodensity in the right thalamus likely represents lacunar. This appears to have been present on CT from 6/14/5 and is likely old.3.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. This appears stable when compared to 20054.CT is insensitive for the early detection of nonhemorrhagic CVA |
Generate impression based on findings. | 74-year-old female status post GIST resection, history of stage I lung cancer ABDOMEN:LUNG BASES: See CT chest report, dictated separately.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Small hypoattenuating lesions, likely representing cysts.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: Clips along the lesser curvature of the stomach are again noted without evidence of recurrent disease. The bowel is normal in caliber.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Postsurgical changes of the stomach without evidence of recurrent or metastatic disease in the abdomen or pelvis. See separately dictated CT chest for further detail. |
Generate impression based on findings. | Status post total laryngectomy with bilateral neck dissection and tracheotomy for recurrence left laryngeal poorly differentiated SCCA with widespread lymphatic invasion. Head: There is no evidence of intracranial mass, or abnormal enhancement. Thre are bilateral basal ganglia calcifications. The 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 osseous structures are unremarkable. Neck: There are postoperative findings related to total laryngectomy, neck dissection, tracheostomy, and voice prosthesis insertion. There is scattered subcutaneous emphysema, diffuse subcutaneous edema, retropharyngeal fluid collection, and small fluid collections in the region of the surgical site. The neopharynx appears grossly unremarkable. There is no definite evidence of residual tumor or significant cervical lymphadenopathy, although assessment is limited in the setting of early post-treatment changes. There is a 5 mm calcification within the left thyroid lobe. There is a punctate calcification within the left parotid gland, which may represent a calculus. The major cervical vessels are intact. There is multilevel degenerative spondylosis with loss of the cervical lordosis and a prominent posterior disc-osteophyte complex that appear to impinge upon the spinal cord. The imaged portions of the lungs are unremarkable. There is a 4 mm skin excrescence arising from the lower lip, as well as smaller lesions in the left cheek. | 1. No definite evidence of gross residual tumor or significant cervical lymphadenopathy, although assessment is limited in the setting of early post-treatment changes. 2. No evidence of intracranial metastases. |
Generate impression based on findings. | 28 year-old female with chest pain, SOB, elevated D-dimer. PULMONARY ARTERIES: Diagnostic quality exam. Small filling defect in subsegmental branch of the lingula, consistent with small pulmonary embolus (series 5, image 119). No other pulmonary emboli identified.LUNGS AND PLEURA: Punctate calcified and noncalcified micronodules, all measuring less than 4 mm and likely result of prior granulomatous infection. No consolidation or pleural effusions.MEDIASTINUM AND HILA: Residual thymic tissue in anterior mediastinum. No significant lymphadenopathy. Heart size normal, without evidence of right heart strain.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Small pulmonary embolus in subsegmental branch of the left upper lobe. |
Generate impression based on findings. | Reason: history of Wegener's, evaluate for recurrence History: dyspnea, cough LUNGS AND PLEURA: Scattered benign-appearing micronodules are present, some calcified granulomas.There are some areas of subtle ground glass opacity, which can be the residua of pulmonary hemorrhage related to Wegener's granulomatosis.No areas of active vasculitis.MEDIASTINUM AND HILA: There are no significantly enlarged mediastinal or hilar lymph nodes.Moderate coronary artery calcifications are present.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Scattered hepatic cystlike hypodensities are unchanged. | Subtle ground glass opacities could be the residua of pulmonary hemorrhage related to Wegener's granulomatosis. |
Generate impression based on findings. | 64-year-old male with lung cancer status post 3 cycles of chemotherapy. CHEST:LUNGS AND PLEURA: Status post right upper lobectomy. Right paramediastinal and perihilar post radiation scarring appears unchanged. Several ill-defined, nodular opacities along right major fissure and in left apex appear unchanged (series 4, image 28, 31, 22). No new suspicious opacities or nodules.MEDIASTINUM AND HILA: Left thyroid lobe nodule unchanged. Postsurgical changes in right hilum appear similar. No significant lymphadenopathy. Small, superiorly loculated pericardial effusion is unchanged. Heart size normal.CHEST WALL: Unchanged appearance of right lateral rib fractures (sagittal series image 17).ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Stable punctate hypodensity in right lobe of liver, likely cyst. No new or suspicious lesions.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Stable left adrenal nodule measures 2.8 x 2.0 cm, previously measured 2.8 x 2.0 cm (series 3, image 95). Right adrenal unremarkable.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications in aorta. No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Degenerative changes of thoracolumbar spine.OTHER: No significant abnormality noted. | 1.Postsurgical changes in the right lung. Stable nodular opacities in both lungs. No new suspicious nodules.2.Stable left adrenal nodule. |
Generate impression based on findings. | 76 year old female patient with metastatic colorectal cancer. Restaging. CHEST:LUNGS AND PLEURA: Index right lower lobe pulmonary nodule is no longer cavitary in appearance and measures 9 x 8 mm (series 4 image 55), previously 7 mm. Scattered pulmonary nodules are not significantly changed compared to prior examination.Stable moderate right pleural effusion.MEDIASTINUM AND HILA: Heart is mildly enlarged. Index precarinal lymph node measures 1.2 x 0.7 cm (series 3 image 37), previously 1.3 x 0.9 cm. Atherosclerotic changes in the thoracic aorta.CHEST WALL: Right chest port with tip in the right atrium. Heterogeneous left thyroid nodule with calcification is stable compared to prior examination.ABDOMEN:LIVER, BILIARY TRACT: Status post right hepatectomy with adjacent ductal dilatation, stable. Index lesion measures 1.2 x 1.2 cm (series 3 image 101), previously 0.9 x 0.7 cm. Additional hypoattenuating lesions in the liver are larger in size compared to examination on 6/28/2013.Perihepatic collection is stable.SPLEEN: No significant abnormality noted.PANCREAS: Punctate parenchymal calcification, stable.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left kidney with subcentimeter hypoattenuating lesions, stable compared to prior.RETROPERITONEUM, LYMPH NODES: Atherosclerotic changes in the abdominal aorta and iliac arteries. No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted. No mesenteric lymphadenopathy.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumbar spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted. No mesenteric lymphadenopathy.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumbar spine.OTHER: No significant abnormality noted. | 1.Increasing size of hypoattenuating liver lesions.2.Interval increase right lower lobe pulmonary nodule. |
Generate impression based on findings. | 66 year old female postoperative day 2 status post aortic arch replacement. Evaluate for progression of thoracic aneurysm. ANGIOGRAPHY:Postoperative changes from aortic arch replacement with reimplantation of the arch vessels. The graft originates approximately 8.5 cm superior to the sinus of Valsalva; the central anastomosis is unremarkable. The innominate anastomosis is patent and unremarkable, arising from right lateral proximal transverse segment of graft. There is a large filling defect at the origin of the right common carotid artery indicating a thrombus (series 7 image 94).The proximal left common carotid artery demonstrates a dissection flap originating from the anastomosis and extending approximately 2.8 cm (series 7 image 141) in length. The false lumen compresses the true lumen, resulting in marked narrowing. Multiple filling defects are present in the left common carotid distal to the dissection compatible with thrombi (series 7 image 105, 87, and 65).The left subclavian artery is markedly narrowed from the anastomosis for approximately 2cm in length. Originating in the region of the subclavian anastomosis, there are two pseudoaneurysms. The larger component is fingerlike and extends anterosuperiorly adjacent to the left common carotid artery to the level of the left clavicular head (series 7 image 111 and 118). The posterior component is smaller and less well-defined (series 7 image 133).There is an additional pseudoaneurysm extending from the distal aortic graft anastomosis (series 7 image 152). This pseudoaneurysm is fingerlike and extends anteriorly and superiorly. The neck of the aneurysm measures approximately 5 mm in anteroposterior dimension and extends for approximately 2.8 cm in length and measures 8mm at its widest point.New type B dissection within the distal thoracic aorta arising at the level of the distal aortic graft anastomosis (series 10 image 36). This extends for approximately 4 cm.The thrombosed aneurysm sac left lateral to the graft has increased in size compared to prior measuring 5.7 x 6.5 cm (series 7 image 170), previously 4.6 x 4.5 cm. This increase in size occurs primarily due to new posterior extension along the distal arch and likely reflects a combination of postoperative hematoma and contributions from the pseudoaneurysms. A small amount of postoperative gas is noted within it. An aorta to OM2 venous bypass graft is widely patent at the aortic anastomosis; however, there is a filling defect compatible with a thrombus at the distal anastomosis (series 7 image 369).There are postsurgical changes from a LIMA graft, but the vessel is diminutive and poorly opacified.The descending thoracic aorta remains mildly ectatic with numerous small penetrating ulcers.There is new narrowing at the origin of the celiac axis which appears to reflect kinking/external compression. No thrombus is evident. The superior mesenteric artery origin is widely patent. There is marked narrowing of the origin of the renal arteries due to atherosclerotic calcification appearing similar to prior.The inferior mesenteric artery origin is patent.Severe multifocal atherosclerotic calcification affects the distal abdominal aorta and iliac arterial systems. No distal thrombi are evident.CHEST:LUNGS AND PLEURA: Moderate right pleural effusion with associated compressive atelectasis/consolidation. The effusion has low attenuation making hemothorax unlikely. In addition there is atelectasis involving the posterior basal segment of the left lower lobe.MEDIASTINUM AND HILA: Three mediastinal surgical drains. Swan-Ganz catheter with tip positioned at the pulmonary artery bifurcation. There is a thin eccentric low density extending along the right internal jugular catheter raising the possibility of adherent thrombus.Aneurysm sac/hematoma as described above. Small volume of postoperative pneumopericardium. Moderate aortic valve calcification.CHEST WALL: Postoperative changes from median sternotomy.ABDOMEN:LIVER, BILIARY TRACT: The gallbladder is distended, but there is no CT evidence of acute cholecystitis. No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Ill-defined small peripheral hypodensity in the inferior pole of the right kidney is nonspecific but could potentially represent a developing infarct.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The small bowel wall appears minimally thickened, but this is equivocal and may represent a sequela of the patient's anasarca.The colon however demonstrates concentric wall thickening and hyperemia compatible with colitis. This is slightly more prominent in the transverse and descending colon with relative sparing of the cecum. In the postoperative period this is highly suspicious for ischemic colitis. No intramural or intraperitoneal free air is noted.BONES, SOFT TISSUES: Diffuse soft tissue edema.OTHER: New moderate ascites.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: There is a Foley catheter within the bladder and a small focus of intravesicular air presumably related to instrumentation.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic wall thickening as described above.BONES, SOFT TISSUES: Partially visualized left inguinal catheter tubing which is only partially visualized but appears to be extravascular and looped within the soft tissues.OTHER: Diffuse soft tissue edema. | 1. Postoperative changes from aortic arch replacement with reimplantation of the arch vessels. There are pseudoaneurysms arising from the the left subclavian artery anastomosis and the distal aortic anastomosis, as described.2. New type B aortic dissection originating at the distal aortic graft anastomosis extending for approximately 4 cm.3. Left common carotid artery dissection with marked associated narrowing of the true lumen and multiple foci of thrombus within the artery distal to the dissection flap.4. Large thrombus at the origin of the right common carotid artery.5. Colonic wall thickening and hyperemia compatible with colitis. In the postoperative period this is highly suspicious for an ischemic etiology. No thrombi are evident within the mesenteric vessels and there is no associated intramural or intraperitoneal air.6. Thrombus within the distal aorta to OM2 venous graft. Postoperative changes from LIMA to LAD graft; however, the graft vessel is diminutive and poorly opacified in multiple segments.7. Left inguinal catheter appears extravascular.8. Anasarca with diffuse soft tissue edema, right pleural effusion, and ascites. |
Generate impression based on findings. | 31-year-old male with pancreatic cancer status post chemotherapy and resection. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Stable small mediastinal lymph node which measures 7 x 6 mm and previously measured 7 x 6 mm (image 36, series 3).CHEST WALL: No significant abnormality notedABDOMEN:LUNG BASES: . Status post cholecystectomy. No new lesions. Nodular density within the ligamentum teres is unchanged.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Status post Whipple procedure without evidence of recurrent or metastatic disease.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Status post Whipple procedure without evidence of recurrent or metastatic disease. |
Generate impression based on findings. | 58-year-old female with metastatic lung cancer. Participant in clinical trial status post 6 cycles of chemotherapy. CHEST:LUNGS AND PLEURA: Right upper lobe mass appears minimally decreased, measuring 47 x 36 mm, previously measured 48 x 38 mm (series 5, image 28). Reference left upper lobe nodule is stable to slightly decreased, measuring 13 x 13 mm, previously measured 15 x 13 mm (series 5, image 40). Ill-defined opacity in the left apex unchanged (series 5, image 7).No new nodules identified.Stable moderate emphysema.MEDIASTINUM AND HILA: Reference left paratracheal node is difficult to accurately measure but unchanged, measuring approximately 8 mm, previously measured 8 mm (series 3, image 15). Reference subcarinal node also unchanged, measuring 9 mm, previously 9 mm (series 3, image 35).CHEST WALL: Reference right lower neck node unchanged, measuring 12 mm, previously 12 mm (series 3, image 4). Stable T10 compression fracture.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Stable punctate hypodensity in right lobe of the liver, likely cyst. No new or suspicious lesions.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Stable right adrenal gland nodule measures 10 x 7 mm, previously 10 x 7 mm (series 3, image 94).KIDNEYS, URETERS: Stable bilateral renal cysts. 4-mm nonobstructing stone located in the inferior calix of left kidney unchanged.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.Stable to slightly decreased size of pulmonary masses. No new nodules or masses.2.Stable lymphadenopathy.3.Stable right adrenal nodule. |
Generate impression based on findings. | 66 year-old female with dyspnea and groundglass opacity seen on abdominal CT. LUNGS AND PLEURA: Mild basilar groundglass opacities most compatible with atelectasis. Mild scarring in anterior aspects of both upper lobes, left more than right. Mild centrilobular emphysema.Several punctate calcified and noncalcified nodules compatible with prior granulomatous disease.Ill-defined nodular opacity in the left base was obscured on the 2011 CT due to atelectasis on that exam, however, this most likely post-inflammatory in nature (series 5, image 51).MEDIASTINUM AND HILA: Multiple calcified mediastinal and hilar lymph nodes compatible with prior granulomatous infection.Mild atherosclerotic calcifications affect coronary arteries and aorta. There is fusiform aneurysmal dilation ascending aorta, measuring 4.3 cm in maximal diameter at level of main pulmonary artery, not significantly changed.Heart size within normal limits.CHEST WALL: Degenerative changes in the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Status post cholecystectomy. | 1.Ground glass opacities in the lung bases most compatible with mild atelectasis.2.Scattered punctate calcified and noncalcified lung nodules most likely represent sequela of prior granulomatous infection.3.Stable fusiform aneurysmal dilation of the ascending aorta.4.Ill-defined nodular opacity in the left base may be inflammatory or scar like in nature. |
Generate impression based on findings. | Reason: h/o HNC, h/o CRT, compare to previous, measurements pls History: none LUNGS AND PLEURA: Calcified granuloma left upper lobe, but no pulmonary or pleural metastases noted.MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy.Calcified nodes are the result of prior granulomatous disease. CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Gastrostomy tube. Cholecystectomy clips. | No evidence of metastases, or other significant abnormality. |
Generate impression based on findings. | 61-year-old male. Lung cancer screening. LUNGS AND PLEURA: Minimal basilar atelectasis. No suspicious nodules or masses.MEDIASTINUM AND HILA: No significant abnormality noted.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. | No suspicious lung nodules or masses. |
Generate impression based on findings. | Undifferentiated thyroid carcinoma s/p thyroidectomy, right radical neck dissection, and right pectoralis flap. There are postoperative findings related to recent thyroidectomy, right radical neck dissection, and right pectoralis flap reconstruction. There are several fluid collections that are compatible with seromas within the surgical bed, the largest of which is located in the right lower neck, which measures 5.5 AP x 6.5 RL x 5.0 SI mm. There is a defect in the overlying skin incision site, which may represent wound dehiscence. There are nodular soft tissue attenuation areas within the right thyroidectomy bed that measure 16 x 13 mm and 21 x 16 mm. There are several lower right paratracheal and upper mediastinal lymph nodes, which have increased in size, although these may be reactive in nature. For example, a right tracheoesophageal groove lymph node measures 7 mm in diameter (image 66, series 6), previously 4 mm. The imaged intracranial structures are grossly unremarkable. The right internal jugular vein is not apparent and appears to have been sacrificed. There is moderate stenosis of the proximal left internal carotid artery. There are no lytic or blastic lesions. | Interval recent thyroidectomy, right radical neck dissection, and right pectoralis flap reconstruction with several fluid collections that are compatible with seromas. Nodular soft tissue attenuation areas within the right thyroidectomy bed that measure 16 x 13 mm and 21 x 16 mm may represent residual thyroid tissue and/or tumor, although assessment is limited in the early post-treatment period. Increase in size of lower right paratracheal and upper mediastinal lymph nodes, which may be reactive in nature. |
Generate impression based on findings. | 3 year-old male with history of disseminated mycobacterial infection and lymphadenopathy. Follow up examination. CHEST:LUNGS AND PLEURA: No focal air space opacities or pleural effusions. No pneumothorax.Aeration of the left upper lobe appears similar to the prior examination with persistent mild residual atelectasis in the apical posterior segment.MEDIASTINUM AND HILA: Left main pulmonary artery and left mainstem bronchial stents are again noted which are unchanged in position since the prior study.A left-sided central venous catheter is again noted with its tip at the junction of the innominate vein and the SVC.Left hilar lymphadenopathy is again noted which is unchanged since the prior study. No new mediastinal or hilar lymphadenopathy is present.CHEST WALL: Small axillary lymph nodes are again noted and are unchanged.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: A gastrostomy tube balloon is again noted within the stomach. The stomach is collapsed.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 | No significant interval change since the prior study. Persistent mild left hilar lymphadenopathy and residual left upper lobe atelectasis. |
Generate impression based on findings. | 40-year-old male patient with gastric cancer. Please compare to previous scans and provide index lesion measurements. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Right chest wall Port-A-Cath with catheter tip in the superior vena cava.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: Gastric wall thickening, most prominent in gastric fundus and body. Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Extensive osseous metastases involving the sternum, bilateral ribs and multiple thoracic vertebral bodies. T6 and T9 vertebral body osseous metastases appear larger 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: Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Multiple osseous metastases in the lumbar vertebral bodies, stable. No compression fractures are identified.OTHER: No significant abnormality noted. | Interval increase in T6 and T9 vertebral body osseous metastases. |
Generate impression based on findings. | Reason: eval PE size following TPA administration History: see above PULMONARY ARTERIES: Technically adequate examination. Significant interval resolution of filling defects in bilateral pulmonary arteries. Filling defect in the left lower lobe pulmonary artery extending into the subsegmental arteries. Filling defect causing complete occlusion of the lateral segment pulmonary artery of the right lower lobe. Main pulmonary artery caliber is within normal limits. Pulmonary artery catheter with tip in left main pulmonary artery.LUNGS AND PLEURA: New subpleural posterior left lower lobe opacity may represent a subacute infarct or less likely atelectasis.Interval resolution of peripheral ground glass opacity in the right middle lobe and right anterior upper lobe.MEDIASTINUM AND HILA: Heart size is normal. No evidence of right ventricular strain. Mildly enlarged mediastinal and hilar lymphadenopathy unchanged. No pericardial effusions.CHEST WALL: Sclerotic focus in the right scapula. Mildly enlarged right lower cervical lymph nodes unchanged.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Splenule adjacent to spleen. Hypodense lesion in the dome of the liver (series 12, image 23) is unchanged. | 1.Significant interval resolution of bilateral pulmonary emboli with residual filling defects at the left and right lower lobe segmental levels.2.New subpleural left posterior lower lobe ground glass opacity may represent an infarct or less likely atelectasis3.Interval resolution of right ground glass opacities. |
Generate impression based on findings. | 57-year-old male with lung cancer, follow-up exam CHEST:LUNGS AND PLEURA: Posttreatment change and scarring of the right upper lobe with volume loss and bronchiectasis appears similar to the prior study. Small right pleural effusion is unchanged.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality notedABDOMEN: Limited evaluation of solid organ pathology due to contrast phase.LIVER, BILIARY TRACT: Reference right hepatic lesion is not well visualized due to contrast phase. No new lesions are visualized.SPLEEN: Unchanged splenic venous thrombosis.PANCREAS: Atrophy of the pancreatic tail.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Symmetric bilateral contrast excretion. No hydronephrosis or hydroureter. No visualized ureteral stones.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: The prostate is enlarged.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality noted | 1. Posttreatment changes of the right upper lobe without evidence of new recurrence.2. Reference hepatic lesions are poorly visualized due to contrast phase, which was delayed due to technical malfunction.2. No hydronephrosis, hydroureter or ureteral stones. |
Generate impression based on findings. | 59-year-old male with history of metastatic prostate cancer status post 7 cycles of investigational therapy CHEST:LUNGS AND PLEURA: Right apical scarring, unchanged. Scattered micronodules unchanged. No suspicious nodules or masses. No pleural effusion. MEDIASTINUM AND HILA: Enlarged right hilar lymph node is unchanged measuring 1.6 x 1.3 cm (image 52; series 3). Unchanged subcentimeter mediastinal lymph nodes.. The heart size is normal without pericardial effusion.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Subcentimeter exophytic hypodensity in the left kidney is too small to characterize.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes throughout the spine.OTHER: No significant abnormality notedPELVIS: PROSTATE, SEMINAL VESICLES: Status post prostatectomy.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: Degenerative changes of the lumbar spine. No suspicious osseous lesions. | 1.Stable examination without definitive evidence of metastatic disease.2.Stable right hilar lymph node. |
Generate impression based on findings. | 44 year-old female with upper abdominal pain for 3 months and history of gallstone. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No cholelithiasis or right upper quadrant inflammation.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: Several upper normal sized mesenteric lymph nodes are identified, slightly more prominent than on the prior exam.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Multiple prominent mesenteric lymph nodes are identified.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No specific findings to account for the patient's abdominal pain. No visualized gallstones or right upper quadrant inflammation. Multiple prominent mesenteric lymph nodes are nonspecific but may be reactive in etiology. |
Generate impression based on findings. | 61-year-old male, pretransplant evaluation. ABDOMEN:LUNG BASES: Small pericardial effusion.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: Moderate atherosclerotic calcifications of the aorta and its branches most pronounced medially along the common iliac arteries with sparing of the external iliac arteries.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: The prostate is enlarged.BLADDER: The bladder is partially distended with apparent wall thickening.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality noted | 1. Moderate atherosclerotic calcifications of the aorta and its branches most pronounced medially along the common iliac arteries with sparing of the external iliac arteries.2. Small pericardial effusion. |
Generate impression based on findings. | IL-12 receptor beta1 deficiency with diffuse mycobacterial infection & interferon gamma pathway defect s/p PBSCT. There has been slight interval increase in size of the cervical lymph node, many of which are partially calcified. For example, a left level 2 lymph node measures 11 x 18 mm (series 5, image 62), previously 9 x 15 mm and a right level 2 lymph node measures 10 x 10 mm (image 55, series 5), previously 8 x 8 mm. The thyroid and major salivary glands are unremarkable. There is a left subclavian venous catheter. The major cervical vessels are otherwise patent. The imaged intracranial structures are grossly unremarkable. The osseous structures are unremarkable. There is persistent partially imaged segmental left upper lobe opacification. Please refer to the separate chest CT report for additional details. | 1. Mild interval increase in size of the cervical lymphadenopathy.2. Persistent partially imaged segmental left upper lobe opacification. Please refer to the separate chest CT report for additional details. |
Generate impression based on findings. | 72-year-old male patient. Pretransplant evaluation of aortic and iliac vessels. Note the lack of intravenous contrast limits evaluation of vasculature, lymph nodes in the solid viscera.ABDOMEN:LUNG BASES: Bibasilar scarring versus atelectasis.LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral hypoattenuating well-circumscribed lesions like represent simple and complex cysts.RETROPERITONEUM, LYMPH NODES: Mild to moderate atherosclerotic changes of the abdominal aorta. Bilateral external iliac arteries with mild atherosclerotic changes in the anterior walls. There are circumferential atherosclerotic changes immediately distal to the origin of the left external iliac artery.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumbar spine.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Prostatic calcifications.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumbar spine. Bilateral fat filled inguinal hernias.OTHER: Bilateral external iliac arteries with mild atherosclerotic changes in the anterior walls. There are circumferential atherosclerotic changes immediately distal to the origin of the left external iliac artery. | 1.Mild to moderate atherosclerotic changes in the abdominal aorta. Mild atherosclerotic changes involving the bilateral external iliac arteries.2.Bilateral simple and complex renal cysts. |
Generate impression based on findings. | 42 year-old female with head and neck cancer. CHEST:LUNGS AND PLEURA: Stable pulmonary micronodules, with largest located in left upper lobe measuring 4 mm (series 5, image 50). No new nodules identified. No consolidation or pleural effusions.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Hypodense lesion in left lobe of liver is not significantly changed accounting for differences in timing of contrast bolus; currently this measures 3.7 x 3 .7 cm, previously measured 3.7 x 3.6 cm (series 3, image 74).SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small, heterogeneous exophytic lesion containing fat in left kidney not significantly changed, measuring 12 mm, previously measured 11 mm (series 3, image 101). No new renal lesions identified.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: Multiple lucent lesions throughout the osseous structures are not significantly changed.OTHER: No significant abnormality noted. | 1.Stable pulmonary micronodules. No new nodules.2.Stable hypoattenuating lesion in left hepatic lobe.3.No significant change in benign appearing multiple lucent lesions throughout the osseous structures. |
Generate impression based on findings. | Reason: pt with lung ca s/p 2 newer cycles of chemo History: now needs disease evaluation compare to previous scans and comment CHEST: Limited exam due to motion artifact.LUNGS AND PLEURA: Interval increase in moderate left and mild right pleural effusion with overlying atelectasis and fluid tracking into the fissures. Postsurgical changes to the right upper lobe is again seen. Interval resolution of hydropneumothorax. Right upper lobe lesion previously measuring 24 x 23 mm now measures 25 x 24 mm (series 4, image 33).The left lower lobe nodule is no longer visualized due to increasing pleural effusion. Scattered additional micronodules not significantly changed.MEDIASTINUM AND HILA: Mild, necrotic appearing mediastinal lymphadenopathy unchanged in size. No pericardial effusion. Heart size is normal. Stenosis of the proximal left subclavian artery unchanged. Right reference paratracheal lymph node previously measuring 10 mm now measures 9 mm (series 3, image 34). Right hilar lymphadenopathy unchangedCHEST WALL: Lower cervical lymphadenopathy unchanged.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Interval increase in size and number of the metastases. No evidence of biliary ductal dilatation. Portal veins appear patent.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Nodular adrenal glands, left greater than right.KIDNEYS, URETERS: Multiple bilateral hypodense lesions.PANCREAS: No significant abnormality noted. RETROPERITONEUM, LYMPH NODES: Interval increase in size of a para-aortic iliac lymphadenopathy. Interval increase in porta hepatis lymphadenopathyBOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Sclerotic foci of the C6 -C7 vertebral bodies. Sclerosis and pathologic compression fracture of the T7 and T8 vertebral bodies. A lytic lesion in the T9, T12, L1, L3, L4 vertebral bodies. Lytic lesion in the spinous process of L4. Deformity of the anterior left sixth rib. Lytic lesion of the right sacrum and right iliac bone, the latter appears to have an impending pathologic fracture.OTHER: No significant abnormality noted. | 1.Interval increase in bilateral pleural effusions, left greater than right.2.Interval resolution of right hydropneumothorax.3.No significant change in right upper lobe mass. 4.Progression of metastatic disease and lymphadenopathy in the abdomen.5.Numerous lesions in the right iliac wing appears suspicious for impending pathologic fracture. |
Generate impression based on findings. | Malignant neoplasm of the extrahepatic bile ducts CHEST:LUNGS AND PLEURA: Subpleural reticulation and ground-glass opacities are unchanged. Scattered nonspecific calcified and noncalcified micronodules are unchanged. No pleural effusions or focal consolidation. MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. No axillary lymphadenopathy. Mild coronary artery calcifications. Normal heart size. No pericardial effusion. Coronary artery calcifications.CHEST WALL: Right chest port with tip at the cavoatrial junctionABDOMEN:LIVER, BILIARY TRACT: The poorly defined hilar mass splaying the portal vein bifurcation demonstrated best on the arterial phase is grossly unchanged in size from the prior measuring 4.3 x 2.5 cm (image 34; series 9). As noted briefly, this lesion enlarges and extends down the common bile duct. Bilobar intrahepatic biliary ductal dilatation is unchanged. The main portal vein remains patent. The right portal vein remains closely associated with the mass but appears patent. Two internal biliary drains within the right hepatic lobe are stable.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts are unchanged.RETROPERITONEUM, LYMPH NODES: Increasing lymphadenopathy. Reference aorta caval lymph node is larger measuring 1.9 by 1.0 cm (image 112; series 12). Reference caval lymph node is slightly larger measuring 1.8 x 1.2 cm (image 104; series 12). A third lymph node adjacent to the celiac axis (image 98; series 12) has also enlarged and measures 1.7 x 1.6 cm; previously this same node measured 0.9 x 0.9 cm (image 100; series 12; 7/24/2013 study). Atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace pelvic ascites is unchanged. | 1.Hepatic hilar mass is not grossly changed in size from the prior MRI. Stable intrahepatic biliary ductal dilatation. The portal vein appears patent.2.Enlarging abdominal lymph nodes. Reference measurements are given above.3.Subpleural reticulation and ground-glass opacities are unchanged. |
Generate impression based on findings. | 80 year-old female with lung cancer. CHEST:LUNGS AND PLEURA: Spiculated nodule in right lobe not significantly changed, measuring 14 x 9 mm, previously measured 16 x 9 mm (series 5, image 20). Pleural based spiculated nodule in the right upper lobe also not significantly changed, measuring 23 x 10 mm, previously 21 x 10 mm (series 5, image 35). The more inferior aspect of this lesion extending along right cardiophrenic angle slightly decreased in size (series 80316, image 46); this measures 16 x 28 cm, previously measured 19 x 28 cm.Multiple other nodules in both lungs are unchanged. No new nodules identified. Postsurgical changes in the right middle lobe. Bilateral basilar pleural thickening unchanged.Moderate centrilobular emphysema.MEDIASTINUM AND HILA: Interval increase in mediastinal lymphadenopathy. Subcarinal node measures 24 mm, previously measured 20 mm (series 80316, image 39). Reference right paratracheal node measures 20 mm, previously measured 18 mm (series 80316, image 33). Reference right internal mammary node not significantly changed, measuring 12 mm, previously measured 13 mm (series 80316, image 25).Reference left hilar node not significant changed, measuring 15 mm, previously measured 16 mm (series 80316, image 43).CHEST WALL: Increase in bilateral axillary lymphadenopathy, with interval progression of central necrosis of many axillary nodes. Reference right axillary node measures 15 mm, previously measured 13 mm. Previously measured left axillary node is not completely included in the field of view.Sclerotic lesion in anterior right sixth rib appears 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 hypodensities appear unchanged, most consistent with cysts. Small amount of fluid around the kidneys is unchanged.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mild increase in bulky retroperitoneal lymphadenopathy. Reference conglomerate of nodes below level of kidneys measures 5.5 x 2.5 cm, previously measured 5.0 x 2.3 cm (series 80316, image 118). Reference gastrohepatic node measures 16 mm, previously measured 16 mm (series 80316, image 81). Reference left periaortic node measures 16 mm, previously measured 13 mm (series 80316, image 101).Severe atherosclerotic calcifications affect the aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Multiple enlarged mesenteric lymph nodes.BONES, SOFT TISSUES: Severe degenerative changes affect the lower lumbar spine.OTHER: No significant abnormality noted. | 1.No significant change in lung lesions.2.Increase in mediastinal, axillary, and retroperitoneal adenopathy. |
Generate impression based on findings. | Viral URI symptoms after Mexico trip in July assess for interval clearance. Cough. LUNGS AND PLEURA: Scarring in the upper lobes bilaterally. Minimal residual atelectasis in the right middle lobe medial segment with internal bronchiectasis. No pleural fluid or pneumothorax. Interval clearing of diffuse bronchiolitis and areas of subpleural consolidation on the outside prior study. Minimal residual scattered foci of bronchial wall thickening and minimal distal endobronchial debris.MEDIASTINUM AND HILA: Normal heart size. Coronary artery calcifications. Faint calcification of the aortic valve noted. Small hiatal hernia. Calcified lymph nodes in the region of the right hilum.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. Cholecystectomy clips. Granulomas in the liver. Vascular calcifications in the spleen and at the origin of the left renal artery. | Interval resolution of bilateral areas of subpleural consolidation. Near complete resolution of of airway abnormalities with mild residual distal endobronchial debris and bronchial wall thickening. |
Generate impression based on findings. | 74-year-old male with history of cholangiocarcinoma presents for restaging. CHEST:LUNGS AND PLEURA: Scattered pulmonary micronodules are not typically changed in size or number. No suspicious pulmonary masses or nodules. No pleural effusions.MEDIASTINUM AND HILA: Mediastinal or hilar lymphadenopathy. Severe coronary artery atherosclerotic calcification. Normal cardiac size without pericardial effusion.CHEST WALL: Bilateral gynecomastia. Small bilateral axillary lymph nodes. Lucency in upper thoracic vertebra (image 44; series 80440) is stableABDOMEN:LIVER, BILIARY TRACT: Three metallic biliary stents. Right hepatic lobe biliary ductal dilatation has regressed slightly. Left hepatic lobe pneumobilia indicating left biliary tree stent patency. Perihepatic ascites has resolved. Persistent thrombosis of the anterior branch of the right portal vein. There is a subcapsular enhancing region in the dome of the right lobe liver (image 8; series 80440) which may reflect fluid redistributions secondary to portal vein occlusion; suggest continued follow-up of this area on subsequent exams.SPLEEN: No significant abnormality notedPANCREAS: Scattered punctate calcifications within the pancreas. ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Moderate atherosclerotic calcification of the abdominal aorta and the iliac vessels without aneurysmal dilatation. Subcentimeter retroperitoneal lymph nodes are stable..BOWEL, MESENTERY: Multiple small subcentimeter mesenteric lymph nodes are similar in size.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: Sigmoid diverticulosis without pericolonic inflammatory changes.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No substantial interval change compared to prior with the exception of an enhancing area in the dome of the right lobe which should be followed. See above for discussion. |
Generate impression based on findings. | 72-year-old male with metastatic renal cell cancer CHEST:LUNGS AND PLEURA: Unchanged reference right middle lobe nodule measures 1.4 x 1.2 cm and previously measured 1.4 x 1.1 cm (image 62, series 4).Multiple additional nodules are unchanged. New scattered ground glass opacities may represent edema or treatment effect.MEDIASTINUM AND HILA: Reference right hilar lymph node measures 2.9 x 2.8 cm and previously measured 2.7 x 2.9 cm (image 45, series 3). Corner vascular calcifications and vascular stents are again noted.CHEST WALL: The chest wall pacemaker.Right chest wall nodule measures 2.1 x 2.8 cm and previously measured 2.1 x 2.8 cm (image 80, series 3).ABDOMEN:LIVER, BILIARY TRACT: . Calcified granulomas are again noted. No focal hepatic lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Right adrenal gland nodules appear similar similar to the prior study, not fully characterized on this noncontrast exam.KIDNEYS, URETERS: The left kidney is absent. Right renal cysts are unchanged.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes in the lumbar spine, and levoscoliosis, unchanged.OTHER: Mild atherosclerotic calcifications of the abdominal aorta and its branches. | Unchanged reference lesions without new evidence of metastatic disease. New scattered pulmonary ground glass opacity, which may represent edema/treatment effect. |
Generate impression based on findings. | Reason: PT with hx of HNC s/p CRT History: has new cough LUNGS AND PLEURA: Large right upper lobe granuloma and scattered benign appearing micronodules are unchanged.There is no evidence of pulmonary or pleural metastases.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.Incidental note is made of an aberrant right subclavian artery.Moderate coronary calcifications are present.CHEST WALL: Mild degenerative changes affect the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Small right renal cyst. | No evidence of metastases, or other significant abnormality. |
Generate impression based on findings. | Esophageal perforation. LUNGS AND PLEURA: Dependent atelectasis bilaterally in the posterior lung fields. Patchy faint areas of atelectasis and air space opacity in the posterior right upper lobe most suggestive of sequela of prior aspiration event.MEDIASTINUM AND HILA: Trace pneumomediastinum near the level of the thoracic inlet on the right. A stent traverses the distal esophageal mass. Cranial to level of the stent, there is short segment of esophageal thickening causing shouldering and possible occlusion cranial to the stent. A feeding tube traverses the stent and then enters the upper abdomen, incompletely included in the scanning range. Large volume of debris and air surrounds the proximal portion of the nasogastric tube above the level of the stent. Right PICC tip at the SVC/RA junction.Mild paratracheal lymphadenopathy, minimally more prominent. Subcarinal lymphadenopathy minimally more prominent. The distal anastomosis is surrounded by atelectatic lung and soft tissue stranding similar in appearance to the prior examination. Mildly enlarged lymph node adjacent to suprahepatic inferior vena cava is similar in size.CHEST WALL: Fragmented ossified left glenohumeral "joint mouse".UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Postsurgical changes upper abdomen. | Trace right superior pneumomediastinum without visible site of origin. Large amount of air and debris in the proximal thoracic esophagus above the level of the stent with shouldering. Soft tissue just above the level of the stent likely representing tumoral encasement. |
Generate impression based on findings. | Prematurity (born at 25-26 weeks) with history of BPD, NEC with bowel perforation, PDA, GERD and hydrocephalus s/p reinsertion of VP shunt. There is has been interval removal of a right transfrontal ventricular catheter and insertion of a left transparietal ventricular shunt that terminates in the midline of the lateral ventricles. There is a small amount of pneumoventricle and hyperdense material layering within the right occipital horn, which likely represent hemorrhage from recent shunt insertion. There has been interval increase in size of the lateral and fourth ventricles as well as marked dilatation of the bilateral foramina of Luschka and marked thinning of the brain parenchyma, including compression of the brainstem. There is interval development of a cystic cavity in the left basal ganglia that measures up to 23 mm, which partially effaces the third ventricle. Otherwise, there is no significant change in the left parieto-occipital porencephalic cyst. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. There is a small amount of fluid in the right parietal scalp surrounding the cathter insertion site. | Interval ventricular catheter exchange with a small amount of intraventricular hemorrhage. Interval development of a left basal ganglia porencephalic cyst that measures up to 23 mm with partially effacement of the third ventricle and interval increase in size of the lateral and fourth ventricles. In particular, the fourth ventricle may be trapped.Discussed with Dr. Warnke at 12:00 on 11/15/13. |
Generate impression based on findings. | Malignant neoplasm of lower lobe. Status post 15 month after right lower lobectomy for management of T1bN0M0 stage IB adenocarcinoma. Three month follow-up. Also has history of GIST. LUNGS AND PLEURA: Right lower lobe wedge resection. Emphysema. Right pleural fluid collection is smaller. Scattered pulmonary nodules not significantly changed. Left lower lobe solid nodule unchanged at 6-mm in size dating back to at least 7/17/12 (4/201). This has angulated margins and an appearance suggestive of an intrapulmonary lymph node. An additional solid micronodules in the left lower lobe (4/22 is also stable in size dating back to 7/2012. Scar-like opacities adjacent to an area of emphysema in the periphery of the left upper lobe is not conclusively changed(5/34). Groundglass nodule left lower lobe previously 2-3mm in size and not conclusively changed (4/174). Persistent focal area of bronchial wall thickening posterior left lower lobe (4/194) unchanged. Hazy groundglass opacity in the medial aspect of the right apex (4/66) not measurable but unchanged since 7/2012. This should be monitored to differentiate a benign AAH from a small AIS/MIA.MEDIASTINUM AND HILA: Postsurgical changes of a right thyroidectomy. Atherosclerotic calcifications. Left atrium is enlarged. No significant lymphadenopathy.CHEST WALL: Mildly enlarged left low cervical lymph nodes up to 9mm in size unchanged. Left subpectoral lymph node slightly larger 9-mm compared to 6-mm on the prior study.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Suture line along the lesser curvature of the stomach. Please refer to dedicated abdominal CT of the same date for further findings. | No signs of localized recurrence near the right lower lobe resection site. Mildly enlarged contralateral low cervical and subpectoral lymph nodes are of unclear significance. Pulmonary nodules are stable in appearance, favoring benign lesions. |
Generate impression based on findings. | History of head and neck cancer (supraglottic). Post chemo- and radiotherapy for reassessment. There is soft tissue thickening and edema demonstrated within the hypopharyngeal and supraglottic regions in a mucosal and submucosal distribution resulting in significant narrowing of the supraglottic airway (unchanged). The epiglottis is thickened as result of edema and fat planes within the supraglottic neck are obscured. There is dermal thickening and stranding of subcutaneous fat in keeping with edema. Muscles of the supraglottic neck are also enlarged, presumably on the basis of edema. Each of these findings most likely represent posttreatment changes.There is no pathologic lymphadenopathy. The limited portion of the sinuses and posterior fossa included in the field of view is unremarkable. There are no aggressive bony lesions demonstrated, though there is significant multilevel spinal stenosis on the basis of posterior longitudinal ligament calcification in addition to anterior longitudinal in calcification and degenerative change. | 1.Post therapeutic changes including extensive subcutaneous, scular and mucosal/submucosal edema resulting in unchanged narrowing of the supraglottic airway without CT evidence of active disease.2.Unchanged multilevel spinal stenosis on the basis of ligamentous calcification with superimposed degenerative change. |
Generate impression based on findings. | Chest pain, tachycardia, elevated d-dimer. Evaluate for PE. PULMONARY ARTERIES: Technically diagnostic quality exam with no evidence of acute pulmonary embolus.LUNGS AND PLEURA: Mild dependent and basilar atelectasis.MEDIASTINUM AND HILA: Abrupt change in caliber of the thoracic aorta along the distal aspect of the arch. The ascending aorta measures up to 4-cm in AP dimension (7/121). The proximal descending thoracic aorta measures 2.7-cm in AP dimension. This is radiographically consistent with a pseudocoarctation given lack of collateral arterial vessel opacification. Common origin of the carotid arteries and right subclavian artery.Moderate cardiomegaly.Right hilar lymphadenopathy 2.2-cm (7/128).Prominent perihilar and subcarinal lymphatic tissues bilaterally, right greater than left. No pericardial fluid. The distal esophagus near the GE junction appears to have a mild concentric wall thickening measuring 19 x 29 mm in transaxial dimensions. There is a mildly enlarged right paraesophageal lymph node (7/211) nearby.Mildly enlarged right cardiophrenic lymph node (7/201).CHEST WALL: Mildly prominent left lower cervical lymph node. No evidence of the dilatated intercostal vasculature.Sclerosis in the T6 through T8 vertebral bodies. The T6 and T8 sclerosis occurs near the endplate however the T7 sclerosis at is more diffuse in nature.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Nonenlarged lymph nodes in the gastrohepatic ligament. | 1.No evidence of acute pulmonary embolus.2.Concentric wall thickening of the distal esophagus is nonspecific by CT however the presence of adjacent mildly enlarged lymph nodes could indicate an inflammatory or neoplastic process. Consider correlation with endoscopy.3.Lymphadenopathy in the region of the right hilum and subcarinal space.4.Pseudocoarctation of the aorta. This should be correlated with physical examination.5.Fairly extensive sclerosis within T6-T8 vertebral bodies appears slightly atypical in distribution although there are degenerative osteophytes present at these levels. Query history of prior chest radiation therapy which may produce this appearance. Metastatic disease is considered less likely but cannot be excluded if the patient has a history of known neoplasm.6.The above findings and recommendations were discussed with and acknowledged by the ED resident at extension 4-541 at the time of dictation. |
Generate impression based on findings. | 61 years old female with base of tongue cancer, status post CRT. The orbits are unremarkable. The paranasal sinuses and mastoid air cells are clear. Limited view of the intracranial structure is unremarkable. Mild deformity affecting the left base of tongue is not significantly changed. No mucosal based mass lesions are seen.No pathologic adenopathy is identified by CT size criteria. Reference right jugulodigastric node measures 5 x 5 mm (image 75, series 4), unchanged. Reference left jugulodigastric node measures 5 x 5 mm (image 79, series 4), unchanged.The salivary glands and thyroid are free of concerning lesions. No significant vascular abnormalities are detected. Lung apices are clear. No destructive bony lesions. Sclerotic focus in the C3 vertebral body is stable. | Stable examination with no evidence of recurrent disease or lymphadenopathy. |
Generate impression based on findings. | Back pain. Bony abnormality. There are extensive changes related to prior surgery including fusion of T10-S1. There are transpedicular screws at each level except L3 and through the right pedicle of T12 including within the iliac bones bilaterally. There are bilateral rods which are encased in bone from bony fusion of the posterior elements spanning T9-S1. There is a lead from a stimulator which accesses the spinal canal at the T12-L1 interspace and ascends within the canal to the L4-5 level. There are no findings suggesting device complication.Visualization of bony structures is limited due to streak artifact from hardware. Within this limitation there is severe osteopenia. Alignment is unchanged from previous with accentuation of the lumbar lordosis and an unchanged grade 1 spondylolisthesis (8 mm) at the L4-5 level. There is loss of vertebral body height posteriorly at the L3 level and multilevel disk calcification with fusion of vertebral bodies at T12-L1 and T8-9. There is moderate narrowing of the spinal canal and bilateral neural foramina at the level of the spondylolisthesis (L4-5) which is unchanged from previous. There is no spinal or neural foraminal stenosis elsewhere. There is no acute fracture. | 1.Extensive postoperative changes which limit assessment as described. 2.Unchanged moderate spinal canal and neural foraminal stenosis at L4-5 on the basis of grade 1 spondylolisthesis, likely degenerative. 3.No acute pathology including fracture. |
Generate impression based on findings. | Pleural mass. Please compare to previous CT scan of 5/2013. Patient did have a chest tube placed on the left after the CT scan of 10/2012. LUNGS AND PLEURA: Left posterior pleural soft tissue lesion at the level of the ninth/tenth rib interspace has decreased in size, currently measuring 7 x 15 mm, previously 10 x 23 mm. The interval decrease in size strongly favors a benign lesion. Previously seen adjacent subpleural soft tissue stranding and nodularity persists but there is no intercostal lymphadenopathy.Interval development of an 8mm peribronchial nodule the right upper lobe posterior segment (5/35). This is irregularly marginated and contains internal Hounsfield units consistent with soft tissue and lipid attenuation. Numerous adjacent small endobronchial filling defects appear chronic. A nearby 3-mm micronodule (5/36) is unchanged compared to the patient's earliest exam from10/2012.Bilateral subpleural linear and nodular opacities are unchanged compared to the most recent previous scan.MEDIASTINUM AND HILA: Small mediastinal lymph nodes are unchanged. Normal heart size. Moderate coronary artery calcifications. No pericardial fluid. Normal caliber of the main pulmonary artery.CHEST WALL: Retained chest port antibiotic cuff in the soft tissues of the right anterior chest wall (3/14).UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. Cholecystectomy clips. Lymph nodes in the porta hepatis region difficult to see given the paucity of intra-abdominal fat. Cirrhotic liver morphology. | 1. Interval decrease in size of left posterior pleural mass, strongly favoring a benign lesion. Follow up to complete radiographic resolution is suggested.2. Interval development of an 8mm irregular nodule in the right upper lobe. 3 to 6 month CT follow-up recommended. Dr. Gottlieb (9498) verbally notified. If the patient has chronic obstructive bronchiolitis, this could be the result of endogenous lipoid pneumonia however the appearance is atypical. Given the patient's history of prior chemotherapy follow-up to resolution is recommended.3. Chronic peripheral nodular opacities in the upper lung zones with areas of endobronchial impaction. This may be post inflammatory however chronic obstructive bronchiolitis or sarcoidosis could have a similar radiographic appearance. |
Generate impression based on findings. | Male, 65 years old, history of tongue cancer, status post CRT. Treatment related findings are redemonstrated including infiltration of the fascial planes and supraglottic mucosal edema. Similar findings are seen on the prior exam. No evidence of recurrent tumor or pathologic adenopathy is seen.Salivary glands and thyroid are free of focal lesions. The anterior aspects of the IJ veins again fail to opacify. Vessels are otherwise unremarkable. Lung apices are unremarkable. No concerning osseous lesions are seen. Since the prior examination, a left maxillary dental post has been removed. | Redemonstration of treatment related findings in the neck with no evidence of recurrent disease. |
Generate impression based on findings. | Reason: h/o salivary gland cancer History: eval for chest mets LUNGS AND PLEURA: Benign-appearing micro-nodule, without evidence of pulmonary or pleural metastases.MEDIASTINUM AND HILA: Calcified right hilar lymph nodes, but no significant abnormality. CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | No evidence of metastases, or other significant abnormality. |
Generate impression based on findings. | Male 42 years old; Reason: AAA, appy History: chest pain, abd pain - pt unable to receive IV or oral contrast ABDOMEN:LUNGS BASES: Heart size is enlarged. Cardiac pacer leads.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No nephrolithiasis or hydronephrosis in either kidney.RETROPERITONEUM, LYMPH NODES: Multiple retroperitoneal lymph nodes mostly within the pelvis. For example, a left common iliac lymph node measures 1.3 x 0.9 cm (image 84/series 3). No retroperitoneal hematoma.Abdominal aorta is normal in caliber.BOWEL, MESENTERY: Small bowel is normal in caliber. Appendix is normal in caliber in the right lower abdomen without surrounding inflammatory changes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Multiple small pelvic and inguinal nodes.BOWEL, MESENTERY: Small ventral abdominal hernia containing a loop of small bowel without obstruction, unchanged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Normal caliber of the abdominal aorta without retroperitoneal hematoma.2.No findings of appendicitis.3.No renal or ureteral calculi.4.Multiple small pelvic and retroperitoneal lymph nodes which are abnormal in number. |
Generate impression based on findings. | Reason: hx H\T\N ca, post CRT, evaluate dx and compare measurements to previous scans History: as above CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.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: Small right renal cyst.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No evidence of metastases, or other significant abnormality. |
Generate impression based on findings. | Reason: eval for pe History: as abovr PULMONARY ARTERIES: No pulmonary embolus to the subsegmental level.LUNGS AND PLEURA: Opacities of subsegmental atelectasis. No pleural effusion.MEDIASTINUM AND HILA: The heart size is normal. No pericardial effusion.No mediastinal or hilar lymphadenopathy.CHEST WALL: No axillary lymphadenopathy.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | No evidence of pulmonary embolus. |
Generate impression based on findings. | Female, 47 years old, bilateral thyroid cysts. The thyroid gland demonstrates normal size and morphology and shows homogeneous enhancement characteristics. No cystic lesions are evident within or around the gland.Bubbly soft tissue material is evident within the vallecula which likely represents trapped secretions. The aerodigestive tract is otherwise within normal limits. No pathologic adenopathy is detected by size criteria. The salivary glands are free of focal lesions. The cervical vessels are patent and normal. No concerning osseous lesions are seen. There is a posterior disk-osteophyte complex at C5-6 which mildly indents the ventral thecal sac. Presumed scleral buckle is partially visualized on the left. | No evidence of cystic thyroid lesions or other specific abnormalities of the thyroid gland. |
Generate impression based on findings. | 69-year-old male patient with left lower quadrant abdominal pain, cramping and diarrhea. Note that the lack of intravenous contrast limits evaluation of vasculature, lymph nodes and solid viscera.ABDOMEN:LUNG BASES: No significant abnormalities in the posttransplant right lung. Left lung with extensive honeycombing, fibrosis and volume loss.LIVER, BILIARY TRACT: Scattered punctate calcifications consistent with prior granulomatous disease.SPLEEN: Scattered punctate calcifications consistent with prior granulomatous disease.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic changes in the abdominal aorta and iliac arteries.BOWEL, MESENTERY: No significant abnormality noted. BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumbar spine with dextroscoliosis of the lumbar spine. Posterior fusion hardware in place involving the L5 and S1 vertebral bodies.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Bowel normal in caliber without wall thickening. Beam hardening artifact limits complete evaluation of the pelvis.BONES, SOFT TISSUES: Status post bilateral hip arthroplasty causing beam hardening artifact in the pelvis.OTHER: No significant abnormality noted. | No CT evidence of bowel pathology to explain patient's symptomatology. |
Generate impression based on findings. | 60 year-old male with metastatic renal cancer CHEST:LUNGS AND PLEURA: Multiple pulmonary nodules are not significantly changed in size. Reference left lower lobe nodule measures 1.1 x 1.2 cm (image 25 series 5) and previously measured 1.2 x 1.2 cm. Interval improvement of right basilar consolidation and removal right mainstem bronchus stent.MEDIASTINUM AND HILA: Unchanged mediastinal lymphadenopathy. Reference AP window lymph node measures 1.2 x 0.9 cm (image 40, series 3) and previously measured 1.1 x 0.9 cm. Small pericardial effusion. The heart size is normal.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Scattered, unchanged hypodensities, too small to characterize.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Unchanged left adrenal mass measuring 1.2 x 2.6 cm and previously 1.2 x 2.1 cm (image 104, series 3).KIDNEYS, URETERS: Heterogeneous left renal mass measures 6.5 x 9.5 cm and previously measured 6.1 x 10 .3 cm, not significantly changed (image 113, series 3).RETROPERITONEUM, LYMPH NODES: Small unchanged retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small umbilical hernia containing small bowel.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: The prostate is enlarged.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 | Multiple metastatic lesions and renal mass as detailed above without significant interval change. |
Generate impression based on findings. | Reason: lung cancer History: lung cancer s/p resection LUNGS AND PLEURA: Postsurgical findings reflect prior left upper lobectomy. Right-sided volume loss as a result of radiation exposure. Stable bronchial impaction throughout the left lower lobe with diffuse2 left-sided granulomas. Scarlike opacity at the right cardiophrenic angle no longer visualized.Previously described nodular area of interstitial thickening in the posterior aspect of the left lower lobe has increased, currently measuring 12 mm transverse (series 4 image 115). Using similar measurement technique on prior study, this was 7 mm (series 6 image 119). This is highly suspicious for adenocarcinoma in situ orminimally invasive adenocarcinoma.MEDIASTINUM AND HILA: The heart size remains normal. Stable circumferential pericardial thickening or trace effusion. Extensive atherosclerotic disease involving the thoracic aorta. Mild calcifications only aortic valve and coronary arteries.No mediastinal lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Stable L1 compression fracture. Nodularity of the left adrenal gland is unchanged compared to 2008. Limited visualization of the superior poles of the kidneys are visualized. Left hydronephrosis with a loop of catheter visualized in the superior collecting system. Gas is again noted within the right collecting system. | Focus of interstitial thickening within the posterior aspect of the left lower lobe has increased in the size. This is highly suspicious for adenocarcinoma in situ or minimally invasive adenocarcinoma.No mediastinal lymphadenopathy |
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