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Generate impression based on findings. | 69-year-old male with history of recurrent hypopharyngeal squamous cell carcinoma, on therapy, reevaluate Head: The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, midline shift, intra- or extra-axial fluid collection/gross acute hemorrhage, or abnormal contrast enhancement. Stable CSF density extra-axial lesion along the inferior left frontal lobe with associated calvarial scalloping which is compatible with an arachnoid cyst.The orbits are unremarkable. Similar to the prior, there is near complete opacification of the right maxillary sinus and moderate patchy opacification of the ethmoid air cells.Neck: Interval increase in the size of the large nodal conglomerate centrally necrotic mass centered in the right retropharyngeal and carotid spaces. This mass measures 5.6 x 4.6 x 6.3 cm (series 6 image 19, series 80471 image 67), previously measured 4.3 x 4.0 x 6.0 cm. Multiple additional enlarged necrotic lymph nodes have increased in size in the right neck. Similar to the prior, there is complete encasement of the upper cervical right internal carotid artery at the levels of the mass as well the branches of the right external carotid artery. The right internal carotid artery remains patent and similar in caliber to the most recent comparison study. Interval increase in effacement of the right internal jugular vein which is slitlike but remains patent throughout its course. Asymmetry and soft tissue fullness of the right fossa of Rosenmuller, unchanged. The tumor invades the posteromedial margin of the right pterygoid muscle, abuts the medial aspect of the right parotid gland as well as the right C2 and C3 vertebrae. The cervical segment of the right vertebral artery abuts a portion of the mass, but remains patent throughout its course. The major left cervical vasculature is patent.Although exact measurements are difficult to accurately produce, the heterogenous mass centered at the level of the larynx appears similar in size to the prior examination measuring 3.8 x 5.3 cm (series 6 image 34), previously measured 3.4 x 5.2 cm. Asymmetric sclerosis of the left thyroid cartilage with diminutive appearance posteriorly is similar to prior. Tracheostomy tube in place.Salivary glands and thyroid gland are unremarkable.The reference left level 3/4 lymph node measures 3.5 x 2.7 cm (series 6 image 39), previously measured 3.0 x 2.6 cm. Additionally, there has been interval development of a new prominent necrotic lymph node anterior to this reference lesion.The non-necrotic left level IIa lymph node measures 1.8 x 1.3 cm (series 6 image 17), previously measured 1.9 x 1.4 cm.Partially visualized right chest port. Redemonstration of bilateral pulmonary nodules some of which are cavitary. Tracheal debris. Please see dedicated chest CT for further details. Multilevel degenerative changes of the visualized cervicothoracic spine without destructive osseous lesions. | 1. Interval increase in size of large right necrotic conglomerate neck mass and bilateral cervical lymphadenopathy. The right cervical vessels are encased but remain patent.2. No evidence of intracranial metastases.3. Bilateral pulmonary nodules some of which are cavitary. Please see dedicated chest CT from today's date for further details. |
Generate impression based on findings. | Facial myxoid sarcoma LUNGS AND PLEURA: No distinct nodules seen. No focal airspace opacities or pleural effusions.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Normal sized heart without pericardial effusion.CHEST WALL: No osseous or soft tissue abnormality. No axillary lymphadenopathy. Left chest port with tip at the superior cavoatrial junction.UPPER ABDOMEN: 1.1 cm round hypoattenuating focus in segment 7 of the liver, which is incompletely evaluated on this exam. | Non-specific 1.1 cm hypoattenuating focus in segment 7 of the liver. This is not fully evaluated on this non-contrast examination and dedicated liver imaging with ultrasound or contrast-enhanced CT or MR is recommended. |
Generate impression based on findings. | Reason: s/p 13 yrs after lobectomy with extrapleural resection of carcinoma in 2000 for management of T3N0M0 stage IIB poorly differentiated squamous cell carcinoma History: new right upper lobe pulmonary nodule LUNGS AND PLEURA: Left hemithorax post surgical changes. Stable severe centrilobular emphysema with large bulla in the left apex. Dystrophic calcification in the right apex with decreasing soft tissue component (series 5, image 20) compared to prior exam. Multiple calcified granulomas in the right lung.Paramediastinal consolidation and traction bronchiectasis is again noted. No additional suspicious pulmonary nodules or masses. No pleural effusions. Interval decrease in size of left medial, lower lobe pleural based nodule previously measuring 23 x 10 mm now measures 21 x 8 mm (series 5, image 92).MEDIASTINUM AND HILA: Heart size is normal. Small stable pericardial effusion. Calcified hilar and mediastinal lymph nodes, unchanged.CHEST WALL: Sclerotic focus in the right side of the C6 vertebral body. Near complete collapse of the T7 vertebral body, unchanged. Superior endplate depression of the T5 vertebral body. Stable left lateral fifth rib deformity. Punctate calcification in the right breast unchanged. Scattered small lower cervical lymph nodes. Anterior cardiophrenic lymph nodes unchanged. Mildly enlarged left axillary lymph nodes unchanged in size.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.Slight interval decrease of soft tissue component of the right apical dystrophic calcification.2.Slight interval decrease in size of the left lower lobe pleural based nodule. |
Generate impression based on findings. | HPT re-op outside nuclear scan will be submitted. Please help to localize parathyroid adenoma There are several nodules present in the soft tissues of the lower neck . Their locations and serial Hounsfield units on dynamic CT or listed below along with some density units of normal structures:Houndsfield units through nodules (0seconds, 25 seconds, 55 seconds, 85 seconds):Right thyroid (image # )::Right Carotid artery (image # 50 ):: 54.0HU, 268.2HU, 116.7HU, 112.4HURight Jugular vein (image # 50 ):: 42.0HU, 168.0HU, 160.0 HU, 135.6HURight submandibular gland (image # 33): 34.7HU, 94.0HU, 105.4HU, 93.9HURight sternocleidomastoid muscle: (image # 37 ): 70.7 HU, 63.5HU, 66.5 HU, 60.9HULymph node right jugulodigastric (image# 25) 23.6HU, 92.1HU, 111.4HU, 114.2HU7x17mm Nodule anterior to T1 vertebra to the right and adjacent to the esophagus (image # 49): 61.04HU, 190.55HU, 159.68HU, 139.73HU3mm nodule behind left side of larynx at the level of the cricoid (image #44): 20.8HU, 20.5HU, 58.0HU, 41.8HUCT neck:Within the suprahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated. Within the infrahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated.Within the visceral space the thyroid gland has been removed. Surgical clips are present in the thyroid bedThe airway appears patent.The visualized intracranial structures which include the posterior fossa are intact. The visualized portions of the orbits and paranasal sinuses are intact. The mastoid air cells are clear. There is mucosal thickening in the right maxillary sinus. The ethmoid air cells and frontal sinuses and the upper parts of the maxillary sinuses are not included on this exam.The parotid and the submandibular glands appear intact.The visualized lung apices appear clear.The carotid and vertebral vasculature visualized on this exam appears intact.The cervical vertebral bodies in general are intact with no evidence for canal stenosis. There are degenerative changes present in the cervical spine with facet hypertrophy predominantly on the left side at C2-3 C3-4 and C4-5Parathyroid sampling:Intraprocedural images demonstrate the location of venous sampling.Reported PTH, Intact values (REF 15-75 pg/mL):FEMORAL VEIN: 126SUPERIOR VENA CAVA: 249INNOMINATE VEIN JUNCTION: 224 LEFT INNOMINATE VEIN: 233LEFT INTERNAL JUGULAR VEIN, LOWER: 136LEFT INTERNAL JUGULAR VEIN,MID: 133LEFT INTERNAL JUGULAR VEIN, UPPER: 139RIGHT INTERNAL JUGULAR VEIN, LOWER: 468RIGHT INTERNAL JUGULAR VEIN, MID: 179RIGHT INTERNAL JUGULAR VEIN, UPPER: 153 | 1.There is a 7x17 mm nodule located anterior to the T1 vertebral body and adjacent and to the right of the esophagus which is suspicious for parathyroid adenoma. Venous drainage corresponds to the elevated PTH levels.2.Parathyroid venous sampling. |
Generate impression based on findings. | Reason: tongue cancer History: r/o lung mets LUNGS AND PLEURA: No pulmonary or pleural metastases.Previously reported 8mm ground glass nodule no longer seen.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | No sign of metastases, or other significant abnormality. |
Generate impression based on findings. | Lung nodules. History of prostate adenocarcinoma. LUNGS AND PLEURA: Numerous pulmonary micronodules and subpleural/intrapulmonary lymph nodes are noted bilaterally. Reference lesion in the right middle lobe has an appearance consistent with an intrapulmonary lymph node, again measuring 4-mm in size (5/60). Similarly, the reference left lower lobe nodule measures 5-mm and is angular margins, also suggestive of an intrapulmonary or subpleural lymph node, stable. A small area of rounded atelectasis associated with pleural scarring from and adjacent rib abnormality is chronic and unchanged. Scarring in the right apex is slightly nodular but unchanged. Scattered punctate calcified micronodules are most consistent with granulomas. Pseudo-nodules from focal endobronchial impaction are also appreciated. No new or suspicious lesions. No pleural fluid.MEDIASTINUM AND HILA: Surgical clips in the right thyroid bed. Left thyroid gland and isthmus are unchanged in appearance. Severe coronary artery calcifications. Normal heart size. No lymphadenopathy.CHEST WALL: Degenerative change of the spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. Cyst in the apex of the left kidney. Subcentimeter hypoattenuating lesions in the liver most likely represent cysts but are too small to be characterized. Cholecystectomy clips. There appears to be a spilled gallstone along the posterior margin of the liver (3/98), unchanged in appearance. | Benign appearing pulmonary micronodules and intrapulmonary/subpleural lymph nodes are unchanged over one year strongly favoring benign lesions. Additional one year follow-up may be obtained in 11/2014 or as clinically warranted to exclude growth. |
Generate impression based on findings. | 69 year-old female, assess for metastatic endometrial adenocarcinoma evaluate response to hormones. CHEST:LUNGS AND PLEURA: Interval decrease in pleural nodularity and resolution of right pleural effusion. Right middle lobe nodule measures 1.7 x 1.5 cm and previously measured 1.9 x 1.3 cm (image 71, series 5). Additional pulmonary nodules are suspicious for metastatic disease.MEDIASTINUM AND HILA:Right superior mediastinal lymph node is decreased in size and measures 1.2 x 1.6 cm and previously measured 2.4 x 2.2 cm (image 31, series 3). Additional mediastinal and hilar lymphadenopathy is reidentified. Atherosclerotic calcifications of the coronary arteries.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral hypodensities, too small to characterize.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Absent.BLADDER: No significant abnormality noted.LYMPH NODES: Subcentimeter iliac lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Metastatic disease involving the pleura and mediastinum with interval decrease in pleural nodularity, mediastinal lymphadenopathy and resolution of right pleural effusion. |
Generate impression based on findings. | 60-year-old male patient with melanoma. Restaging scan. CHEST:LUNGS AND PLEURA: Scattered bilateral micronodules are increased in number compared to prior examination and remain less than 3 mm in diameter. Calcified pleural plaques are stable compared to prior examination.MEDIASTINUM AND HILA: No mediastinal lymphadenopathy.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Hypoattenuating lesion adjacent to the porta hepatis measures 1.0 x 1.0 cm (series 3 image 90), previously 1.5 x 1.5 cm. Subcentimeter hypoattenuating lesion in the dome of the liver is stable compared to prior examination and is too small to characterize.Gallbladder is absent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal subcentimeter hypoattenuating lesion is stable compared to prior examination and likely represents a cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis without CT evidence of diverticulitis.BONES, SOFT TISSUES: Mild degenerative changes in the thoracic and lumbar spine.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: Bilateral bladder diverticula, stable.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Mild degenerative changes in the thoracic and lumbar spine. Degenerative changes of the bilateral hips.OTHER: No significant abnormality noted. | Increased number of scattered pulmonary micronodules are remain less than 3 mm in diameter. Recommend continued follow-up. |
Generate impression based on findings. | Female 52 years old; Reason: F s/p RYGB, now s/p small bowel bypass of JJ anastomosis, and POD4 s/p washout with increasing leukocytosis. Assess for pathology/abscess History: Nausea, leukocytosis ABDOMEN:LUNG BASES: Subsegmental atelectasis in both lower lobes. Small left pleural effusion.LIVER, BILIARY TRACT: No suspicious hepatic lesions. Stable hypodensity about the hepatic hilum is nonspecific and may represent focal fatty infiltration.SPLEEN: The spleen is normal in size.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts and possible nonobstructive bilateral renal calculi.RETROPERITONEUM, LYMPH NODES: Calcific arteriosclerotic disease affects the aorta. No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Post operative changes from Roux-en-Y gastric bypass with an antecolic limb. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Multiple surgical drains in both upper quadrants. Small amounts of interloop fluid which is not well loculated currently. There is a 4.1 x 4.3 cm fluid collection in the left flank (image 89; series 3)PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Air in the bladder presumably reflect recent instrumentation.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Please see aboveBONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is a 10 x 8.1-cm fluid collection in the pelvic cul-de-sac (image 128; series 3) which is partially loculated. Other smaller areas of interloop fluid are also noted. | New bibasilar atelectasis and left pleural effusion. Multiple small fluid collections, some poorly marginated throughout the lower abdomen and pelvis. Largest collection is in the cul-de-sac. The findings were discussed with the clinical service (pager number 6471) at the time of dictation. Findings also discussed with Dr. Leef in IR. |
Generate impression based on findings. | HNC, CRT. CHEST:LUNGS AND PLEURA: Mild septal thickening at the lung bases. No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Mildly enlarged mediastinal lymph nodes are unchanged compared to prior examinations. Subaortic lymph node in the region of the AP window 7 mm, unchanged (3/27). Small volume of the anterior pericardial fluid or thickening increased from previous.CHEST WALL: Ossification of the posterior longitudinal ligament narrows the visualized cervical spinal canal, worst at C6/C7. In addition, in the upper thoracic spine facet hypertrophy causes narrowing of the left aspect of the spinal canal at several levels. ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic calcification of the aorta.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No specific evidence of metastatic disease to the chest or upper abdomen. Severe cervical spinal stenosis. Subtle increase in volume of anterior pericardial fluid which remains small. |
Generate impression based on findings. | Metastatic head and neck cancer on therapy. CHEST:LUNGS AND PLEURA: Aspiration pneumonia in the right middle and lower lobes. The smaller cavitary pulmonary nodules continue to decrease in size and degree of the wall thickness.Right apical nodule 15 x 20 mm (series 10231, image 23), previously 16 x 19 mm. Although not significantly changed in overall size, wall thickness of the lesion has decreased. Left upper lobe solid mass continues to enlarge, now measuring 34 x 48 mm, previously 32 x 34 mm (image 54 of lung windows).The remaining visible lesions appear improved. A lesions in the right lung base are obscured by superimposed aspiration pneumonia.MEDIASTINUM AND HILA: Tracheostomy tube in place. There is a large amount of internal debris in the trachea. The right lower lobe and proximal right middle lobe airways are occluded with aspirate.Necrotic lymphadenopathy in neck and a partially visualized laryngeal mass; please refer to separately reported neck CT for details.Mild circumferential thickening of the tracheal wall. Precarinal lymph node 12 mm compared to 15-mm previously. Additional mediastinal and hilar lymph nodes are unchanged with the exception of peribronchial lymph nodes in the region of aspiration which are likely reactive.CHEST WALL: The left jugular vein is severely compressed by neck lymphadenopathy.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: 13 x 8mm exophytic lesion arising from the apex of the left kidney difficult to measure but appears increased in size, previously 10-mm in diameter on the axial images. This lesion is hyperattenuating relative to simple fluid and may represent a renal cell carcinoma, hemorrhagic cyst or proteinaceous cyst. Given interval growth, assessment with dedicated renal CT is now recommended. Right kidney appears atrophic.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Severe aspiration pneumonia in the right middle and lower lobes. Six week plain film follow-up is suggested in the adult patient to assess for clearance.2. Mixed response with decrease in the majority of the pulmonary nodules with the exception of the left upper lobe mass which is larger3. Indeterminate 13-mm lesion at the apex of the left kidney; a small renal cell carcinoma cannot be excluded. Recommend correlation with dedicated renal CT within the next 6 months.Dr. Villaflor's service verbally notified of the above findings at the time of dictation. |
Generate impression based on findings. | Reason: Restaging scans s/p 6 cycles of oral TKI therapy History: hx of metastatic renal cell cancer LUNGS AND PLEURA: Biapical scarring/atelectasis unchanged. Moderate centrilobular and paraseptal emphysema with an upper lobe predominance not significantly changed from prior study. Multiple scattered small pulmonary nodules without significant change from prior exam. No new pulmonary nodules or mass are identified. MEDIASTINUM AND HILA: Atherosclerotic calcifications of the aortic arch. Heart size is normal.Mildly enlarged mediastinal nodes without significant change.CHEST WALL: Hypodense nodule in bilateral lobes of the thyroid unchanged. Old fractures of the right lateral eighth and ninth ribs. Slight endplate deformities of the T2 vertebral body. UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Hepatic hypodensities throughout the liver are again noted. Reference right hepatic lesion (series 4, image 109) now measures 28 x 15 mm previously measuring 30 x 18 mm. Infiltrating large right renal mass is incompletely visualized on this exam. New soft tissue nodule next to the spleen may represent a splenule. | 1.No evidence of intrathoracic metastatic disease.2.Interval decrease in size of hypodense lesions in the liver, suspicious from metastatic disease.3.Redemonstration of incompletely visualized large infiltrative right renal mass. |
Generate impression based on findings. | Neuroblastoma. Completed radiation therapy. CHEST:LUNGS AND PLEURA: Dependent subsegmental atelectasis. No distinct pulmonary nodules. No focal air space opacities or pleural effusions.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Normal sized heart without pericardial effusion.CHEST WALL: No axillary lymphadenopathy. No osseous or soft tissue abnormality.ABDOMEN:LIVER, BILIARY TRACT: Normal enhancement, without focal lesions. No intrahepatic or extrahepatic biliary ductal dilatation. Normal appearing gallbladder.SPLEEN: Normal in appearance, without focal lesions.PANCREAS: Normal in appearance, without focal lesions.ADRENAL GLANDS: Postsurgical changes of a right suprarenal mass resection. No discrete soft tissue mass identified.The left adrenal gland is normal a in appearance.KIDNEYS, URETERS: Normal symmetric enhancement, without pelvicaliceal dilatation or focal lesions.RETROPERITONEUM, LYMPH NODES: Prominent retroperitoneal lymph nodes, similar to the prior exam. The reference left periaortic lymph node measures 8 x 5 mm (series 3, image 62), previously 8 x 6 mm.BOWEL, MESENTERY: Nondistended loops of bowel, without wall thickening, associated mesenteric stranding, or fluid collections.BONES, SOFT TISSUES: No osseous or soft tissue abnormality seen.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: Normal appearing loops of bowel.BONES, SOFT TISSUES: No osseous or soft tissue abnormality seen. | 1. Unchanged retroperitoneal lymph nodes.2. No new sites of disease identified. |
Generate impression based on findings. | 57-year-old male patient with severe edema and preserved ejection fraction without proteinuria. Evaluate for IVC clot or mass impinging the IVC. ABDOMEN:LUNG BASES: Bilateral scarring versus atelectasis. Round density in the posterior right lower lobe is contiguous with scarring and is nonspecific. Metallic fragments adjacent to the pleura in the left lower lobe, consistent with bullet fragments.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 animality noted.RETROPERITONEUM, LYMPH NODES: Scattered subcentimeter retroperitoneal lymph nodes. IVC normal in caliber without evidence of thrombosis.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Soft tissue density in the left mid abdomen measures 2.2 x 2.0 cm (series 3 image 40) and is slightly secondary to subcutaneous injections.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Bilateral inguinal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild multilevel degenerative changes in the thoracic and lumbar spine.Bilateral fat filled inguinal hernias.OTHER: No significant abnormality noted | 1.No evidence of mass compressing the inferior vena cava or thrombosis.2.Rounded density contiguous with scarring in the right lower lobe is nonspecific but an underlying mass cannot be entirely excluded. |
Generate impression based on findings. | Male, 60 years old, melanoma, restaging. No mass effect, focal edema or suspicious enhancement is seen to suggest brain parenchymal metastatic disease. The bones of the calvarium and skull base are intact. Postsurgical findings are redemonstrated including evidence of a left parotid space resection and bilateral neck dissection. There remains ill-defined soft tissue thickening through the left parotid space. In most areas, this thickening is unchanged. There does appear to be some extension of thickening within the subcutaneous space below the left ear (see image 9 of series 6). Also redemonstrated is evidence of a prior left hemimandibulectomy with bone graft reconstruction. The bone graft and affixing plate/screw device are difficult to visualize secondary to metallic streak artifact.No pathologic adenopathy is detected in the neck by size criteria. A reference right submandibular space node measures 1.2 x 0.9 cm (image 27 series 6), previously 1.2 x 0.8 cm. The right parotid gland is stable in appearance. The submandibular glands have been resected. Cervical vessels are patent and unremarkable.No definite worrisome osseous lesions are seen. The joint capsule of the left sternoclavicular joint appears to be thickened with perhaps some fluid in the joint space. This is similar to the immediate prior exam but somewhat more prominent when compared to more remote studies. The head of the clavicle demonstrates sclerosis and degenerative change but no definite lysis or focal destruction. The appearance of the bony clavicular head is unchanged dating back to 2008. | 1. Redemonstration of postsurgical/post treatment findings in the neck. This includes partial resection of the left parotid gland. There remains some ill-defined and infiltrating soft tissue thickening within the left parotid space. In most areas this is stable and may therefore reflect postoperative scarring. There is, however, some extension of this thickened tissue more posteriorly in the subcutaneous space below the left ear. This also could simply reflect progressive scarring but it is nonspecific and continued attention to this area on subsequent exams is advised.2. No evidence of pathologic adenopathy or other definite soft tissue masses in the neck.3. Thickening of the left sternoclavicular joint capsule with perhaps some fluid in the joint space itself. The left clavicular head shows a degenerative appearance, stable over many years, without frank erosion or destruction. These findings are likely to reflect inflammation secondary to arthropathy, but again, continued attention will be required.4. No intracranial metastatic disease. |
Generate impression based on findings. | 70 year old female. Reason: Stage IV gastric cancer please compare to previous scans and provide index lesion measurements and assess previous areas of lung opacities History: As above CHEST:LUNGS AND PLEURA: Increasing bilateral ground-glass opacities which are becoming more solid in some areas. Unchanged nodular opacity at the right base. No pleural effusions.MEDIASTINUM AND HILA: Decreasing adenopathy. Reference right paratracheal lymph node measures 2.5 x 1.6 cm (series 3, image 34). Reference right hilar lymph node measures 1.8 x 1.2 cm (series 3, image 42). Heart size is normal. No pericardial effusion.CHEST WALL: Nodular thyroid with calcifications as noted previously. Right chest wall Port-A-Cath tip at the superior cavoatrial junction. Healing left rib fractures. No suspicious osseous lesions.ABDOMEN:LIVER, BILIARY TRACT: Innumerable hepatic metastases. Reference right hepatic lobe mass measures 3.8 x 3.2 cm (series 3, image 76), stable.SPLEEN: Stable splenomegaly. Large accessory splenule.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Mildly nodular adrenal glands, unchanged.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: Reference left periaortic lymph node measures 1.3 x 0.6 cm (series 3, image 109), unchanged.BOWEL, MESENTERY: Thickening of the gastric mucosa without discrete mass. No evidence of bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Calcified fibroids.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. | 1.Increasing pulmonary ground-glass opacities which are becoming more solid in areas.2.Decreasing mediastinal and hilar adenopathy. 3.Stable hepatic metastases with reference measurements as above. |
Generate impression based on findings. | 50 year-old male with history of tongue cancer and status post surgery. The orbits are unremarkable. The paranasal sinuses and mastoid air cells are clear. Limited view of the intracranial structure is unremarkable. Reidentified are postsurgical changes of the right sided nodal dissection.No identifiable tongue mass. Several small lymph nodes are identified but none of which are pathologically enlarged by CT criteria. The oral cavity, oro/nasopharynx, hypopharynx, larynx and subglottic airways are unremarkable/patent. The epiglottis, vallecula, piriform sinuses, and vocal cords are normal. The parotid, submandibular, and thyroid glands are unremarkable.Mild degenerative disease of the cervical spine with an anterior fixation device with plates, screws and cage which traverse from C5 to C7 is unchanged. The pre-and paravertebral soft tissues are within normal limits.The lung apices are clear bilaterally. For detailed evaluation, please refer to dedicated chest CT examination performed same day. | Stable postsurgical changes in the neck soft tissue with no mass or lymphadenopathy. |
Generate impression based on findings. | Metastatic (pT3N1bM1) medullary thyroid cancer status post RUL lobectomy in 3/06 and thyroidectomy in 4/06. There are postoperative findings related to total thyroidectomy. There is no evidence of recurrent tumor with the resection bed. There is no significant cervical lymphoma. The airways are patent. The major salivary glands are unremarkable. The major cervical vessels are intact. The imaged intracranial structures are grossly unremarkable. There are no lytic or blastic lesions. The imaged portions of the lungs are clear. | No evidence of locoregional tumor recurrence of significant cervical lymphadenopathy. |
Generate impression based on findings. | 58 year male with prostate cancer. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Mediastinal lymphadenopathy with the largest subcarinal lymph node measuring 1.6 x 1.2 cm (image 54, series 4). The heart size is normal. Atherosclerotic calcification of the coronary arteries and aorta.CHEST WALL: Mild degenerative changes of the thoracolumbar spine. No osseous lesions are seen on CT, refer to bone scan for further detail.ABDOMEN:LIVER, BILIARY TRACT: Biliary sludge. No focal hepatic lesions.SPLEEN: Small splenule.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Marked atherosclerotic calcification and noncalcified plaque of the abdominal aorta and its branches. Scattered prominent retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Prominent pelvic lymph nodes measuring up to 2.4 x 0.8 cm (image 196, series 4).BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Mild degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality noted | Mediastinal lymphadenopathy and scattered prominent retroperitoneal and pelvic lymph nodes. No osseous lesions identified on CT, refer to bone scan for further detail. |
Generate impression based on findings. | Hemangioendothelioma of the lung. CHEST:LUNGS AND PLEURA: Innumerable pulmonary nodules. Index lesion left upper lobe measures 2 x 2.4-cm, previously 1.8 x 2.1 cm (5/30). Postsurgical changes consistent with previous resections.MEDIASTINUM AND HILA: Reference prevascular lymph node 13 mm, previously 12-mm .3/34). Other mildly enlarged low cervical and mediastinal lymph nodes appear similar to previous.CHEST WALL: Expansile appearance of the left fourth and fifth rib heads unchanged. Numerous scattered sclerotic and lytic foci in the ribs unchanged.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Hepatic metastases increased in number. Reference lesion measures 11 mm, and changed (3/77).SPLEEN: Nonspecific hypodense lesion in the posterior aspect of the spleen is unchanged and could represent a cyst. There is an additional lesion at the tip of the spleen which is also unchanged.ADRENAL GLANDS: TheKIDNEYS, URETERS: Several hypoattenuating lesions in the spleen, some of which are atypical for simple cysts and could be metastases are unchangedPANCREAS: Focal hypoattenuation in the pancreatic body indeterminate but could be a small metastasis (3/93).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: Lytic lesion in the left ilium is unchanged.OTHER: No significant abnormality noted. | Metastatic hemangioendothelioma with index measurements provided in the body of the report. Increase in number of hepatic metastases. |
Generate impression based on findings. | Reason: h/o HNC, s/p CRT, compare to previous measurements History: none CHEST:LUNGS AND PLEURA: Mild interval resolution of partial right middle lobe atelectasis likely compressive from elevated hemidiaphragm. No new pulmonary nodules or masses.MEDIASTINUM AND HILA: No pericardial effusions. Main pulmonary artery caliber is mildly enlarged raising question of pulmonary hypertension, unchanged. Mild-to-moderate atherosclerotic calcifications of the coronary arteries and aortic arch. No mediastinal or hilar lymphadenopathy.CHEST WALL: Sclerotic focus in the T12 vertebral body is unchanged. ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Stable two hypodense lesions in the right lobe of the liver unchanged. Cholelithiasis without evidence of cholecystitis.SPLEEN: Multiples small hyperdense lesions with hypodense centers are unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No specific evidence of metastatic disease. Lesions in the liver and spleen are incompletely assessed due to contrast. Lack of change favors benign lesions. Dedicated liver CT may be obtained if clinically warranted. |
Generate impression based on findings. | 60 year-old with prostate cancer. Evaluate disease. ABDOMEN:LUNG BASES: No effusions or lung masses.LIVER, BILIARY TRACT: There is normal in morphology. No suspicious hepatic lesions Hepatic and portal veins are patent. Multiple peripherally calcified gallstones layer within a nondistended gallbladder.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Multiple small retroperitoneal lymph nodes are unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomyBLADDER: No significant abnormality notedLYMPH NODES: Small pelvic nodes. No enlarged by CT size criteria.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No evident metastatic disease. |
Generate impression based on findings. | Reason: rule out CAD, pt has anterior Q wave. History: abnormal ECG, family hx of premature CAD. Coronary arteries: LM: The left main coronary artery arises normally from the left sinus of Valsalva and trifurcates into the left anterior descending, ramus intermedius and left circumflex coronary arteries. There are no significant stenoses present in the left main.LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove, supplying two diagonal and several septal branches. There are no significant stenoses in the left anterior descending artery.LCx: The left circumflex coronary artery is non-dominant. It courses normally in the left atrioventricular groove. It gives rise to one high obtuse marginal branch. There are no significant stenoses in the left circumflex coronary artery.RCA: The right coronary artery is large and arises normally from the right sinus of Valsalva. It is the dominant coronary artery supplying a posterior descending artery and a posterolateral branch. The proximal 3 cm of the PDA are visualized; this is unremarkable. There is a high acute marginal that supplies the inferior walls the ventricles from mid-chamber level. There are no significant stenoses in the right coronary artery.Left Ventricle: The left ventricular late diastolic volume is normal.Right Ventricle: Visually the right ventricular late diastolic volume is within normal limits.Left Atrium: Visually, the left atrial volume appears to be normal in size. There are 5 distinct pulmonary veins which drain normally into the left atrium. Three veins are on the right, with a separate vein draining the middle lobe. Two veins are on the left. There is no evidence of left atrial appendage thrombus.Right atrium, vena cavae, and coronary sinus: The right atrial volume is normal in size. The superior and inferior vena cavae are unremarkable. The coronary sinus is normal in size. Valves: There is no calcification on the aortic or mitral valves.Great vessels: The visualized portions of the thoracic aorta demonstrate no evidence of dissection or aneurysm. The aortic arch is not visualized. The main pulmonary artery is normal in size.Pericardium: The pericardium is normal in thickness. There is no pericardial effusion.LUNGS AND PLEURA: Visualization of the lung parenchyma is limited by the field of view and length of scan which excludes a substantial amount of the lungs. Thickening of the interlobular septa which is more prominent in the lung bases compatible with pulmonary edema. Scattered nonspecific micronodules.MEDIASTINUM AND HILA: The mediastinal and hilar lymph nodes are mildly prominent throughout likely reflecting edema.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Irregularly marginated lesion in segment 7 of the liver is only partially visualized at the caudal-most aspects of the exam. This corresponds to a focus of focal nodular hyperplasia seen on the prior liver MRI. | 1. There are no significant coronary artery stenoses present.2. Findings compatible with pulmonary edema. |
Generate impression based on findings. | 67 year-old female with headache and vertigo. NONCONTRAST CT HEADThere is patchy hypoattenuation in the cerebral white matter (internal capsules and periventricular white matter). The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The mastoid air cells are clear. There is inflammatory disease of the paranasal sinuses. CTA HEAD AND NECKThere is normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The bilateral vertebral artery origins are normal. There is minimal calcified atherosclerosis at the left common carotid and left subclavian artery origins. There is normal contrast opacification through the bilateral common carotid arteries, carotid bifurcations, cervical internal/external carotid, and vertebral arteries. Mild calcified atherosclerosis is seen along the left common carotid artery and at left common carotid bifurcation extending into proximal external carotid artery.There is normal contrast opacification through anterior circulation (bilateral petrous/cavernous/supraclinoid internal carotid arteries, anterior and middle cerebral arteries), posterior circulation (vertebral-basilar, posterior-inferior cerebellar, anterior-inferior cerebellar, superior cerebellar, and posterior cerebral arteries), and distal intracranial vasculature. Mild calcified atherosclerosis is noted in bilateral cavernous/supraclinoid carotid arteries. There is normal contrast opacification through a complete circle-of-Willis with a patent anterior communicating artery and bilateral posterior communicating arteries. No evidence of aneurysm, significant stenosis, occlusive thrombus, dissection, or vascular malformation is noted.There is normal superficial and deep intracranial venous drainage.There is pulmonary emphysema. | 1. No acute intracranial abnormality. Mild chronic small vessel ischemic disease. CT is insensitive to early detection of CVA. MRI should be considered if clinical suspicion for CVA persists. 2. No evidence of aneurysm, significant stenosis, occlusive thrombus, dissection, or vascular malformation. Mild calcified atherosclerosis as described above. |
Generate impression based on findings. | 44-year-old male patient. Pre-kidney transplant evaluation. Note that the lack of intravenous contrast limits evaluation of vasculature, lymph nodes and the solid viscera.ABDOMEN:LUNG BASES: Cardiomegaly with moderate sized pericardial effusion.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral atrophic kidneys.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic changes in the abdominal aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Moderate multilevel degenerative changes in the thoracic and lumbar spine.OTHER: Renal transplant in the right iliac fossa without hydronephrosis or perinephric fluid collection.Moderate atherosclerotic changes in the common and external iliac arteries. | 1.Mild atherosclerotic changes in the abdominal aorta with moderate atherosclerotic changes in the common and external iliac arteries.2.Cardiomegaly with moderate pericardial effusion. |
Generate impression based on findings. | Head and neck cancer CHEST:LUNGS AND PLEURA: Previously seen thin walled cystic lesion in the periphery of the right upper lobe has filled in with solid material currently measuring 12 x 14 mm. The cyst seen previously measured 13 x 15 mm.A nonspecific thin-walled cystic lesion or area of emphysema seen abutting the right major fissure (/55) should be monitored on subsequent examinations.Subpleural reticulation at the lung bases.MEDIASTINUM AND HILA: Coronary artery calcifications. No significant lymphadenopathy. Small amounts of chronic thrombus seen on the left which is nonocclusive (3/49) at the proximal segmental level.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Mild nodularity of the adrenal glands unchanged.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Right upper lobe lesion has become solid in the interim. No significant lymphadenopathy. Minimal residual nonocclusive pulmonary artery thrombus in the left lower lobe. |
Generate impression based on findings. | 76-year-old female patient with end-stage renal disease. Evaluate kidney anatomy for possible nephrectomy. ABDOMEN:LUNG BASES: Bilateral atelectasis versus scarring. Cardiomegaly with moderate sized pericardial effusion.LIVER, BILIARY TRACT: Nonspecific hypoattenuating linear lesion adjacent to the falciform ligament is too small to characterize.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left kidney with percutaneous nephrostomy tube with pigtail catheter in the inferior pole. No perinephric fluid or hydronephrosis.RETROPERITONEUM, LYMPH NODES: Moderate atherosclerotic changes in the abdominal aorta and iliac arteries.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Bilateral subcutaneous soft tissue changes on the anterior abdominal wall consistent with injections. OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted. BOWEL, MESENTERY: Probable stercoral colitis in the rectum with mild perirectal fat strandingBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted | 1.Left kidney with percutaneous nephrostomy without hydronephrosis or perinephric fluid.2.Cardiomegaly with moderate pericardial effusion.3.Probable stercoral colitis in the rectum. |
Generate impression based on findings. | Right upper lobe nodule on CT scan. Dyspnea and chest pain. LUNGS AND PLEURA: Right upper lobe well circumscribed nodule measures 14 x 10 mm (5/97). This is not significantly changed from prior outside CT allowing for the relatively thick acquisitions on the outside study which would produce volume averaging (calibrated measurements are 14 x 11 mm). The nodule contains internal Hounsfield units consistent with lipid (-48 HU on the source images), but no internal calcification.Note is made of decreased lung attenuation in the subsegment peripheral to the nodule though there is no visible extrinsic compression of the airway, artery or vein. Right lower lobe calcified micronodule is likely a granuloma. Mosaic attenuation of the lung parenchymal noted.MEDIASTINUM AND HILA: Enlarged thyroid gland with substernal extension of the left lobe. Hypoattenuating cyst or nodule in the left lobe is nonspecific by CT.A calcified right hilar region and subcarinal lymph nodes, suggestive of old, healed granulomatous infection.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. Calcified granulomas in the spleen. Hypoattenuation of the hepatic parenchyma consistent with fatty infiltration. | Well-circumscribed benign-appearing right upper lobe nodule containing internal attenuation is suggestive of but not pathognomonic for a hamartoma. CT follow up in 9 months suggested (August, 2014). |
Generate impression based on findings. | Female, 74 years old, head and neck cancer. Ill-defined soft tissue thickening and enhancement involving the right base of tongue and floor of mouth is redemonstrated. Comparison is probably best made in the coronal plane where this abnormality measures 2.0 x 1.4 cm (image 53 series 80412). The prior exam was performed without contrast and therefore comparison is difficult. However, the lesion is probably no larger and it may be a bit smaller.Treatment related subcutaneous and deep fascial infiltration is redemonstrated appearing similar to the immediate prior exam and perhaps a bit improved when compared to a more remote study.A right level 2 reference lymph node measures 2.2 x 1.4 cm (image 27 series 6), previously 1.9 x 1.6 cm. A left level 2 reference node measures 1.3 x 1.2 cm (image 28 series 6), previously 1.4 x 1.2 cm. Left level Ib reference node measures 1.1 x 0.7 cm (image 25 series 6), previously 1.0 x 0.8 cm. No new or definitely progressing adenopathy is seen. The salivary glands and thyroid are free of concerning lesions. The cervical vessels are unremarkable with the exception of the nonvisualized left IJ vein.Prior cystic lesion in the right lung apex is now a solid soft tissue abnormality. A peripheral cystic lesion is also redemonstrated in the left lung apex.No concerning osseous lesions are demonstrated. Again seen is a bulky posterior disk-osteophyte complex at the C5-6 level which results in some degree of canal stenosis. | 1. Right tongue base/floor of mouth lesion shows no definite change in size.2. Stable adenopathy in the bilateral neck. No evidence of new lymphadenopathy or neck masses.3. Changing appearance of a right apical lung lesion. Please refer to the separately dictated chest CT report for details. |
Generate impression based on findings. | 47-year-old male, assess for small bowel lesion/carcinoid. ABDOMEN:LUNG BASES: Basilar atelectasis/scarring.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: Scattered mildly prominent mediastinal lymph nodes without evidence of mass, bowel wall thickening, or other specific findings to account for the patient's abdominal pain.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: Scattered mildly prominent mediastinal lymph nodes without evidence of mass, bowel wall thickening, or other specific findings to account for the patient's abdominal pain.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Normal caliber bowel without wall thickening or evidence of mass. No specific signs account for patient's abdominal pain. |
Generate impression based on findings. | Reason: h/o met medullary thyroid ca, compare to previous, measurements pls History: none LUNGS AND PLEURA: Stable mild bronchiectasis. No new pulmonary opacities, nodules or masses. Overall stable peripheral endobronchial filling defects. No pleural effusions.MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. Status post thyroidectomy. Mild cardiomegaly. No pericardial effusions. Mild to moderate coronary artery calcifications.CHEST WALL: Lytic lesion in the T11 vertebral body is unchanged and likely represent a hemangioma.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Severe atherosclerotic calcifications of the descending aorta. | 1.No specific evidence of metastatic disease.2.Stable chronic pulmonary changes with bronchiectasis bilaterally consistent with known history of prior MAI infection. |
Generate impression based on findings. | 45 -year-old female with headache, evaluate for subarachnoid hemorrhage or intracranial abnormality Nonspecific subcentimeter mildly hypoattenuating focus in the left basal ganglia.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.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 acute intracranial abnormalities.2. Nonspecific subcentimeter mildly hypoattenuating focus in the left basal ganglia may be artifactual in etiology. If clinically warranted, MRI may be obtained for further characterization. |
Generate impression based on findings. | 8-year-old male with history of pulmonary metastatic embryonal rhabdomyosarcoma. Evaluate for disease. LUNGS AND PLEURA: Postoperative changes are again noted in the left upper lobe appearing similar to the prior study. Micronodules along the right major fissure are unchanged and likely represent benign lymph nodes. No new pulmonary nodules or masses are identified.No pleural effusions or pneumothorax.MEDIASTINUM AND HILA: A left chest port is noted with its tip at the SVC/RA junction.There is no gross mediastinal or hilar lymphadenopathy.The heart size is within normal limits.No pericardial effusion is present.CHEST WALL: A chest port is again noted in the left chest wall. No osseous lesions are present.UPPER ABDOMEN: The visualized portions of the liver, spleen, pancreas, and kidneys appear within normal limits. | No evidence of recurrent or metastatic disease. Stable postoperative changes in the left upper lobe. |
Generate impression based on findings. | GE junction cancer CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Marked decrease in size of distal esophageal/GE junction mass described previously. At a similar level, the esophagus measures 3.6 x 2.8 cm (image 70; series 3). Adenopathy has likewise regressed. The reference gastrohepatic ligament lymph node (image 93; series 3) currently measures 2.4 x 1.9 cm, smaller compared to previousCHEST WALL: Right chest port.ABDOMEN:LIVER, BILIARY TRACT: Too small to characterize subcentimeter bilobar low attenuation foci, unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts. Bilateral subcentimeter nonobstructing renal stones.RETROPERITONEUM, LYMPH NODES: Marked regression of retroperitoneal adenopathy extending below the level of the renal veins. The reference left para-aortic lymph node (image 120; series 3) measures 1.4 x 1.0 cm, smaller compared to previous.BOWEL, MESENTERY: The concentric bowel wall thickening of multiple loops of small bowel (predominantly ileum) in the mid abdomen and right lower quadrant (image 86; series 80216). Consider infectious or drug-related enteritis.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 | Marked regression of disease with measurements given above. Thickening of multiple loops of small bowel in the midabdomen; this finding is nonspecific and may represent infectious or drug-related enteritis. |
Generate impression based on findings. | Male 62 years old Reason: Eval glenohumeral joint for deformity History: multiple dislocations with shoulder pain No intra-articular contrast is seen entering the subacromial subdeltoid space indicating that the rotator cuff is intact. There is equivocal mild fatty atrophy of the inferior aspect of the subscapularis muscle.There is near bone on bone apposition of the glenohumeral joint with numerous subchondral cysts and subchondral sclerosis compatible with severe osteoarthritis. Numerous cysts are also seen in the greater tuberosity, which are likely degenerative in etiology. Moderate osteoarthritis affects the acromioclavicular joint. Small density of gas foci are seen in the soft tissues of the anterior shoulder, reflecting recent instrumentation. | 1. Severe osteoarthritis of the glenohumeral joint.2. Intact rotator cuff. |
Generate impression based on findings. | Dyspnea. Sarcoidosis. Tobacco use, chemo for AML. LUNGS AND PLEURA: Scattered calcified and noncalcified pulmonary micronodules measuring up to 3-mm in diameter (right upper lobe 4/21). Bilateral areas of scarring in the upper lung zones. No pleural fluid or pneumothorax.MEDIASTINUM AND HILA: Thyroid gland is mildly enlarged with caudal extension to the level of the manubrium on the left.Atherosclerotic calcifications of the thoracic aorta. Severe coronary artery calcifications. Normal heart size. No pericardial fluid.CHEST WALL: Severe scoliosis. Sternal wires.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. Nonspecific hypoattenuating lesion in the liver near the porta hepatis (3/85), incompletely characterized IV contrast but possibly a cyst. | No signs of pneumonia. No suspicious pulmonary nodules or masses. The noncalcified nodules are benign in appearance and may be followed in 6 to 12 months given the patient's history of smoking. No significant lymphadenopathy in the thorax or specific pulmonary findings of intrathoracic sarcoidosis. |
Generate impression based on findings. | 40 year-old female with head trauma. The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. | No acute intracranial abnormality. |
Generate impression based on findings. | Status post chemoradiation and neck dissection for a T1 oropharyngeal squamous cell carcinoma completed in September of 2009. Streak artifact related to dental amalgam obscures regional anatomy. Within this limitation, there are stable post-treatment findings related to right neck dissection and radiation. There is an unchanged configuration of the oropharynx without evidence of locoregional tumor recurrence. There is no significant cervical lymphadenopathy by size criteria. The airway is patent. The parotid and the submandibular glands appear unremarkable. The thyroid gland is unremarkable. The carotid and vertebral vasculature appear intact. There is a partially imaged aberrant right subclavian artery. The osseous structures appear unchanged. The imaged portions of the intracranial structures and orbits are unremarkable. The imaged lung apices appear clear. | No evidence for locoregional tumor recurrence or significant cervical lymphadenopathy on the basis of size criteria. |
Generate impression based on findings. | Reason: RUL lung nodule, annual follow up. SUPER D protocol History: none LUNGS AND PLEURA: 5-mm right upper lobe nodule, "flat" in appearance suggestive of a intrapulmonary lymph node, adjacent to the major fissure image 62 series 8, unchanged as far back as 8/17/2012.Punctate calcified granuloma right middle lobe. MEDIASTINUM AND HILA: Scattered mediastinal lymph nodes are visible, but are within normal size limits.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. | Stable 5-mm right upper lobe nodule consistent with a benign etiology such as an intrapulmonary lymph node. One more annual follow-up is recommended, and if unchanged no further CT follow-up for this nodule. |
Generate impression based on findings. | Dysphagia, choking, coughing no aggressive mediastinal lymphoma. Evaluate for bronchial collapse. LUNGS AND PLEURA: There is extrinsic compression of the airways from the patient's mediastinal tumor. This is most pronounced on the left. Measurements of the airway as follows:Level of the manubrium transverse dimension of the trachea is 12-mm (4/28). Approximately 1 cm above the level of the carina the trachea measures 7-mm in AP dimension.Level of the carina the proximal main bronchi each measure 7-mm in AP dimension.Distal right main bronchus 5-mm in AP dimension, right upper lobe bronchus 6-mm in AP dimension (4/44).Right upper lobe segmental airways are patent. Bronchus intermedius is mildly compressed at its origin but is patent distal to that level as are the right middle and right lower lobe airways.Distal left main bronchus 5-mm (4/46). Proximal left upper lobe bronchus 3-mm in AP dimension (4/47). The lingular bronchus is focally compressed as it crosses in front of the left descending pulmonary artery (4/40, coronal image 38)The segmental branches of the left upper lobe and lingula are thickened and narrowed proximally with associated linear atelectasis.The left lower lobe bronchus is severely compressed as it crosses posterior to the left descending pulmonary artery. Its proximal branches are also attenuated but are patent more distally. All but the posterior segment of the left lower lobe is aerated. There is compressive atelectasis of the posterior segment by a moderate left pleural fluid collection.In the left apex paramediastinal groundglass opacity and septal thickening are consistent with passive congestion. Mild thickening of the fissures on the right. Mild septal thickening right lung base.MEDIASTINUM AND HILA: Please see lungs and pleura section for description of the airways. Large mediastinal mass consistent with patient's known lymphoma encases the aorta, pulmonary artery, esophagus and central airways. The esophagus is collapsed by the tumor at the level of the aortic arch (3/34). Distal to that level, the esophageal wall is severely thickened and the lumen is narrowed, indistinguishable from tumor. The esophagus returns to a normal size near the GE junction. Left subclavian ICD leads are in expected position. Small pericardial fluid collection. Small superior and anterior mediastinal lymph nodes are noted separate from the mass. A small periaortic fluid collection is seen at the level of the arch. This is nonspecific in appearance and of vascular invasion and/or rupture cannot be excluded by unenhanced technique.CHEST WALL: Left chest wall generator. Mild internal mammary chain lymphadenopathy bilaterally..UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Nonspecific hypoattenuating hepatic lesion (3/89), too small to characterize. Several small lymph nodes in the upper abdomen noted.. | Severe compression of the airways and thoracic esophagus by the patient's known mediastinal lymphoma. Vascular encasement of the thoracic aorta is noted with a small amount of nonspecific associated periaortic fluid. Moderate left pleural fluid collection. |
Generate impression based on findings. | Male, 68 years old, larynx cancer. Status post laser resection. New baseline evaluation. There is a tiny, 1 mm focus of mucosal irregularity along the left vocal cord (see axial thin section 167, series 3). This is nonspecific and may be postoperative in nature.The right piriform sinus is effaced without evidence of focal mass lesion. The aerodigestive mucosa is otherwise within normal limits. No pathologic adenopathy is seen. The salivary glands and the thyroid are free of focal lesions. Micronodules are evident in the lung apices. No concerning osseous lesions are seen. | 1. Mild mucosal irregularity along the left vocal cord. This is nonspecific and may be postoperative in nature.2. No pathologic adenopathy is seen in the neck. |
Generate impression based on findings. | Reason: requesting post-op CT scan for changes; no contrast needed History: 79 yo M hx of RUL wedge resection, 3-7 rib resection for chest wall hemangioma, s/p recent washout of chest wall abscess, requesting post-op CT scan for changes; no contrast needed LUNGS AND PLEURA: Decrease in right posterior paramediastinal air collection adjacent to the suture line. Although no bronchopleural fistula is identified, the air leak is most likely coming from the suture lineSurgical changes in the right hemithorax but right lung wedge resection and resection of the posterior chest wall is again seen. Interval decrease in the previously described fluid collection with multiple air foci in the right upper pleural space and subcutaneous tissue around the scapula. Narrowing of the right upper lobe in the right apex remains consolidated. Heterogeneous fluid collection located posteriorly and extends inferiorly. Small loculated appearing right pleural effusion. The remainder of the right lung appears relatively stable.Interval reexpansion of the left lower lobe with minimal pleural effusion with fluid tracking along the fissures. Debris within the a few left lower lobe segmental bronchi. New small pulmonary nodule in the left upper lobe may represent new focus of infection or rounded atelectasis.MEDIASTINUM AND HILA: Tracheostomy tube noted. Heart size is normal. Mild atherosclerotic calcifications of the coronary arteries and aorta. CHEST WALL: Anasarca. Soft tissue stranding and layering of fluid in the right posterior chest wall decreased from prior exam. Postsurgical changes to the ribs are unchanged. Multiple chest wall collaterals. Right axillary lymphadenopathy is again noted and likely reactive. Two chest tubes are seen coursing from the right axilla superomedially, the more cranial tube appears situated in the posterior soft tissues near the apex. The tip does not appear to be in communication with the collection. UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Hyperattenuation of the liver may be secondary to iron deposition if the patient has had multiple transfusions. Small amount of ascites anterior to the liver. | 1.Interval decrease in size of previously described right subcutaneous and extrapleural fluid collection.2.Interval reexpansion of the left lower lobe with residual debris seen within the lower lobar bronchi.3.Tube situated in the posterior soft tissue near the apex does not seem to be in communication with the fluid collections. This was previously communicated to the clinical service.4.Decrease in size of right pleural air collection. Suspect small air leak from right paramediastinal suture line. |
Generate impression based on findings. | Occlusion and stenosis of vertebral artery without mention of sternal or infarction evaluate vertebral abnormality on MRA 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. The left common carotid artery originates from the innominate artery.There is occlusion of the left vertebral artery at its origin. The left vertebral arteries reconstituted via muscular branches from the left ascending cervical artery as well as the left occipital artery .There is a high-grade stenosis present at the origin of the right vertebral artery which very tiny at its origin but receives collateral flow from muscular branches from the ascending cervical artery . the right vertebral artery is not identified intracranially.There is 60% stenosis at the origin of the left subclavian artery due to atherosclerosisThere are multiple hypodense foci present in the thyroid gland the largest one in the right thyroid gland lobe measures 5 mm in diameterThe patient status post laminectomies at the C4 and C5. There is a right sided facet fusion at C2 and C3 and some obliteration of the left C2-3 facet joint appeared there is normal from line encroachment present bilaterally at C3-4 and and at C4-5 due to osteophytesBrain 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 anterior communicating artery is small the posterior communicating arteries are medium-sized. In general the basilar artery is relatively small measuring approximately 2-2.5 mm diameter throughout its course. The right posterior inferior cerebellar artery is not readily identifiedCT head:The CSF spaces are appropriate for the patient's stated age with no midline shift. Atherosclerotic calcifications are present along the distal internal carotid 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 demonstrates mucosal thickening in the sphenoid sinuses and right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.There is a 60% stenosis at the origin of the left subclavian artery.2.There is occlusion of the left vertebral artery at its origin with reconstitution from muscular collaterals from the ascending cervical artery and the left occipital artery.3.There is occlusion of the right vertebral artery within the distal cervical portion.4.Multiple thyroid nodules are nonspecific. Please correlate with clinical symptoms5.Degenerative changes are present in the cervical spine |
Generate impression based on findings. | Lung mass. Super D. protocol. LUNGS AND PLEURA: Right lower lobe mass measures 3.7 x 2.9 cm (6/70), previously 2.1 x 1.9 cm. There is thickening of the adjacent inferior pulmonary ligaments and a linear band of atelectasis extends peripherally and caudally from the lesion. New 6-mm nodule in the right upper lobe may be a metastasis. No contralateral suspicious nodules or masses. No pleural fluid.MEDIASTINUM AND HILA: No significant lymphadenopathy. Normal heart size. No pericardial fluid. Vascular calcifications.CHEST WALL: T1 spina bifida occulta.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. Subcentimeter hypoattenuating lesion in the left hepatic lobe (4/92) is unchanged, too small to characterize but possibly a cyst. Hypoattenuating lesions near the falciform ligament in both lobes unchanged. | Interval enlargement of right lower lobe mass with associated subsegmental atelectasis and thickening of the inferior pulmonary ligament. A new right upper lobe nodule is suspicious for a metastasis. |
Generate impression based on findings. | Female, 66 years old, tongue cancer status post surgery. Limited intracranial views are significant for evidence of old ischemia in the left cerebellum.Since the prior examination, extensive new post operative findings are demonstrated including resection of the residual tongue and epiglottis and repair with a soft tissue flap, as well as excision of the floor of mouth with soft tissue flap repair, and excision of the lingual cortex of the mandibular symphysis. There is extensive scarring and likely some edema along the pedicle of the tongue flap, and scarring along the suture lines of the floor of mouth flap. Within this extremely altered background, however, no definite evidence of recurrent disease is seen.No pathologic adenopathy is detected in the neck by size criteria. The parotid glands are hyperemic but free of focal lesions. The submandibular glands have been resected. The thyroid is within normal limits.Atherosclerotic disease is seen at the carotid bifurcations. The left ECA seems to end in a stump and may have been sacrificed. The left IJ vein is not seen. Emphysema and scarring are demonstrated in the lung apices. No worrisome osseous lesions are demonstrated. | 1. Interval resection of the tongue and floor of mouth with soft tissue flap repair. Within this extremely altered background, no definite evidence of recurrent disease is seen. This examination will serve as a new baseline.2. No evidence of pathologic adenopathy in the neck. |
Generate impression based on findings. | 53 year-old male with history of headache and hypertension. The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The mastoid air cells are clear. There is moderate inflammatory disease of the paranasal sinuses. Low density in the nasopharynx, which may represent cysts or secretions. Clinical correlation is recommended. | No acute intracranial abnormality. |
Generate impression based on findings. | Cushing's, aspergillus pneumonia. Following up lesions. LUNGS AND PLEURA: Numerous pulmonary nodules and micronodules, some of which are cavitary. The majority of the lesions are in the right lung. For reference, a lesion containing internal cavitation in the right lower lobe measures 18-mm in length (4/57).. A left apical cavitary lesion measures 13-mm in length (4/15) a solid lesion in the right upper lobe measures 13-mm in length (4/24).MEDIASTINUM AND HILA: Small pericardial fluid collection. Normal heart size. No significant lymphadenopathy. Mild mediastinal lipomatosis.CHEST WALL: Mild calcification of the posterior longitudinal ligament of the spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Bilateral solid and cavitary lung nodules are nonspecific but remain consistent with hematogenous spread of infection such as semi-invasive Aspergillus as provided in the clinical history. Follow-up to complete radiographic resolution is recommended to exclude a synchronous neoplastic process. |
Generate impression based on findings. | 63 year-old female. Pancreatic cancer. Nausea, vomiting, and abdominal pain. ABDOMEN:LUNG BASES: No effusions or masses.LIVER, BILIARY TRACT: Unchanged hepatic steatosis limiting evaluation for parenchymal masses. Within this limitation, there are at least two nodules which may represent metastases given the patient's history. For reference purposes, nodule the right lobe (image 24; series 3) measures 1.2 x 1.8 cm. Note that this could also represent focal fatty sparing in the proper clinical context (however this finding is new compared to prior). Focal fatty sparing along the ligamentum teres. CBD stent with expected pneumobilia.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic tumor in the head measures 5.7 x 4.1 cm, stable or equivocally decreased in size compared to prior. Continued encasement of the portal vein as described previously.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Air in nondilated loops of small bowel is abnormal but nonspecific finding. There is no evidence of bowel dilatation to suggest obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Fibroid in the uterus.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Moderate amount of fecal material throughout the colon. No definite evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Pancreatic carcinoma with encasement of the portal vein. Possible new liver metastasis versus focal fatty sparing. |
Generate impression based on findings. | High grade myxoid sarcoma of her left face, status post recent debulking and chemotherapy. There are interval postoperative findings related to partial debulking of an infiltrative, heterogeneously enhancing mass in the left face with residual tumor that measures approximately 10.5 AP x 6.5 RL x 9.5 SI cm. The mass appears to have a somewhat different configuration compared to the prior MRI with increased bulk in the perioral region for example, perhaps due to the intervening procedure or growth of the mass. The mass extends to anteriorly and medially towards the midline in the perioral and periorbital region, as well as into the left maxillary sinus, masticator space, parotid space, and buccal space, where there is a defect that extends from the oral cavity into the substance of the tumor. The tumor extends into the left pterygopalatine fossa and inferior orbital fissure and skull base. There are erosions in the left zygomatic and and lateral portions of the maxillary sinus. The inferior alveolar canal is widened and there is expansion of the left mandibular ramus and cavitary change in the mandible body, where there is a pathologic fracture of posteriorly. The tumor abuts the superior portion of the left internal carotid artery without associated narrowing. There is no definite significant cervical lymphadenopathy beyond the left suprahyoid region, where lymphadenopathy may be inseparable from the mass. There is opacification of the left mastoid air cells. The brain parenchyma appears unremarkable. The ventricles are normal in size and configuration. | Interval partial debulking of the transpatial left face sarcoma that extends to the skull base, left orbit, and left maxillary sinus, as described in the findings section. Of note, there is a pathologic fracture of the left mandible body. The tumor abuts the left internal carotid artery without evidence of vascular compromise. |
Generate impression based on findings. | Female, 42 years old, fever, neutropenia. History of ALL. Evaluate for sinusitis. The frontal sinuses are clear. There is mucosal thickening at the level of the bilateral fronto-ethmoidal recesses, left more than right. The sphenoid sinuses and sphenoethmoidal recesses are clear. The ethmoid air cells are largely free of mucosal disease/opacification.Peripheral mucosal thickening is evident along the floor of the right maxillary sinus and very minimally along the floor of the left maxillary sinus. The maxillary outflow pathways are patent bilaterally.Nasal cavity is clear. The nasal septum is intact with a leftward projecting bony spur. The turbinates are unremarkable. | Mild sinus mucosal thickening as above with no evidence of any severe or active sinusitis. |
Generate impression based on findings. | 54 year-old male with history of altered mental status. The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. | No acute intracranial abnormality. CT is insensitive to early detection of CVA. MRI should be considered if clinical suspicion for CVA persists. |
Generate impression based on findings. | Chronic sinusitis. There are postoperative findings related to endoscopic sinus surgery, including septoplasty, bilateral uncinectomy and internal ethmoidectomy. There is moderate mucosal thickening within the bilateral maxillary sinuses. The neoinfundibulum is patent, while the left neoinfundibulum is partially obstructed by a lateralized middle turbinate. There is mild scattered ethmoid sinus opacification. There is mild opacification of the left sphenoid sinus with suggestion of air-fluid levels. There is partial opacification of the right frontoethmoid recess, but the frontal sinuses are clear. There is a defect in the cartilaginous nasal septum that measures up to 15 mm, but no significant nasal septal deviation. The optic canals and carotid grooves are covered by bone. The ethmoid roofs are intact and nearly symmetric. The lamina papyracea are intact and the orbits are grossly unremarkable. There are bilateral basal ganglia calcifications. | Postoperative findings related to endoscopic sinus surgery and septoplasty with moderate bilateral maxillary sinus mucosal thickening and milder scattered paranasal sinus opacification elsewhere is a sporadic pattern. |
Generate impression based on findings. | Acute myeloid leukemia. Neutropenic fever. Evaluate for source of infection. The following observations are made given the limitations of an unenhanced studyCHEST:LUNGS AND PLEURA: A few scattered subpleural micronodules are noted.Atelectasis at both lung bases should be followed. Trace left pleural effusion.MEDIASTINUM AND HILA: Subcentimeter mediastinal lymph nodes. Small pericardial effusion.CHEST WALL: Right-sided PICC line terminates at the confluence of brachiocephalic veins.ABDOMEN:LIVER, BILIARY TRACT: Diffuse fatty infiltration of the liver without evidence of focal lesions. Liver appears enlarged measuring 24 cm in craniocaudal dimension.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: Stomach is collapsed limiting evaluation but there may be some mild wall thickening concentrically.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Intrauterine device.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No definite findings to suggest source of infection with the exception of atelectasis at the lung bases. Diffuse fatty infiltration of an enlarged liver. Intrauterine device. |
Generate impression based on findings. | Male 32 years old; Reason: 31 year-old male with a history of seminoma of the testes. History: 31 year-old male with a history of seminoma of the testes. CHEST:LUNGS AND PLEURA: No suspicious primary nodules. The pleural spaces are clear. Nonspecific micronodule in the left lower lobe (image 75/series 5)MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. Soft tissue in the anterior mediastinum is unchanged.CHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes, unchanged.BOWEL, MESENTERY: Small calcification in the course of the appendix likely representing an appendicolith. No surrounding inflammation.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Stable exam with no significant change in the subcentimeter retroperitoneal lymph nodes.2.Soft tissue the anterior mediastinum possibly representing thymic tissue, unchanged. |
Generate impression based on findings. | 59-year-old female with history of malignant solitary fibrous tumor. CHEST:LUNGS AND PLEURA: There are again noted multiple, confluent low-attenuation masses arising from the pleura in the right hemithorax. There is continued displacement of the right atrium and right ventricle by masses. Slight interval increase in posterior mass on image 36/216, measuring 10.7 x 11.8 cm compared with 10 x 10.7 centimeters on prior exam. The lesion adjacent to the right crux measures 2.2 x 4.5 cm on image 75/216, increased from prior measurement of 1.5 x 3.5 cm. Tip of the right-sided venous catheter is in the SVC.Two sphenoid and mass involving the right thigh from a cruise and infiltrating the oblique musculature posteriorly measures 2.9 x 5.1 cm on image 89 the size to 16 increased from 3.8 x 2.4 cm.Tumor invades the right hemidiaphragm.There is continued mass effect on the right atrium and ventricle.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Postsurgical change involving the right posterior ribs.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No change in small splenic mass, presumably cyst.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Progressive disease in the right hemithorax. |
Generate impression based on findings. | Male 71 years old; Reason: baseline prior to starting investigational agent. Please give bidimensional measurements History: hx of metastatic bladder cancer CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion.Right chest wall port terminates at the caval atrial junction.CHEST WALL: Chronic appearing right rib fractures.OTHER: ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Probable small bilateral renal cortical cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Severe arterial sclerotic disease of the aorta.Left para-aortic lymphadenopathy measures 1.3 x 1.1 cm (image 129/series 6) previously, 1.4 x 1.1 cm BOWEL, MESENTERY: Right lower abdominal ostomy/ileal conduit.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post cystoprostatectomyBLADDER: Status post cystoprostatectomyLYMPH NODES: Lymphadenopathy adjacent to right iliac vessels.BOWEL, MESENTERY: Post operative changes in the small bowel with ileal conduit reconstruction. No bowel obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Retroperitoneal lymphadenopathy without evident change. |
Generate impression based on findings. | Chronic sinusitis. Recurrent sinus infections. recurrent sinus infections, nasal congestion, crusting at the right OMU The ostiomeatal complex units are patent bilaterally. Within the nasal cavity no obstructive lesions are appreciated. The nasal septum is mildly deviated towards the left. There is partial opacification of the right nasal cavity at the level of the superior middle concha . There is opacification of the right ostiomeatal complex unit and the right middle meatusThe frontal sinuses are clear.Maxillary sinuses are clear. Ethmoid air cells demonstrate mild mucosal thickening along the right ethmoid air cells . Sphenoid sinuses are clear. Visualized portions of the mastoid air cells and middle ears are clear. Visualized orbits are intact and the visualized intracranial structures are within normal limits. | Opacification in the expected location of the right to hiatus semilunaris , middle meatus into the superior meatus is at present. Underlying pathology such as polyposis cannot be excluded. Please correlate with physical findings. |
Generate impression based on findings. | 10 day old male status post VPS. The patient is status post a right parietal approach ventriculostomy shunt catheter placement. The catheter traverses the lateral ventricles and terminates in the left lateral ventricle body. No significant hemorrhage is seen. The catheter appears intact with no fracture or kinking.Again seen are severely dilated lateral and third ventricles compatible with congenital hydrocephalus, which has not changed significantly since prior, allowing for differences in techniques. This results in severe thinning of the cerebral mantles. There is absence of septum pellucidum. There is widening of the fontanelles. The pituitary region is difficult to assess. The corpus callosum likewise is difficult to assess. It may be present but it has been maximally thinned and distorted secondary to ventriculomegaly. The cerebral aqueduct is not patent. Findings on the posterior cranial fossa are compatible with a classic Dandy-Walker malformation.The globes are small, misshapen and demonstrate increased density, which suggests proteinaceous material or hemorrhage. Persistent hyperplastic primary vitreous or some other congenital globe anomaly cannot be ruled out.Posterior scalp swelling is evident which may reflect birth trauma has decreased. | 1. Status post a right parietal approach ventriculostomy shunt catheter placement. Grossly unchanged marked hydrocephalus allowing for differences in techniques.2. Redemonstration of additional intracranial and orbital abnormalities. |
Generate impression based on findings. | 51-year-old male with shortness of breath. PULMONARY ARTERIES: Diagnostic quality exam without evidence of pulmonary embolus. Mixing artifact noted in the main pulmonary arteries.LUNGS AND PLEURA: Normal variant azygos lobe is noted. No consolidation or pleural effusions. Punctate calcified and noncalcified micronodules measuring less than 4 mm, most likely benign in nature.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Left chest wall device noted. No significant abnormalities. | No pulmonary embolus or other acute intrathoracic abnormality to account for patient's symptoms. |
Generate impression based on findings. | 49-year-old female with rectal cancer, chest pain, shortness of breath. PULMONARY ARTERIES: Diagnostic quality exam without evidence of pulmonary embolus.LUNGS AND PLEURA: Lungs are underinflated. No consolidation or pleural effusions. No suspicious nodules or masses.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Multiple mildly enlarged axillary lymph nodes; reference left axillary node measures 9 mm in short axis, measured 8 mm on 8/26/2013 CT (series 9, image 59).UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Moderate amount of ascites fluid. Hypodense lesion in left lobe of liver, unchanged. Renal cysts. Several dilated bowel loops in partially visualized upper abdomen; refer to dedicated abdominal CT report for abdominal findings. | 1.No pulmonary embolus. 2.Lungs are underinflated, likely due to abdominal ascites and may be cause of shortness of breath. 3.Hypodense lesion in left lobe of the liver, compatible with metastatic lesion from known rectal cancer.4.Ascites and several dilated small bowel loops in partially visualized abdomen; refer to dedicated abdominal CT report for abdominal findings. |
Generate impression based on findings. | 81 year-old male with metastatic prostate cancer, nausea, vomiting and hypotension. The ventricles, sulci, and cisterns are symmetric and appropriate for the patient's age. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. | No acute intracranial abnormality. |
Generate impression based on findings. | 50 year-old male with history of CLL and confusional state. The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The mastoid air cells are clear. Status post endoscopic sinus surgery. There is mild mucosal thickening in the paranasal sinuses and frothy materials in the sphenoid sinuses. | 1. No acute intracranial abnormality. 2. Paranasal sinus inflammatory disease with acute sphenoid sinusitis. |
Generate impression based on findings. | 63-year-old male with new hypoxia. History of cirrhosis. PULMONARY ARTERIES: Diagnostic quality exam without evidence of pulmonary embolus.LUNGS AND PLEURA: Moderate paraseptal and centrilobular emphysema. Basilar atelectasis/scarring, basilar predominant moderate bronchiectasis and mild diffuse bronchial wall thickening. No consolidation or pleural effusions.Scattered calcified and noncalcified micronodules, likely benign in etiologyMEDIASTINUM AND HILA: Mild coronary artery calcifications. Calcified lymph nodes compatible with prior granulomatous infection. Heart normal in size without pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Cirrhotic liver with multiple mildly enlarged upper intraperitoneal lymph nodes likely reactive in nature. Bullet fragment is again seen along proximal aspect of right psoas muscle, with associated inferior endplate changes of adjacent L1 vertebral body. | 1.No evidence of pulmonary embolus or other acute intrathoracic abnormality.2.Moderate emphysema and bronchiectasis. |
Generate impression based on findings. | 79 year old female with lung cancer, on Tarceva over 9 months. CHEST:LUNGS AND PLEURA: Status post right middle lobectomy and associated volume loss.Previously measured soft tissue lesion located in right mid lung superior to suture line is increased size, measuring 2.7 x 2.6 cm, previously measured 1.9 x 2.2 cm (series 5, image 50). The previously measured soft tissue nodule located more posteriorly along the suture line cannot be accurately measured but appears increased in size.Interval increase in nodularity and consolidation in the right upper and right lower lobes. Moderate right pleural effusion with percutaneous pleural catheter, not significantly changed. Interval resolution of previously seen air in right pleural space.Significantly increased number of nodules in the left lung.MEDIASTINUM AND HILA: Mild increase in size of multiple mediastinal lymph nodes. Heart size normal. Severe coronary artery and aortic calcifications.CHEST WALL: Degenerative changes in the spine. Subtle sclerotic foci in seventh and ninth vertebral bodies appear 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: Left adrenal gland nodule unchanged, measuring 1.4 x 2.0 cm (series 3, image 90). Nodularity of right adrenal gland not significantly changed (series 3, image 92).KIDNEYS, URETERS: Subcentimeter hypodensities in the left kidney unchanged, compatible with cysts.PANCREAS: Dilation of pancreatic duct appears unchanged. Heterogeneity of pancreatic tail unchanged.RETROPERITONEUM, LYMPH NODES: Reference gastrohepatic node unchanged, measuring 9 mm, previously measured 9 mm (series 3, image 89).BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Severe degenerative changes affect lumber spine.OTHER: No significant abnormality noted. | 1.Interval increase in size of reference right lung lesion adjacent to suture line. 2.Innumerable new nodules in both lungs as well as increased consolidation in right lung, compatible with progression of disease. |
Generate impression based on findings. | 10 month old male status post fall. The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and right mastoid air cells are opacified. There is left parietooccipital plagiocephaly. | No acute intracranial abnormality. |
Generate impression based on findings. | 82 year-old female with syncope. The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. There is calcification of the distal vertebral arteries. | 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. | 4 year-old female with head injury. The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. | No acute intracranial abnormality. |
Generate impression based on findings. | 59 year-old female with altered mental status. There is scattered patchy hypoattenuation in the cerebral white matter. The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The mastoid air cells are clear. There is moderate mucosal thickening in the paranasal sinuses. There is blowout fracture of the left lamina papyracea. | 1. No acute intracranial abnormality. Mild small vessel ischemic disease of indeterminate age. However, CT is insensitive to early detection of CVA. MRI should be considered if clinical suspicion for CVA persists. 2. Paranasal sinus inflammatory disease. 3. Blowout fracture of the left lamina papyracea, likely chronic. |
Generate impression based on findings. | 65-year-old female patient with vomiting, abdominal pain and known hernia. Evaluate for obstruction. ABDOMEN:LUNG BASES: Trace bilateral dependent atelectasis.LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral subcentimeter hypoattenuating lesions in the inferior poles of kidney are too small to characterize and likely represent cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Bowel is normal in caliber without evidence of obstruction. Clonic diverticulosis without evidence of diverticulitis. Umbilical hernia containing fat.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Bowel is normal in caliber without evidence of distraction. Clonic diverticulosis without evidence of diverticulitis. Umbilical hernia containing fat.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No acute intra-abdominal pathology or evidence of bowel obstruction. |
Generate impression based on findings. | 66 year old female with tongue cancer. LUNGS AND PLEURA: Severe centrilobular emphysema. No consolidation or pleural effusions. 4-mm left upper lobe micronodule along left major fissure is suggestive of intrapulmonary lymph node based on location (series 5, image 46). No other nodules or masses.MEDIASTINUM AND HILA: No mediastinal lymphadenopathy. Heart is normal in size without pericardial effusion. Severe calcifications affect coronary arteries, aorta, and great vessels. Right port catheter terminates in distal SVC.CHEST WALL: Posttreatment changes in lower neck; please see dedicated neck CT report for neck findings.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Gastrostomy tube in place. Nonspecific thickening of left adrenal gland. | 1.4-mm micronodule along left major fissure has location most suggestive of intrapulmonary lymph node; however, given patient's history of cancer, continued follow-up is recommended.2.Emphysema. |
Generate impression based on findings. | 50-year-old male patient with CLL status post bone marrow transplant and prior history of graft versus host disease presents with abdominal pain, diarrhea and nausea. Evaluate for acute process including graft versus host disease recurrence. ABDOMEN:LUNG BASES: Interval decrease in right lower lobe consolidation.LIVER, BILIARY TRACT: Diffuse fatty infiltration of the liver.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Scattered subcentimeter retroperitoneal lymph nodes. Index left periaortic lymph node measures 0.9 x 0.9 cm (series 3 image 96), previously 1.5 x 1.1 cm.BOWEL, MESENTERY: Bowel is normal in caliber without evidence of obstruction. No CT evidence of bowel wall thickening. Appendix is well-visualized and within normal limits. Colonic diverticulosis without CT evidence of diverticulitis.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumbar spine. Height loss in the T7 vertebral body.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Scattered bilateral peri-iliac lymph nodes not significantly changed. Reference right peri-iliac lymph node measures 0.6 x 0.7 cm (series 3 image 119), previously 1.3 x 1.1 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumbar spine. OTHER: No significant abnormality noted. | 1.No evidence of bowel wall thickening or bowel obstruction.2.Slight interval decrease in size of index lymph nodes. |
Generate impression based on findings. | 78 year-old female evaluate for retroperitoneal bleed. History of recent femoral line placement The study is limited due to lack of IV contrastABDOMEN:LUNG BASES: A bilateral large pleural effusions, increased compared to previous study. Dilated esophagus. Cardiomegaly.LIVER, BILIARY TRACT: Mild splenomegaly.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: Small amount of ascites. Right lower quadrant ostomy.BONES, SOFT TISSUES: Generalized anasarca.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Ascites.BONES, SOFT TISSUES: Generalized anasarca.OTHER: Left common femoral vein catheter extending to the suprahepatic IVC. | The study is limited due to lack of oral and IV contrast. No evidence of intraperitoneal or retroperitoneal bleed.Bilateral large pleural effusions, cardiomegaly, ascites and generalized anasarca.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 55-year-old male patient with nausea and vomiting. Evaluate for obstruction or bowel ischemia. ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Status post cholecystectomy. Mild intrahepatic and common biliary ductal dilatation, similar compared to prior.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts, stable. No evidence of hydronephrosis or hydroureter.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Bowel is normal in caliber without evidence of obstruction.Status post umbilical hernia repair. There is a rim enhancing periumbilical fluid collection superficial to hernia repair mesh, measuring 4.1 x 3.8 cm (series 3 image 55) with adjacent gas. No herniation of bowel.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Fluid collection superficial to umbilical hernia repair mesh. No evidence of bowel herniation or obstruction. |
Generate impression based on findings. | Right distal tibia and fibula fracture status post reduction Oblique fracture through the distal fibula metadiaphysis, in near-anatomic alignment. Comminuted Salter-Harris 4 fracture of the distal tibia, with distinct anterior and posterior components, in near-anatomic alignment. The growth plate is widened to 4 mm. Small joint effusion and soft tissue swelling. Overlying cast identified. | Distal fibular and tibial fractures, as described above. |
Generate impression based on findings. | 36 year old female presenting with fever and abdominal pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Mild hepatomegaly.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Uterus is enlarged. There are some calcified fibroids within the uterus. In the left adnexa there is a 2.9 x 2.4 cm cystic lesion. Small amount of air is present between this lesion and the uterus. There is also fascinating and inflammation in the left lower quadrant involving the left-sided abdominal wall muscles and subcutaneous tissues of the pelvis.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 | Left adnexal cystic lesion associated with adjacent inflammation the anterior abdominal wall and small amount of punctate free air inferior and medial to the lesion. Although this lesion may also represent an ovarian cyst and postoperative changes, a pelvic abscess cannot be excluded. Clinical correlation is recommended.Dr. Siddiqui was notified and acknowledged about these findings at the time of dictation. |
Generate impression based on findings. | 87 year-old female with headache and unsteady gait. NONCONTRAST CT HEADThere is patchy hypoattenuation in the cerebral white matter. The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. Lens prostheses. CTA HEAD AND NECKThere is common aortic arch origin of the right brachiocephalic and left common carotid arteries. The left subclavian and bilateral vertebral artery origins are normal.There is normal contrast opacification through the bilateral common carotid arteries, carotid bifurcations, cervical internal/external carotid, and vertebral arteries. Mild calcified atherosclerosis is seen along the common carotid arteries and at bilateral common carotid bifurcations.There is normal contrast opacification through anterior circulation (bilateral petrous/cavernous/supraclinoid internal carotid arteries, anterior and middle cerebral arteries), posterior circulation (vertebral-basilar, posterior-inferior cerebellar, anterior-inferior cerebellar, superior cerebellar, and posterior cerebral arteries), and distal intracranial vasculature. Mild calcified atherosclerosis is noted in bilateral cavernous/supraclinoid carotid arteries. There is normal contrast opacification through circle-of-Willis with a patent anterior communicating artery and bilateral posterior communicating arteries. Fetal origin of the left posterior cerebral artery. No evidence of aneurysm, significant stenosis, occlusive thrombus, dissection, or vascular malformation is noted.There is normal superficial and deep intracranial venous drainage.Thyroid nodules are noted. | 1. No acute intracranial abnormality. Mild small vessel ischemic disease of indeterminate age. However, CT is insensitive to early detection of CVA. MRI should be considered if clinical suspicion for CVA persists. 2. No evidence of aneurysm, significant stenosis, occlusive thrombus, dissection, or vascular malformation. 3. Mild calcified atherosclerosis of the carotid arteries. |
Generate impression based on findings. | 54-year-old male patient with nausea, vomiting, abdominal pain and history of incarcerated hernia. Evaluate for small bowel obstruction. Note that the lack of intravenous contrast limits evaluation of vasculature, lymph nodes and solid viscera.ABDOMEN:LUNG BASES: Right lung base scarring, stable.LIVER, BILIARY TRACT: Cirrhotic morphology. Cholelithiasis. No focal liver lesions identified in this limited, noncontrast examination.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: Bowel is normal in caliber without evidence of obstruction. No pneumoperitoneum.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Large abdominal ascites, stable.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Fully catheter in place. Air in the bladder, likely secondary to instrumentation.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Ventral abdominal skin staples.OTHER: Large abdominal ascites, stable. | 1.No evidence of small bowel obstruction.2.Stable abdominal ascites.3.Cirrhotic liver. |
Generate impression based on findings. | 67-year-old female with history of metastatic lung cancer CHEST:LUNGS AND PLEURA: Index lingular nodule now measures 1.5 by 1.4 cm on image number 49, series number 4, slightly increased in size compared to previous study.Index left lower lobe nodule now measures 2.6 by 2 cm on image number 55, series number 4 , slightly increased in size compared to previous study. Bilateral other numerous metastatic lesions are also either stable to minimally increased in size compared to previous study.MEDIASTINUM AND HILA: Index pretracheal lymph node is unchanged measuring 10 mm on image number 36 on series number 3 in short axis.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Moderate left-sided hydronephrosis and dilated left ureter is again noted.RETROPERITONEUM, LYMPH NODES: Endovascular stent within the IVC is again noted. There is also stenting in the left external iliac vein, unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic bone lesion involving the L3 vertebral body, best seen on image number 40, coronal series, unchanged. This lesion is suspicious for metastatic disease.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Index left inguinal lymph node measures 2.2 x 2.2 cm in image number 204, series number 3, unchanged. New inflammatory changes around this lymph node are likely secondary to recent biopsy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Minimal interval increase in the size of the lung nodules. Left hydronephrosis and enlarged left inguinal lymph nodes are unchanged. L3 vertebral body likely metastatic lesion, unchanged. |
Generate impression based on findings. | 49 year-old female patient with history of locally advanced rectal cancer presents with abdominal pain, nausea, vomiting, chest pain and shortness breath. Evaluate for masses and ascites. ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Segment two hepatic hypoattenuating lesion measures 1.1 x 1.6 cm (series 12 image 27), increased in size compared to examination on 8/26/2013. Subcentimeter hypoattenuating lesion adjacent to falciform ligament in the right hepatic lobe is stable compared to prior examination.Mild intrahepatic and extrahepatic biliary ductal dilatation, similar to prior.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable left renal cyst. Bilateral hydronephrosis despite bilateral nephroureteral stents in place, similar to prior.RETROPERITONEUM, LYMPH NODES: Low density posterior to the inferior vena cava (series 12 image 65) may be secondary to lymphadenopathy.BOWEL, MESENTERY: Continued increase in proximal small bowel dilatation up to 4 cm. Transition zone is within the pelvis. Stool throughout the colon. Wall thickening and edema in the cecum and descending colon is stable compared to prior examination. Rectum with patent intraluminal stent. Large necrotic rectal tumor. In the area of the right adnexa there is a soft tissue density that may represent tumor.Diffuse mesenteric and peritoneal soft tissue implants in the abdomen are similar to prior examination.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of abdominal ascites.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Nephroureteral stents terminate in the bladder.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of abdominal ascites. | 1.Distal small bowel obstruction with transition point in the pelvis.2.Enlarging hypoattenuating liver lesion is suspicious for metastatic disease.3.Metallic stents in the rectum. Wall thickening of the cecum and sigmoid colon. Right adnexal soft tissue density likely representing patient's known malignancy. |
Generate impression based on findings. | 63-year-old male with history of head and neck squamous cell carcinoma This study is limited due to lack of intravenous contrast.CHEST:LUNGS AND PLEURA: There is paramediastinal fibrosis which may be secondary to radiation. In addition there are irregular air space opacities predominately in the right lung. These may also represent postradiation changes, however, metastatic disease cannot be excluded. Index lesion in the right middle lobe measures 1.1 x 1.1 cm image number 55, series number 5.MEDIASTINUM AND HILA: Superior mediastinal paratracheal adenopathy measuring 2.6 x 1.7 cm on image number 24, series number 4. There is also additional bilateral hilar and prevascular enlarged lymph nodes.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: There is an ill-defined hypodense lesion within the liver measuring 2.6 x 2.8 cm on image number 80, series number 4. Lack of IV contrast precludes characterization of this lesion but this lesion is suspicious for metastatic disease.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Horseshoe kidney. Right-sided renal cyst versus dilated renal pelvis.RETROPERITONEUM, LYMPH NODES: 2.7 x 1.8 cm left para-aortic adenopathy, seen on image number 108, series number 4 suspicious for metastatic disease. There is also right-sided retrocaval and para-aortic lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Radiation pellets in the prostate.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 | Postradiation changes in the lungs and mediastinum. Mediastinal metastatic adenopathy.Irregular shaped air space opacities predominately in the right lung representing radiation changes versus metastatic disease. Follow-up imaging is recommended.Hypodense lesion in the liver which cannot be optimally characterized due to lack of IV contrast but suspicious for metastatic disease.Horseshoe kidney. Cystic lesion in the right side of the kidney may represent a dilated pelvis versus a renal cyst. Lack of IV contrast limits optimal evaluation.Retroperitoneal metastatic adenopathy. |
Generate impression based on findings. | History of pancreatic cancer, status post Whipple surgery CHEST:LUNGS AND PLEURA: Scattered micronodules are unchanged.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Superior endplate deformity of T8 vertebral body, unchanged.ABDOMEN:LIVER, BILIARY TRACT: Numerous hypodensities in the liver are grossly unchanged. Presence of these numerous small hypodense lesions limits evaluation of the liver for metastatic disease.SPLEEN: No significant abnormality noted.PANCREAS: Mild narrowing of the portal vein and superior mesenteric vein is again noted. Multiple collateral veins are again noted in the upper abdomen. Postsurgical changes involving the pancreas. Infiltrative soft tissue surrounding the celiac trunk and stomach and is suspicious for peritoneal carcinomatosis. In addition there are new peritoneal soft tissue densities consistent with peritoneal carcinomatosis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Borderline enlarged retroperitoneal lymph nodes are again noted.BOWEL, MESENTERY: Interval development of soft tissue densities in the omentum consistent with peritoneal carcinomatosis. Small amount of ascites, slightly decreased compared to previous study.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Leiomyomatous uterus, again 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. | Interval development of omental and peritoneal soft tissue density lesions most prominent in the left side of the abdomen consistent with peritoneal carcinomatosis. Soft tissue surrounding the celiac trunk, main portal vein and stomach is grossly unchanged. |
Generate impression based on findings. | 45-year-old female evaluate for abscess ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is a 2-cm rim enhancing periumbilical abscess in the subcutaneous tissues of the anterior abdominal wall.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: 5.4 by 5.1-cm left adnexal mass adjacent to the cervix best seen on image number 82, series number 3. The etiology is unknown. An ovarian neoplasm cannot be excluded. Further evaluation with pelvic ultrasound is recommended.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 | Anterior abdominal wall periumbilical abscess. Left adnexal mass suspicious for ovarian neoplasm. Further evaluation with pelvic ultrasound is recommended. |
Generate impression based on findings. | 29 year-old female with metastatic melanoma now presenting with acute renal failure This study is limited due to lack of intravenous contrast.CHEST:LUNGS AND PLEURA: Bilateral numerous lung metastases. Moderate-sized left-sided pleural effusion and dependent atelectasis, not significantly changed from previous study.MEDIASTINUM AND HILA: Mediastinal adenopathy consistent with metastatic disease.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Hepatic and perihepatic metastatic lesions are again noted. Bilateral paracardiac adenopathy, unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: Retroperitoneal metastatic adenopathy.BOWEL, MESENTERY: Extensive peritoneal and omental caking consistent with peritoneal metastatic disease. Lack of oral contrast limits multiple evaluation of the bowel.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Extensive peritoneal carcinomatosis. Minimally distended small bowel loops in the left lower quadrant measuring up to 3 cm. These bowel loops cannot be optimally evaluated due to lack of intravenous contrast. There is a peritoneal catheter with its tip in the left lower quadrant. Small amount of fluid and air is present around the tip of this catheter.BONES, SOFT TISSUES: Nonspecific sclerotic lesion involving the right ischium, unchanged.OTHER: No significant abnormality noted. | Significant interval increase in the amount of peritoneal carcinomatosis with interval decrease in the amount of ascites.Lack of oral and intravenous contrast significantly limits evaluation of the bowel loops. There are mildly dilated small bowel loops in the left lower quadrant. Etiology is unknown. Clinical correlation is recommended.Extensive metastatic disease in the lungs, mediastinum, paracardiac regions and retroperitoneum as described above, not significantly changed from previous study. |
Generate impression based on findings. | 54-year-old female patient with right upper quadrant pain. Evaluate for appendicitis versus colitis versus renal calculus versus biliary etiology. ABDOMEN:LUNG BASES: Left lower lobe cyst. 5-mm right middle lobe pulmonary nodule (series 6 image 30).LIVER, BILIARY TRACT: Hepatomegaly with heterogeneous fatty infiltration of the liver with focal sparing of the caudate lobe. No radiopaque cholelithiasis or CT evidence of consciousness.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: Scattered atherosclerotic changes in the abdominal aorta and iliac arteries.BOWEL, MESENTERY: Bowel is normal in caliber without evidence of obstruction. Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Bowel is normal in caliber without evidence of obstruction. Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.No evidence of acute intra-abdominal pathology.2.5-mm right middle lobe pulmonary nodule. Follow-up with chest CT is recommended.3.Hepatomegaly with heterogeneous fatty infiltration. |
Generate impression based on findings. | 58-year-old male with history of lung cancer CHEST:LUNGS AND PLEURA: Postsurgical changes in the left lung with associated pleural thickening and volume loss. Significant interval increase in the air space consolidation involving the left lung which likely represents a combination of tumor growth and pneumonia. Small amount of left pleural effusion is unchanged.New large air space consolation the right lower lung and interval development of multiple small nodules, suspicious for metastatic disease.MEDIASTINUM AND HILA: Index AP window lymph node is unchanged measuring 2 x 1.3 cm image number 41, series number 3.Index left cardiophrenic lymph node measures 1.2-cm on image number 94, series number 3.Soft tissue thickening along the mediastinal pleural surface measures 1.5-cm image number 36, series number 3, not significantly changed from previous study. Left hilar adenopathy cannot optimally evaluated due to worsening disease in the left lung.CHEST WALL: Again noted sclerotic foci in thoracic vertebral bodies, increase in size and density compared to previous study.ABDOMEN:LIVER, BILIARY TRACT: Liver metastases and increase in size and number compared to previous study. Index left lobe lesion now measures 5.5 x 2.8 cm image number 107 of series number 3. This lesion is difficult to measure due to its conflagration with a surrounding metastases. The second index lesion in the right lobe of the liver has also significantly increased in size and now measures 3.6-cm by 2.5-cm image number 106, series number 3.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Interval increase in the size of the left adrenal metastatic lesion. The lesion now measures 2.2 x 1.6 cm on image number 101, series number 3. This lesion was measuring 1.5 x 1.6 cm on image number 99, series number 4. Right adrenal gland is unremarkable.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Interval development of sclerotic lesions in the lumber vertebral bodies and pelvic bones consistent with metastatic disease.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: Interval developing of sclerotic lesions in pelvic bones consistent with metastatic disease.OTHER: No significant abnormality noted | Interval progression of disease with interval increase in the size of the left lung mass, hepatic metastases, also as metastases and left adrenal metastatic disease.Interval development of right sided pulmonary static disease. |
Generate impression based on findings. | 39-year-old male with history of colon cancer CHEST:LUNGS AND PLEURA: Index right middle lobe nodule measures 6 mm in diameter image number 53, series number 4, minimally increased in size compared to previous study. Other scattered pulmonary nodules have also minimally increased in size compared to previous study and suspicious for metastatic disease. A second index nodule in the left lower lobe now measures 7 x 6 mm on image number 59, series number 4. This nodulewas measuring 5 mm in diameter image number 52, series number 4 in the previous study.MEDIASTINUM AND HILA: Small mediastinal lymph nodes are unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Index right inferior hepatic lesion now measures 1.5 by 1.2 cm on image number 106, series number 3, not significantly changed from previous study. Extensive other hepatic metastases are also grossly stable.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Mild wall thickening involving the sigmoid colon, unchanged.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Slight interval increase in the size of the lung nodules which are suspicious for metastatic disease.Extensive hepatic metastases are unchanged.Sigmoid wall thickening. |
Generate impression based on findings. | 34-year-old male with tachycardia and pleuritic chest pain. PULMONARY ARTERIES: Large pulmonary embolus in right lower lobe pulmonary artery branch (series 7, image 159). Additional smaller embolus in segmental branch of right upper lobe (series 7, image 124).LUNGS AND PLEURA: Small left pleural effusion with left basilar atelectasis/consolidation. Minimal right lung atelectasis. No opacity suggestive of hemorrhage or infarction.MEDIASTINUM AND HILA: Heart size normal, without evidence of right heart strain or pericardial effusion. Multiple small mediastinal lymph nodes. Normal variant origin of left common carotid artery from right brachiocephalic artery (bovine arch).Collateral blood flow from left upper extremity contrast injection through the azygous and hemiazygous veins, unchanged and consistent with occlusion of the left brachiocephalic vein and SVC occlusion. Linear high density in SVC most consistent with calcifications. CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.Large pulmonary embolus in right lower lobe pulmonary artery branch and small embolus in subsegmental right upper lobe branch. No evidence of right heart strain or lung infarction/hemorrhage.2.Unchanged collateral flow through hemiazygos and azygos veins from left upper extremity due to known occlusion of SVC and left brachiocephalic veins.3.Small left pleural effusion with left basilar subsegmental atelectasis/consolidation. |
Generate impression based on findings. | 22-year-old female with right upper lobe pneumonia on chest radiograph. Concern for worsening. LUNGS AND PLEURA: Consolidation in right upper lobe consistent with pneumonia. Scattered smaller areas of consolidation are also seen in the right lower lobe and lingula. Bilateral small pleural effusions with subsegmental basilar consolidation/atelectasis, right more than left.MEDIASTINUM AND HILA: Multiple nonspecific enlarged mediastinal lymph nodes, which may be reactive in nature. Left port catheter tip terminates in the upper right atrium. Heart is normal in size without pericardial effusion.CHEST WALL: Right humeral head AVN.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Multifocal consolidation, worst in the right upper lobe, compatible with pneumonia and likely not significantly changed since most recent radiograph. Bilateral small pleural effusions, right more than left, with underlying atelectasis/consolidation in the bases. |
Generate impression based on findings. | History of rectal cancer CHEST:LUNGS AND PLEURA: Scattered bilateral pulmonary nodules, not significantly changed from previous study.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: 1.3-cm right adrenal adenoma, unchanged.KIDNEYS, URETERS: Left nephroureteral stent is again noted.RETROPERITONEUM, LYMPH NODES: Index left para-aortic node measures 1.6 by 1 cm image number 125, series number 3, slightly smaller compared to previous study.Index mesentery Lymph node measures 1.2 by 1 cm image number 147, series number 3, minimally smaller compared to previous study.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Soft tissue mass insinuating the left bladder base now measures 3.9 by 3 .7-cm on image number one on the seventh 6, series number 3, minimally enlarged compared to previous study.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Left lower quadrant ostomy, unchanged.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Minimal decrease in the size of the index lymph nodes and minimal interval increase in the size of the pelvic mass invading the bladder base. |
Generate impression based on findings. | 63 year old female, former smoker, preoperative evaluation for VAD in plant. Evaluate for malignancy. LUNGS AND PLEURA: Bilateral pleural effusions, moderate right and small left, with bilateral basilar consolidation/atelectasis, right more than left. No underlying suspicious nodules or mass identified. MEDIASTINUM AND HILA: Multiple enlarged, nonspecific mediastinal lymph nodes, which may be reactive in nature. Calcified lymph nodes compatible with prior granulomatous infection.Severe cardiomegaly. Trace pericardial effusion. Moderate coronary artery and aortic arch calcifications. Right central venous catheter terminates in the right brachiocephalic vein. Two ICD leads in appropriate position.CHEST WALL: Left chest wall ICD device. Diffuse anasarca.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Multiple punctate splenic calcifications consistent with prior granulomatous infection. Left adrenal gland thickening, nonspecific. | 1.Severe cardiomegaly and bilateral pleural effusions with overlying basilar consolidation/atelectasis, compatible with CHF/volume overload.2.No evidence of malignancy. |
Generate impression based on findings. | 55 year-old female with shortness of breath. LUNGS AND PLEURA: Bilateral basilar groundglass and linear opacities, most compatible with scarring and subsegmental atelectasis. No consolidation to suggest pneumonia. No edema or pleural effusions.MEDIASTINUM AND HILA: No pathologically enlarged mediastinal lymph nodes. Mild coronary calcifications. Moderate cardiomegaly. No pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.Basilar subsegmental atelectasis/scarring, without edema, pneumonia, or other acute cardiopulmonary abnormality.2.Moderate cardiomegaly. |
Generate impression based on findings. | 62 year old female with history of uterine neoplasm CHEST:LUNGS AND PLEURA: Bilateral lung nodules, some of which demonstrate central cavitation, suspicious for metastatic disease. An index nodule in the left lower lobe measures 1.3 by 1 cm on image number 54, series number 5.MEDIASTINUM AND HILA: Bilateral small hilar lymph nodes. Esophagus is dilated throughout its course. Etiology is unknown.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: 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. | Metastatic lung nodules. |
Generate impression based on findings. | Female 53 years old Reason: left knee pain Evaluation of the knee is limited by streak artifact related to the patient's total knee arthroplasty device.Hardware components of a left total knee arthroplasty device are situated in near anatomic alignment. No specific radiographic features of infection are present. There is a small knee joint effusion that is incompletely imaged on this study. There is thin lucency along the stem of the tibial component, but this is not necessarily of clinical significance. There is atrophy of the popliteus muscle. The remainder of the musculature is within normal limits. | Total knee arthroplasty as above. |
Generate impression based on findings. | 43-year-old male with B12 deficiency ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Nonspecific hypodense lesions in the liver likely representing benign cysts.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Simple right 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: 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 | Hepatic and right renal cysts. Normal small bowel. |
Generate impression based on findings. | 63 year-old male with HNSCC. There is focus of hypoattenuation in the left superior frontal lobe. The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The orbits are unremarkable. The paranasal sinuses and mastoid air cells are clear except for mild paranasal sinus mucosal thickening. There is atrophy of the left hemitongue. There is posttreatment change in the left anterior neck. A right level 4 node (image 166 of series 4) measures 12 x 10 mm. There are multiple smaller nodes along the jugulodigastric chains. The airways are unremarkable/patent. The epiglottis, vallecula, piriform sinuses, and vocal cords are normal. The left submandibular gland appears absent. The parotid, right submandibular, and thyroid glands are unremarkable. The carotid arteries and jugular veins are patent. The osseous structures are unremarkable. Disc osteophyte complex at C5-C6. Limited view of the chest shows mediastinal lymphadenopathy and paramediastinal fibrosis. | Lack of IV contrast limits evaluation. With this limitation, 1. Mildly enlarged right level 4 node and multiple smaller nodes. 2. Atrophy of the left hemitongue. There is posttreatment change in the left anterior neck. No evidence of mass in the neck. 3. Mediastinal lymphadenopathy and paramediastinal fibrosis. 4. Focus of hypoattenuation in the left superior frontal lobe is nonspecific and may represent encephalomalacia, ischemia or edema from underlying processes such as metastasis. Contrast enhanced exam is recommended. |
Generate impression based on findings. | 63 year-old male with slurred speech. There is hypoattenuation in the cerebral white matter, left greater than right and most prominent in the left frontal lobe. There is associated ex vacuo dilatation of the left lateral ventricle. There are foci of hypoattenuation in the left cerebellum. The ventricles, sulci, and cisterns are 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. Intracranial arterial calcifications and ectasia. The osseous structures are unremarkable except for a left parietal bone burr hole. The mastoid air cells are clear. The previously seen periorbital/preseptal and facial hematomas have resolved. The intraorbital contents are unremarkable. The paranasal sinuses and mastoid air cells are clear. | 1. No acute intracranial hemorrhage. 2. Left greater than right small vessel ischemic disease of indeterminate age. 3. Infarcts in the left cerebellum and left frontal lobe, probably chronic. CT is insensitive to early detection of CVA. MRI should be considered if clinical suspicion for CVA persists. |
Generate impression based on findings. | 20 year-old male with hearing loss. CT RIGHT TEMPORAL BONEThe pinna is normal. There is minimal opacification of the mastoid air cells, which is otherwise well developed with clear air cells and intact trabeculae. The external auditory canal is normal. The middle ear cavity is aerated. The malleus, incus, and stapes are normal. The oval and round windows are normal. The inner ear structures (cochlea, vestibule, and semicircular canals) are normal. The cochlear and vestibular aqueducts are normal. The tegmen tympani appears intact. The internal auditory canal including porus and aperture is normal in size. The facial nerve canal is normal. The carotid canal, sigmoid sinus plate, and jugular fossa are normal. CT LEFT TEMPORAL BONEThe pinna is normal. There is minimal opacification of the mastoid air cells, which is otherwise well developed with clear air cells and intact trabeculae. The external auditory canal is normal. The middle ear cavity is aerated. The malleus, incus, and stapes are normal. The oval and round windows are normal. The inner ear structures (cochlea, vestibule, and semicircular canals) are normal. The cochlear and vestibular aqueducts are normal. The tegmen tympani appears intact. The internal auditory canal including porus and aperture is normal in size. The facial nerve canal is normal. The carotid canal, sigmoid sinus plate, and jugular fossa are normal. Left maxillary sinus mucosal thickening. | 1. Normal CT appearance of the otic capsule, labyrinthine windows, and internal auditory canals.2. No CT evidence for abnormality of the ossicles and middle ear cavity. |
Generate impression based on findings. | 67 year-old male with history of head and neck cancer. The orbits are unremarkable. The paranasal sinuses and mastoid air cells are clear. Visualized intracranial contents are unremarkable. Stable postoperative changes status post supraglottic laryngectomy and bilateral neck dissection. Diffuse mucosal edema in the upper aerodigestive tract is compatible with sequela of radiation therapy, unchanged. The upper airway is patent. There is a focus of hyperdensity in the left lateral oral cavity. Clinical correlation is suggested. Edentulous. The oral cavity, oro/nasopharynx, and hypopharynx are unremarkable. No abnormal areas of exophytic mass or enhancement to suggest residual recurrent disease. Patulous esophagus may is unchanged.Status post supraglottic laryngectomy, unchanged. Mild paramedian displacement of the left vocal cord is unchanged compared to the previous examination. Salivary and thyroid glands are unremarkable. No significant cervical lymphadenopathy by CT criteria.Degenerative changes of the cervical spine without significant spinal stenoses. Significant caliber attenuation of the left common and internal carotid arteries, unchanged from prior. The left internal jugular vein is not visualized, likely postoperative.Emphysema and biapical scarring, unchanged. | Stable posttreatment changes in the neck without evidence of recurrent or residual tumor or lymphadenopathy. |
Generate impression based on findings. | 37 year-old male with sepsis. The orbits are unremarkable. The mastoids are clear. Limited view of the intracranial structure is unremarkable. There is minimal mucosal thickening in the maxillary sinuses. The frontal sinuses, frontal-ethmoid recesses, anterior/posterior ethmoids, sphenoid sinuses, and maxillary sinuses are well developed and clear. The osteomeatal complexes are normal with intact uncinate processes and patent infundibuli. The intersphenoid septum is normal. The nasal turbinates and nasal septum are normal. The cribriform plate, fovea ethmoidalis and lamina papyraceae appear normal. There is periapical lucency of the mandibular and maxillary incisors. The osseous structures are unremarkable. | 1. Unremarkable CT paranasal sinuses apart from minimal maxillary sinus mucosal thickening. 2. Periapical lucency of the mandibular and maxillary incisors is nonspecific and may represent periapical cyst, periodontal disease or abscess. |
Generate impression based on findings. | 66 year old female, unresponsive. Motion degraded exam. There has been interval progression of supra and infratentorial hypodensities, which involve bilateral watershed zones (right greater than left), basal ganglia and bilateral cerebellar hemispheres. There is blurring of gray-white differentiation and partial sulcal effacement in some of the regions. There is no midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The ventricles and cisterns remain patent. There are heavy calcifications of the vertebral arteries with probable high grade stenoses. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. The patient is intubated. | Motion degraded exam. Interval progression of supra and infratentorial hypodensities, which involve bilateral watershed zones (right greater than left), basal ganglia and bilateral cerebellar hemispheres. The finding is highly suspicious for acute infarcts. There is no associated hemorrhage or brain herniation. MRI brain is recommended. |
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