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Generate impression based on findings. | Reason: s/p ileocecectomy, POD 13, now with tachycardia, r/o PE History: s/p ileocecectomy, POD 13, now with tachycardia, r/o PE PULMONARY ARTERIES: No evidence of PE.LUNGS AND PLEURA: Mild nonspecific bronchial wall thickening and basilar linear atelectasis. No evidence of consolidation or significant pulmonary edema.MEDIASTINUM AND HILA: Venous catheter tip at RA/SVC junction.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. The abdomen and pelvis will be reported separately. | No evidence of PE.Mild nonspecific bronchial wall thickening and basilar linear atelectasis. No evidence of consolidation or significant pulmonary edema. |
Generate impression based on findings. | Reason: FU CT to eval lung nodule History: s/p resection for early stage lung cancer CHEST:LUNGS AND PLEURA: Evidence of postsurgical changes in the right upper lobe . At this opacity at the surgical site (image 46 series 5) measuring approximately 10 mm x 10 mm in size is unchanged in comparison to prior outside exams dated 5/14/13 and 2/12/13 and probably represents postsurgical changes. Residual or recurrent neoplasm cannot be definitively excluded a less likely acute the lack of interval change.Small 5-mm nodule (image 50 series 5) most likely represents an intrapulmonary lymph node.Focal ground glass opacity at posteriorly in the right lower lobe (image 80 of series 5) is associated bronchial wall thickening is compatible with aspiration/inflammation.No pleural effusions.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of pericardial effusion.Moderate coronary artery calcification.CHEST WALL: Median sternotomy.Moderate degenerative changes in the thoracic spine.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Well-defined 2.3-cm hypodensity in the dome of the liver most likely represents a cyst.Status post cholecystectomy.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic changes 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. | 1.Postsurgical changes in the right upper lobe with nodular opacity noted at the surgical site most likely represents postsurgical changes. There has been no interval change in comparison to exams dated 2/12/13 and 5/14/13. Recurrent or residual neoplasm cannot be definitively excluded, however is considered to be less likely.2.No evidence of metastatic disease. |
Generate impression based on findings. | 79-year-old female with continued weight loss, CHEST:LUNGS AND PLEURA: Stable 3mm right upper lobe nodule (image 14, 5) and left lower lobe (image 50, 5).Two calcified granuloma in the left lower lobe.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Diffusely dilated thoracic and distal esophagus with air fluid levels with a small hiatal hernia mostly unchanged from prior study. Prominence of the gastric folds within the hiatal hernia, also unchanged from prior studystable intrahepatic biliary ductal dilatation is unchanged.SPLEEN: No significant abnormality noted.PANCREAS: Diffuse pancreatic ductal dilatation is stable. No abnormal focal lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts are grossly unchanged. Areas of cortical thinning and scarring of redemonstrated. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Known history of malrotation. Multiple dilated small bowel loops in the abdomen and pelvis, measuring up to 4 cm without any definite transition point most likely representing an ileus pattern over a partial small bowel obstruction. No evidence of wall thickening noted within the small bowel loops. Mild ascites is noted in the abdomen and pelvis, mostly unchanged from prior study. The large bowel loops distally are not collapsed. Cecum probably is identified in the right upper quadrant.BONES, SOFT TISSUES: Degenerative changes in the lumbosacral spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Uterine fibroidsBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Multiple dilated small bowel loops in the abdomen and pelvis, measuring up to 4 cm without any definite transition point most likely representing an ileus pattern over a partial small bowel obstruction. BONES, SOFT TISSUES: Mild soft tissue edema about reduced from prior studies. OTHER: Ascites | Multiple dilated small bowel loops in the abdomen and pelvis, measuring up to 4 cm without any definite transition point most likely representing an ileus pattern over a partial small bowel obstruction. Findings mostly unchanged from recent MRI study. Mild to moderate amount of ascites grossly unchanged.Stable pancreatic and intrahepatic ductal dilatation is also unchanged. |
Generate impression based on findings. | Female 76 years old; Reason: 76 yr old patient with ST 3C ovarian cancer s/p 9 cycles of Gemzar/Avastin eval disease process History: none CHEST:LUNGS AND PLEURA: Moderate right sided pleural effusion is stable since prior exam. There is stable scattered right-sided atelectasis. Scattered micronodules are unchanged.MEDIASTINUM AND HILA: Small left thyroid nodule. Small scattered mediastinal lymph nodes are unchanged. No mediastinal or hilar lymphadenopathy. Heart size is normal without pericardial effusion.CHEST WALL: Surgical clips in left axilla. No axillary lymphadenopathy.ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. Mild intrahepatic biliary ductal dilatation appears similar to the prior exam the common bile duct measures 1.0 cm, unchanged. Status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple bilateral renal hypodensities are too small to characterize and unchanged. A large left upper pole cyst is unchanged in size measuring 3.3 cm and likely represents a benign cyst.RETROPERITONEUM, LYMPH NODES: Reference porta hepatic lymph node is unchanged measuring 1.5 x 1.1 cm (3/96) compared to 1.4 x 1.0 cm.BOWEL, MESENTERY: Loculated right subphrenic fluid collection with scalloping of the adjacent liver is slightly smaller in size measuring 11.1 x 5.9 cm (3/90) compared to 12.4 x 6.3 cm previously. Additional loculated peritoneal fluid collections (3/92, 97) are also smaller. Scattered peritoneal soft tissue nodules are unchanged with a reference perigastric foci of nodularity measuring 2.2 x 1 .9 cm, previously 2.4 x 1.5 cm (3/94).BONES, SOFT TISSUES: Foci of subcutaneous air and soft tissue nodules along the right anterior abdominal wall subcutaneous tissues. Foci of sclerosis along the right posterior 10th rib is unchanged since 4/30/2012.OTHER: Moderate ascites, decreased from the prior exam.PELVIS: UTERUS, ADNEXA: Status post hysterectomy and bilateral salpingo-oophorectomyBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diverticulosis without evidence of diverticulitis. Peritoneal soft tissue nodules are unchanged, however more conspicuous given adjacent ascites has decreased..BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Stable peritoneal soft tissue implants compatible with peritoneal carcinomatosis.2.Mild ascites, decreased from the prior exam with stable to slightly smaller loculated perihepatic ascitic collections. |
Generate impression based on findings. | T3N2b right tonsil SCCa s/p chemoRT, completed in June 2013. There is interval increase in the degree of supraglottic edema, likely related to radiation. Otherwise, there is no discernable residual mass in the right tonsillar fossa, although streak artifact related to dental amalgam obscures portions of this region. There has been interval decrease in size of the right level 2 lymph node that measures 12 x 9 mm (image 34, series 6), previously 16 x 11 mm. In addition, the lymph node no longer appears necrotic. The other cervical lymph nodes are not significantly enlarged. The major salivary glands are unchanged. The thyroid gland is unremarkable. The osseous structures are unchanged. The partially imaged intracranial structures are grossly unremarkable. The partially imaged upper lungs are clear. | No measurable residual tumor in the treated right tonsillar fossa. Interval decrease in size of the right cervical metastatic lymphadenopathy. |
Generate impression based on findings. | 61 year old with prostate cancer CHEST:LUNGS AND PLEURA: Interval reduction in previously described right pleural effusion.Right upper lobe apical scarring. Basilar atelectasis has also improved. Scattered pulmonary nodules are unchanged.MEDIASTINUM AND HILA: Trace Pericardial effusion.CHEST WALL: Known thoracic metastatic disease. Referenced lesion in the form of an expansile left rib lesion measures 5.9 x 5 cm appears to measure 5.9 x 5 cm (image 37 and 3.) Unchanged.ABDOMEN:No significant abnormality notedLIVER, BILIARY TRACT: Heterogenous liver attenuation noted with multiple hypodense lesions consistent with metastases. Referenced lesion in segment 6 measures 1 x 1 cm, previously measured 1.9 x 1.6 cm (image 111, 3), reduced in size in comparison with prior study. Stable left lobe cyst measuring 1.2 cm is noted. Previously described perihepatic fluid with rim enhancement is not seen on today's imaging. Prominent paracardiac lymph nodesSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral Percutaneous nephrostomy catheters noted. Right-sided hydronephrosis despite the right nephrostomy catheter appears grossly unchanged since 10/26/13, however, new since 8/8/13.RETROPERITONEUM, LYMPH NODES: Mild interval increase in retroperitoneal lymphadenopathy. The referenced aortocaval lymph node measures 3.2 x 2.7 cm, previously measured 2 x 2.1 cm (image 127, 3).Enlarged asymmetric left psoas and bilateral iliacus muscle demonstrates improvement since 10/26/13. No evidence of abscess or collection within the muscle.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Extensive bone metastases, stable.OTHER: Body wall anasarca.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Multiple bilateral enlarged pelvic lymph nodes are stable.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Extensive osseous metastatic disease. Body wall anasarca.OTHER: No significant abnormality noted | Overall mixed response1. Interval resolution of right pleural effusion. Stable left rib expansile soft tissue lesion.2. Minimal interval decrease in segment 6, right lobe of liver hypodense lesion. Interval resolution of perihepatic fluid with rim enhancement3. Interval increase in retroperitoneal lymphadenopathy.4. Considerable improvement in asymmetric enlargement of the left psoas and bilateral iliacus muscle.5. Stable enlarged pelvic lymph nodes.6. Extensive osseous metastatic disease.7. Right-sided hydronephrosis in spite of a right nephrostomy tube, unchanged since 10/26/13 |
Generate impression based on findings. | Right maxillary There is near complete opacification of the right maxillary sinus, extending into the right infundibulum and middle meatus with secretions that measure up to approximately 45 HU. There is dehiscence of the medial floor of the right maxillary sinus as well as demineralization of the right hard palate. The other paranasal sinuses are clear. There is mild nasal septal deviation and spur to the right. The ethmoid roofs are nearly symmetric and intact. The optic canals and carotid grooves are covered by bone. The mastoid air cells are clear. The orbits are unremarkable. The partially imaged intracranial structure are grossly unremarkable. | Near complete opacification of the right maxillary sinus, extending into the right infundibulum and middle meatus. Dehiscence of the medial floor of the right maxillary sinus may represent an oroantral fistula. |
Generate impression based on findings. | T4N0M0 supraglottic carcinoma S/P chemoradiation completed in 1/2011. There are post-treatment findings in the region of the larynx, including persistent hypopharyngeal mucosal edema. However, there is no evidence of recurrent tumor in the treatment bed. There is no significant cervical lymphadenopathy, including an unchanged right paratracheal lymph node that measures 9 x 8 mm, which is unchanged. The major salivary glands appear unchanged. The thyroid gland appears unremarkable. There is mild atherosclerotic plaque in the proximal right ICA. The osseous structures are unchanged, including a left mandible enostosis. There is a partially imaged right paraclinoid meningioma. There are bilateral lens implants. The imaged lung apices are clear. | 1. No evidence of locoregional tumor recurrence or significant cervical lymphadenopathy.2. Partially imaged right paraclinoid meningioma. |
Generate impression based on findings. | Reason: abnormal CXR, +ANA/dsDNA, granuloma on BM bx - eval for sarcoid vs other ILD History: as above LUNGS AND PLEURA: Bilateral upper lobe predominant small subcentimeter centrilobular nodular opacities. No significant bronchial wall thickening or traction bronchiectasis. Small 5-mm isolated nodule in medial right middle lobe (image 56/102). No pleural effusion. Mild superimposed emphysema.MEDIASTINUM AND HILA: Scattered small subcentimeter nodes.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Upper abdominal lymphadenopathy, which is only partially visualized and incompletely evaluated. | 1. Diffuse upper lobe predominant nodular abnormality which is suggestive of sarcoidosis. There is no significant thoracic lymphadenopathy though the lower images of the scan show upper abdominal lymphadenopathy. While this may be related to the same process, it is incompletely evaluated.2. 5-mm pulmonary nodule in the right lower lobe is likely related to the underlying presumed sarcoidosis though it is isolated. Given the presumed smoking history and presence of emphysema, a 12 month follow up CT is recommended to monitor for growth as malignancy cannot be definitively excluded. |
Generate impression based on findings. | 20 year-old female. Rule-out appendicitis ABDOMEN:LUNG BASES: No significant abnormality noted inLIVER, 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: Appendix is well opacified with oral contrast normal in course and caliber and is identified in the right lower quadrant without any secondary signs of inflammation around it or wall thickening. No evidence of bowel obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Fluid noted within the endometrial cavity, kindly correlate with menstrual cycle. Right adnexa is well visualized appears unremarkable. Left adnexa is not well visualized. BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No evidence of bowel obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No evidence of acute appendicitis as clinically questioned. |
Generate impression based on findings. | Reason: evaluate for right apical nodule seen on CTA neck History: evaluate for right apical nodule seen on CTA neck. patient is a smoker. LUNGS AND PLEURA: Three partially calcified roughly 1 cm thick areas of subpleural nodularity with associated calcification (right upper lobe posteriorly image 23, 42, and 49/128) are not significantly changed. The appearance favors post inflammatory abnormality, possibly calcified pleural plaques from previous asbestos exposure or empyema or hemothorax.Emphysema. Mild bronchial wall thickening which is nonspecific.MEDIASTINUM AND HILA: Calcified mediastinal nodes consistent with healed granulomatous disease. Coronary calcification. Atherosclerotic calcification of the aorta and its branches.CHEST WALL: Small subcentimeter submental lymph nodes.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Calcified splenic granulomas. Hypodensity in right lobe of liver (image 128/128) only partially visualized but appears to measure near water density and is likely a cyst. A hypodense exophytic left renal nodule it is incompletely evaluated (image 122/128) without IV contrast. Bilateral adrenal nodules are present which are nonspecific. The nodule on the right is calcified and presumably benign. The left shows very low density and is also presumably benign. | 1. Three partially calcified roughly 1 cm thick areas of subpleural nodularity with associated calcification are not significantly changed, though were poorly evaluated on prior due to technique. The appearance favors a post inflammatory abnormality, possibly calcified pleural plaques from previous asbestos exposure or empyema or hemothorax. Emphysema. Given that the patient is high risk, 1 year CT follow up is recommended to confirm stability as malignancy cannot be definitively excluded.2. Small 1 cm exophytic renal nodule incompletely evaluated without IV contrast. US or contrast enhanced CT or MR would provide better characterization.3. Bilateral adrenal nodules are nonspecific but most likely adenomas in the absence of known malignancy. |
Generate impression based on findings. | Female 32 years old; Reason: 32 year old female with Hodgkin lymphoma. In remission after ABVD chemotherapy. Compare to prior scan. History: Chronic cough. CHEST:LUNGS AND PLEURA: Minimal scarring and atelectasis in the anterior aspect of the right upper lobe. No suspicious pleural effusions. Pleural spaces are clear.MEDIASTINUM AND HILA: Mediastinal lymph node measures 9 x 5 mm (image 34/series 3) previously, 1.1 x 0.5 cm .CHEST WALL: Right chest wall port terminates at the caval atrial junction. Bilateral breast prosthesis.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: Small retroperitoneal lymph nodes. Left periaortic node measures 1.2 x 1.0 cm, previously 1.4 x 1.2 cm (image 128/series 4).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: Right obturator node measures 1.5 x 0 .5 cm, previously 1.2 x 0.7 cm (image 178/series 3) previously, 1.4 x 0.8 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Stable exam with no significant change in the size of the reference lesions. |
Generate impression based on findings. | 61-year-old female status post craniotomy. Changes from right calvarial craniotomy are present from resection of right frontal extra axial mass lesion. This includes pneumocephalus, fluid admixed with blood products, subcutaneous soft tissue swelling and air, an extracalvarial subcutaneous drain, calvarial fixation devices, and overlying skin staples. There are no postoperative hematomas.As before, subcortical and periventricular hypodensities are preent, more so on the left than on the right, which is nonspecific but most likely represents age indeterminate small vessel ischemic disease. No other definite focal parenchymal edema, loss of the gray-white differentiation or other CT findings of acute territorial ischemia are seen. No generalized mass-effect is demonstrated. The ventricular system is patent and within normal limits for size. The paranasal sinuses as visualized are clear. | Expected postoperative findings status post right craniotomy for resection of a right frontal extra-axial mass lesion, without complicating intracranial hematoma formation. |
Generate impression based on findings. | 87-year-old male with subdural hemorrhage. Redemonstrated are bilateral subdural hemorrhages, unchanged in depth when measuring on coronal view (7 mm right, 4 mm left). There has been some redistribution of hyperdense components on the left, without evidence of interval frank new subdural hemorrhage. Small amount of bilateral subarachnoid hemorrhage, stable from prior exam. Findings suggesting moderate chronic small vessel disease. | No significant interval change from prior exam. |
Generate impression based on findings. | 36 year-old female status post ileocecectomy 13 days ago, now with tachycardia. Evaluate for anastomotic leak or 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: Status-post ileocecectomy, with residual postsurgical inflammatory changes in the right lower quadrant. No evidence of intra-abdominal fluid collection to suggest abscess. Evidence of anastomotic leak.BONES, SOFT TISSUES: New foci of low attenuation in the right lower quadrant abdominal wall surgical site, which likely represents postsurgical seroma although superimposed infection/abscess formation is also possible if there is focal tenderness in this location (one series 12, image 103).OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Status-post ileocecectomy, with residual postsurgical inflammatory changes in the right lower quadrant. No evidence of intra-abdominal fluid collection to suggest abscess. Evidence of anastomotic leak. Small amount of free fluid in the pelvis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Status post ileus technique without evidence of intra-abdominal abscess or leak.2.New foci of low attenuation in the right lower quadrant abdominal wall surgical site, which likely represent postsurgical seroma although superimposed infection/early abscess formation is also possible if there is focal tenderness in this location. |
Generate impression based on findings. | 60 year-old male with history of colon cancer. Restaging exam. CHEST:LUNGS AND PLEURA: Multiple bilateral pulmonary nodules are redemonstrated, suspicious for metastatic disease. No new lesions are seen, and no definite interval growth of any nodule is appreciated. Left lower lobe index lesion measures 9 x 5 mm (image 65, series #3), decreased in size. Another left lower lobe index lesion measures 9 x 8 mm (image 62, series #3), stable in size.MEDIASTINUM AND HILA: Interval resolution of pulmonary embolism in the upper and lower branches of the pulmonary artery. Bilateral mediastinal lymph nodes are unchanged.CHEST WALL: No significant abnormality notedABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Multiple small hypoattenuating lesions are redemonstrated, not significantly changed in, with stable index lesion of the right lobe measuring 12 x 9 mm.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral simple renal cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Posterior changes of right hemicolectomy are redemonstrated. No evidence of local recurrence or peritoneal carcinomatosis.BONES, SOFT TISSUES: Right posterior fifth rib fracture, not seen on prior exam.OTHER: Bilateral thyroid nodules, unchanged from exam dated 4/9/2013. | 1.Essentially stable examination without evidence of disease progression. Multiple bilateral pulmonary nodules as well as hypoattenuating liver lesions are grossly unchanged from prior exam. An index left lower lobe lung lesion is centrally necrotic and slightly decreased in size, consistent with posttreatment changes.2.Posterior right fifth rib fracture, new from prior exam.3.Bilateral thyroid nodules, unchanged from 4/9/2013. |
Generate impression based on findings. | Stage IIIB nodular sclerosing Hodgkin lymphoma treated with ABVD x 6 cycles, which was completed in July, 2011. There is no significant cervical lymphadenopathy. The Waldeyer ring structures are unremarkable. The thyroid gland and major salivary glands appear unchanged. The airways are patent. There is a right internal jugular venous catheter. The osseous structures are unremarkable. There is mild scattered paranasal sinus opacification. The mastoid air cells are clear. The partially imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear. | No significant cervical lymphadenopathy. |
Generate impression based on findings. | NHL lymphoma. Re-evaluate and compare CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Interval removal of right-sided Port-A-CathIndex right paratracheal lymph node measures 0.5 x 0.5 cm (series 3 image 13), previously measured 0.5 x 0.5 cm.Reference right hilar lymph node measures 0.5 x 0.7 cm cm (series 3 image 48), previously measured 0.9 x 0.9 cm.Ectatic ascending aorta with dilatation of the aortic annulus is unchanged. Coronary artery calcifications.CHEST WALL: Benign appearing right axillary lymph node measures 1.5 x 1 cm (series 3 image 24), previously measured 1.5 x 0.9 cm, unchanged.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable left renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Index left external iliac lymph node measures 1.8 x 0.9 cm (series 3 image 190), previously measured 1.8 x 0.9 cm.Index right inguinal lymph node measures 1.9 x 0.6 cm (series 3 image to 211), previously measured 1.8 x 0.7 cmBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No interval change. No evidence of new metastatic disease. |
Generate impression based on findings. | 66-year-old male with history of hoarseness in January 2013 diagnosed with cancer right true vocal cord February 2013. Underwent 18/34 radiation treatments, with subsequent concern for radiation exposure On direct inspection, "white lesion along free edge of right anterior half of true vocal cord crossing the anterior commissure to the anterior portion of the left true vocal cord" without ulceration. Limited intracranial views are unremarkable. The visualized mastoid air cells are clear. Minimal mucosal thickening of the right maxillary sinus, otherwise the visualized paranasal sinuses are clear.The salivary glands are free of focal lesions. Hypodense somewhat heterogeneous left thyroid nodule. No cervical lymphadenopathy by CT size criteria.The left piriform sinus is not well aerated. Sclerosis of the left superior cornua of the thyroid cartilage is nonspecific but may be post-therapeutic in etiology. No definite focal vocal cord lesion is identified. No exophytic masses are present in the aerodigestive tract. No soft tissue masses are present in the neck.Minimal left carotid bifurcation atherosclerotic calcification. The left internal jugular vein is distended but does not opacify just after exiting the skull base. The major cervical arterial vasculature and right internal jugular vein are patent.The visualized lung apices are clear. Punctate calcified granuloma in the right upper lobe. Please see dedicated chest CT from today's date for further details. Multilevel degenerative changes of the visualized cervicothoracic spine including scattered moderate to severe neuroforaminal narrowing, most pronounced at C5-C6 and C6-C7, as well as marked loss of disk height, endplate degenerative changes, uncovertebral hypertrophy and osteophyte formation. Probable Schmorl's node at the inferior endplate of C6. | 1. No CT evidence of vocal cord abnormality to correspond with those seen on direct inspection.2. Concern for thrombosis of the left internal jugular vein given lack of contrast opacification. Recommend vascular ultrasound for further evaluation. 3. Heterogeneous, primarily hypodense left thyroid lobe nodule. Recommend thyroid ultrasound for further characterization. |
Generate impression based on findings. | Stage IIA DLBCL (IPI 0) presented today for cycle 4 of R-CHOP treatment. There is persistent asymmetric enlargement of the right palatine tonsil with associated effacement of the right glossotonsillar sulcus and mild narrowing of the oropharynx. There is no significant cervical lymphadenopathy. The major salivary glands and thyroid are unremarkable. There is a right internal jugular venous catheter. The major cervical vessels are otherwise patent. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. The partially imaged intracranial structures are unremarkable. The imaged upper lungs are clear. | Persistent asymmetric enlargement of the right palatine tonsil, which is unchanged. There is no significant cervical lymphadenopathy. |
Generate impression based on findings. | 64-year-old female smoker with history of 5 mm left lower lobe nodule LUNGS AND PLEURA: Mild paraseptal and centrilobular emphysema. Left lower lobe nodule measures 5 mm (image 25, series 6) and previously measured 5 mm. Several additional micronodules are unchanged. Diffuse bronchial wall thickening which is nonspecific but suggestive of chronic bronchitis in a smoker.MEDIASTINUM AND HILA: Scattered atherosclerotic calcification of the thoracic aorta and moderate coronary arterial calcification.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Atherosclerotic calcifications of the abdominal aorta and its branches. | 1. Stable 5 mm nonspecific pulmonary nodule, left lower lobe. The size and short term stability favor a benign etiology, however, these nodules are typically followed to 2 years to exclude malignancy.2. Emphysema.3. Nonspecific bronchial wall thickening suggestive of chronic bronchitis. |
Generate impression based on findings. | Reason: evaluate ILD History: cough sob fibrosis LUNGS AND PLEURA: Bronchiectasis and diffuse bronchial wall thickening identified throughout both lungs most pronounced in the left lower lobe.Pleural and subpleural scarring/fibrosis with mild septal thickening identified predominantly at the bases more pronounced on the left.No evidence of air trapping.No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Multiple prominent mediastinal lymph nodes with a precarinal lymph node (image 34 series 3) measuring 14 mm.Mild cardiac enlargement without evidence of pericardial effusion.CHEST WALL: Degenerative changes throughout the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Cirrhotic morphology of liver. | Diffuse bronchial wall thickening and bronchiectasis throughout both lungs. No evidence of significant pulmonary fibrosis. |
Generate impression based on findings. | 10-year-old female, assess for liver pathology. Correlate with hypodensity on previous CT. Please assess for metastasis in setting of facial myxoid sarcoma. ABDOMEN:LUNG BASES: The lung bases are clear without evidence of effusion or consolidation. No pericardial effusion.LIVER, BILIARY TRACT: A 1.2 x 0.9 cm hypoattenuating lesion in the posterior right hepatic lobe is seen (image 17, series 3). No intrahepatic or extrahepatic delayed ductal dilatation is identified. The portal vasculature is patent. The gallbladder is unremarkable.SPLEEN: The spleen is normal in size and morphology.PANCREAS: The pancreas is normal in size and morphology. No signs of peripancreatic inflammation are seen.ADRENAL GLANDS: No significant abnormality noted. No adrenal masses are detected.KIDNEYS, URETERS: Bilateral punctate non obstructing renal calculi. Additionally, a 3mm non-obstructing stone is noted in the distal left ureter near the left UVJ. No focal renal lesions are seen.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy is identified. BOWEL, MESENTERY: A gastrostomy is tube is present. No evidence of bowel obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality noted. The appendix is visualized and within normal limits.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Trace pelvic ascites. | 1. A 1.2-cm hypodense lesion in the right hepatic lobe remains nonspecific on post contrast imaging. An MRI may be helpful for further evaluation. Alternatively, close interval follow up is suggested. 2. Bilateral punctate non obstructing renal calculi and 3mm non-obstructing calculus in the distal left ureter. |
Generate impression based on findings. | 59 year-old female with breast cancer on chemotherapy, assess response CHEST:LUNGS AND PLEURA: Moderate emphysema. Linear scarring in the region of the previously identified reference right lower lobe nodule (image 60 series 4), essentially no longer measurable and 4 x 1 mm. Multiple scattered additional nodules appear stable to decreased.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Coronary arterial calcification.CHEST WALL: Reference left axillary lymph node measures 1.4 x 0.7 cm and previously measured 1.4 x 0.7 cm (image 20, series 3). Left breast nodules are again noted and are more conspicuous on current study (ie image 37/142) though this is likely due to phase of contrast enhancement. 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: Hypoattenuating left renal lesion too small to characterize likely represents a cyst.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Scattered punctate areas of sclerosis are stable and presumably degenerative in nature.OTHER: No significant abnormality noted. | 1. Continued decrease in pulmonary metastases.2. Stable axillary nodes and breast nodules. Some nodules are conspicuous on current study though this is likely due to phase of contrast enhancement. |
Generate impression based on findings. | Reason: pulmonary nodules History: pulmonary nodules LUNGS AND PLEURA:Reference ground glass right upper lobe nodule measures 5 mm on image 36/100 (7-mm on prior). Similar groundglass nodule in superior segment of the right lower lobe also slightly decreased to 6 mm on image 50/100 (8 mm on prior).4 mm micro-nodule the left upper lobe (image 36/100).Punctate 4-mm groundglass micronodule in the left upper lobe adjacent to the fissure (image 46/100) is also stable.No new pulmonary nodules.MEDIASTINUM AND HILA: Reference left paratracheal lymph node is stable at 13 mm (image 43/126). Atherosclerotic calcification of the aorta and its branches. Small tracheal diverticulum. Small hiatal hernia.CHEST WALL: Borderline left sided level 2 axillary node measures 11 mm on image 26/126 unchanged. UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Stable to slightly decreased nonspecific pulmonary nodules. Though malignancy cannot be entirely excluded, the findings are more suggestive of benign postinflammatory nodules than metastases or primary lung malignancy. In the absence of known malignancy, nonspecific pulmonary nodules are typically followed to two years to confirm stability. |
Generate impression based on findings. | 63-year-old male with respiratory distress, rule out PE PULMONARY ARTERIES: Technically adequate study without evidence of pulmonary embolus. The main pulmonary artery is enlarged, measuring 3.3 cm, suggesting pulmonary arterial hypertension. LUNGS AND PLEURA: Small left pleural effusion with compressive atelectasis.MEDIASTINUM AND HILA: Cardiomegaly and reflux of contrast into the IVC suggestive of right heart failure. Coronary calcification.CHEST WALL: Gynecomastia.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Left adrenal nodule incompletely evaluated/visualized but appears grossly stable and is likely an adenoma. Ascites. | No evidence of pulmonary embolus. Findings suggestive of CHF. |
Generate impression based on findings. | Cough and congestion. The paranasal sinuses are clear. There is a right Onodi cell. There is no significant nasal septal deviation and the nasal cavity is clear. The inferior turbinates do not appear particularly enlarged. The mastoid air cells are clear. The partially imaged intracranial structures and orbits are grossly unremarkable. | No evidence of sinusitis. |
Generate impression based on findings. | 51-year-old male with lymphoma status post 4 cycles of chemotherapy. CHEST:LUNGS AND PLEURA: Mild dependent atelectasis. No suspicious nodules or masses.MEDIASTINUM AND HILA: No pathologically enlarged mediastinal lymph nodes. Right chest wall port catheter terminates in upper right atrium.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: 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: Mild decrease in borderline enlarged inguinal lymph nodes; reference right inguinal node measures 10 x 7 mm, previously measured 14 x 9 mm (series 401, image 195).BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Mild decrease in previously measured right inguinal lymph node. No pathologically enlarged lymph nodes on current exam. |
Generate impression based on findings. | Reason: Patient with a h/o scca left vocal cord s/p partially treated with radiation. now with persistant disease and cough History: Patient with a h/o scca left vocal cord s/p partially treated with radiation. now with persistant disease and cough LUNGS AND PLEURA: Scattered calcified and noncalcified micronodules compatible with prior granulomatous disease.No suspicious pulmonary nodules or masses.Three mild bronchial wall thickening.No pleural effusions.MEDIASTINUM AND HILA: Skull nonspecific hypodensity in the left lobe of the thyroid gland.No mediastinal or hilar lymphadenopathy.Cardiac size is normal without evidence of a pericardial effusion.Marked coronary artery calcification.CHEST WALL: Degenerative changes in the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Partially visualized left renal cyst. | No evidence of metastatic disease. |
Generate impression based on findings. | 77-year-old male with left lower lobe nodule seen on chest x-ray LUNGS AND PLEURA: Multiple calcified nodules consistent with prior granulomatous disease. No pulmonary nodule corresponds with that seen on chest radiograph; the abnormality on CXR correlates with a cutaneous nodule in the left back. Correlate with dermatologic exam.MEDIASTINUM AND HILA: Coronary calcification. S/P CABG.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Small calcified granulomas in the liver and spleen. Small hypoattenuating pancreatic lesions are too small to characterize. | The abnormality on CXR correlates with a cutaneous nodule in the left back. Correlate with dermatologic exam. |
Generate impression based on findings. | 53 year-old female with abdominal epigastric pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Hypoattenuating lesion in left lobe of the liver with nodular peripheral enhancement is most consistent with benign hemangioma. No suspicious liver lesions identified. Gallbladder appears unremarkable.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Hypoattenuating lesions in both kidneys, most likely benign cysts. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small hiatal hernia.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Large fibroid uterus extends superiorly into abdomen to level of kidneys.PELVIS:UTERUS, ADNEXA: Large, heterogeneous uterus with multiple hypoattenuating lesions, some of which contain internal calcifications, most compatible with numerous leiomyomas. The total uterine size including fibroids measures approximately 19 cm in craniocaudal dimension and 11.5 x 14 cm in maximal axial dimension (sagittal series image 66; axial series 4, image 69).BLADDER: No significant abnormality notedLYMPH NODES: Multiple prominent inguinal lymph nodes.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Multiple pelvic phleboliths. | 1.Large uterus containing multiple heterogeneous lesions most compatible with leiomyomas. The uterus extends superiorly into abdomen and is likely source of patient's discomfort.2.Peripherally enhancing lesion in left lobe of liver compatible with benign hemangioma. |
Generate impression based on findings. | Reason: evaluate ILD History: cough sob fibrosis, UCTD poss sarcoid LUNGS AND PLEURA: Mild diffuse bronchial wall thickening with very mild cylindrical bronchiectasis bilaterally. Scattered small cysts. No definitive areas of fibrosis or architectural distortion though there is very minimal reticulation at the subpleural right lung base which persists on prone imaging (series 11, image 27/29) and may be related to very mild interstitial disease rather than typical dependent edema or atelectasis.No significant air trapping on expiratory phase imaging.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Mild scoliosis.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Mild diffuse bronchial wall thickening with very mild cylindrical bronchiectasis bilaterally. No definitive areas of fibrosis or architectural distortion though there is very minimal reticulation at the subpleural right lung base which persists on prone imaging and may be related to very mild interstitial disease rather than typical dependent edema or atelectasis. The findings are not typical of sarcoidosis. |
Generate impression based on findings. | 72-year-old female with pain. ABDOMEN:LUNG BASES: Basilar scarring/atelectasis, right more the left.LIVER, BILIARY TRACT: Hepatic steatosis without suspicious lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Thickening bilaterally without discrete nodules.KIDNEYS, URETERS: Hypodense lesion in right kidney most compatible with cysts. Punctate stone in right renal calix measuring approximately 1 mm.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications affect the aorta and its branches. No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Multiple diverticuli in distal colon without evidence of diverticulitis. No bowel obstruction. NG tube tip in stomach.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality noted. Foley catheter in place.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diverticulosis without diverticulitis. No bowel obstruction.BONES, SOFT TISSUES: Lucent lesion in L2 vertebral body, with morphology most consistent with hemangioma (series 4, image 41).OTHER: No significant abnormality noted | 1.No evidence of bowel obstruction or other acute to account for symptoms.2.Diverticulosis without diverticulitis.3.Hepatic steatosis.4.Punctate nonobstructing stone in right kidney. |
Generate impression based on findings. | 67-year-old with history of bladder cancer and shortness of breath CHEST:LUNGS AND PLEURA: Stable left lower lobe subpleural nodule.No pleural effusion.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Metallic fragment adjacent to the right lower T11 thoracic vertebral body.ABDOMEN:LIVER, BILIARY TRACT: Referenced hypodense subtle lesion in segment 7 right lobe of liver measures 1 x 0 .9 cm, previously measured 0.9 x 0.8 cm (image 93, 3), unchanged from prior study. No other lesions noted. Hepatic vessels are patent.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Indeterminate left adrenal nodule measures 2 x 1.1 cm, previously measured 2.0 x 0.9 cm (series 3, image 107), grossly unchanged.KIDNEYS, URETERS: Right upper pole hypodense lesion is unchanged from prior study.RETROPERITONEUM, LYMPH NODES: Atherosclerotic disease of the abdominal aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Metallic density in the posterior thoracic soft tissues.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Calcifications in the prostateBLADDER: Nodularity and bladder wall thickening with infiltration in the perivesicular fat more prominent from prior study.LYMPH NODES: Small pelvic lymph nodes.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Sclerotic lesion of the left sacrum is unchanged.OTHER: No significant abnormality noted | Slightly more prominent bladder wall nodularity and irregular thickening with infiltration in the peri-vesicular fat.Indeterminate stable left adrenal nodule.Stable right lobe of liver hypodense lesion. |
Generate impression based on findings. | 88 year-old male with dilated bowel on radiographs. Evaluate for ileus or fluid collection. ABDOMEN:LUNG BASES: Small bilateral pleural effusions with bilateral basilar consolidation/atelectasis, right more than left. Bilateral pleural calcifications and thickening.Severe coronary artery calcifications and stents. Moderate cardiomegaly.LIVER, BILIARY TRACT: Hypoattenuating lesion in the left lobe compatible with cyst. No suspicious lesions. Gallbladder unremarkable.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Hypoattenuating lesions in both kidneys, most likely benign cysts. Mild bilateral hydronephrosis, expected finding after cystectomy.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy. Significant atherosclerotic calcifications throughout aorta and its branches.BOWEL, MESENTERY: High attenuation material present throughout small and large bowel consistent with prior administration of contrast. Dilation of multiple small bowel loops in the left hemiabdomen with diameter measuring up to 4.4 cm; there is a transition point in the right hemipelvis, consistent with low-grade small bowel obstruction likely due to post-surgical adhesion (series 3, image 137). No evidence of small bowel wall thickening. Trace amount of free fluid in the pelvis.Dobbhoff tube tip in stomach.BONES, SOFT TISSUES: Fat-containing left diaphragmatic hernia (Bochdalek). Postsurgical changes in anterior abdominal wall.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post cystoprostatectomy.BLADDER: Status post cystoprostatectomy with creation of ileal conduit, with percutaneous ureteral stents in place.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Postsurgical changes with creation of ileal conduit.As described above, there is dilation of multiple small bowel loops in the left hemiabdomen, with transition point occurring in right hemipelvis, consistent with low-grade partial small bowel obstruction.Trace amount of free fluid is present in the pelvis (series 3, image 134).There is thickening of the rectal wall, which may be treatment related (series 3, image 162).Pelvic percutaneous surgical drain is in place.BONES, SOFT TISSUES: Right abdominal wall stoma.Presacral soft tissue thickening may be postsurgical in nature (series 3, image 129).Extensive degenerative changes and postsurgical changes in the lower lumbar spine.OTHER: No significant abnormality noted | 1.Dilation of multiple small bowel loops in the left hemiabdomen with transition point in the right hemipelvis, consistent with low-grade small bowel obstruction. 2.Changes status post cystoprostatectomy and creation of ileal conduit. Presacral soft tissue thickening and rectal wall thickening may be treatment related changes. |
Generate impression based on findings. | 69-year-old male with history of RCC (status post partial right nephrectomy October 2011, clear cell renal carcinoma), pulmonary nodules. Evaluate for metastases. CHEST:LUNGS AND PLEURA: Left upper lobe 7-mm pulmonary nodule is significantly decreased in size, now measuring 2 mm. Multiple other subcentimeter bilateral pulmonary nodules are unchanged.MEDIASTINUM AND HILA: Stable subcentimeter mediastinal nodes.CHEST WALL: No significant abnormality noted.ABDOMEN: LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable postoperative changes of right lower pole nephrectomy. Subcentimeter hypodensity of the interpolar region of the right kidney is too small to further characterize, however is stable in size and appearance. Simple left upper pole cyst unchanged.Bilateral calcifications represent either vascular calcifications or punctate nonobstructing calculi, unchanged from prior exam. No hydronephrosis.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No evidence of disease progression. Interval decrease in size of left upper lobe nodule. Remainder of pulmonary nodules are stable in size. |
Generate impression based on findings. | 35-year-old female with history of suprapubic pain 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: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Unremarkable study. |
Generate impression based on findings. | Congestive heart failure, chronic air or obstruction, preop evaluation, evaluate for free air versus ascites CHEST:LUNGS AND PLEURA: Bilateral Mosaic perfusion and patchy groundglass opacities, nonspecific and may secondary to edema or chronic airway obstruction. 7-mm nodule in the right lower lobe image number 62 series number 3. And other subcentimeter nodules in the left lower lobe measured at 7 mm on image number 61, series number 3. Follow-up imaging is recommended for further evaluation.MEDIASTINUM AND HILA: Borderline enlarged mediastinal lymph nodes. Index node anterior to the trachea measures 1.2-cm in diameter are some 24, series number 3.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Cirrhotic appearing liver. Lack of intravenous contrast limits evaluation of the liver for a focal lesions. Layering possible sludge versus cholelithiasis in the gallbladder. No evidence of biliary dilatation.SPLEEN: Splenic calcifications.PANCREAS: No significant abnormality notedADRENAL GLANDS: Nodular left adrenal gland, nonspecific.KIDNEYS, URETERS: Left renal cyst. There other hypodense lesions in both kidneys which cannot be optimally characterized with this noncontrast study. There is a 1.7 x 1.5 cm hypodense lesion on image number 118, series number 3 no mid portion of the left kidney, of uncertain etiology. A high density well-defined lesion measures 1.9-cm image number one other 6 clusters number 3 the upper pole right kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Moderate amount of ascites.BONES, SOFT TISSUES: UnremarkableOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Small amount of ascites. BONES, SOFT TISSUES: No significant abnormality notedOTHER: Penile prosthesis. | A limited study of the of IV contrast. Bilateral subcentimeter nodules. Follow-up imaging with chest CT is recommended.Mosaic perfusion in bilateral lungs which may be secondary to edema, heart failure and/or small airway obstruction.Bilateral lesions in the kidneys which cannot be optimally characterizing to lack of intravenous contrast.Cirrhotic appearing liver and small amount of ascites. |
Generate impression based on findings. | Male 61 years old; Reason: gastric cancer s/p neoadjuvant chemo but upon resection two peritoneal nodules not present prior to chemo. Restaging CT prior to palliative chemotherapy History: none CHEST:LUNGS AND PLEURA: Right basilar atelectasis. Scattered air cysts.MEDIASTINUM AND HILA: Increasing amount of borderline adenopathy seen, for example, new prevascular node now measures 8 mm previously not seen. Severe coronary artery calcifications.CHEST WALL: Right chest port tip in the right atrium. No axillary adenopathy. Gynecomastia. ABDOMEN:LIVER, BILIARY TRACT: A few new hypoattenuating lesions in segments 8, 2, and 4 A all measuring under 1 cm, are worrisome for metastatic disease.SPLEEN: Accessory splenule.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right renal cyst.RETROPERITONEUM, LYMPH NODES: Peripancreatic lymph node measures 1.3 x 0.7 cm (image 112 series 3), previously 1.3 x 0.8 cm.BOWEL, MESENTERY: There is progression of the mass in the body of the stomach, now measuring 2.9 x 4 .0 cm, previously 3.6 x 3.0 cm (image 89, series 3).Perigastric lymph nodes measuring 2.0 x 2.1 cm are seen (series 3 image 95) which are new since previous exam.Small nodule noted on series 3 image 47, worrisome for peritoneal nodule.BONES, SOFT TISSUES: Degenerative changes in the spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostate is enlarged.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes in the spine.OTHER: Small amount of pelvic ascites. Special attention on follow up exams for peritoneal nodularity. | Progression of the gastric mass with metastatic disease as described above.Dr. Catenacci notified of the findings at 3:30pm on 11/18/13. |
Generate impression based on findings. | Possible retroperitoneal bleed CHEST:LUNGS AND PLEURA: Bilateral moderate pleural effusions. Dependent atelectasis. Mild to moderate pulmonary edema.MEDIASTINUM AND HILA: Cardiomegaly. Enlarged pulmonary arteries suggestive of pulmonary arterial hypertension.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Enlarged left lobe of the liver and caudate lobe with nodular contours suggestive of chronic liver disease which may be secondary to heart failure. Cholelithiasis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The kidneys have inherent high density which may the secondary to previous administration of contrast and kidney failure.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 | Limited study due to lack of IV contrast. No evidence of retroperitoneal bleed.Bilateral moderate pleural effusions and changes secondary to congestive heart failure. Changes suggestive of pulmonary arterial hypertension and likely cardiac cirrhosis.Cholelithiasis. |
Generate impression based on findings. | History of metastatic colon cancer CHEST:LUNGS AND PLEURA: Index left basilar nodule measures 1.3 x 1.4 cm image number 71, series number 4, not significantly changedRight middle lobe nodule measures 1 cm in diameter image number 57, series number 4, not significantly changed from previous study.Right lower lobe nodule measures 1.4-cm in diameter on image number 43, series number 4, not significantly changed from previous study. Other smaller bilateral lung nodules are also grossly stable. New small bilateral pleural effusions, larger on the right compared to the left.MEDIASTINUM AND HILA: Stable subcentimeter mediastinal lymph nodes. New small pericardial effusion.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Index lesion in the right lobe of the liver is slightly increased in size and now measures 1.7 by 1.4-cm image number 82, series number 3. Mild periportal edema. Partially calcified lesion near the dome is unchanged. There is a new hyperdense lesion in the left lobe of the liver, best seen in the image number 83, series number 3 measuring 1.6 centimeter in diameter consistent with metastatic disease.SPLEEN: No significant abnormality notedPANCREAS: Soft tissue mass invading the splenic vein and main portal vein and SMV at the level of confluence, arises from the mesentery and is grossly unchanged.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Index left para-aortic node measures 1.6-cm in diameter image no 115, series number 3, not significantly changed from previous studyBOWEL, MESENTERY: Interval development of large amount of ascites.. Metallic stent in the transverse colon, unchanged. Possible peritoneal carcinomatosis, unchanged.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Interval increase in the amount of ascites.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Left-sided fluid containing inguinal hernia. New generalize anasarca. | Lung nodules are unchanged. Bilateral new pleural effusions.Interval development of large amount of ascites.Interval slight increase in the size of the index hepatic metastases and interval development of new metastatic hepatic lesion.Mesenteric mass invading the portal vein confluence and SMV, unchanged.Retroperitoneal adenopathy, unchanged. |
Generate impression based on findings. | Reason: r/o PE, eval of progression of IPF History: Resp Distress PULMONARY ARTERIES: There is adequate opacification of pulmonary arterial tree only to the segmental level.Evaluation is limited by patient motion.No definite evidence of a pulmonary embolus.LUNGS AND PLEURA: Diffuse interval increase in ground glass opacities throughout both lungs with scattered isolated areas of sparing.Traction bronchiectasis in both the upper and lower lung zones.No definite evidence of honeycombing.Scattered areas of air trapping. No pleural effusions.Postsurgical changes in the right lower lobe compatible with a prior wedge resection.MEDIASTINUM AND HILA: Significant mediastinal lipomatosis.Multiple enlarged hilar and mediastinal lymph nodes similar in appearance to the prior exam.Cardiac enlargement without evidence of pericardial effusion.Marked coronary artery calcification.Enlargement of the pulmonary artery compatible pulmonary atrial hypertension. CHEST WALL: Degenerative changes of the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Cholelithiasis. | 1.No evidence of a pulmonary embolus to the segmental level. 2.Significant interval increase in diffuse groundglass opacities throughout both lungs most likely presenting acute exacerbation of this patient's known ILD. |
Generate impression based on findings. | 60 year-old with malignant carcinoid tumor of unknown primary site, progression of hepatic metastases? ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Multiple hepatic hypodense lesions compatible with metastases are unchanged in number in comparison with most recent scan dated 11/7/13. They are better demonstrated with contrast study. A new previously described referenced segment 5, hypodense lesion best seen on image 43 measures 1.6 x 1.3 cm, unchanged from prior study.Referenced lesion in segment 6 measures 1.5 x 1 .4 cm, previously measured 1.6 x 1.4 cm (image 58, 5), unchanged from prior study.No new lesions identified. Hepatic vessels are patent.Pneumobilia within the left lobe of liver is unchanged. A CBD stent in appropriate location. Contracted gallbladder.SPLEEN: No significant abnormality notedPANCREAS: Prominent pancreatic head with the distal pancreatic ductal dilatation and atrophy.ADRENAL GLANDS: Stable left adrenal thickeningKIDNEYS, URETERS: Atrophic left kidney with nonobstructing renal stones in the left inferior collecting system appears similar to the prior study.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Distended small bowel loops specially in the left mid abdomen measuring up to 3 centimeters without a transition point. Colon is well distended with air and fecal material. Small amount of small bowel ileus is suspected. No evidence of interloop fluid.Area of transitional narrowing within the transverse colon is seen in the axial plane on image 42 is most likely due to peristalsis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Markedly distended bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No evidence of bowel obstruction.BONES, SOFT TISSUES: Sclerotic foci in the left proximal femur and right anterior ilium likely represent benign bone islands and are unchangedOTHER: No significant abnormality noted | 1. Multiple hepatic bilobar metastases are unchanged in size and number, better seen on the postcontrast study today.2. Pancreatic head lesion with distal pancreatic ductal dilatation and atrophy unchanged.3. Distended small bowel loops reaching upto 3 cm in mid abdomen without wall thickening or interloop fluid or transition point, suggestive of a ileus pattern. |
Generate impression based on findings. | 68 year-old male with abdominal pain for two weeks. History of lung squamous cell carcinoma. ABDOMEN:LUNG BASES: Moderate left and trace right pleural effusions. Multiple metastases are again seen in both lung bases and mediastinum, significantly increased since 6/14/2013.Small pericardial effusion not significant changed.LIVER, BILIARY TRACT: No significant change in metastatic lesion in hepatic segment 7, measuring 2.3 x 2.8 cm (series 5, image 29). Large metastatic lesion also noted in the caudate lobe.SPLEEN: Multiple calcified granulomas.PANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal gland unremarkable. The right adrenal gland is difficult to evaluate without IV contrast.KIDNEYS, URETERS: Large heterogeneous mass is again seen in the right kidney with posterior infiltration of proximal aspect of the psoas muscle and invasion into the chest wall/12th rib. There is also medial infiltration into the right renal vein and likely into the IVC. Overall this appears not significantly changed.Hypoattenuating lesion in the left kidney unchanged, compatible with cysts.RETROPERITONEUM, LYMPH NODES: Increase in retroperitoneal lymphadenopathy (series 5, image 48, 60). For reference, upper retroperitoneal node measures 1.8 x 2.9 cm (series 5, image 27).BOWEL, MESENTERY: Large amount of stool throughout the colon. No evidence of bowel obstruction, bowel thickening, or or free fluid.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: New right inguinal lymphadenopathy; for reference, right inguinal measures 12 x 18 mm (series 5, image 113).BOWEL, MESENTERY: Large amount of stool in colon and rectum, consistent with constipation.BONES, SOFT TISSUES: Interval increase in soft tissue lesion in the right spermatic cord (series 5, image 120).OTHER: No significant abnormality noted | 1.Extensive metastatic disease, with increase in retroperitoneal lymphadenopathy, hepatic metastases, and right inguinal lymphadenopathy since 6/14/2013.2.Large amount of stool throughout colon consistent with constipation. |
Generate impression based on findings. | Reason: Eval possible mets History: HCC, cirrhosis, HCV LUNGS AND PLEURA: Emphysema. No evidence of pulmonary metastases.MEDIASTINUM AND HILA: Hypodense nonspecific right thyroid nodule, roughly 1 cm. Scattered small subcentimeter lymph nodes. Coronary calcification.CHEST WALL: Degenerative change involving thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Ascites. Cirrhotic liver morphology. Please see recent MR for further details. | No evidence of pulmonary metastases. |
Generate impression based on findings. | Reason: Characterize bilateral infiltrates seen on CXR. ?pneumonia, pleural effusion. History: bilateral infiltrates, hypoxia, fever/nausea/vomiting x 5 days. Works cleaning cages of research animals. LUNGS AND PLEURA: Patchy multifocal multilobar bilateral groundglass and air space opacity. There is a slight nodular component to some of the basilar opacity. There does not appear to be significant associated bronchial thickening or bronchiectasis. No pleural effusion.MEDIASTINUM AND HILA: Slightly enlarged mediastinal lymph nodes. Largest cysts prevascular (image 34/15).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. | Multifocal pulmonary opacities with slightly enlarged intrathoracic lymph nodes suggestive of infection. The imaging appearance is nonspecific though atypical pneumonias and viral etiologies should be considered. If the patient is HIV+, Pneumocystis pneumonia can appear this way. An acute hypersensitivity pneumonitis is considered less likely. |
Generate impression based on findings. | 66-year-old male, evaluate for PE PULMONARY ARTERIES: Technically adequate study without evidence of pulmonary embolus. The main pulmonary artery is mildly enlarged, measuring 3.1 cm.LUNGS AND PLEURA: Extensive bilateral interstitial opacity with traction bronchiectasis, architectural distortion and honeycombing, and scattered regions of ground glass opacity markedly progressed from the prior study. MEDIASTINUM AND HILA: Mediastinal lymphadenopathy. Calcified hilar lymph nodes indicate prior granulomatous disease. Coronary arterial calcifications.CHEST WALL: Degenerative changes of the spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Reflux of contrast into the IVC. | No pulmonary embolus. Marked interval increase in ground glass opacities with previously demonstrated underlying pulmonary fibrosis consistent with acute exacerbation of interstitial lung disease. Superimposed pulmonary edema cannot be excluded. |
Generate impression based on findings. | 46 year old male with subjective lymphadenopathy There is no acute intracranial hemorrhage, masses or edema within the visualized brain parenchyma. The visualized portions of the paranasal sinuses are clear. The mastoid air cells are opacified bilaterally with partial opacification of the right middle ear cavity.The oral cavity, oro/nasopharynx, hypopharynx, larynx and subglottic airways are patent. The epiglottis, vallecula, piriform sinuses, and vocal cords are normal. Mild asymmetry of the basal tongue soft tissues is present without aggressive features. The parotid, submandibular, and thyroid glands are unremarkable. There are numerous cervical lymph nodes without aggressive features. The carotid arteries and jugular veins are patent. There are mild degenerative changes of the cervical spine. | 1.Multiple small scattered cervical lymph nodes without aggressive features and do not meet CT size criteria for lymphadenpathy.2.Bilateral opacification of the mastoid air cells may represent a sequela of otomastoiditis.3.Mild asymmetry of the base of the tongue soft tissues without evidence of mass. |
Generate impression based on findings. | Reason: evaluate for changes to ILD History: worseing sob LUNGS AND PLEURA: Bilateral subpleural and basilar predominant reticulation with honeycombing and traction bronchiectasis is typical of UIP and is stable in severity and distribution. Postop change on the right from previous biopsy.MEDIASTINUM AND HILA: Large central pulmonary arteries suggestive of pulmonary hypertension. Atherosclerotic calcification of the aorta and its branches.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. | UIP pattern chronic interstitial lung disease/fibrosis stable in severity and distribution. |
Generate impression based on findings. | Reason: 71 y/o male w/ chronic cough with bibasilar crackles History: chronic cough x8 months LUNGS AND PLEURA: Subpleural basilar predominant, left greater than right, reticulation with mild traction bronchiectasis. There is no significant air trapping.Scattered clustered micronodules are not significantly changed in the short interval and were described in detail on recent CT.MEDIASTINUM AND HILA: Calcified nodes consistent with healed granulomatous disease.CHEST WALL: Degernerative change involving the spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Findings noted on recent CT persist on prone imaging and are consistent with interstitial disease with fibrotic changes including architectural distortion and mild bronchiectasis. The differential considerations are broad but primary considerations include NSIP and, less likely, UIP. |
Generate impression based on findings. | 31-year-old male patient with history of thyroid cancer. Evaluate for adenopathy or recurrence. LUNGS AND PLEURA: Scattered punctate micronodules, unchanged and presumably postinflammatory.MEDIASTINUM AND HILA: No significantly enlarged mediastinal or hilar lymph nodes.Small pericardial cyst no significantly changed.CHEST WALL: Mild degenerative disk disease.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | No evidence of metastases. |
Generate impression based on findings. | Clinical question :evaluate for bleed. Signs and symptoms: MVC with loss of consciousness. Nonenhanced head CT:No detectable acute posttraumatic intracranial or calvarial findings.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation. Unremarkable calvarial, paranasal sinuses and mastoid air cells.Unremarkable images through the orbits. | Unremarkable nonenhanced head CT. |
Generate impression based on findings. | Clinical question: Hit head. Signs and symptoms: Fall. Nonenhanced head CT:No detectable acute posttraumatic intracranial or calvarial findings.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation.Unremarkable calvarium and soft tissues of the scalp.Unremarkable orbits, paranasal sinuses and mastoid air cells. | Unremarkable nonenhanced head CT. |
Generate impression based on findings. | 34-year-old female with abdominal pain and vomiting. History of cervical cancer and recent SBO with sigmoid perforation status post double loop ileostomy and mucocutaneous fistula on 10/27/2013. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Status post cholecystectomy. Several hypodense lesions are again noted throughout the liver parenchyma, most compatible with cysts. Hypoattenuating lesion in segment 6 consistent with known hemangioma.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes with right lower quadrant loop ileostomy and presumed sigmoid mucous fistula in left lower quadrant. Contrast passes through loop ostomy into external bag and no obstruction is identified. There are foci of extraluminal air in the left lower quadrant located inferiorly to mucous fistula, with air extending from rectus sheath, through mesentery posteriorly to left psoas muscle; this is suspicious for leak, likely from sigmoid (series 4, image 88). Although lack of IV contrast limits evaluation for abscess, no loculated fluid collection is identified.Multiple matted loops of bowel and mesenteric thickening in the left lower quadrant, immediately posterior to rectus sheath, but without evidence of obstruction. BONES, SOFT TISSUES: Foci of gas are present in subcutaneous fat of lower abdominal wall located to left of midline wound. There is no significant associated inflammation or fluid to suggest infection or abscess formation. This gas may be due to development of fistulous collection to previously described matted bowel loops and mesenteric thickening or due to dehiscence of abdominal wound. OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Postsurgical changes in the pelvis, including multiple surgical clips and fat stranding/inflammatory change. Although lack of IV contrast limits evaluation, no loculated fluid collection is identified to suggest abscess.Air and stool in sigmoid colon. As noted above, there are foci of free intraperitoneal gas in the left lower quadrant, which are suspicious for leak. BONES, SOFT TISSUES: Postsurgical changes in the anterior and left lower quadrant abdominal wall.OTHER: No significant abnormality noted | 1.Foci of extraluminal air in left lower quadrant suspicious for leak, likely from sigmoid.2.Foci of gas in subcutaneous fat of lower abdominal wall located to left of midline wound, which may be due to development of fistulous collection to adjacent matted bowel loops or due to dehiscence of abdominal wound. Findings communicated to Dr. Julia Simon at 9:10 am 11/19/2013. |
Generate impression based on findings. | 70 year-old male with prostatic stromal sarcoma status post cystoprostatectomy. CHEST:LUNGS AND PLEURA: Multiple lung nodules are present; for reference, pleural-based nodule in the right middle lobe measures 6 mm (series 5, image 62). No consolidation or pleural effusions.MEDIASTINUM AND HILA: Heterogeneous nodule in left thyroid lobe. No pathologically enlarged mediastinal lymph nodes. Mild coronary calcifications. Heart size normal.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Hypoattenuating lesions in both kidneys, most likely benign cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No pathologically enlarged lymph nodes. Atherosclerotic calcifications throughout the aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild compression deformity of superior endplate of L1 vertebral body, likely degenerative in nature.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post cystoprostatectomy.BLADDER: Status post cystoprostatectomy.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Postsurgical changes with creation of ileal conduit and right ostomy. Status post bilateral inguinal hernia repair; persistent inguinal herniation of fat and soft tissue on the left.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Multiple pulmonary nodules, largest measuring 6 mm; while nonspecific, these are suspicious for metastases.2.No evidence of intra-abdominal metastatic disease. 3.Status post cystoprostatectomy. |
Generate impression based on findings. | Clinical question: Follow-up subarachnoid hemorrhage. Signs and symptoms:headache. Nonenhanced head CT:There is questionable slight interval increased subarachnoid hemorrhage in particular in the right aspect of basal cistern and interpeduncular cistern. Previously noted a small amount of hemorrhage in the right perimesencephalic cistern shows no convincing evidence of interval change.There is no evidence of any mass effect, midline shift or hydrocephalus. The CSF spaces remain within normal for patient stated age. The gray -- white matter differentiation is preserved.Calvarium and soft tissues of the scalp are unremarkable.Blastic vessels, paranasal sinuses remain well pneumatized. | Questionable subtle interval increased subarachnoid hemorrhage and stable exam otherwise. |
Generate impression based on findings. | 10-year-old male with persistent air flow obstruction on spirometry. Rule out bronchiolitis obliterans. The evaluation of solid organ pathology and lymphadenopathy is limited by the lack of IV contrast. LUNGS AND PLEURA: There is very mild bronchial wall thickening, compatible with bronchiolitis or reactive airway disease. The central airways are patent. No focal lung opacity or consolidation is seen. The pleural spaces are clear.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. The heart is normal in size. No pericardial effusion.CHEST WALL: No axillary lymphadenopathy.UPPER ABDOMEN: No significant abnormality is seen in the visualized upper abdomen. | Mild bronchial wall thickening compatible with bronchitis or reactive airway disease. No other significant findings are seen on this non contrast chest CT. |
Generate impression based on findings. | Clinical question: Patient with known brain metastases. Signs and symptoms: Aphasia. Nonenhanced head CT:Hemorrhage in the left inferior frontal lobe measuring at 40 x 33 mm sized is identical in measurement to prior exam.Surrounding vasogenic edema and subtle subfalcine midline shift to the right remains also similar to prior exam. The degree of mass effect on the left frontal horn of lateral ventricle is also similar to prior study.A second left parietal hemorrhagic tumor measuring at 29 times 26-mm is also identical to prior study. This metastases tumor also demonstrates subtle surrounding vasogenic edema and regional mass-effect which remains as well stable.There is no convincing evidence of any new findings and stable since prior exam.Calvarium and soft tissues of the scalp are unremarkable. Unremarkable limited images through the orbits, paranasal sinuses and mastoid air cells. | 1.Stable hemorrhagic metastatic lesions, surrounding vasogenic edema and associated regional mass-effect in the left inferior frontal and left parietal lobes since prior exam.2.Unremarkable exam otherwise and stable since prior study. |
Generate impression based on findings. | 50 year-old male status post transanal endoscopic microsurgical excision of local colon cancer, now with fever and rectal pain concerning for pelvic 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: Mildly enlarged aortocaval lymph node is unchanged in size.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Orthopedic hardware is noted in L4 and L5 vertebrae.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Complex right perirectal collection is intimately associated with or adjacent to the anorectal wall, measuring approximately 4.2 x 2.5 cm series #3, image 131). An air-fluid level is seen within this collection. Adjacent infiltration and stranding coalesces into a second collection in the presacral space, demonstrating an enhancing wall, gas formation, and thick debris, measuring 5.6 x 1.7 cm (series #3, image 124). The collection also extends inferiorly, tracking along the perianal soft tissues (coronal images 16 to 23).BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Three likely contiguous loculated complex collections associated with rectal surgical bed likely represent abscess and/or leak. |
Generate impression based on findings. | 60 year-old male with headaches and history of right maxillary adenoid cystic carcinoma. CHEST:LUNGS AND PLEURA: No suspicious nodules or masses. Triangular shaped nodular opacity along the left major fissure most compatible with intrapulmonary lymph node (series 4, image 49).No consolidation or pleural effusions.MEDIASTINUM AND HILA: No pathologically enlarged mediastinal lymph nodes. Mild coronary artery calcifications. Heart size normal. No pericardial effusion.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: New hyperattenuating lesion in segment 7 measures 9 x 10 mm (series 3, image 83). No other lesions are identified. Hepatic steatosis. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Hypoattenuating lesions in both kidneys, consistent with benign cysts. RETROPERITONEUM, LYMPH NODES: Portocaval node is unchanged, measuring 1.5 x 1.2 cm, previously measured 1.5 x 1.1 cm (series 3, image 114). Atherosclerotic calcifications throughout the aorta and its branches.BOWEL, MESENTERY: Multiple prominent mesenteric nodes are not significantly changed.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.New liver lesion; - fatty infiltration of liver makes characterization difficult and if better characterization is needed, dedicated liver MRI is recommended to exclude new metastasis. 2.Stable portocaval node and prominent mesenteric nodes. |
Generate impression based on findings. | Clinical question: 72-year-old male with tonic-clonic movements status post cardiac arrest history of hemorrhagic stroke. Signs and symptoms: As above. Nonenhanced portable head CT:Examination demonstrates a focus of low-attenuation involving the cortex and subcortical white matter of right occipital lobe highly suspected for a leak acute/early subacute nonhemorrhagic stroke. The finding measures approximately 28 times 19-mm in its trans-axial dimensions. It is resultant regional mass effect evident by effacement of adjacent cortical sulci. No detectable acute intracranial hemorrhage midline shift or hydrocephalus. Unremarkable cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation are otherwise.Calvarium and soft tissues of the scalp are unremarkable.Examination demonstrates extensive opacification of paranasal sinuses. The contents of the sphenoid sinus demonstrate high density and with fluid/fluid level concerning for hemorrhage within the sinus. Patient is intubated and the findings within the paranasal sinuses are likely result of intubation. | 1.Focus of late acute/early subacute nonhemorrhagic stroke in the right occipital lobe measuring at 28 x 19-mm and unremarkable nonenhanced head CT otherwise.2.Extensive fluid and suspected blood layering of the paranasal sinuses likely results of intubation.3.Unremarkable exam otherwise and in particular no evidence of hemorrhage as is questioned clinically. |
Generate impression based on findings. | Intracerebral hemorrhageIntracerebral hemorrhage There is a redemonstration of a 34 by 11-mm coronal dimension hematoma involving the left thalamus and left midbrain which is associated with a intraventricular blood. Intraventricular blood appears similar when compared to the prior exam. The patient is status post ventriculostomy tube placement. The ventriculostomy tube courses through the right frontal lobe into the right lateral ventricle with the tip in the region of foramen of Monro. There is a small amount of blood products surrounding the ventriculostomy tube. Biventricular diameter on coronal imaging at the level of the entry point of ventriculostomy tube is 45 mm currently and previously was 48 mmPeriventricular and subcortical white matter hypodensities of a moderate degree are present.The visualized portions of the paranasal sinuses partially opacified. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.Since the prior exam the patient's intraparenchymal and intraventricular blood has remained stable.2.Since prior exam the lateral ventricles have mildly decreased in size3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. |
Generate impression based on findings. | 82 year female, status post transurethral resection of bladder tumor complicated by intraperitoneal bladder perforation. High suspicion for urine leakage intra-abdominal. ABDOMEN: Within the limitations of a non-IV contrast enhanced examination limiting evaluation of solid parenchymal organs investor structures to following observations can be made:LUNG BASES: New left pleural effusions, left greater than right, with associated atelectasis.LIVER, BILIARY TRACT: No significant abnormality noted in liver parenchyma. Layered gallstones again seen in the gallbladder without other complication. No intrahepatic or extrahepatic biliary duct dilatation is seen.SPLEEN: No significant abnormality notedPANCREAS: Numerable calcifications again seen in the pancreas/pancreatic duct. Lack of IV contrast limits evaluation of prior noted cystic lesions cannot be evaluated. No evidence of acute change or abnormality.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification again seen in the aorta and major iliac vessels. No retroperitoneal masses or fluid collections are seen.BOWEL, MESENTERY: Free intraperitoneal air is seen anteriorly about the liver and upper abdomen, presumably relating to recent surgical procedure. Collapsed small bowel is seen throughout, without distention or intrinsic abnormality. Colon is air and feces filled without abnormality. No free mesenteric fluid is seen.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Foley catheter in collapsed bladder. Air is seen in the superior, anterior bladder wall with slight thickening of the bladder wall (series 7, image 112), representing postoperative change in the region of prior noted tumor. No peri-cystic fluid collections are seen..LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Collapsed small bowel is seen throughout, without distention or intrinsic abnormality. Colon is air and feces filled without abnormality. No free mesenteric fluid is seen. No free mesenteric air is seen in the pelvis, although there is free air in the abdominal anterior, superior peritoneal spaces, presumably relating to recent surgical procedure. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. New bilateral pleural effusions and associated atelectasis. 2. Residual bladder wall thickening and air in the bladder wall in an area of prior tumor and recent surgical procedure. 3. Free intraperitoneal air in amount typically seen following recent surgery. 4. No significant amounts of free mesenteric fluid or peri-bladder fluid collections. 5. Chronic calcifications in pancreas and unable to evaluate prior noted cystic pancreatic lesions due to lack of IV contrast. 6. Gallstones without additional complication. Unchanged. |
Generate impression based on findings. | Clinical question: Evaluate for hemorrhage. Signs and symptoms: Status post craniofacial reconstruction. Nonenhanced head CT:Examination demonstrate extensive postoperative changes of bilateral frontal craniofacial surgery changes. Surgical changes also in involves bilateral roofs. There is no evidence of intracranial subarachnoid or parenchymal hemorrhage. There is however noticeable with widening of the epidural space under the craniotomy/construct flaps and with resultant fluid and blood accumulation. This finding in the right anterior temporal measures approximately 9.4 mm in thickness and and in the left anterior frontal measures approximately 9.3 mm in size. The findings are believed to be within expected postop change. There are bony grafts along the floors of bilateral anterior cranial fossa and in the midline along the course of metopic suture.The grafts along the floor of the anterior cranial fossa they appear to project in cranial cephalad access and with resultant protrusion into the retro-orbital extraconal space (left greater than right). The graft on the left is in contact with the superior aspect of the left globe (best appreciated on coronal reformatted images).There is a drain under the frontal scalp extending from the left superiorly and across the midline to the right and exiting the scalp in the right posterior temporal region. | 1.No evidence of subarachnoid or parenchymal hemorrhage.2.Extensive postoperative changes of bilateral frontal cranioplasty including placement of bony grafts along the floor of bilateral anterior cranial fossa and midline frontal skull.3.The bony grafts along the floor of anterior cranial fossa has a cranial cephalad projection (more on the left). The graft on the left is in contact with the superior aspect of globe without deformity as detailed.4.Widening of the epidural space containing blood/fluid density content under the craniotomy/cranioplasty flaps as detailed. |
Generate impression based on findings. | Intracerebral hemorrhageIntracerebral hemorrhage There is a redemonstration of a 34 by 11-mm coronal dimension hematoma involving the left thalamus and left midbrain which is associated with a intraventricular blood. Intraventricular blood appears similar when compared to the prior exam. The patient is status post ventriculostomy tube placement. The ventriculostomy tube courses through the right frontal lobe into the right lateral ventricle with the tip in the region of foramen of Monro. There is a small amount of blood products surrounding the ventriculostomy tube. Biventricular diameter on coronal imaging at the level of the entry point of ventriculostomy tube is 48 mm currently and previously was 41 mmPeriventricular and subcortical white matter hypodensities of a moderate degree are present.The visualized portions of the paranasal sinuses partially opacified. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.Since the prior exam the patient's intraparenchymal and intraventricular blood has remained stable.2.Since prior exam the lateral ventricles have increased in size3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. |
Generate impression based on findings. | 31-year-old male with bilateral lower abdominal pain, blood in stool. Evaluate for infectious process such as colitis. 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 evidence of obstruction or bowel inflammation. Moderate amount of stool throughout colon.The appendix is not visualized, however, there are no inflammatory changes in the right lower quadrant to suggest appendicitis.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 evidence of obstruction or bowel inflammation. Moderate amount of stool throughout colon.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Moderate amount of stool throughout colon without evidence of colitis or other specific abnormality to account for symptoms. |
Generate impression based on findings. | Headaches. History of right maxillary adenocarcinoma. CT facial bones: Previously described postoperative changes include the right antrectomy with middle/inferior turbinectomy and left antrostomy which has intervally been widened by an uncinectomy and is widely patent. There is intervally improved mucosal thickening within the left maxillary sinus. A previously seen left-sided Haller cell has also been partially resected. The left sided ethmoids demonstrate patchy opacification anteriorly with aerated secretions posteriorly. There is stable mucosal thickening within the right maxillary sinus, more prominent inferiorly where there is contiguity with incidental persistent periapical lucency associated with a right second maxillary premolar, now with increased conspicuity of a small focal osseous defect. There is also periapical lucency associated with right-sided maxillary molar teeth which, demonstrated previously. There is no focal mucosal thickening or soft tissue masses demonstrated in the sinuses/nasopharynx. Orbits are unremarkable. There are no aggressive bony lesions demonstrated.CT neck: There is no mucosal irregularity or soft tissue mass associated with the nasopharynx, oropharynx or hypopharynx. The epiglottis, larynx and upper airway are normal. The submandibular, parotid and thyroid glands are normal. There are no abnormal nodes by size criteria. There are no aggressive appearing bony lesions. There is calcified and uncalcified plaque at the bifurcation of the left carotid artery. Incidental note is made of degenerative change including loss of intervertebral disk height at the C5-6 level with 3 mm retrolisthesis and straightening of the cervical lordosis. | 1.Sinonasal postoperative changes without obvious tumor recurrence.2.Interval left uncinectomy and antrostomy with improved appearance of the left maxillary sinus.3.Stable mild mucosal thickening in the right maxillary sinus and minimal residual findings on the left likely related to inflammatory changes.4.Persistent periapical lucencies associated with right maxillary premolar and molar teeth likely representing sequela of dental disease, with slight interval progression along ADA #4. Please correlate with dental exam.5.No evidence of nodal metastasis or malignancy within the neck. |
Generate impression based on findings. | 33-year-old male with abdominal distention, dyspnea, elevated lactate. Evaluate for signs of GI ischemia or other abnormality. CHEST:LUNGS AND PLEURA: Apical septal thickening, scattered areas of basilar predominant ground glass opacity, left more than right, most consistent with edema. Subsegmental consolidation in the left base suspected to represent superimposed infection or aspiration.No pleural effusions.MEDIASTINUM AND HILA: Severe cardiomegaly. No pericardial effusion.Right-sided aortic balloon pump catheter enters the aorta through the right brachiocephalic artery; the superior metallic marker of the aortic balloon pump is in the proximal descending aorta, in appropriate position (coronal series image 43).CHEST WALL: Left chest wall ICD in place. ABDOMEN:LIVER, BILIARY TRACT: Stable hepatomegaly, which may be due to passive congestion/heart failure.High density within gallbladder likely represents residual vicariously excreted contrast material from prior exam.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 obstruction or bowel wall thickening. Small amount of free fluid in the lower abdomen and pelvis.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 obstruction or bowel wall thickening. Small amount of free fluid in the pelvis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Scattered lung ground glass opacities and septal thickening are most consistent with edema. Subsegmental consolidation in left base may represent superimposed aspiration and/or pneumonia. 2.Small amount of free fluid in lower abdomen and pelvis without other significant intra-abdominal abnormality, likely due to volume overload. |
Generate impression based on findings. | 51-year-old female with history of cholangiocarcinoma, rule out metastatic disease LUNGS AND PLEURA: Moderate right pleural effusion with adjacent consolidation and atelectasis. Bilateral pulmonary nodules measuring up to 5 x 5 mm on the right are suspicious for metastatic disease (image 58, series 4).MEDIASTINUM AND HILA: Port catheter extends to the SVC. Nonspecific hypoattenuating thyroid lesions. Prominent prevascular mediastinal lymph node measuring up to 8 mm (image 35, series 3). Left internal mammary lymphadenopathy.CHEST WALL: Right chest wall port.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Numerous hypoattenuating hepatic lesions consistent with the patient's history of cholangiocarcinoma. | 1. Multiple small pulmonary nodules and right pleural effusion suspicious for metastatic disease. 2. Extensive hepatic lesions consistent with patient's history of cholangiocarcinoma. |
Generate impression based on findings. | 54-year-old male with end-stage renal disease and gross hematuria and abdominal pain. Evaluate for kidney stones. Within the limits of a non-IV contrast enhanced examination limiting evaluation of solid parenchymal organs of vessel structures, the following observations can be made:ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality noted in liver. Gallstones again seen without complication. No intrahepatic or extrahepatic biliary duct dilatation is seen to suggest obstruction.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilaterally small kidneys, with extensive vascular calcifications. No calcifications are seen within the expected regions of the pyelocalyceal systems. No ureteral calcifications are seen. No hydronephrosis. No renal masses are seen, however, lack of IV contrast limits ability to evaluate parenchyma.RETROPERITONEUM, LYMPH NODES: Extensive vascular calcification seen throughout -- no retroperitoneal masses or abnormal fluid collections.BOWEL, MESENTERY: Small sliding hiatal hernia, unchanged. Intestinal tract is otherwise unremarkable. No free mesenteric fluid is seen. Small anterior ventral umbilical hernia containing only mesenteric fat.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate without focal abnormality.BLADDER: Semi-distended bladder seen with diffuse wall thickening, which is accentuated by lack of distention. No focal abnormality seen.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Intestinal tract is otherwise unremarkable. No free mesenteric fluid is seen. Small anterior ventral umbilical hernia containing only mesenteric fat.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. No evidence of urinary tract calculus disease and no hydronephrosis. 2. Cholelithiasis again seen without complication. 3. Bladder wall diffusely, mildly thickened -- this may be accentuated by lack of distention. |
Generate impression based on findings. | Male; 15 years old. Reason: 15 y/o male with Crohn and history of possible vasculitis now with L foot swelling with darkened areas on dorsum and now plantar surface of foot concerning for cellulitis vs abscess vs other tissue compromise History: swelling, erythema, parasthesias, severe pain. Dopplars at bedside show good perfusion. Cap refill appropriate Normal appearance of the bones without evidence of acute fracture or osteomyelitis. Alignment is anatomic.Within the limits of CT evaluation of the soft tissues, there is no acute ligamentous injury evident.Subcutaneous soft tissue swelling, particularly along the dorsum of the foot, without evidence of focal fluid collection to suggest abscess. The deep fascial planes are within normal limits. | Soft tissue swelling, particularly along the dorsum of foot, which is nonspecific and may be due to cellulitis; clinical correlation is advised. No evidence of abscess. |
Generate impression based on findings. | 34-year-old female with right lower quadrant pain, nausea and vomiting. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Orally administered contrast rapidly progresses through normal appearing stomach and small bowel to the right lower quadrant and terminal ileum. No intrinsic abnormalities are seen and no evidence of obstruction. Colon is feces filled and without other abnormality. Appendix is well visualized and normal and no periappendiceal inflammatory changes are seen. No free mesenteric fluid. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Orally administered contrast rapidly progresses through normal small bowel to the right lower quadrant and terminal ileum. No intrinsic abnormalities are seen and no evidence of obstruction. Colon is feces filled and without other abnormality. Appendix is well visualized and normal and no periappendiceal inflammatory changes are seen. No free mesenteric fluid. Small ventral umbilical hernia containing only mesenteric fat.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Small umbilical anterior wall hernia containing only mesenteric fat. 2. No other abnormality seen and no findings seen to account for patient's symptomatology. |
Generate impression based on findings. | Female 65 years old; Reason: 65Yrs old Black/African-American female with longstanding history of ileocolonic Crohn's disease s/p multiple abdominal surgeries with G-tube for decompression. RLQ pain, fevers, decreased output from g-tube History: RLQ pain, decreased output from g-tube followed by yellow/bilious output and c/o diarrhea ABDOMEN:LUNG BASES: Bibasilar subsegmental atelectasis.LIVER, BILIARY TRACT: Unchanged calcified granulomata. Subcentimeter hepatic hypodensities, which are too small to characterize though appear similar to the prior exam. Status post cholecystectomy.SPLEEN: Unchanged calcified granulomata.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: IVC filter in place. Atherosclerotic calcification of the abdominal aorta without aneurysm. No mesenteric or retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Pull type gastrostomy tube is present, without evidence of complication. No surrounding fluid collection is seen to suggest abscess formation. Mildly dilated loops of small bowel without obstruction, wall thickening, or associated mesenteric stranding. Unremarkable colon.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Surgically absent.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Stable mildly dilated loops of small bowel more distal normal claiber and clustered bowel unchanged since most recent CT, but markedly improved from more remote CT examinations. Stable wall thickening, or associated mesenteric stranding. No surrounding fluid collection is seen to suggest abscess formation. Unremarkable colon.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No acute intraabdominal pathology detected. Stable mildly dilated loops with of small bowel thickened walls change -- element of partial small bowel obstruction cannot be excluded although markedly improved from more remote CT examinations. |
Generate impression based on findings. | 70 year-old female with abdominal pain, rule out mesenteric ischemia, splenic infarct. ABDOMEN:LUNG BASES: Left basilar atelectasis. Fibrotic changes of the right chest wall may represent posttreatment changes relating to right mastectomy and radiation.LIVER, BILIARY TRACT: Large gallstone redemonstrated in the gallbladder. Haziness seen in the gallbladder fossa is likely artifactually-induced due to motion -- this appears unchanged accounting for this, but if gallbladder disease is of concern ultrasound is recommended.SPLEEN: No significant abnormality notedPANCREAS: Atrophic pancreas.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple bilateral cysts appear unchanged from prior study.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Orally administered contrast progresses rapidly through the stomach and small bowel without evidence of ileus or obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: A round, well-defined, homogeneous lesion of water density with imperceptible wall in the left adnexa demonstrates interval increase in size from 4/5/2012. Currently measures 4.7 x 3.9 cm, from 3.6 x 2.8 cm on the previous exam.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.No evidence of mesenteric ischemia or splenic infarct, as clinically questioned.2.Large gallstone probably unchanged and without complication, however gallbladder incompletely evaluated due to motion artifact. If there is clinical concern for cholecystitis, right upper quadrant ultrasound would be recommended.3.Interval growth of left adnexal unilocular cystic lesion. Although this most likely represents benign process, ultrasound is recommended for further characterization to make sure no solid components exist. |
Generate impression based on findings. | 58-year-old male with, tachycardia and shortness of breath PULMONARY ARTERIES: Technically adequate study without evidence of pulmonary embolus. LUNGS AND PLEURA: New bilateral pleural effusions with associated compressive atelectasis. Multiple cavitating masses and nodules are identified, with the largest reference right upper lobe mass measuring 3.5 x 4.5 cm and previously measuring 2.5 x 4.8 cm (image 69, series 10).MEDIASTINUM AND HILA: Mediastinal lymphadenopathy measuring up to 1.5 cm (image 137, series 9).CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Mild abdominal ascites. | Bilateral cavitating nodules and masses suspicious for atypical infection. Interval development of new small bilateral pleural effusions. New abdominal ascites. |
Generate impression based on findings. | Reason: worsening sob, yellow sputum, increasing o2 requirements s/p RML, slightly worse RLL opacity from cxr on 11/13/13. LUNGS AND PLEURA: Status post right middle lobectomy. Paramediastinal air is noted adjacent to the surgical bed (series 5 image 50) and is likely postsurgical. There is right lower lobe patchy airspace and interstitial opacities with an associated anterior loculated pleural effusion. Small right layering pleural effusion. Focal area of groundglass opacity in the left upper lobe (series 5 image 37) is nonspecific and may represent aspiration. Mild centrilobular emphysema. Scattered pulmonary micronodules.MEDIASTINUM AND HILA: The reference right hilar lymph node is no longer measurable. No hilar or mediastinal lymphadenopathy by CT criteria. Normal sized heart with small pericardial effusion. Moderate coronary artery and aortic calcifications. Unchanged left Bochdalek hernia.CHEST WALL: Right lateral chest wall fluid collection is incompletely visualized and is consistent with a postsurgicalseroma versus hematoma. Subcentimeter axillary lymph nodes. Mild to moderate degenerative changes in the thoracic spine. UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. The small non-enhancing fat-containing mass with peripheral calcifications at the dome of the liver is unchanged from 10/1/2013 and may representing a benign granuloma.Scattered small peritoneal calcifications are again seen. | 1. Interval right middle lobectomy with small loculated right pleural effusion with findings suggestive of post surgical changes and/or infection in the right lower lobe.2. Right lateral chest wall seroma / hematoma.Small pericardial effusion. |
Generate impression based on findings. | 85 year-old male with left upper lobe mass LUNGS AND PLEURA: Large heterogeneously enhancing left upper lobe mass measures 6.3 x 6.4 cm (image 33 series 3), invades the mediastinum, compresses the left main pulmonary artery and encases the left mainstem bronchus and its branches. Debris is noted in the lower airways. Moderate centrilobular and paraseptal emphysema.MEDIASTINUM AND HILA: Severe coronary arterial calcifications. Calcified and non-calcified hilar lymph nodes..CHEST WALL: Degenerative changes of the thoracolumbar spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Pancreatic calcifications suggest chronic pancreatitis. Bilateral hypoattenuating renal lesions are incompletely visualized. | Large left upper lobe mass invading the mediastinum and encasing the left main pulmonary artery and mainstem bronchus most likely representing a primary carcinoma. |
Generate impression based on findings. | 45-year-old male with history of cholangiocarcinoma and increasing shortness of breath. PULMONARY ARTERIES: Technically adequate study without evidence of pulmonary embolus..LUNGS AND PLEURA: Right lower lobe nodule measures 1.9 x 1.3 cm (image 174, series 7) and previously measured 1.1 x 0.8 cm. Basilar atelectasis.MEDIASTINUM AND HILA: Mediastinal lymphadenopathy measuring up to 1.2 cm (image 101, series 5). Center venous catheter extends to the SVCCHEST WALL: Left chest wall port.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Partially visualized hepatic masses with embolization coils are incompletely evaluated. | No pulmonary embolus. Enlarging right lower lobe nodule suspicious for metastatic disease. |
Generate impression based on findings. | Seizure. There is a ventriculostomy shunt extending from a right parietal approach into the right lateral ventricle with its tip in the anterior horn. There has been no interval change in catheter position or ventricular caliber since the prior examination. There is a right frontal burr hole presumably related to prior shunt insertion site.There is a rounded area of gray matter attenuation associated with the cingulate gyrus at the medial aspect of the right ventricular body possibly representing a focus of cortical dysplasia, less likely of gray matter heterotopia, as demonstrated previously. No intracranial mass, hemorrhage or edema. The midline is intact. Visualized portions of the orbits and paranasal sinuses are unremarkable. There are no bony fractures or extracranial soft tissue abnormalities. | 1.Right ventriculostomy catheter in unchanged position. Stable ventricular size.2.Stable rounded area of gray matter attenuation associated with the cingulate gyrus suspicious for cortical dysplasia, less likely gray matter heterotopia. |
Generate impression based on findings. | Male 49 years old; Reason: CT for possible PT drain removal History: CT for possible PT drain removal The absence of intravenous and oral contrast limits evaluation of the solid organs and of the bowels. Given these limitations, the following observations were made:ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Lack of IV contrast limits evaluation the liver, and previously seen hypodensities are not well visualized. Normal gall bladder without evidence of gallbladder wall thickening or cholelithiasis. SPLEEN: No significant abnormality notedPANCREAS: Left-sided drain with the tip in the prior site of a pancreatic tail pseudocyst. There has been significant resolution of the previously noted pancreatic body/tail pseudocyst and is now not discernible. The pancreatic body and tail are incompletely characterized given lack of IV contrast. There is thrombosis of the splenic and superior mesenteric veins with venous collaterals, unchanged.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The previously seen bilateral hydronephrosis has decreased with mild residual, right greater than left.RETROPERITONEUM, LYMPH NODES: Right-sided retroperitoneal fluid collection overlying the right psoas muscle is smaller measuring 3.8 x 0.9 cm, (series 4 image 82) previously 5.1 x 1.3 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild levoscoliosis of the lumbar spine. L1 mild compression deformity, unchangedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Scattered bilateral inguinal lymph nodes.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Interval resolution of the previously noted pancreatic body/tail pseudocyst extended down into the left retroperitoneum. Majority of the pancreatic tail and body are not well characterized on this examination.2.Right-sided retroperitoneal fluid collection overlying the right psoas muscle is slightly smaller in size.3.Decrease in the bilateral hydronephrosis, with mild residual right greater than left. |
Generate impression based on findings. | evaluate for vetebral artery compression at C1-2. Cervicalgia; Ankylosing spondylitis Neck CTA: There is opacification of great vessels from the aortic arch and carotid arteries and vertebral arteries. The origins of the great vessels from the aortic arch are not included on this exam. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is approximately 30% narrowing at the origin of the left internal carotid artery and 30% right internal carotid artery.The left internal carotid artery is displaced anteriorly and laterally a mild degree related to bony proliferation from C1 C2Atherosclerotic calcifications are present at the carotid bifurcations.There is a basilar invagination at C1-C2 associated with adjacent bony proliferation which was present on a CT from 11/6 /2012. The degree of basilar invagination in appearance but have progressed when compared to the prior CT exam. In addition the character of the adjacent bony proliferation appears to have changed and the progressed. There is associated compression of the right more than the left vertebral arteries at the level of the C1 and C2 neural foramen. The right vertebral artery is smaller than the left vertebral artery and is significantly narrowed at the mid and C2 foramen transversarium by approximately 70% related to bony proliferation and mildly narrowed at the C1 foramen transversarium. The left vertebral artery is a folded on itself at the C2 level and narrowed by approximately 40%.There is associated anterior subluxation of C1 relative to C2 with narrowing of the foramen magnum which appears so worse when compared to the October MRI exam.There are multilevel degenerative changes present in the cervical spine with endplate and uncovertebral osteophytes at the C3-4, C4-5, C5-6 and C6-7 associated with varying degrees of neural foraminal narrowing and a narrowing of the spinal canal worse at C3-4 other findings consistent with spinal stenosisThe eyeball lenses are thin. | 1.There is a right vertebral artery stenosis of approximately 70% at the C2 level related to bony proliferation at the neural foramen. There is mild narrowing of the left vertebral artery related to basilar invagination and bony proliferation. Please note the right vertebral artery is the nondominant vertebral artery2.since prior exams basilar invagination at the C1 has progressed and there is a narrowing of the foramen magnum.3.There are multilevel degenerative changes present in the cervical spine worst at C3-4 with spinal stenosis and associated multilevel neural foramina encroachment. Please refer to the MRI of the cervical spine from 10/2/13 for further comments |
Generate impression based on findings. | Female, 52 years old, vocal cord paresis, thyroid nodule. Head:Mild periventricular and patchy subcortical hypoattenuation is seen, nonspecific but likely indicative of age indeterminant small vessel ischemic disease. No enhancing abnormality is evident. No intracranial hemorrhage or abnormal extra-axial fluid collection is seen. There is no evidence of mass effect or midline shift. The ventricles and basal cisterns are patent and normal in size. Postsurgical changes seen consistent with functional endoscopic sinus surgery. There is a nasal septal prosthesis in place. Additional details regarding the paranasal sinuses are better assessed on the accompanying sinus CT.The bones of the calvarium and skull base are otherwise intact. Neck:No suspicious mucosal based masses are seen. There may be some volume loss affecting the left aspect of the tongue, but this is equivocal. The left piriform sinus and laryngeal ventricle are slightly larger than the right which could be a secondary sign of left vocal cord dysfunction. The aerodigestive tract is otherwise unremarkable.There is a 2.7 x 2.5 x 1.5-cm nodule in the left lobe of the thyroid. The right lobe of the thyroid appears mildly heterogeneous as well.The salivary glands are free of focal lesions. No pathologic adenopathy is seen. No other neck masses are evident including along the expected course of the recurrent laryngeal nerves.Lung apices are unremarkable. No concerning osseous lesions are demonstrated. | 1. A left thyroid lobe nodule is nonspecific and has been better assessed on prior ultrasound.2. No other neck mass or pathologic adenopathy is seen.3. Secondary evidence of left vocal cord dysfunction. Correlation with direct visualization is suggested.4. No intracranial mass or other significant intracranial abnormality. |
Generate impression based on findings. | Altered mental status. There is diffuse symmetrical prominence of CSF spaces and ventricular size, as well as subcortical hypoattenuation most likely representing sequela chronic small vessel ischemic disease. There is a focus of atherosclerotic calcification along the course of the right vertebral artery. There is no intracranial mass, hemorrhage or edema. There is no midline shift. Paranasal sinuses are unremarkable. Mastoid cells are aerated. There is no bony abnormality demonstrated. | Mild age indeterminate small vessel ischemic changes, without CT evidence of acute pathology. |
Generate impression based on findings. | 46-year-old female with history of right jaw solitary fibrous tumor, reevaluate Limited intracranial and orbital views are grossly unremarkable. The visualized paranasal sinuses and mastoid air cells are clear.Similar to the prior, a surgical clip is present inferior to the right mandible with overlying scar tissue. The right mandible is intact. No evidence of recurrent or residual disease.Scattered small cervical lymph nodes without evidence of lymphadenopathy by CT size criteria. The submandibular and parotid glands are free of focal lesions. The thyroid gland is within normal limits. The major cervical vasculature is patent bilaterally. No exophytic masses or focal effacement of the aerodigestive tract. No soft tissue masses are present in the neck.The visualized lung apices are clear. Aberrant right subclavian artery, normal anatomic variant. No suspicious osseous lesions are present. Partially visualized lucency at T4 is likely an intravertebral hemangioma. | No evidence of recurrent or residual disease. |
Generate impression based on findings. | Female, 52 years old, sphenoid sinusitis, vocal cord weakness. The frontal sinuses and frontoethmoidal recesses are clear. Postoperative change is evident status post resection of some of the ethmoid air cells. There is mild patchy opacification involving the remaining air cells. Previously seen soft tissue opacification of an expanded left ethmoid air cell and the left sphenoid sinus has resolved. The right sphenoid sinus is clear.Findings are redemonstrated status post endoscopic sinus surgery including resection of the ostiomeatal units. The neo-antra are widely patent and there is no significant mucosal thickening within the maxillary sinuses.The nasal septum is deficient with a septal prosthesis in place. The nasal cavity is otherwise clear. | 1. Demonstration of postoperative findings consistent with functional endoscopic sinus surgery.2. Interval resolution of soft tissue opacification in the region of the left ethmoids and left sphenoid sinus. |
Generate impression based on findings. | Male, 67 years old, AML, neutropenic fever, previous CT showing extensive sinusitis. Concern for Mucor. Peripheral mucosal thickening is again seen within the right maxillary sinus. Centrally, there is hyperdense material also similar to prior. A bony defect persists within the posterior lateral wall of the sinus through which mucosal thickening slightly bulges. The retromaxillary fat is mildly encroach upon and infiltrated similar to prior. The bony defect continues inferiorly to the level of the alveolar ridge, also unchanged. The walls of the right maxillary sinus are sclerotic suggesting long-standing inflammation.Minimal mucosal thickening is evident within the left maxillary sinus. There are matching focal defects within the medial walls of both maxillary sinuses which predate the present inflammation and which may reflect accessory ostia or less likely surgical change.The frontal sinuses and frontoethmoidal recesses are clear. The ethmoid air cells are essentially clear allowing for some minimal mucosal thickening. The sphenoid sinuses and sphenoethmoidal recesses are clear.The nasal septum is intact with a rightward deviation and a rightward projecting bony spur. The turbinates are unremarkable. | Persistent mucosal thickening and hyperdense material within the right maxillary sinus, along with persistent erosion of the sinus walls. The constellation of findings remains concerning for an aggressive or invasive fungal process, particularly given the clinical history. |
Generate impression based on findings. | 38 year-old female with cirrhosis, sepsis, respiratory failure, bloody ascites with possible SBP. ABDOMEN:LUNG BASES: Interval improvement in previously seen groundglass opacities. Bilateral basilar consolidation/atelectasis. Trace bilateral pleural effusions. Paraseptal emphysema. Central venous catheter terminates in right atrium.LIVER, BILIARY TRACT: Cirrhotic liver morphology with large amount of ascitesSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Again seen is high attenuation collection in the inferior pole of the right kidney consistent with hematoma; this is less dense in attenuation compared to prior exam but similar in size, measuring 6.7 x 9.7 cm, previously measured 6.6 x 9.7 (series 3, image 102).RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Increased large amount of ascites fluid in the abdomen. There are foci of high attenuation within the ascites fluid in the right hemi-abdomen, consistent with hemorrhage (series 3, image 88). No evidence of loculation. Interval improvement in previously seen dilation of multiple bowel loops in, consistent with improved ileus.NG tube tip in stomach.BONES, SOFT TISSUES: Diffuse anasarca.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Large amount of ascites fluid in the abdomen and pelvis with layering regions of high attenuation consistent with blood (series 8020, image 110).Rectal tube in place.BONES, SOFT TISSUES: Diffuse anasarca.OTHER: No significant abnormality noted | 1.Evolving right inferior right renal pole hematoma is not significantly changed in size.2.Increased large amount of ascites fluid with new areas of high attenuation consistent with blood. Although no loculations are evident, superimposed infection cannot be excluded. 3.Improved ileus. 4.Consolidation in both lung bases. |
Generate impression based on findings. | 70 year-old male with GI stromal tumor -- surveillance. CHEST:LUNGS AND PLEURA: No change in lung parenchyma -- small micronodular left lung base (MIP series image 44) unchanged dating back to 2011 and represents benign postinflammatory nodule. No other nodules, masses, areas of consolidation or effusion seen. MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted in the liver parenchyma.Gallstones again seen without complication. No evidence for biliary tract obstruction.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral benign renal cysts, unchanged. No other significant abnormality seenRETROPERITONEUM, LYMPH NODES: Scattered mildly prominent. Lymph nodes are again seen, unchanged. The reference left para-aortic lymph node (series 3, image 128) is unchanged, measuring 1.4 x 1 .0 cm, previously 1.5 x 1.0 cm.BOWEL, MESENTERY: Relatively diffuse wall thickening of the descending colon again seen, unchanged. No other abnormalities in the GI tract seen. There is been a decrease in the small amount of mesenteric fluid adjacent to the descending colon..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 abnormalities seen in the small or large bowel in the pelvis. No free mesenteric fluid.BONES, SOFT TISSUES: Right inguinal herniaOTHER: No significant abnormality noted | 1. No definite ascites now seen. 2. Mild colonic wall thickening descending colon, nonspecific and unchanged. 3. Small retroperitoneal lymph nodes, stable. 4. No sites of new disease seen. |
Generate impression based on findings. | Reason: vocal cord paresis History: vocal cord paresis LUNGS AND PLEURA: Minimal basilar scarring and bronchiectasis. No other significant pulmonary or pleural abnormality.MEDIASTINUM AND HILA: Heterogeneous left thyroid lobe enlargement.There is 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 significant abnormality except for heterogeneous left-sided thyroid enlargement. |
Generate impression based on findings. | Reason: 61 yo M with AML s/p multiple BMT. Febrile, dry cough, SOB. Eval for infectious etiology History: see above LUNGS AND PLEURA: Moderate to severe emphysema.New pleural effusions are present.New basilar predominant bronchial wall thickening and patchy consolidation, which could be from recurrent aspiration or even infection.There are no findings suggestive of typical fungal infection, however.MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy.Left subclavian port catheter extends to the SVC.Mild coronary and aortic calcifications are present.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Stable splenomegaly. New abdominal ascites. | 1. New pleural effusions, basilar opacities and bronchial wall thickening likely the result of recurrent aspiration, possibly infection but not a typical fungal etiology.2. New abdominal ascites. |
Generate impression based on findings. | Reason: Please perfrom high resolution CT to assess COPD. No contrast History: hypoxia, present reported history of intraperitoneal bladder perforation following transurethral resection of bladder tumor. LUNGS AND PLEURA: Severe centrilobular emphysema extending to the lower lobes. Bilateral pleural effusions, moderate on the left and small right. Associated, left greater than right, basilar atelectasis.MEDIASTINUM AND HILA: Heart size is normal. Low-density blood pool is consistent with anemia. No pericardial effusion. Mild coronary artery calcification involving the left main and proximal LAD.No mediastinal lymphadenopathy.CHEST WALL: Notable paucity of subcutaneous fat.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Pneumoperitoneum, likely postoperative, given stated history. Lucency of gas tracks along the suprahepatic IVC and intrahepatic veins; this does not appear within the biliary system. | Severe centrilobular emphysema extending to the bases. Bilateral pleural effusions, moderate on the left and small right.Nodular consolidation peripheral right lower lobe which can be followed on subsequent CT thorax following diuresis.Postoperative pneumoperitoneum with gas that tracks along the intrahepatic veins. |
Generate impression based on findings. | 65 year-old female, evaluate lung disease LUNGS AND PLEURA: No suspicious nodules or masses. There is atelectasis and bronchiectasis in the superior segment of the right middle lobe with concave margins. No pleural effusions.MEDIASTINUM AND HILA: Right hilar lymph node measures 9 mm (image 42 series 3). No mediastinal lymphadenopathy. The heart size is normal.CHEST WALL: Mildly prominent axillary lymph nodes. UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.. | Atelectasis and bronchiectasis involving the superior segment of the right lower lobe suggestive of a resolving inflammatory process such as an organizing pneumonia. Follow up imaging in 3 months is recommended to confirm resolution. Comparison with prior imaging if available would also be helpful. |
Generate impression based on findings. | Male, 31 years old, thyroid cancer, history of neck recurrence, evaluate for adenopathy. Limited intracranial views are again significant only for a small dense focus in the region of the fourth ventricle which is unchanged from prior.The thyroid gland has been resected. Only mild nonspecific soft tissue thickening is evident within the thyroid bed, similar to the prior exam. No evidence of recurrent mass or pathologic adenopathy is seen.Infiltration of the fascial planes is likely related to prior therapy. The aerodigestive tract is unremarkable. Salivary glands are free of focal lesions. Cervical vessels remain patent. Lung apices are clear. No concerning osseous lesions are demonstrated. | No evidence of recurrent disease in the neck. |
Generate impression based on findings. | right serous otitis media, assess for parapharyngeal or nasopharyngeal lesion The orbits are unremarkable. The mastoids are clear. Limited view of the intracranial structure is unremarkable. The maxilla, mandible, sphenoid bone, nasal bones, zygoma, hard palates, pterygoid plates, visualized cervical spine and TMJs are intact, without fracture. Mucosal thickening compatible with chronic sinusitis is present in the frontal, bilateral ethmoid, and maxillary sinuses. Mucosal thickening causes narrowing of a still patent left ostiomeatal complex, and the right ostiomeatal complex is completely occluded. The nasal septum is moderately deviated to the left without bony septal spur. No parapharyngeal or nasopharyngeal mass is identified. | 1. No nasopharyngeal lesion to account for patient's symptoms. 2. Chronic pansinusitis. |
Generate impression based on findings. | 44-year-old male with AML LUNGS AND PLEURA: Small pleural effusions and basilar atelectasis/consolidation. Left lingular consolidation.MEDIASTINUM AND HILA: Left central venous catheter extends to the mid left innominate vein. Scattered small mediastinal lymph nodes without adenopathy. Small pericardial effusion.CHEST WALL: Note is made of cervical fusion hardware and reticulation of the cutaneous fat in the anterior thorax. Deformity consistent with an old right anterior thoracic rib fracture.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Small hiatal hernia. Splenomegaly. | Small pleural effusions with basilar atelectasis/consolidation as well as left lingular consolidation suspicious for an infectious process. |
Generate impression based on findings. | Reason: patient is 18, use low dose, evaluate for bronchiectasis History: cough LUNGS AND PLEURA: Diffuse bronchial wall thickening with scattered foci of mucoid impaction and mild bronchiectasis. Associated centrilobular nodules and tree in bud opacities consistent with bronchiolitis.Three nodular fissural opacities in the left major fissure favoring intrapulmonary lymph nodes.No associated pleural effusion.MEDIASTINUM AND HILA: A partially calcified right hilar lymph node compatible with prior granulomatous disease. No mediastinal lymphadenopathy.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. | Diffuse bronchial wall thickening with scattered foci of mucoid impaction and mild bronchiectasis. Associated centrilobular nodules and tree in bud opacities consistent with bronchiolitis.No mediastinal lymphadenopathy. |
Generate impression based on findings. | Reason: lung Ca, reassessment on chemo after 2 months. History: cough CHEST:LUNGS AND PLEURA: Previously noted large right lower lobe mass as slightly decreased in size now measuring 6.8 cm x 5.5 cm (image 79 series 4) previously measuring 7.3 cm x 6.1 cm.Reference nodules in the right low in the also slightly decreased in size.Right middle lobe nodule (image 86 series 4) now measures 11 mm x 8 mm previously measuring 13 mm x 10 mm.Reference nodule in the anterior segment of the right upper lobe (image 49 series 4) now measures 4 mm previously measuring 5 mm.Pleural nodularity is again noted without evidence of a pleural effusion.No new pulmonary nodules identified.MEDIASTINUM AND HILA: Reference right hilar and lymphadenopathy (image 63 series 3) is decreased in size now measuring 9 mm previously measuring 14 mm.Mild cardiac enlargement with a small pericardial effusion that has increased in size since the prior exam.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mildly enlarged retroperitoneal lymph nodes similar in appearance the prior exam.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.Large lobulated right lower lobe mass slightly decreased in size in since the prior exam. Additional pulmonary nodules in the right lung have also minimally decreased in in size.2.Right hilar lymphadenopathy with interval decrease in size.3.Small pericardial effusion with interval increase in size. |
Generate impression based on findings. | 87 year-old male with abdominal pain. Mesothelioma. CHEST:LUNGS AND PLEURA: No significant abnormality notedin the lung parenchyma. No nodules, foci of consolidation or effusions. No pleural thickening or pleural masses.MEDIASTINUM AND HILA: Coronary artery calcification. Scattered small subcentimeter right cardiophrenic angle. Lymph nodes are seen -- largest of these measures 1.2 x 0.7 cm (series 3, image 68 and are of uncertain significance.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Scattered small subcentimeter nonspecific hypodensities are seen in the right lobe and cannot definitely be characterized, but the marked low attenuation makes this most likely. No other parenchymal abnormalities. Portal venous, and hepatic veins appear normal.Patient is status post cholecystectomy. No evidence for biliary obstruction seen.SPLEEN: Multiple calcified granulomata -- no other abnormalitiesPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Atherosclerotic changes in the aorta. No retroperitoneal adenopathy or masses.BOWEL, MESENTERY: Orally administered contrast material rapidly progresses through normal-appearing stomach and small bowel to the colon. No evidence of intrinsic abnormality is seen. Colon is feces filled throughout with scattered diverticular changes in the sigmoid colon without complication.Diffuse ascites is seen without loculation. The peritoneum shows slight wall thickening, relatively diffusely, particularly in its lateral aspects, and tumor cannot be differentiated from chronic inflammatory change. There has a confluence focus of soft tissue infiltration into the omentum/peritoneum adjacent and inferior to the right hepatic flexure and transverse colon (see coronal image 83 and axial series 3, image 99-101) measuring approximately 15.0 x 2.6 cm in maximal cross-sectional diameter, and extends approximately, across half of the transverse colon, mesentery. This extends more inferiorly towards the left midabdomen in the, mesentery (image 94). BONES, SOFT TISSUES: No significant abnormality noteddOTHER: No significant abnormality noteddPELVIS:PROSTATE, SEMINAL VESICLES: Marked prostate enlargement without other abnormality..BLADDER: No significant abnormality noteddLYMPH NODES: No significant abnormality noteddBOWEL, MESENTERY: Diffuse ascites is seen without loculation. The peritoneum shows slight wall thickening, relatively diffusely, particularly in its lateral aspects, and tumor cannot be differentiated from chronic inflammatory change. No confluent masses in the pelvic mesentery are seen.BONES, SOFT TISSUES: Diffuse degenerative changes without focal abnormality.OTHER: No significant abnormality notedd | Small subcentimeter right cardiophrenic angle lymph nodes of uncertain significance -- no other thoracic abnormality seen. 2. Diffuse ascites with slight thickening diffusely of the peritoneal wiles. 3. Soft tissue mass with Infiltration in the omentum/mesentery near the right hepatic flexure and transverse colon into the mid and left abdomen. |
Generate impression based on findings. | 55-year-old female patient with history of sarcoidosis presents with lung nodule per outside hospital chest x-ray. Evaluate for lung lesion. LUNGS AND PLEURA: Bullae, bronchiectasis and scarring, predominantly in the upper lung zone is consistent with history of sarcoidosis and has decreased compared to prior examination. Notably, the consolidative component in the right upper lung is decreased compared to prior. Scattered ill-defined nodules have decreased in size compared to prior examination. There is interval resolution of the focal groundglass opacities previously seen in the azygoesophageal recess.Interval improvement of bilateral mainstem bronchial narrowing, which may be due to lymphadenopathy and/or endobronchial involvement by sarcoidosis.MEDIASTINUM AND HILA: Bilateral mediastinal and hilar lymphadenopathy is decreased compared to prior examination, given limitations of the lack of IV contrast. Heart size within normal limits. Mild atherosclerotic changes in the aorta.CHEST WALL: Significant interval decrease in bilateral axillary lymphadenopathy. Mild multilevel degenerative changes in the thoracic spine without interval compression fractures.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Interval improvement of sarcoidosis in the lungs. Interval decrease in lymphadenopathy.No new suspicious nodules. |
Generate impression based on findings. | Reason: Evaluate LLL Density History: Abdominal cramping, nausea, vomiting LUNGS AND PLEURA: Surgical findings reflect prior left upper lobectomy. Stable redundant tissue at the resection site but no sign of localized recurrence.New spiculated mass with central necrosis within the left lower lobe measuring 3.0 x 3.9 cm (series 5 image 69). Surrounding groundglass and consolidation extending to the pleural surface and posterior basilar segment. Given the time interval when compared to the radiograph of 8/2/13, this may represent a necrotic infection. However, necrotic lung cancer is also in the differential.Small left pleural effusion.New, scarlike opacities in the right upper lobe within the parenchyma (series 5 image 22 and 40) and pleural-based (series 5 image 26). Clustered nodules with mucoid impaction within the left upper lobe and superior segment right lower lobe. These findings are nonspecific and may represent inflammatory change, possible spillage and spread of contents from the left lower lobe necrotic mass. Continued surveillance to ensure resolution recommended.Centrilobular emphysema is stable. The previously described ovoid nodule in the right middle lobe, adjacent to the major fissure is slightly decreased in size, 16 x 21 mm (series 4 image 184), as compared to 16 x 24 mm.MEDIASTINUM AND HILA: No mediastinal lymphadenopathy.The heart size is normal. Extensive calcification occupies the aortic valve. There is moderate coronary artery calcification. No interval pericardial effusion. There is atherosclerotic disease involving the ostium of the innominate artery, contributing to approximately 30 to 40% stenosis.Mild nodularity and density at the mitral valve location is not as well visualized. If echocardiography has not been performed, consider this imaging modality for further investigation of possible fibroelastoma.CHEST WALL: No axillary adenopathy. Partial resection of left eighth rib.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Stable nodularity of the left adrenal gland. Hiatal hernia unchanged. | New spiculated mass with central necrosis within the left lower lobe measuring 3.0 x 3.9 cm (series 5 image 69). Surrounding groundglass and consolidation extending to the pleural surface and posterior basilar segment. Given the time interval when compared to the radiograph of 8/2/13, this may represent a necrotic infection. However, necrotic lung cancer is also in the differential. |
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