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Generate impression based on findings. | 64-year-old female with history of mesothelioma. ABDOMEN:LUNG BASES: Large right and pleural effusion appears increased since 9/5/2013. Overlying right basilar consolidation/atelectasis.Right pleural thickening and pleural nodules (series 8028, image 7, 17).Cardiophrenic angle node appears similar, measuring 10 mm, previously measured 10 mm (series 8028, image 23).LIVER, BILIARY TRACT: Punctate hypodensities appear unchanged, compatible with cysts. No suspicious lesions identified.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: Interval decrease in ascites fluid, with persistent pockets of fluid present in abdomen and pelvis; the left lower quadrant fluid pocket appears loculated and is associated with thickened peritoneum, which may represent inflammation although tumor is also possible (series 8028, image 93).Since 7/8/2013, there has been significant decrease in omental and mesenteric nodularity, with likely interval omentectomy. Persistent mesenteric haziness and nodularity, but no measurable lesions are identified.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Left adnexal cyst measures 1.8 cm (series 8028, image 109).BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Interval decrease in ascites fluid, with a small pockets of fluid in pelvis and abdomen. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Interval decrease in ascites fluid and omental/mesenteric nodularity. Small pockets of residual fluid are present; lower quadrant fluid pocket appears loculated and is associated with thickened peritoneum, which likely represents inflammation although tumor is also possible.2.Large right pleural effusion with pleural nodularity/thickening and right basilar consolidation/atelectasis. |
Generate impression based on findings. | Clinical question: Acute hemorrhagic stroke, evaluate for interval change. Signs and symptoms: Right-sided weakness. Nonenhanced head CT:Examination demonstrate an acute hematoma likely hypertensive bleed in the left basal ganglia measuring 19 x 41 x 25-mm in size. Minute surrounding edema is also present. Subtle mass effect without midline shift. There are no prior exams for comparison. If such studies are available from an outside institution and provided to the radiology department an addendum to this report was resubmitted after comparison. A examination also demonstrates subtle periventricular low-attenuation white matter likely representing age indeterminate small vessel ischemic strokes. Unremarkable exam otherwise.Unremarkable images through the orbits.Unremarkable calvarium and soft tissues of the scalp.Well pneumatized bilateral mastoid air cells and middle ear cavities.Complete opacification of left maxillary sinus with mild bony thickening consistent with chronic long-standing sinus disease. There is resultant occlusion of the left ostiomeatal unit. All other paranasal sinuses are well pneumatized and unremarkable. | 1.Acute hematoma in the left basal ganglia measuring 19 x 41 x 25-mm with minute surrounding edema and no appreciable significant mass effect.2.Mild age indeterminate small vessel ischemic strokes.3.Complete opacification of left maxillary sinus, minimal sinus wall thickening and well pneumatized other paranasal sinuses, mastoid air cells and middle ear cavities.. |
Generate impression based on findings. | Male, 53 years old, history of recurrent laryngeal cancer, new baseline scans. Circumferential enhancing thickened soft tissue is evident at the presumed level of the glottis and the supraglottic larynx compatible with stated history of recurrent tumor. This process results in obliteration of the airway and obscuration of the expected anatomic features of the larynx. The thyroid cartilage is deformed and there is a deficiency affecting its right aspect through which a pocket of air and some enhancing tissue does extend. The cricoid cartilage is not distinctly visualized.At the superior aspect of the lesion, enhancement blends in ill-defined fashion with the markedly thickened aryepiglottic folds extending in the lateral dimension to both piriform sinuses. The epiglottis itself is also markedly thickened. At the inferior and posterior aspect of the tumor, there seems to be extension into the hypopharynx, but again, this is ill-defined.There is a nodule of enhancing tissue along the right tracheoesophageal groove within the superior mediastinum measuring 1.5 x 1.1 cm (image 61 of series 6). Small nodes are evident elsewhere in the neck but none of these meets criteria for pathologic enlargement.The anterior soft tissues of the neck are extensively infiltrated compatible with prior therapy. The salivary glands are free of focal lesions. The surgically divided thyroid is also unremarkable. A tracheostomy is in place.Lung apices are remarkable for a calcified granuloma on the right and peripheral cystic change. No concerning osseous lesions are detected. | A large circumferential enhancing tumor is present affecting the larynx with obscuration of normal laryngeal anatomy and airway effacement. This process extends superiorly at least to the level of the piriform sinuses and aryepiglottic folds. Tumor also appears to extend through a deficiency in the right thyroid cartilage. Inferiorly and posteriorly, there may be involvement of the hypopharyngeal wall.There is a suspicious enhancing nodule along the right tracheoesophageal groove. Elsewhere, no definite pathologic adenopathy is seen in the neck. |
Generate impression based on findings. | 78 yer-old female with left leg weakness. Motion degraded exam. There appears a focus of hypoattenuation in the anterior limb of the right internal capsule (image 15 of series 3). The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. Atherosclerotic calcifications are present along the distal internal carotid arteries.Incidental note is made of hyperostosis frontalis interna. The osseous structures are otherwise unremarkable. The paranasal sinuses and mastoid air cells are clear. | 1. No acute intracranial hemorrhage or territorial infarct. CT is insensitive to early detection of CVA. MRI should be considered if clinical suspicion for CVA persists. 2. Focus of hypoattenuation in the anterior limb of the right internal capsule could represent age indeterminate ischemic change. |
Generate impression based on findings. | 35-year-old female with possible adnexal mass. 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: Large cystic mass arising from left adnexa extends into central abdomen and displaces bowel loops. No bowel obstruction, wall thickening, or other significant abnormality.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Large cystic mass with internal septations and mural solid components arises from the left adnexa and measures 22.9 x 17.1 cm in maximal axial dimension (series 3, image 90).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.Large predominantly cystic mass arising from left adnexa, most consistent with ovarian neoplasm such as serous cystadenocarcinoma. 2.No evidence of metastatic disease. |
Generate impression based on findings. | 74-year-old male with urothelial cancer status post surgery and chemotherapy. Evaluate lung nodule. CHEST:LUNGS AND PLEURA: Mild centrilobular emphysema.Left apical nodule is increased in size, currently measuring 8 mm, previously measured 4 mm (series 4, image 16). No new suspicious nodules.MEDIASTINUM AND HILA: No pathologically enlarged lymph nodes. Moderate coronary calcifications. 3-lead left chest wall ICD in place. Heart is normal in size without pericardial effusion.CHEST WALL: Sclerosis of anterior aspect of right third rib is unchanged. Several other punctate sclerotic foci in osseous structures are unchanged.ABDOMEN:LIVER, BILIARY TRACT: Stable nonspecific hyperenhancing focus in segment 6 (series 3, image 115). No new lesions identified.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Stable mild nodularity of left adrenal gland. Right adrenal unremarkable.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Stable aneurysmal dilation of the infrarenal abdominal aorta containing eccentric plaque, measuring 3.1 cm in maximal diameter (series 3, image 133).BOWEL, MESENTERY: Stable postoperative changes with diverting right lower quadrant urostomy.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post cystoprostatectomy.BLADDER: Status post cystoprostatectomy.LYMPH NODES: New soft tissue attenuation lesion adjacent to surgical clip in right hemipelvis measures 3.5 x 2.5 cm (series 3, image 188); highly suspicious for local recurrence.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes affect the lumbar spine. Punctate sclerotic foci in osseous structures appear unchanged, likely bone islands (series 3, image 201, .64).OTHER: No significant abnormality noted | 1.Increase in size of left apical lung nodule, suspicious for metastatic focus.2.New soft tissue lesion in right hemipelvis adjacent to surgical clip, highly suspicious for local recurrence. |
Generate impression based on findings. | 77-year-old female with history of colon cancer with liver metastases status post resection, now with elevated CEA. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Prominent right hilar lymph node is unchanged measuring 1.9 x 1.2 cm (image 46, series #3).CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Postsurgical changes from left lobe resection are redemonstrated. Small likely postsurgical perihepatic fluid collections persist, slightly decreased in size. An ill-defined subcentimeter hypodensity in the right dome of the liver is not seen on prior exams.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Nodular left adrenal gland is unchanged from prior examKIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Moderate diffuse atherosclerotic calcification of the abdominal aorta and its branches is seen.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Status post right hemicolectomy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Newly demonstrated ill-defined subcentimeter right dome liver lesion, too small to further characterize.2.Redemonstrated postsurgical changes of the liver with resolving small perihepatic fluid collections. |
Generate impression based on findings. | 55-year-old male with history of rectal cancer. Evaluate pre-sacral lymph nodes seen on 8/23/2013 exam. CHEST:LUNGS AND PLEURA: Cluster of tree in bud opacities in lateral aspect of right middle lobe and subsegmental consolidation in the right base, which may be result of mild aspiration (series 4, image 54 and 78).No suspicious nodules identified.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Punctate hypodensity in the right liver lobe unchanged since 2011, consistent with cyst. No new or suspicious lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Hypoattenuating lesions in both kidneys, most likely benign cysts. Left renal atrophy.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post colectomy. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Several small presacral lymph nodes are not significantly changed. Reference left presacral node measures 16 x 8 mm, previously measured 17 x 9 mm (series 3, image 177). BOWEL, MESENTERY: Status post colectomy. Stable appearing presacral soft tissue thickening likely reflecting treatment related changes.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Stable presacral thickening and pelvic lymph nodes. |
Generate impression based on findings. | Reason: h/o recurrent laryngeal ca, new baseline scans, measurements pls History: none CHEST:LUNGS AND PLEURA: Paraseptal emphysematous changes, most prominent in the upper lungs. Calcified granuloma in the right upper lobe. There is diffuse bronchial wall thickening and mucoid impaction within right middle lobe and medial segment atelectasis of the right middle lobe, consistent with aspiration. There is visible aspiration in the bronchus intermedius.MEDIASTINUM AND HILA: An enlarged lymph node is identified along the right tracheoesophageal groove in the superior mediastinum (series 3 image 19). Please refer to CT neck soft tissue report for futher details. Otherwise, there are scattered subcentimeter mediastinal lymph nodes, some of which are partially calcified. There is a right hilar lymph node that measures 9 mm (series 3 image 52). No right hilar lymphadenopathy. Heart size is upper limit of normal. There is thymic hypertrophy without a discrete nodule.CHEST WALL: Tracheostomy in place. There is a heterogeneous soft tissue mass immediately superior to the tracheostomy site, refer to CT scan of the neck for complete details. Scattered, non-pathologically enlarged axillary lymph nodes. ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Scattered punctate calcifications consistent with prior granulomatous disease.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Minimal atherosclerotic changes in the abdomen aorta and iliac arteries.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Mild multilevel degenerative changes in the thoracic and lumbar spine.OTHER: No significant abnormality noted. | Evidence of active aspiration with mucoid impaction in the right middle lobe.No suspicious lesions suggestive of metastatic disease. |
Generate impression based on findings. | 66 year-old female with chronic sinusitis. The orbits are unremarkable apart from lens prostheses. The mastoids are underdeveloped. Limited view of the intracranial structure is unremarkable. There is minimal mucosal thickening in the left maxillary sinus. The frontal sinuses, frontal-ethmoid recesses, anterior/posterior ethmoids, sphenoid sinuses, and right maxillary sinus are well developed and clear. The osteomeatal complexes are normal with intact uncinate processes and patent infundibuli. The intersphenoid septum is normal. The nasal turbinates and nasal septum are normal. The cribriform plate, fovea ethmoidalis and lamina papyraceae appear normal. The osseous structures are unremarkable. | No evidence of sinusitis. |
Generate impression based on findings. | 54-year-old female with GIST, evaluate for recurrence/metastatic disease. CHEST:LUNGS AND PLEURA: Scattered bilateral calcified and noncalcified pulmonary micronodules are stable. MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No evidence of metastatic disease in the liver. Unchanged segment 8 hemangioma in the right lobe of the liver.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: Unchanged 8mm unilocular homogeneous cyst in the tail of the pancreas (image 99, series #3).RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Bilateral breast implants without evident complication. IVC and hepatic veins are prominent in size; while a stable finding, raises question of right heart failure. | Stable exam with no evidence of recurrent or metastatic disease. |
Generate impression based on findings. | chronic sinusitis s/p ESS x3 The ostiomeatal complex units are patent bilaterally. Within the nasal cavity no obstructive lesions are appreciated. The patient is status post right-sided turbinectomy and bilateral uncinectomies.The frontal sinuses are clear.Maxillary sinuses are clear. Ethmoid air cells are clear . Sphenoid sinuses are clear. Visualized portions of the mastoid air cells and middle ears are clear. Visualized orbits are intact and the visualized intracranial structures are within normal limits. | Status post paranasal sinus surgery. No evidence for paranasal sinus outlet obstruction |
Generate impression based on findings. | L sided frontal HA, in pt with prostate ca hx, L sided tinnitus. visual disturbances Headache. LUE numbness The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.No evidence for intracranial mass lesion.2.No evidence for acute intracranial hemorrhage mass effect or edema. |
Generate impression based on findings. | 72 year old female. Reason: Pancreas cancer. Please compare to all previous scans and provide index lesion measurements for RECIST. CHEST:LUNGS AND PLEURA: The focal, patchy RML groundglass opacities have resolved. Subcentimeter nodules in the right middle lobe. Calcified granulomata compatible with old granulomatous disease. MEDIASTINUM AND HILA: Borderline enlarged right hilar lymph node is stable measuring 1.4 x 1 cm image number 41, series number 3. Coronary artery calcifications. CHEST WALL: Venous access device in the right chest wall. ABDOMEN:LIVER, BILIARY TRACT: Index right lobe metastatic lesion measures 3 x 2.4-cm at image number 64, series number 3, increased in size from previous study. New lesions are seen throughout the liver. Other metastatic lesions are larger compared to previous study. Another reference lesion in the dome measures 1.7 x 1.9 cm in diameter image number 63, series number 3 is increased in size. SPLEEN: No significant abnormality noted.PANCREAS: Patient's known pancreatic head mass is not well seen on today's study and is larger, measuring 1.7 x 2 cm at image 93 of series 3. Pancreatic duct in the body and tail remains dilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal angiomyolipoma is unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable compression fracture of L5 vertebral body.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable L5 vertebral body compression deformity. OTHER: No significant abnormality noted. | Increased size and number of multiple hepatic metastases.Probable increase in the size of the patient's known pancreatic head mass. |
Generate impression based on findings. | Reason: COPD with history of nodules History: dyspnea LUNGS AND PLEURA: Unchanged subcentimeter nodules, likely benign. Left lower lobe granuloma. No suspicious pulmonary nodules. Near complete resolution of previous bibasilar atelectasis.MEDIASTINUM AND HILA: The heart size remains normal. Moderate inferior mitral annular calcification. No pericardial effusion. Pericardial thickening is stable. Mild coronary arterial calcification.CHEST WALL: Right breast nodule is decreased in size when compared to 2006. Continued surveillance with mammography and physical examination is recommended.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Unchanged subcentimeter nodules, likely benign. Left lower lobe granuloma. No suspicious pulmonary nodules. Near complete resolution of previous bibasilar atelectasis. |
Generate impression based on findings. | Reason: 53yo female - assess lung nodule History: as above - abnormal CXR LUNGS AND PLEURA: Minimal apical scarring.No suspicious pulmonary nodules or masses.No pleural effusions.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.Cardiac size is normal evidence of pericardial effusion.CHEST WALL: Intraspinal stimulation device noted in the midthoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | No significant pulmonary or pleural abnormalities. Specifically no pulmonary nodule or mass can be identified. |
Generate impression based on findings. | Prostate carcinoma; left-sided pelvic lymph node dissection aborted secondary to presence of mass 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: Ectopic left pelvic kidney at the level of L5/S1 just anterior to the left proximal external iliac artery.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Expected postoperative subcutaneous emphysemaOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomyBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Mild pelvic fat infiltration consistent with recent postoperative stateBONES, SOFT TISSUES: Expected postoperative subcutaneous emphysemaOTHER: No significant abnormality noted | Left ectopic pelvic kidney as described. No evidence for regional adenopathy, lymphocele, or other mass lesion other than ectopic left pelvic kidney.Status post prostatectomy with usual postoperative findings. |
Generate impression based on findings. | 68-year-old male with history of HCC status post resection. Evaluate for recurrence. CHEST:LUNGS AND PLEURA: No parenchymal lung abnormalities of significance seen. No pleural abnormalities or effusions.MEDIASTINUM AND HILA: Scattered mildly prominent lymph node nodes are seen, the largest of which, in the anterior mediastinum (series 13, image 29) measures 1.5 x 1.1 cm.. These mildly prominent lymph node nodes are nonspecific. No other masses seen. Diffuse coronary artery calcification.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Status post right hepatectomy and prior wedge resection of the apex of the lateral segment of the liver. Along the lateral resection margin in segment 4 are at least 3 enhancing nodules (see series 10, image 32 and series 10, image 25) the largest of which measures 1.8 x 2.5 cm. These enhancing portions do not demonstrate washout on delayed imaging on these images, but do on the prior outside CT dated 8/13/13 (which did not include arterial phase imaging) and would, therefore meet AASLD criteria for diagnosis of HCC. The enhancing lesions are all new since prior outside CT examination of 5/13/13. Segments two and 3 of the liver do not show abnormal mass lesions.Patient is status post cholecystectomy. No evidence of biliary obstruction is seen.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Small benign cortical cysts bilaterally -- no other significant abnormality seen.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: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. Scattered mildly prominent mediastinal lymph nodes, which are nonspecific. No other thoracic abnormalities of significance seen. 2. Status post right hepatectomy with multiple enhancing lesions adjacent to the resection one of which meets AASLD criteria for HCC, but all of which are new since 5/13/13 and suspicious for multifocal HCC. |
Generate impression based on findings. | 46 year old female. Carcinoid tumor. PET scan on 10/2/2013 showed increased activity in multiple left axillary and supraclavicular lymph nodes. History of flushing, diarrhea. 6 mm rectal carcinoid tumor and a history of flushing, diarrhea. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Borderline enlarged left axillary node measures 0.9 x 1.5 cm at image 26 series 3. Mildly prominent left subclavian and upper mediastinal nodes are sub-cm in size at images 12, 15, 18 of series 3. All of these nodes had increased PET uptake on recent exam. ABDOMEN:LIVER, BILIARY TRACT: Hypodense liver parenchyma compatible with fatty infiltration. Cholelithiasis without cholecystitis. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Fat-containing umbilical hernia. PELVIS:UTERUS, ADNEXA: Status post hysterectomy. Right adnexal cyst measures 5.4 x 4.3 cm, new since 10/2/2013. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Borderline left axillary adenopathy. No other measurable metastatic disease. Fatty liver. Cholelithiasis. |
Generate impression based on findings. | Reason: patient with AML, neutropenic fever, previous CT showing extensive sinusitis. Concern for mucor History: neutropenia, fever CHEST:LUNGS AND PLEURA: Stable calcified and noncalcified micronodules.Moderate upper lobe predominant centrilobular and paraseptal emphysema.Mild bronchial wall thickening and pleural thickening unchanged.No focal airspace opacities identified to indicate infection.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of a pericardial effusion.Severe coronary and aortic calcifications.CHEST WALL: Degenerative changes in the thoracic spine.ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic changes of the aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Upper lobe predominant emphysema and mild bronchial wall thickening unchanged from the prior exam.2.No specific evidence of acute infection. |
Generate impression based on findings. | 58 year old female. Reason: History of bladder cancer with cystectomy, Indiana Pouch. Assess for recurrence. CHEST:LUNGS AND PLEURA: Stable micronodules. Chronic right middle lobe atelectasis and volume loss at image 63 series 4 is stable. MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis with distended gallbladder. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral mild hydronephrosis is new. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Uterus absent or atrophicBLADDER: Status post cystectomy. Stable ileal conduit and reservoir. The conduit is markedly distended, probably causing the hydronephrosis. Right lower quadrant ostomy site. LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality. | Ileal loop marked distension with new mild hydronephrosis. Otherwise stable examination. No measurable metastatic disease. |
Generate impression based on findings. | Reason: preop coronary eval prior to atrial fib ablation, previous pulmonary vein isolation History: palpitations Coronary arteries: LM: The left main coronary artery arises normally from the left sinus of Valsalva and bifurcates into the left anterior descending and left circumflex coronary arteries. There are no significant stenoses present in the left main.LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove, supplying two diagonal and septal branches. Both diagonal branches are nonstenotic. There are no significant stenoses in the left anterior descending artery.LCx: The left circumflex coronary artery is non-dominant. It courses normally in the left atrioventricular groove. It gives rise to one dominant obtuse marginal branch which is nonstenotic. It terminates in two bifurcating posterior lateral branches which are unremarkable. There are no significant stenoses in the left circumflex coronary artery. RCA: The right coronary artery is large and arises normally from the right sinus of Valsalva. It is the dominant coronary artery supplying a posterior descending artery and a posterolateral branch. There are no significant stenoses in the right coronary artery. The proximal 2 cm of the posterior descending artery are visualized and are unremarkable.Left Ventricle: The left ventricular late diastolic volume is normal.Right Ventricle: Visually the right ventricular late diastolic volume is within normal limits.Left Atrium: The left atrial volume is 117cc, upper limits normal in size. There is a common ostium of the right superior and middle lobe pulmonary veins, resulting in four distinct pulmonary veins which drain normally into the left atrium. Early branching (approximately 8 mm from the ostium) is demonstrated by the right middle lobe vein. Early branching is also demonstrated by the right inferior pulmonary vein (7 mm from the ostium). No early branching is demonstrated on the left. The following orthogonal dimensions of the pulmonary vein ostia were obtained:Common ostium of the right superior and middle lobe veins: 16 x 19 mmRight inferior pulmonary vein ostium: 13 x 15 mmLeft superior pulmonary vein ostium: 13 x 20 mmLeft inferior pulmonary vein ostium: 15 x 17 mmThere is no evidence of left atrial appendage thrombus.Right atrium, vena cavae, and coronary sinus: The right atrial volume is normal in size. The superior and inferior vena cavae are unremarkable. The coronary sinus is normal in size. Valves: There is no calcification on the aortic valve. Moderate infero-lateral mitral annular calcification is present.Great vessels: The visualized portions of the thoracic aorta demonstrate no evidence of dissection or aneurysm. The aortic arch is not visualized. The main pulmonary artery is normal in size.Pericardium: The pericardium is normal in thickness. There is no pericardial effusion.Lungs: Visualization of the lung parenchyma is limited by the field of view and length of scan which excludes a substantial amount of the lungs. Calcified granuloma in the right lung. No significant abnormality noted. No mediastinal or hilar lymphadenopathy.Multiple surgical staples are noted in the upper abdomen and at the stomach. Small hiatal hernia. Multi-level degenerative changes of the visualized thoracic spine. | 1. There are no significant coronary artery stenoses present.2. Common origin of the right superior and middle pulmonary veins with early branching. Orthogonal ostial pulmonary vein measurements, as above. |
Generate impression based on findings. | History of malignant neoplasm of tongue (squamous cell carcinoma, 2002) and free flap retromolar trigone for trismus. Abnormal involuntary movements. Postoperative changes including surgical clips within the left masticator and carotid spaces are demonstrated in addition to a calcific density possibly representing dystrophic calcification at the left lateral aspect of the mandibular body. There is a significant burden of dental disease including multiple tooth defects and periapical lucencies within both mandibular and maxillary alveolar processes. Within the left maxilla, there is contiguity between periapical lucencies and the maxillary sinuses bilaterally and there is lobulated soft tissue and a left-sided air-fluid level, both likely the result of chronic sinusitis. There is partial opacification of multiple anterior ethmoid sinuses bilaterally. Sphenoid and frontal sinuses are aerated.Oblique images through the oral cavity are not provided and images are limited by streak artifact related to extensive dental hardware. Within this limitation there is no mucosal irregularity or obvious mass is seen with the oropharynx, nasopharynx or hypopharynx. The epiglottis and larynx is normal. There is no adenopathy within the imaged field. There are no aggressive appearing bony lesions. | 1.Postoperative changes without evidence of acute tumor recurrence or spread.2.Extensive dental disease including periapical lucencies likely representing abscesses, some of which are communicating with the maxillary sinuses.3.Findings suggestive of sinusitis. |
Generate impression based on findings. | Reason: staging for head and neck cancer History: tongue cancer LUNGS AND PLEURA: 9-mm groundglass nodule in the apical segment of the right upper lobe, not definitely changed in measurement but questionably slightly denser compared to the previous scan. This finding is suspicious for primary adenocarcinoma, which is usually very indolent and noninvasive with this pure groundglass morphology. A follow-up scan is recommended in approximately 3 months time to evaluate for interval growth.Mild streaky opacity at both lung bases, new from previous, compatible with scarring and subsegmental atelectasis, possibly related to aspiration.MEDIASTINUM AND HILA: Moderately enlarged nonspecific subcarinal lymph node measuring 11 mm in short axis diameter, slightly increased compared to previous. No other significant lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 9-mm right upper lobe pure groundglass nodule, which may represent atypical adenomatous hyperplasia (AAH), adenocarcinoma in situ or minimally invasive adenocarcinoma. A follow-up CT scan is recommended in approximately 3 months to evaluate for interval growth. |
Generate impression based on findings. | 78-year-old female with history of recurrent adrenocortical carcinoma, status post two liver resections. Evaluate for recurrence. CHEST:LUNGS AND PLEURA: Scattered subcentimeter pulmonary nodules are unchanged.MEDIASTINUM AND HILA: Large lateral hernia, unchanged. Transvenous cardiac pacemaker leads are in the expected position. CHEST WALL: Left chest wall cardiac pacemaker with associated metal artifact. ABDOMEN:LIVER, BILIARY TRACT: Hypodense lesions at the normal liver are unchanged. Previously mentioned hypodense lesion in the site of the resection now measures 1.2 x 1.3-cm on image number 78, series 7, unchanged from previous study. There is a questionable 2.5 cm diameter hypodense lesion at the hepatic margin, adjacent to the hypodense one (image 22, series 3). This appears more prominent compared with prior exams that do not include non-contrast or delayed scans. This lesion should be followed closely.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Status post right adrenalectomy. No evidence of local recurrence. Left adrenal gland is unremarkable.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Index porta hepatis lymph node is unchanged measuring 1.7 x 0.8-cm at image number 86, series number 7.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Presumed leiomyomatous uterus, unchanged. 5 x 5 cm right adnexal cystic mass is stable. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Right lateral thigh intramuscular lipoma at image 160, series 7. | Hypodense lesion, 2.5 cm diameter, at liver resection margin is better seen on this scan, especially in non-contrast and delayed series. Recommend follow-up. No other significant change from previous study. |
Generate impression based on findings. | 61-year-old patient with right-sided weakness. CT head: There is diffuse prominence of CSF spaces in addition to patchy periventricular hypoattenuation which is most prominent in the right frontal white matter and internal capsule. There is a region of hypoattenuation representing encephalomalacia within the left posterior temporal, parietal and occipital lobes which is associated with volume loss/ex vacuo dilatation of the left occipital horn and sulcal prominence. There is calcification along the course of the left vertebral and basilar arteries as well as within the left supraclinoid and middle cerebral arteries.There is no intracranial mass or hemorrhage. The midline is intact. Orbits and mastoid air cells are normal. There is partial opacification of the right maxillary sinus which likely represents underlying sinusitis.CT cervical spine: There is normal alignment. Vertebral body and intervertebral disk height is maintained. There are no fractures demonstrated. The status of the cord cannot be adequately assessed on this exam and if there is concern regarding cord compression, MRI is recommended.C2-3: There is mild asymmetric facet arthropathy more prominent on the left without significant neural foraminal or spinal stenosis.C3-4: There is a disk-osteophyte complex and suspected subtle mass effect on the cord consistent with mild spinal stenosis. There is asymmetric facet and uncovertebral joint osteophytes resulting in mild-moderate left-sided neural foraminal stenosis with no significant right neural foraminal stenosis.C4-5: There is mild disk disease and hypertrophic change of the facets which is asymmetric to the left resulting in mild left-sided without significant right-sided neural foraminal stenosis.C5-6: There is mild disk disease with asymmetric facet degeneration on the left. There is no significant neural foraminal or canal stenosis.C6-7 There is mild sclerotic change of the left facet without significant neural foraminal or spinal stenosis.C7-T1: There is asymmetric facet degeneration on the left without significant neural foraminal or spinal stenosis. | 1.Multifocal hypoattenuation in keeping with both small vessel and watershed (left temporal/occipital/parietal) strokes of indeterminate age. If there is concern for ischemia, MRI examination is recommended. 2.No intracranial mass or hemorrhage.3.Multilevel degenerative changes in the cervical spine asymmetric to the left resulting in multilevel mild to moderate foraminal stenosis without acute fracture.4.Mucosal thickening suggestive of right maxillary sinusitisA report was issued verbally to Jose Chavez (#3228) at the time of initial reporting (2:10 p.m.). |
Generate impression based on findings. | 63-year-old male with metastatic pancreas cancer -- restaging. CHEST:LUNGS AND PLEURA: Multiple micronodules, many of which are calcified are all unchanged and no new nodules, masses, or other parenchymal abnormality seen to suggest metastatic disease. MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: The prior noted. Multiple space-occupying lesions in the liver have all decreased in size and some not visualized. The reference lesion in segment 4 (series 3 come image 102) is barely visible and measures 0.5 x 0.7, previously 1.2 x 1.0 cm.SPLEEN: No significant abnormality notedPANCREAS: Resection of the tail and some of the body of the pancreas unchanged in appearance. No evidence of recurrent or residual tumor. Remaining pancreas appears normal.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Orally administered contrast passes through normal appearing stomach and small bowel to the right colon without intrinsic abnormality seen. Post surgical changes about the right colon are again seen. No mesenteric fluid is seen. The nodular changes in the omentum anterior to the transverse colon seen on scan of prior examinations are barely visible on today's examination and not measurable.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate without other abnormality.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 metastatic disease in the chest. 2. Continued decrease in size of liver metastases throughout the liver. Minimal residual persists compared with more remote CT examinations. 3. No discrete omental masses, now identified. |
Generate impression based on findings. | Female, 19 months old, autoimmune neutropenia with swollen by. Evaluate for septic orbit. The periorbital soft tissues are infiltrated and swollen on the left. In addition, there is a rim enhancing low density collection at the inferior medial aspect of the orbit, situated at the orifice of the nasolacrimal duct. This could represent an infected dacryocystocele.No evidence of retrobulbar extension of the inflammatory/infectious process. The globes are symmetric and round. The lenses are normally positioned. The extraocular muscles and optic nerves demonstrate normal morphology. The rudimentary paranasal sinuses are opacified. | Rim enhancing collection along the medial aspect of the left orbit at the orifice of the nasolacrimal duct. This may represent an infected dacryocystocele and likely accounts for the generalized left periorbital inflammation. |
Generate impression based on findings. | 1 year-old male with altered mental status. There appears a focus of hypoattenuation in the posterior left lateral ventricle body (image 26 of series 2 and image 33 of series 80369). The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The mastoid air cells are clear. There is mild maxillary sinus mucosal thickening. | 1. No acute intracranial abnormality. 2. Probable lesion in or adjacent to the posterior left lateral ventricle body. MRI brain is recommended for further evaluation. |
Generate impression based on findings. | 47-year-old male with metastatic renal cell carcinoma. CHEST:LUNGS AND PLEURA: Reference right lower lobe nodule is smaller in size, and measuring 6 mm in maximal dimension, previously measured 8 mm (series 5 image 61). The reference pleural-based left lower lobe nodule not significantly changed, measuring 1.4 x 1.5 cm, previously measured 1.5 x 1.5 cm (series 5, image 78). No new nodules identified.MEDIASTINUM AND HILA: Stable subcarinal node measures 1.8 x 1.5 cm, previously measured 1.8 x 1.5 cm (series 4, image 51). Stable right hilar node measures 2 cm, previously measured 2 cm (series 4, image 54).The heart is normal in size without pericardial effusion. CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Status post distal pancreatectomy.ADRENAL GLANDS: Left adrenal gland not visualized. Right adrenal gland unremarkable.KIDNEYS, URETERS: Status post left nephrectomy. Soft tissue nodule in the left nephrectomy bed adjacent to surgical clips not significantly changed, measuring 2.3 cm, previously measured 2.2 cm (series 4, image 106).RETROPERITONEUM, LYMPH NODES: Extensive postoperative changes not significantly changed. No significant lymphadenopathy.BOWEL, MESENTERY: Postsurgical inflammatory changes and multiple surgical clips in the left upper quadrant, not significantly changed. Interval removal of percutaneous drain. No fluid collections identified.Laxity in left abdominal wall unchanged. No evidence of obstruction.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.Postsurgical changes status post left nephrectomy and resection of pancreatic tail. Soft tissue nodule in left nephrectomy bed appears similar; this is nonspecific and may represent inflammatory change/scarring.2.Interval decrease in the right lower lobe lung nodule size. Stable left lower lobe pleural based nodule.3.Stable mediastinal lymphadenopathy. |
Generate impression based on findings. | symptoms consistent with stroke The patient is status post left-sided craniotomy. Aneurysm clip is present along the left sylvian fissure. Some encephalomalacia is present in the left temporal lobe anteriorlyThe visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. There are scleral calcifications present adjacent to the insertion sites of the ciliary bodies most likely representing scleral plaque.Atherosclerotic calcifications are present along the distal internal carotid arteries. | 1.No evidence for acute intracranial hemorrhage mass effect or edema.2.CT is insensitive for the early detection of nonhemorrhagic CVA.3.Patient is status post left-sided craniotomy for aneurysm clip placement |
Generate impression based on findings. | A 57-year-old male with right upper quadrant abdominal pain, weight loss, alcohol abuse. Assess hepatomegaly and assess for liver lesion, gallbladder pathology. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Diffuse low-attenuation of the liver is seen, suggestive of diffuse hepatic steatosis. No parenchymal lesions are seen in the liver, however, presence of fat can obscure CT demonstration of liver lesions.Gallbladder and biliary tract appearsSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Nonspecific slight enlargement of gastrohepatic lymph nodes are seen, still subcentimeter in short axis diameter.BOWEL, MESENTERY: Administered contrast progresses rapidly through normal-appearing stomach, small bowel to the cecum without intrinsic abnormality of signs of obstruction. Colon is feces filled without diagnostic abnormality. Very small amount of free mesenteric fluid is seen in the dependent pelvis -- no other foci of free fluid seen. 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: Administered contrast progresses rapidly through normal-appearing small bowel to the cecum without intrinsic abnormality of signs of obstruction. Colon is feces filled without diagnostic abnormality. Very small amount of free mesenteric fluid is seen in the dependent pelvis -- no other foci of free fluid seen. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Number one. Diffuse hepatic steatosis. 2. Slightly prominent lymph nodes in the gastrohepatic and retroperitoneal region. There is nonspecific and of uncertain significance. 3. Small amount of free fluid in the pelvic mesentery. 4. No other abnormality seen and no findings seen to account for patient's symptomatology. |
Generate impression based on findings. | Reason: pt with h/o lung ca s/p surgery and RT History: doing well now needs disease evulation compare to previous scans and comment CHEST:LUNGS AND PLEURA: Status post left upper lobectomy. 3-mm micronodule in the right lower lobe unchanged and presumably benign. Moderately severe upper lobe predominant centrilobular emphysema.Left paramediastinal radiation reaction with scarring and traction bronchiectasis.No suspicious nodules.MEDIASTINUM AND HILA: Subcarinal lymph node measuring 11 mm in short axis diameter, unchanged when using comparable measurement parameters.No other significant lymphadenopathy.No pericardial effusion.CHEST WALL: Small hemangioma at T9.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Small cyst in the right lobe unchanged.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral cortical scarring and small hypodensities compatible with cysts.PANCREAS: 10-mm hyperdense nodule in the spleen, unchanged, most likely an hemangioma.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Degenerative disease in the spine. | No significant change and no specific evidence of metastases. |
Generate impression based on findings. | 50 year-old female with right shoulder pain. Evaluate prior to surgery. Dilute contrast and foci of air fill the glenohumeral joint space. A small amount of contrast is seen in the subdeltoid bursa (image 26, series 80430), consistent with a full-thickness rotator cuff tear. There is generalized atrophy of the supraspinatus, infraspinatus, and subscapularis muscles.Severe osteoarthritis affects the glenohumeral joint, with joint space narrowing, sclerosis, and subchondral cyst formation. Prominent osteophytes are also noted along the humeral head. A 5-mm ossific density in the superior subscapularis recess likely represents a calcified loose body. | 1.Small amount of contrast in the subdeltoid bursa, consistent with a full-thickness rotator cuff tear. Generalized atrophy of the rotator cuff muscles.2.Severe osteoarthritis of the glenohumeral joint. |
Generate impression based on findings. | History of papillary thyroid cancer metastatic to brain for follow up of primary thyroid lesion. The mixed cystic solid lobulated mass extending from the thyroid bed demonstrates a similar configuration and pattern of intralesional calcification. This lesion is similar in size when accounting for technical differences in acquisition, measuring 8.2 x 6.5 cm in maximal axial dimension (previously 8.5 x 6.1 cm in similar dimensions). There is mild mass effect on the underlying trachea with no clear fat plane between the lesion and a trachea at the level of the first tracheal ring (axial series 5 image 146). Normal normal contour of tracheal mucosa suggests lack of invasion through its anterior wall.A partially calcified soft tissue density at the site of the previously described cluster of necrotic nodes within the left supraclavicular fossa has intervally decreased on today's examination measuring 2.3 x 1.7 cm (previously 2.5 x 2.0 cm in similar dimension). There are no new conglomerate nodal mass, though scattered nodes are demonstrated measuring up to 9 mm (stable; level 3 - series 5 image 68). There is pleural thickening at the right pulmonary apex which is better characterized on the designated CT examination of the chest.Within the limitations of streak artifact from dental hardware, there are no new masses within the nasopharynx, oropharynx or hypopharynx. There is osteopenia without demonstration of any aggressive bony lesions. | 1.The mixed cystic solid lesion within the thyroid bed is similar to the prior examination when accounting for differences between techniques.2.Interval slight decreased size of the partially calcified conglomerate nodal mass within the left supraclavicular fossa.3.Interval stability af a left level III node without overtly pathologic appearing adenopathy elsewhere.4.Pleural thickening at right apex. Refer to the designated CT chest report for further detail. |
Generate impression based on findings. | Female, 73 years old, status post surgery, evaluate hardware. Postoperative findings are demonstrated following resection of the posterior elements from T3 through T5. The spinous process of T2 has also been partially resected. Fluid and a small bubble of air are evident within the operative bed consistent with recent surgery. There is a surgical drain in the overlying subcutaneous tissues.The thoracic spine remains focally kyphotic from T3 through T5 secondary to loss of height and lytic change within these vertebral bodies. Again seen is hyperdense material within the T4 vertebral body compatible with prior vertebroplasty. Vertebral body material from T4 continues to project posteriorly. The degree of canal decompression would be better assessed on MRI.Posterior spinal fusion hardware has also been placed. There are bilateral transpedicular screws at C6, T1 and T2, as well as from T6 through T9. The screw on the left at T1 traverses the edge of the vertebral body. Bilateral posterior stabilization bars affix the above-mentioned screws. Amorphous bone graft material has been placed along the posterior elements of the fusion zone.Small bilateral pleural effusions are seen. | Surgical findings are seen status post spinal canal decompression from T3 through T5 as well as placement of posterior fusion hardware as above. Fluid and air within the laminectomy bed is consistent with recent surgery. The degree of canal decompression would be better assessed on MRI. |
Generate impression based on findings. | 88 year-old female with headache since yesterday. There is patchy hypoattenuation in the cerebral white matter. There is a punctate calcification in the right basal ganglia. The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable apart from hyperostosis frontalis interna. The mastoid air cells are clear. Lens prostheses. There is complete or near complete opacification of the maxillary, frontal and ethmoid sinuses. The sphenoid sinuses are clear. | 1. No acute intracranial abnormality. CT is insensitive to early detection of CVA. MRI should be considered if clinical suspicion for CVA persists. 2. Small vessel ischemic disease of indeterminate age. 3. Severe paranasal sinus inflammatory disease or sinusitis. |
Generate impression based on findings. | 64-year-old male with history of renal cell carcinoma, enrolled in clinical trial -- please evaluate per RECIST. CHEST:LUNGS AND PLEURA: No significant abnormality notedwithout nodules or masses seen. No pleural abnormality seen.MEDIASTINUM AND HILA: Scattered small anterior and middle mediastinal lymph nodes are again seen. Most of these remain stable in size, but one (series 3, image 37) has increased in size from 0.8 x 0.7 cm in previous examination. 21.3 x 1.0 cm on current examination.CHEST WALL: No change is seen in the appearance of multiple bilateral lytic, expansile metastases affecting predominately the right ribs. Posterior spinal stabilization rods are again seen.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted in liver parenchyma. Patient is status post cholecystectomy. No evidence of biliary obstruction.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality noted with similar appearing, presumably post operative changes in the right kidney. No renal masses are identified.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No change is seen in the appearance, extent or distribution of numerous mixed sclerotic and lytic metastatic lesions in the lumbar spine and pelvis. No new lesions are seen.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Mildly enlarged. Bilateral external iliac lymph nodes are again seen, mostly, unchanged. The referenced left external iliac lymph node (series 3, image 178) is slightly smaller, measuring 1.1 x 0 .8 cm, previously 1.3 x 0.9 cm. The other lymph nodes remain unchanged. BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No change is seen in the appearance, extent or distribution of numerous mixed sclerotic and lytic metastatic lesions in the lumbar spine and pelvis. No new lesions are seen. Bilateral hip prostheses are again seen, creating streak artifact, which obscures the deep pelvis.OTHER: No significant abnormality noted | 1. Stable appearance to the diffuse osseous metastatic lesions. 2. Slightly smaller referenced left external iliac lymph node with predominately stable appearance to the other slightly enlarged. Bilateral external iliac lymph nodes. 3. While still small, an enlarging anterior mediastinal lymph node worrisome for metastatic disease. |
Generate impression based on findings. | Clinical question: Pituitary tumor, preop planning for Thompson and hypophysectomy. Signs and symptoms: Headache. Medtronic fusion sinus CT:All paranasal sinuses are well pneumatized and without evidence of acute or chronic sinus disease.Bilateral ostiomeatal units and the sphenoethmoidal recesses remain patent.Images through nasal cavity demonstrate mild rightward nasal septum deviation. Small left middle turbinate concha bullosa with resultant slight expansion is noted. Sphenoid sinus is well pneumatized. There is a vertically oriented bony septation or extending from midline of the inferior sphenoid sinus superiorly and to the right and terminating superiorly on the right paramedian sphenoid sinus. A second left paramedian vertically oriented septation is also noted. The sella turcica remains normal in size.There is a small chronic blowout fracture of the right lamina papyracea with a thickness of deformity/scarring of right medial rectus muscle which partially herniates through the fracture (coronal reformatted series 80358 images 27 through 29). | .1.No evidence of acute or chronic sinus disease.2.Mild nasal septum deviation to the right, concha bullosa of the left middle turbinate with slight expansion of its size.3.Sphenoid sinus demonstrate to vertically oriented bony septation in bilateral paramedian location (with the right closer to the midline at the level of the floor of the sphenoid sinus).4.Chronic blowout fracture of right lamina papyracea and partial right medial rectus muscle entrapment. |
Generate impression based on findings. | 64 year old female with mesothelioma LUNGS AND PLEURA: Interval increase in right pleural effusion which extends along the right major fissure. Unchanged 5-mm right upper lobe nodule (image 35 series 10282) which is likely benign in etiology. Calcified left upper lobe granuloma is again noted. Resolution of patchy right basilar opacities.MEDIASTINUM AND HILA: Mild atherosclerotic calcification of the thoracic aorta. The heart size is normal. No pericardial effusion. Right cardiophrenic lymph node measures 1.0 cm and previously measured 1.0 cm (image 75 series 10281).CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. See separately dictated abdomen and pelvis CT report. | 1. Increased right pleural effusion and unchanged cardiophrenic lymph nodes.2. See separately dictated abdomen and pelvis CT report for further detail. |
Generate impression based on findings. | 79-year-old male with GIST. CHEST:LUNGS AND PLEURA: Stable pleural based nodule in left lower lobe containing internal calcification and suspected to be benign in nature (series 5 image 61).Mild basilar atelectasis and scarring.MEDIASTINUM AND HILA: Stable mediastinal lymph nodes, not pathologically enlarged (series 3, image 40). Heart normal in size without pericardial effusion. Mild coronary calcifications.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hypodensity in right lobe is too small to characterize but appears slightly smaller (series 3, image 6). The previously seen left lobe subcentimeter hypodensity is not visualized on this exam. No new lesions identified.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: Stable borderline enlarged retroperitoneal lymph nodes (series 3, image 115).Stable aneurysmal dilation of the infrarenal aorta, with maximal axial diameter measuring approximately 3.3 cm compared to 3.3 cm previously (series 3, image 136).Aneurysmal dilation of both common iliac arteries with eccentric prominent plaque unchanged, measuring up to 2.5 cm in diameter bilaterally (series 3, image 144). Dilation of left proximal internal iliac artery also stable.BOWEL, MESENTERY: Postsurgical changes in the stomach. No evidence of abnormal soft tissue around stomach to suggest recurrence.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Stable appearance of enlarged, heterogeneous prostate.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Severe degenerative changes affect the lumbar spine.OTHER: No significant abnormality noted | 1.Postsurgical changes in stomach without evidence of recurrence.2.Stable prominent retroperitoneal lymph nodes.3.Right liver lobe hypodensity is too small to characterize but appears slightly smaller. 4.Stable appearance of aneurysmal dilation of abdominal aorta and iliac arteries. |
Generate impression based on findings. | Male 77 years old; Reason: pancreatic cancer surveillance History: none CHEST:LUNGS AND PLEURA: Numerous new pulmonary nodules are noted throughout the lungs measuring up to 7 mm. For example, nodule in the right lung apex measuring 0.7-cm (series 5 image 22) and left lower lobe (series 5 image 52), are new since previous exam. The previously referenced right lower lobe nodule measures 0.7 cm x 0.7 cm (series 5 image 76). MEDIASTINUM AND HILA: Subcentimeter mediastinal lymph nodes are stable. CHEST WALL: Small bilateral axillary and subpectoral lymph nodes are stableABDOMEN:LIVER, BILIARY TRACT: Minimal intrahepatic biliary ductal prominence and pneumobilia is unchanged. Patent portal vein. Soft tissue in the region of the porta hepatis is unchanged.SPLEEN: Stable marked splenomegalyPANCREAS: Postsurgical changes of prior Whipple procedure. Atrophic pancreatic tail.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Infiltrative soft tissue surrounding the celiac axis is essentially unchanged. Confluent retroperitoneal lymphadenopathy not significantly changed. Reference aortocaval lymph node measures 4.7 x 3.0 cm (series 3 image 106), previously 3.8 cm x 2.9 cm. BOWEL, MESENTERY: Stable scattered mesenteric lymph nodes. No evidence of bowel obstructionBONES, SOFT TISSUES: Minimal stranding of the right lower quadrant anterior abdominal subcutaneous fat. Degenerative changes of the lumbosacral spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Surgical changes of prostatectomyBLADDER: No significant abnormality notedLYMPH NODES: No enlarged pelvic lymph nodesBOWEL, MESENTERY: Nondilated bowel loops. No pelvic ascites.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Stable retroperitoneal lymphadenopathy. Peri-celiac and porta hepatis soft tissue infiltration, unchanged.2. Postsurgical changes of Whipple procedure, unchanged3. Interval development of numerous pulmonary nodules, worrisome for metastatic disease |
Generate impression based on findings. | Reason: evaluate for progression. History: synovial sarcoma. LUNGS AND PLEURA: Reference right middle lobe nodule (series 5 image 41) 11 x 11 mm, unchanged.Superior segment left lower lobe nodule (series 5 image 28) 19 x 22 mm, decreased from 22 x 25 mm previously with interval development of cavitation.Multiple other metastatic nodules without significant change.Bilateral surgical staples compatible with previous resections.MEDIASTINUM AND HILA: No significant lymphadenopathy.Catheter tip in the SVC.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. | Slight decrease in one of the reference pulmonary nodules, and no other significant change. |
Generate impression based on findings. | 71-year-old male patient with small cell lung cancer, reevaluating disease after two cycles of chemotherapy. CHEST:LUNGS AND PLEURA: Left upper lobe subpleural nodule measures 4.5 x 1.8 cm (series 4 image 26), previously 2.6 x 1.1 cm. Additionally, there is interval increase in size of the previous documented adjacent nodules, which coalesce inferiorly (series 4 images 38 through 46).Streaky left upper lobe densities with atelectasis, scarring and volume loss are stable compared to prior examination. Mild centrilobular emphysematous changes.MEDIASTINUM AND HILA: There is extensive, confluent lymphadenopathy involving the anterior mediastinum, subcarinal region and left hilum lymphadenopathy encasing the left main pulmonary artery. There is continued enlargement of the prevascular/AP window lymph node that currently measures 3.0 cm (series 3 image 43), previously 1.5 cm. There is also continued increase in confluent lymphadenopathy in the AP window that measures 2.3 cm (series 3 image 36), previously 2.4 cm.Severe coronary artery calcifications.CHEST WALL: Elevated left hemidiaphragm.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral hypoattenuating renal lesions likely represent cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic changes involving the abdominal aorta and iliac arteries.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Mild multilevel degenerative changes in the thoracic and lumber spine.OTHER: No significant abnormality noted. | 1.Significant interval increase in subpleural and peripheral left upper lobe nodules.2.Interval increase in mediastinal lymphadenopathy. |
Generate impression based on findings. | 59-year-old female with history of chest wall sarcoma. Reason: 59-year-old female with history of chest wall sarcoma and subpleural fluid collections, evaluate for resolution. CHEST:LUNGS AND PLEURA: Postoperative changes in the right lower lobe and right chest wall consistent with history of multiple chest wall resection with flap coverage. New right lower thoracic mass anteriorly measures 10 x 12 x 9 cm at axial image 51 series 3 and coronal image 49. Mass is contiguous with the right hemidiaphragm. MEDIASTINUM AND HILA: Retrosternal goiter with enlarged right thyroid lobe, unchanged. Index precarinal lymph node measures 1 x 0.8 cm image number 30, series number 3, not significantly changed from previous study.CHEST WALL: Postoperative changes with multiple rib resections. Venous access device in the left chest wall. ABDOMEN:LIVER, BILIARY TRACT: Previously described right perihepatic collection is resolved. Fat infiltration of the liver. No focal liver lesions. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | New large right lower thorax mass is compatible with recurrence of chest wall sarcoma. Interval resolution of the subhepatic fluid collection. |
Generate impression based on findings. | 76-year-old male with history of colon cancer and pleural nodule. CHEST:LUNGS AND PLEURA: Right lower lobe pleural-based nodule is slightly increased in size, currently measuring 14 x 9 mm, previously measured 10 x 7 mm (series 4, image 66). More inferiorly located right lower lobe nodule also slightly increased since prior exam (series 4, image 75).Several other calcified and noncalcified punctate nodules not significantly changed. No new nodules identified.Nodule along left major fissure is unchanged, and may represent intrapulmonary lymph node (series 4, image 44). Resolution of previously seen trace left pleural effusion.MEDIASTINUM AND HILA: Right thyroid nodule unchanged.No pathologically enlarged mediastinal or hilar lymph nodes.Moderate coronary calcifications. Heart is normal in size without pericardial effusion.CHEST WALL: Stable compression deformity of T11 vertebral body.ABDOMEN:LIVER, BILIARY TRACT: Stable subcentimeter hypodensities, most likely represent cysts. No suspicious lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable bilateral renal cysts. Bilateral renal stones; largest stone located in left renal pelvis is increased in size since prior exam, currently measuring 1.5 x 2.4 cm (series 3, image 110).RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post colectomy. Small hiatal hernia.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: Status post colectomy. No evidence of inflammatory change in the pelvis to suggest fistulous communication.BONES, SOFT TISSUES: Degenerative changes in lumber spine.OTHER: No significant abnormality noted | 1.Mild increase in size of right lower lobe lung nodules, suspicious for metastases.2.Bilateral renal stones, with increase in size of large left renal stone which measures 2.4 cm in maximal dimension.3.Status post colectomy. |
Generate impression based on findings. | 80 year-old female with weight loss of over 100 pounds in the last year -- evaluate for mass, partial small bowel obstruction. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Liver parenchyma appears normal with normal vascular structures. Gallstone is seen in the neck of the gallbladder withoutSPLEEN: 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 colon. No intrinsic abnormalities other than sigmoid colon diverticulosis seen and no evidence of obstruction. No free mesenteric fluid in the abdomen -- small amount of free fluid seen in the pelvis. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Status post hysterectomy -- no other abnormalities.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Orally administered contrast rapidly progresses through normal appearing stomach and small bowel to the colon. No intrinsic abnormalities other than sigmoid colon diverticulosis seen and no evidence of obstruction. No free mesenteric fluid in the abdomen -- small amounts are seen in the dependent pelvis.. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. No evidence for abnormal abdominal mass. 2. Sigmoid diverticulosis without complication. 3. Small amount of free mesenteric fluid in the pelvis. 4. No abnormality seen to account for patient's symptomatology. |
Generate impression based on findings. | 40 year-old male with history of small bowel carcinoid. Status post laparoscopic bowel resection. Evaluate for interval nodal growth. CHEST:LUNGS AND PLEURA: The lungs are clear with no nodules identified.MEDIASTINUM AND HILA: A low-density structure adjacent to the right trachea is smaller than previously measured and remains of uncertain significance.CHEST WALL: No significant abnormality noted.ABDOMEN: LIVER, BILIARY TRACT: Diffuse hypoattenuation of the liver parenchyma from fatty infiltration decreases sensitivity for subtle solid hepatic lesions. No focal lesion is identified.SPLEEN: A small nodule adjacent and enhancing similarly to spleen likely representing a splenule.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: Unchanged punctate calcification of the pancreatic tail.RETROPERITONEUM, LYMPH NODES: Reference mesenteric lymph node measures 3.0 x 1.7 cm, demonstrating progressive slow growth since 4/10/2012 (image 151, series #3). Calcified focus in the right mesentery measures 1.1 x 0.5 cm, unchanged (image 158, series #3).BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Slow progressive growth of a solitary mesenteric lymph node. |
Generate impression based on findings. | 60-year-old female with history of GIST of jejunal origin, status post surgical resection. Reason: evaluate for recurrent GIST. CHEST:LUNGS AND PLEURA: Minimal bibasilar atelectasis. Small subpleural nodule in the left lower lobe is of uncertain significance.MEDIASTINUM AND HILA: Small right hilar lymph node is noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesion. Patent hepatic vasculature. No biliary ductal dilatation. Stable hepatomegaly, with craniocaudal extent of more than 20 cm. SPLEEN: No significant abnormality PANCREAS: No significant abnormality ADRENAL GLANDS: No significant abnormality KIDNEYS, URETERS: No significant abnormality RETROPERITONEUM, LYMPH NODES: No enlarged abdominal or retroperitoneal lymph nodes.BOWEL, MESENTERY: Stable postoperative changes of the jejunum. BONES, SOFT TISSUES: No significant abnormality OTHER: Fat containing ventral hernia in the supraumbilical midline upper abdomen is stable. PELVIS:UTERUS, ADNEXA: Hypodense lesion, 6 cm diameter, arising from the posterior aspect of the uterine fundus is unchanged, and likely a subserosal leiomyoma.BLADDER: No significant abnormality notedLYMPH NODES: No enlarged pelvic lymph nodesBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Stable postoperative changes of the jejunum. No evidence of recurrence or metastatic disease in the abdomen or pelvis.2. Likely subserosal uterine fibroid is unchanged. |
Generate impression based on findings. | Reason: cad History: chest discomfort, previously reported myocardial infarct in 10/11, angioplasties in 1/2011 and 1/2012. Reported history of hypertension, dyslipidemia, recent ex-smoking, obesity, family history of ischemic heart disease. Calcium Score:LM: 0LAD: 128LCx: 39RCA: 525PDA: 100Total: 792, This represents the 77th percentile for this patients age and gender.Coronary arteries: LM: The left main coronary artery arises normally from the left sinus of Valsalva and bifurcates into the left anterior descending and left circumflex coronary arteries. There are no significant stenoses present in the left main.LAD: The left anterior descending coronary artery courses in the anterior interventricular groove, supplying two diagonal branches. There is a stent that initiates at the proximal LAD, extending to the origin of D2. It crosses the first diagonal branch. Although there is low density noted within the stent on the source images, the degree of possible intra stent stenosis cannot be quantified. The first diagonal branch is small. Approximately 1.2 cm from the ostium, there is a solid, calcified plaque. Due to blooming artifact, the degree of potential stenosis cannot be determined. Immediately distal to the proximal LAD stent, there is mixed plaque extending in the LAD over a length of approximately 6 mm. The density in this short segment is low, raising a question of a focal occlusion or high-grade stenosis. The second diagonal branch arises from this diseased segment.The second diagonal branch demonstrates a mixed plaque at its ostium, contributing to approximately 50% stenosis. Beyond this focal plaque, the second diagonal branch bifurcates. No significant stenosis is noted within either branch. Given the findings of the mid LAD, collateral flow to D2 may be considered.Immediately beyond the origin of D2, a second stent occupies the mid LAD. Immediately distal to this second stent, the mid to distal LAD caliber becomes small and cannot be traced by postprocessing software.LCx: The left circumflex coronary artery is non-dominant and is diminutive in caliber. It courses normally in the left atrioventricular groove. There is a mixed ostial plaque that contributes to approximately 20% stenosis. Approximately 3.6 cm distal to this lesion, a dense calcification is present. The circumflex terminates immediately beyond the calcification. No obtuse marginal branches are identified. RCA: The right coronary artery is large and arises normally from the right sinus of Valsalva. It is the dominant coronary artery supplying a posterior descending artery and a large posterolateral branch. Multifocal eccentric calcifications line the entire length of the RCA. At the ostium of the posterior descending artery, there is an eccentric ostial stenosis that appears severe. Beyond the ostial stenosis, there is a stent in the proximal segment. The PDA is visualized to the infero-apex; however, there are multifocal non-calcified plaques, one is focal and appears severe, approximately 1.4 cm from the distal margin of the stent.Left Ventricle: The left ventricular late diastolic volume is normal.Right Ventricle: Visually the right ventricular late diastolic volume is within normal limits.Left Atrium: Visually, the left atrial volume appears to be normal in size. There are four distinct pulmonary veins which drain normally into the left atrium. There is no evidence of left atrial appendage thrombus.Right atrium, vena cavae, and coronary sinus: The right atrial volume is normal in size. The superior and inferior vena cavae are unremarkable. The coronary sinus is normal in size. Valves: There is no calcification on the aortic or mitral valves. The mitral valve leaflets are moderately thickened.Great vessels: The visualized portions of the thoracic aorta demonstrate no evidence of dissection or aneurysm. The aortic arch is not visualized. The main pulmonary artery is normal in size.Pericardium: The pericardium is normal in thickness. There is no pericardial effusion. Lungs: Visualization of the lung parenchyma is limited by the field of view and length of scan which excludes a substantial amount of the lungs. No significant abnormality noted.Multilevel osteophytes. | 1. Multiple coronary artery stents and native coronary stenoses, as detailed above. 2. Total Calcium score was 792; 77th percentile for age and gender. |
Generate impression based on findings. | Male, 60 years old, glottic cancer, baseline exam. Head:Multiple intraparenchymal enhancing lesions are redemonstrated compatible with metastases. A lesion adjacent to the right frontal horn has increased in size measuring 6 mm in diameter, previously 3 mm, with an increase in surrounding edema. A lesion within the left occipital lobe may also have increased in size with increasing edema. Small enhancing foci within the left middle frontal gyrus and within the left temporal lobe are not definitely changed.Neck:The vocal cords remain thickened and irregular, similar to what was seen on the prior examination. This thickening extends superiorly at least to the edge of the arytenoids cartilages. The paraglottic fat is mildly infiltrated. The thyroid cartilages show inhomogeneous calcification, similar to prior, a nonspecific finding. There has been no significant interval change in the size of right supraclavicular lymph nodes, the largest of which continues to measure 25 x 13 mm (image 59 series 6). Adenopathy is also partially visualized within the upper mediastinum.Elsewhere in the neck, no pathologic adenopathy is seen. The salivary glands and thyroid are free of focal lesions. Infiltration of the subcutaneous and deep fat as well as thickening of the platysma are likely related to prior therapy.Cervical vessels are unremarkable. Left lung nodules are redemonstrated. No concerning osseous lesions are demonstrated. | 1. Redemonstration of multiple subcentimeter metastatic lesions in the brain. Some of these have increased in size with increasing vasogenic edema.2. Redemonstration of thickening/irregularity of the vocal cords appearing similar to the prior exam.3. Adenopathy in the right supraclavicular space has not significantly changed.4. Mediastinal adenopathy and lung nodules are better assessed on the separately dictated chest CT. |
Generate impression based on findings. | 48 year-old female with squamous cell carcinoma of the tongue, metastatic, postradiation and multiple dissections, reevaluate Head:Hypoattenuating focus in the left basal ganglia and genu of the left internal capsule similar to the prior. Mineralization of the globus pallidi. The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, midline shift, intra- or extra-axial fluid collection/acute hemorrhage, or abnormal contrast enhancement.The orbits are unremarkable. Opacification of the mastoid air cells bilaterally. Complete opacification of the ethmoid air cells, sphenoid and maxillary sinuses.Neck: Redemonstration of postoperative findings related to laryngectomy, tracheostomy and neck dissection. Extensive heterogeneous trans-spatial masses throughout the neck involving both deep and superficial spaces as well as the oral cavity and aerodigestive tract which are compatible with necrotic conglomerate lymph nodes. There has been an interval increase in both the extent of the solid and necrotic portions of these masses. Additional necrotic masses are present in the visualized mediastinum and left anterior chest wall.Right common carotid stent in place. The left cervical carotid artery is not discretely identified. The bilateral vertebral arteries are encroached on by tumor, but remain patent. At the level of C5, soft tissue density appears to at least extend up to the right foramen transversarium with diminished caliber of the right vertebral artery at this level.Diffuse skin thickening and subcutaneous fat stranding as well as markedly increased tongue swelling appearing similar to the prior.Multilevel degenerative changes of the visualized cervical thoracic spine without identification of destructive osseous lesions. Anterior translocation of the mandibles condyles bilaterally.Partially visualized large left pleural effusion with associated compressive atelectasis/consolidation. Please see dedicated chest CT from today's date for further details. | 1. Interval increase in amount of extensive necrotic trans-spatial lymph node conglomerates throughout the neck.2. At the level of C5, soft tissue density appears to at least extend up to the right foramen transversarium with diminished caliber of the right vertebral artery at this level. If clinically warranted, MRI of the cervical spine may be obtained for evaluation of foraminal invasion. |
Generate impression based on findings. | 60 year-old male with diffuse large B-cell lymphoma status post 4 cycles of chemotherapy. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Right chest wall port catheter.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications in aorta and its branches. No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No evidence of lymphadenopathy. |
Generate impression based on findings. | 31 year-old female with acute onset right flank pain radiating to the right upper quadrant with nausea and vomiting. Assess for kidney stone. 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: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No nephrolithiasis is noted. A 1.7 x 1.9 cm hypoattenuating lesion of the right kidney is incompletely evaluated on this noncontrast exam, though likely represents a simple cyst. No hydronephrosis, perinephric stranding, or perinephric fluid collection is seen bilaterally.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: There is a well-circumscribed, homogeneously low-attenuating, round structure in the cul-de-sac region measuring 5.4 x 6.9 cm. Appears to arise from the broad ligament and likely represents a large ovarian cyst versus cystic lesion.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 nephrolithiasis or other findings to explain patient's acute abdominal pain.2.Large ovarian cyst versus cystic ovarian lesion in the cul-de-sac. Recommend correlation with physical examination. Ultrasound may be used for further characterization if clinically indicated. |
Generate impression based on findings. | Male, 60 years old, history of stage IIE diffuse large B-cell lymphoma of the oral cavity status post 4 cycles of chemotherapy. No mass effect, focal edema or suspicious enhancement is seen to suggest brain parenchymal metastatic disease. The bones of the calvarium are intact. Previously demonstrated enhancing soft tissue between the lamina papyracea and medial rectus muscle of the right orbit is no longer clearly visualized. There remains only mild infiltration within this space.Opacification of an adjacent right ethmoid air cell and another more posterior left ethmoid air cell is unchanged. The nature of this tissue remains uncertain.Previously seen mucosal thickening involving the left aspect of the hard palate has significantly improved. Previous deficiency within the floor of the left maxillary sinus is no longer clearly visualized and may have healed. Lobular soft tissue thickening seen previously within the left maxillary sinus has substantially improved as well.No pathologic adenopathy is detected in the neck by size criteria. No frankly pathologic lymph nodes were evident on the prior examination either. However, many scattered lymph nodes have nevertheless decreased in size. For example a left level 2 lymph node previously measured 9 mm short axis and now measures 7 mm (image 47 series 1502).Medialization of the right internal carotid artery causes an impression on the hypopharynx. The aerodigestive tract is unremarkable. The salivary glands are free of focal lesions. There is a subcentimeter hypodense focus within the right thyroid lobe, nonspecific.Cervical vessels remain patent. A right chest port catheter has been placed since the prior exam. At the time of placement, catheter orientation was appropriate. However, the catheter has since migrated and extends superiorly into the right IJ vein where it doubles back upon itself.Lung apices are unremarkable. No concerning osseous lesions are seen. | 1. Response to therapy with resolution of a previously seen right extraconal orbital mass as well as significant improvement in the degree of mucosal thickening overlying the left hard palate and left alveolar surface. A deficiency within the floor of the left maxillary sinus seems to have at least partially healed. Soft tissue thickening within the left maxillary sinus has also substantially improved.2. Incidental note is made of improper orientation of the patient's right-sided port catheter. The catheter has migrated into the internal jugular vein where it loops and doubles back upon itself. This is not an urgent abnormality, but consultation with interventional radiology is suggested. Findings were discussed with M. Lappe at 15:45 on 11/19/13. |
Generate impression based on findings. | Female 55 years old; Reason: re-evaluate upper abdominal lymphadenopathy seen on prior ct History: vaginal cancer 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: Stable borderline enlarged portacaval lymph nodes. The reference portacaval lymph node measures 0.9 cm short axis by 2 cm (series 609 image 54) stable. Stable scattered mesenteric lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Status post hysterectomy. Unchanged CT appearance of the vaginal cuff, suboptimally assessed by CT.BLADDER: No significant abnormality notedLYMPH NODES: Stable nonenlarged right obturator lymph nodesBOWEL, MESENTERY: Sigmoid colonic diverticulosis without pericolonic inflammatory changes.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No significant interval change. Stable postsurgical changes of hysterectomy. Sigmoid colonic diverticulosis without evidence of diverticulitis. |
Generate impression based on findings. | 83 year old female with mediastinal nodes seen on neck CT. Abdominal pain. CHEST:LUNGS AND PLEURA: Nodule adjacent to fissure in right middle lobe most likely represents interpulmonary lymph node (series 5, image 41). Cyst noted in the left upper lobe, without evidence of solid component (series 5, image 43).MEDIASTINUM AND HILA: Multiple small mediastinal and supraclavicular lymph nodes. The heart is normal in size without pericardial effusion.Small hiatal herniaCHEST WALL: Several borderline enlarged subpectoral lymph nodes bilaterally, best appreciated in left sub-pectoral node (series 3, image 25).ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without evidence of cholecystitis. No suspicious liver lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stone located in the inferior calix of right kidney measures 8 mm. Extrarenal pelvis on the left. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diverticulosis in distal colon without evidence of diverticulitis. Several calcified mesenteric lymph nodes, unchanged. No bowel obstruction or bowel wall thickening.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Calcifications in heterogeneous appearing uterus, consistent with fibroids.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Multiple nonspecific small to borderline enlarged mediastinal and chest wall lymph nodes, of unclear clinical significance. No evidence of mass or suspicious lesion.2.Diverticulosis without evidence of diverticulitis.3.No significant change in non-obstructing stone in the inferior calix of the right kidney. |
Generate impression based on findings. | 70 year old female. Reason: metastatic breast CA to lung and liver. Also intermittent abdominal pain and constipation. Evaluate state of disease, History: intermittent abdominal pain. CHEST:LUNGS AND PLEURA: Reference right upper lobe nodule is stable and measures 11 x 10 mm on image 36 series 4. Scattered punctate micronodules are unchanged. Scarring and calcification in the left upper lobe unchanged. MEDIASTINUM AND HILA: Atherosclerotic calcification of the aorta and its branches. Coronary calcification. Trace pericardial effusion versus thickening, unchanged. Scattered small mediastinal nodes are unchanged. Calcification the thyroid gland is unchanged.CHEST WALL: Reference left breast nodule is no longer seen. A small metallic clip is seen at the site, image 35, series 3. Postop change involving the left breast and left axilla. Degenerative change involving the spine. Stable left posterior thoracic subcutaneous seroma.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: The reference left lobe hepatic lesion measures 13 x 13 mm on image 102 series 3. Stable biliary ductal dilatation. New large left lateral segment hepatic lesion measures 3 x 3.2 cm at image 98 series 3. SPLEEN: Calcified granulomas.ADRENAL GLANDS: Stable left adrenal nodule (image 94 series 3).KIDNEYS, URETERS: Left renal hypodensities, too small to characterize, but stable.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the aorta and its branches.BOWEL, MESENTERY: No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS: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 | Metastatic breast cancer with new large left hepatic lobe metastasis. Probable additional new smaller hepatic lesions are not as well seen. |
Generate impression based on findings. | Reason: eval for progression History: metastatic SCC of tongue, post radiation and multiple dissection CHEST:LUNGS AND PLEURA: Large left pleural effusion, slightly decreased compared to previous with underlying atelectasis.Subsegmental atelectasis posteriorly at the right base, unchanged.MEDIASTINUM AND HILA: Large enhancing tumor mass at the thoracic inlet, only partially visualized on this thoracic scan.The tumor is compressing the upper airway and a tracheostomy tube is present with the tip about 3 cm above the carina.The tumor extends posterior to the trachea, slightly below the level of the aortic arch.Multiple enlarged mediastinal lymph nodes are present and extremely large necrotic bilateral axillary lymph nodes are present with peripheral enhancement.CHEST WALL: Large necrotic axillary lymph nodes and thoracic inlet the tumor as noted above.Reference left axillary node measures 4.1 x 5.1 cm, markedly increased from previous (series 4 image 37).ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Fatty infiltration adjacent to the falciform ligament.Cholelithiasis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small right renal cyst.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: The enlarged necrotic lymph node adjacent to the gastrohepatic ligament measures 2.3 x 2.1 cm, increased from 1.8 x 1.7 cm.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Feeding tube tip in the stomach.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Enlarged uterus partially visualized. | 1.Marked interval increase in axillary and abdominal lymphadenopathy, and likely increase in partially visualized the tumor mass at the thoracic inlet.2. Persistent large left pleural effusion with underlying atelectasis. |
Generate impression based on findings. | 60 year-old male patient with metastatic thyroid cancer. Evaluate mass in posterior right flank and evaluate for metastatic disease. CHEST:LUNGS AND PLEURA: Extensive metastatic disease throughout both lungs and pleura. There is interval increase in pleural based disease, more prominent in the right lung base, with diffuse nodular pleural thickening and volume loss in the right lung. Small right pleural effusion. Reference left lower lobe mass abutting the mediastinum measures 7.0 x 4.1 cm (series 4 image 57), previously 6.6 x 4.7 cm.Reference right upper lobe nodule measures 1.0 x 1.2 cm (series 4 image 41), previously 1.0 x 1.3 cm. Right lower lobe reference mass measures 3.3 x 3.0 cm (series 4 image 47), previously 3.1 x 2.9 cm. Second right lower lobe reference lesion measures 3.7 x 3.4 cm (series 4 image 61), previously 3.6 x 3.6 cm. MEDIASTINUM AND HILA: Redemonstration of heterogeneous mass in the superior mediastinum, likely arising from the thyroid gland and appears smaller compared to prior examination. Please refer to dedicated CT soft tissue neck performed the same day for further details.No significant change in mediastinal lymphadenopathy. Subcarinal node measures 3.8 x 1.7 cm (series 3 image 46), previously 3.8 x 2.0 cm.Right internal mammary node measures 2.3 x 2.9 cm in (series 3 image 44), previously 1.7 x 1.9 cm.CHEST WALL: Left pectoralis muscle is atrophic compared to the right, new compared to prior.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis. There is a hypoattenuating lesion in the inferior right hepatic lobe that is suspicious for metastatic disease and is of indeterminate age. This portion of the liver was not included in the field-of-view on previous examinations.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left kidney with large superior pole cyst and multiple hypoattenuating lesions that are too small to characterize and likely represent cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: There is a new heterogeneous soft tissue mass with areas of necrosis involving the posterolateral chest wall with destruction of the associated 11th rib that measures 7.7 x 7.2 cm (series 3 image 49) and is consistent with metastatic disease.OTHER: No significant abnormality noted. | 1.New right posterolateral chest wall mass consistent with metastatic disease.2.Interval increase in right lower hemithorax pleural-based disease.3.No significant change in reference pulmonary masses.4.Age indeterminate hypoattenuating liver lesion is suspicious for metastatic disease. |
Generate impression based on findings. | Reason: h/o nasal cavity cancer History: s/p surgery, r/o recurrence LUNGS AND PLEURA: Moderate to severe upper lobe predominant centrilobular emphysema.Interval development of moderate-sized right sided pleural effusion .Right basilar atelectasis.Stable nonspecific calcified and noncalcified micronodules.No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Redemonstration of a right sided mediastinal mass in the tracheo -esophageal groove with connection to the right lobe of the thyroid gland and is compatible with a goiter. There is again noted be compression and deviation of the esophagus to the left.No hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of a pericardial effusion.Severe coronary artery and aortic calcification.CHEST WALL: Severe degenerative changes of the thoracic spine with flowing anterior and calcification of the anterior spinal ligament.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.Interval development of a moderate-sized right pleural effusion with lobe with the suggestion of round atelectasis in the right lower lobe.2.Stable micronodules without evidence of new suspicious pulmonary nodules or masses.3.Mediastinal mass most likely representing goiter. |
Generate impression based on findings. | 83-year-old male with history of nasal cavity cancer (sinonasal adenocarcinoma) status post resection (9/2013) There's been interval resection of a large mass within the left nasal cavity with extensive postsurgical changes including removal of left-sided ethmoid air cells, nasal turbinates, left orbital wall and medial wall of the left maxillary sinus. There is a nonspecific soft tissue density within the surgical bed in the the left maxillary sinus. Mucosal thickening of the right ethmoid air cells are thought to be likely inflammatory. No hemorrhage, extra-axial fluid collections or masses are seen within the visualized intracranial contents. Extensive calcifications are seen within the intracranial carotid arteries.The oral cavity, oro/nasopharynx, hypopharynx, larynx and subglottic airways are patent. The epiglottis, vallecula, piriform sinuses, and vocal cords are normal. The parotid glands are unremarkable. The bilateral submandibular glands appear absent. There are multiple subcentimeter thyroid nodules with a large pedunculated nodule inferoposteriorly which exerts mass effect on the esophagus and posterior trachea. No lymphadenopathy is noted. The carotid arteries and jugular veins are patent. Moderate to severe degenerative changes affect the cervical spine. | 1.Postsurgical changes of left nasal cavity mass resection. There is small amount of residual soft tissue density within the left maxillary sinus which is nonspecific and while this may be treatment related, tumor cannot be completely excluded.2.Multi-nodular goiter with large pedunculated nodule exerting mass effect on esophagus and posterior trachea. |
Generate impression based on findings. | 87 year-old female with nasal congestion. The orbits are unremarkable except for mild posterior staphyloma on the right. The mastoids are clear. Limited view of the intracranial structure is unremarkable. There appears thinning of the bilateral parietal bones, clinical correlation is advised. There is scattered minimal mucosal thickening in the paranasal sinus. Otherwise, the frontal sinuses, frontal-ethmoid recesses, anterior/posterior ethmoids, sphenoid sinuses, and maxillary sinuses are well developed and clear. The osteomeatal complexes are normal with intact uncinate processes and patent infundibuli. The intersphenoid septum is normal. The nasal turbinates and nasal septum are normal. The cribriform plate, fovea ethmoidalis and lamina papyraceae appear normal. The osseous structures are unremarkable. Disc osteophyte complexes at C3-C4 and C2-C3. Edentulous. | No evidence of sinusitis. Minimal paranasal sinus mucosal thickening. |
Generate impression based on findings. | 60 year-old male with head and neck cancer, baseline evaluation CHEST:LUNGS AND PLEURA: Reference left lower lobe pulmonary nodule measures 1.2 x 1.2 cm and previously measured 1.0 1.0 cm (image 59, series 4). Multiple additional bilateral nodules are identified many of which are also increased in size. Large right infrahilar mass extending along the right major fissure and encircling the right lower lobe bronchi appears similar to prior study.MEDIASTINUM AND HILA: Right central venous catheter tip extends to the cavoatrial junction. Reference paratracheal mediastinal lymph node measures 2.8 cm and previously measured 2.8 cm (image 24, series 3).CHEST WALL: Right chest wall port.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Small left hypoattenuating lesion is incompletely characterized.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Hypoattenuating right renal lesions likely represent cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality noted. | 1. Interval increase in size of multiple pulmonary metastases.2. Stable mediastinal lymphadenopathy.3. No new sites of disease. |
Generate impression based on findings. | 66-year-old female, follow-up previously noted nodules Exam limited by motion artifact.LUNGS AND PLEURA: Extensive peribronchial and subpleural ground glass opacity with mild bronchiectasis is again noted. Ill-defined opacity in the lingula is not significantly changed. Mosaic attenuation is similar to the prior exam. No pneumothorax or pleural effusions.Right pulmonary nodule abutting the minor fissure measures 1.1 x 0.8 cm (image 119, series 4) and previously measured 9 x 8 mm.Right upper lobe subpleural nodule (image 96, series 4) is unchanged.MEDIASTINUM AND HILA: Marked coronary arterial ossifications. Aortic valve and mitral valve prostheses. No mediastinal or hilar lymphadenopathy.CHEST WALL: Sternotomy wires.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. Mild unchanged unchanged basilar predominant nonspecific pulmonary fibrosis.2. Stable small pulmonary nodules.3. Unchanged lingular opacity which is likely postinflammatory in etiology. |
Generate impression based on findings. | Male, 86 years old, tonsil cancer status post chemo. No enhancing brain parenchymal lesions are seen. Periventricular hypoattenuation is demonstrated, likely indicating age indeterminate small vessel ischemic disease.An ill-defined heterogeneously enhancing tumor is reidentified centered on the right tonsillar fossa with extension into the soft palate and right masticator space. Accurate measurement is not possible given the very poorly defined margins of the tumor. However, when compared with the prior exam, tumor does appear to be less bulky as evidenced by less effacement of the oropharyngeal airway and the right fossa of Rosenmuller.As before, the tumor extends laterally into the right masticator space as well as anteriorly into the right hard palate. Erosion of the hard palate, pterygoid plates and posterior medial wall of the right maxillary sinus appears similar to prior. Soft tissue thickening of uncertain nature within the maxillary sinus is also improved. Infiltration of the pterygopalatine fossa is seen.Superiorly, tumor extends to the skull base where it invades the middle cranial fossa through the region of the foramen ovale and petrous carotid canal. Tumor also erodes the posterior inferior wall of the right sphenoid sinus. The degree of erosion of the central skull base has not substantially changed. Intracranially, tumor abuts and elevates the dura to a similar degree as before. Tumor does not appear to extend beyond the dura. It does extend medially to the level of Meckel's cave. Meckel's cave remains largely patent though invasion cannot be excluded.Inferiorly, tumor infiltrates through the pterygoid musculature effacing both the masticator and parapharyngeal spaces.No pathologic adenopathy is detected in the neck. Mediastinal adenopathy is better evaluated on the accompanying chest CT. The salivary glands and thyroid are unremarkable. No significant compromise of the cervical vasculature is seen. The lung apices are unremarkable.Extensive degenerative disk disease is redemonstrated in the cervical spine. No concerning or focally destructive osseous lesions are are seen. There is some chronic remodeling of the left aspect of the C5 vertebral body likely secondary to anomalous course of the vertebral artery. | Redemonstration of an ill-defined infiltrating tumor centered on the right tonsillar fossa and soft palate with extension into the right masticator space, hard palate and maxillary sinus. Tumor also extends through the right central skull base with minimal invasion of the right middle cranial fossa. Since the prior examination this extensive tumor does appear less bulky likely indicating some response to therapy |
Generate impression based on findings. | Urothelial carcinoma CHEST:LUNGS AND PLEURA: Interval increase in size of left apical lung nodule best seen on image 13 of series 5 now measuring 1.5 x 1.4 cm; this is comparison to 1.3 x 1.1 cm on 7/16/2013. This lesion has definitely increased in size when compared to 4/3/2012when it measured 0.9 x 0.9 cm.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: 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: Status post cystoprostatectomyBLADDER: Unremarkable ileal diversionLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Left apical peripheral nodule demonstrates slow but definite interval increase in size. Accordingly, a slow growing neoplasm such as carcinoid or even an indolent primary lung carcinoma cannot be excluded.Otherwise stable examination. |
Generate impression based on findings. | 58-year-old female with history of HCV/EtOH cirrhosis, pre-liver transplant. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Liver contour: Nodular, cirrhotic Features of portal hypertension: Gastroesophageal varices are identified. Portal vein: Patent and normal caliberHepatic veins: Patent and normal caliberHepatic artery: Patent with normal anatomyLesions: 2.3 x 1.8 cm lesion (image 14, series 9) in right dome, arterial enhancement - yes; washout - yes; peripheral rim enhancement - yes.1.6 x 1.6 cm lesion (image 37, series 9) in segment 4, arterial enhancement - yes; washout - yes; peripheral rim enhancement - no.2.0 x 1.7 cm lesion (image 49, series 9) in segment 6, arterial enhancement - yes; washout - yes; peripheral rim enhancement - no.1.5 x 1.3 cm lesion (image 68, series 9) in segment 6, arterial enhancement - yes; washout - yes; peripheral rim enhancement - no.Scattered other subcentimeter hyperdense lesions on arterial phase are identified, do not demonstrate washout, and are nonspecific.Subcentimeter cystic lesion in the left lobe is too small to further characterize.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Multiple enlarged lymph nodes in the hepatoduodenal ligament, gastrohepatic ligament, and and retroperitoneum up to 1.8 cm in size. Nodes of this size are seen commonly in association with chronic liver disease, and remain of uncertain significance.BOWEL, MESENTERY: No metastatic peritoneal disease is identifiedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Cirrhotic morphology of the liver.2.Four hepatic lesions meeting AASLD criteria for HCC, as delineated above. |
Generate impression based on findings. | Female 52 years old; Reason: 52F with Crohn's involving ilio-colonic anastomosis, eval for more proximal involvement of small bowel History: diarrhea ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Status post prior liver resection with nonspecific hypoattenuating lesion measuring 2 x 1.8 cm in the hepatic dome (series 3 image 16). Small focal area of nodular enhancement noted, likely suggesting hemangioma. Patient is status post cholecystectomy. No intrahepatic or extrahepatic biliary ductal dilation notedSPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The patient is status post ileocolonic anastomosis with prior ileal resection. Numerous surgical clips are noted in the right hemi-abdomen. Evidence of obstruction or free air. No bowel wall thickening or inflammation to suggest active disease.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Status post prior hepatic and ileal resection with ileocolonic anastomosis without evidence of obstruction or active disease. |
Generate impression based on findings. | 79 year-old female with metastatic lung adenocarcinoma. Left rib pain. CHEST:LUNGS AND PLEURA: Significant pleural thickening, volume loss, and cavitation with air-fluid level/hydropneumothorax in left hemithorax. Heterogeneous left mid lung mass measures approximately 6.4 x 4.8 cm (series 3, image 46). Nodule in right lower lobe measures 6 mm (series 4, image 61). Otherwise, right lung unremarkable.Fluid is present in the left mainstem bronchus.MEDIASTINUM AND HILA: Several enlarged lymph nodes in the upper mediastinum; for reference, left upper mediastinal node measures 10 x 12 mm (series 3, image 16).Severe atherosclerotic calcifications the aorta and coronary arteries. Heart is normal in size without pericardial effusion.Right central venous catheter terminates in upper right atrium.CHEST WALL: Significant left axillary lymphadenopathy and multiple left chest wall metastatic lesions; for reference left axillary node measures 3.1 x 3.9 cm (series 3, image 28).Multiple sclerotic foci in the osseous structures consistent with metastases. Significant sclerosis of all left ribs, which may be due to superimposed post radiation change. ABDOMEN:LIVER, BILIARY TRACT: Multiple hypoattenuating liver lesions compatible with metastases; reference segment 4 lesion measures 1.9 x 1.6 cm (series 3, image 86).SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Right adrenal gland nodule measures 1.4 x 2.0 cm, nonspecific but may represent metastatic lesion (series 3, image 83).KIDNEYS, URETERS: Atrophic right kidney containing upper pole cyst. Status post left nephrectomy.RETROPERITONEUM, LYMPH NODES: Significant atherosclerotic disease affects the aorta and its branches. No evidence of retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multiple sclerotic foci in the osseous structures consistent with metastases.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Large amount of stool in the rectum.BONES, SOFT TISSUES: Multiple sclerotic foci in the osseous structures consistent with metastases.OTHER: Right iliac fossa transplant kidney containing cyst noted. | 1.Left lung mass consistent with known lung neoplasm, with associated significant left hemithorax volume loss, hydropneumothorax, and pleural thickening consistent with diffuse involvement by tumor.2.Metastatic disease noted involving osseous structures, axilla, chest wall, and liver, as described above. 3.Extensive sclerosis in left ribs suspected to represent post-radiation change superimposed on metastatic disease. No pathologic fractures identified. 4.Right adrenal gland nodule is nonspecific but may represent additional metastatic lesion.5.Transplant kidney in right iliac fossa. |
Generate impression based on findings. | Male 25 years old; Reason: Met Adenocarcinoma of unknown primary: Restaging History: s/p 4 cycles chemotherapy CHEST:LUNGS AND PLEURA: Bilateral multiple parenchymal masses consistent with metastatic disease are again noted and slightly smaller and less conspicuous. The reference nodule in the right lung measures 1.1 x 0.8-CM, previously 1.3 by 0.7-cm on image number 60, series number 5. Numerous other non-reference nodules are stable to slightly smaller and less conspicuous.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Patient's known large liver mass replacing the entire left lobe and extending into the right lobe is again noted and measures 23 by 10.5 cm, previously 26 by 12.4-cm in image number 84, series number 3. Better reference mass measures 4 x 4.7 cm, previously 5.3 x 6.2 cm on the same image. Left portal vein is not visualized. There are collateral vessels in the hepatic hilum. There is also tumor thrombus in the main portal vein.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal gland cannot be well seen due to surrounding metastatic retroperitoneal adenopathy.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Large portacaval metastatic adenopathy measuring 3.3 x 1.5-CM, previously 3.4 x 1.8 cm image number 109, series number 3.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: Small amount of free fluid in the pelvis. | Slight interval improvement of the large hepatic mass causing tumor thrombus in the main portal vein . Slight interval decrease in the metastatic lung lesions and metastatic adenopathy. |
Generate impression based on findings. | 84-year-old female with benign resected. Small bowel carcinoid tumor. Evaluate for disease. CHEST:LUNGS AND PLEURA: Scattered micronodules -- no old studies for comparison, but these are most likely prior inflammatory micronodules from old granulomatous disease.No other parenchymal nodules, masses or airspace consolidation. No pleural disease seen. MEDIASTINUM AND HILA: No adenopathy or masses. Calcified normal sized scattered lymph nodes consistent with prior granulomatous disease. No other significant abnormalities.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted in liver. Again, small layer of gallstones seen without complication. No evidence of biliary obstruction..SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable, benign left renal cyst. No other significant abnormality seen in no change in appearance.RETROPERITONEUM, LYMPH NODES: Atherosclerotic changes seen in the aorta without aneurysmal dilatation. No lymphadenopathy identified.BOWEL, MESENTERY: Orally administered contrast passes through a normal appearing stomach, small bowel, and colon without intrinsic abnormality. Mesentery shows no masses and no free mesenteric fluid.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Prior hysterectomy. No other abnormalities seen. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Orally administered contrast passes through a normal appearing stomach, small bowel, and colon showing only. Postsurgical changes as demonstrated on prior examinations without intrinsic abnormality. Mesentery shows no masses and no free mesenteric fluid.BONES, SOFT TISSUES: Diffuse bony degenerative changes seen without focal abnormality to suggest metastatic disease.OTHER: No significant abnormality noted. | 1. Postsurgical changes in the ileum. 2. No evidence of recurrent or residual tumor. No evidence of metastatic disease. 3. Gallstones without change and no other complication. |
Generate impression based on findings. | Reason: h/o hnc, s/p chemo, compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: Stable scattered nonspecific micronodules.No suspicious pulmonary nodules or masses.Incidental azygos lobe.No pleural effusion.MEDIASTINUM AND HILA: The previously referenced high right paratracheal lymph node is stable, at 12 x 25 mm (series 3 image 20). No new mediastinal lymphadenopathy. Right hilar and subcarinal partially calcified lymph nodes indicative of prior granulomatous disease. Heart size remains stable. Mild coronary artery calcification stable. No new pericardial effusion.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Stable scattered hypodensities too small to characterize.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts unchanged.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Stable sclerotic T8 lesion. Multilevel degenerative osteophytes.OTHER: No significant abnormality noted. | No evidence of pulmonary metastases. |
Generate impression based on findings. | Paraganglioma syndrome ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Stable subcentimeter right lobe cystic foci. Previously noted temporally enhancing lesion within segment 4/5 seen on the prior MR is not appreciated on the current examination.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Trace ascites; favor physiologicBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Negative for acute, inflammatory, or neoplastic process. Specifically, no evidence for adrenal mass or periaortic paraganglioma. |
Generate impression based on findings. | 64 -year-old female with new diagnosis of non-small cell lung cancer -- needs staging CHEST:LUNGS AND PLEURA: Increasing left pleural effusion. Left lower lobe consolidation persists. The left hila again is ill-defined, but in light of history, most likely contains an immeasurable, hilar mass encompassed by the distal atelectasis.Resolution of right pleural effusion. Right middle lobe atelectasis and poorly defined right hilum -- adenopathy there cannot be excluded.MEDIASTINUM AND HILA: Increasing pericardial effusion. Enlarged mediastinal adenopathy seen, unchanged. Largest lymph node in the pretracheal space (series 401, image 32) measures 1.7 x 1.5 cm. enlarged subcarinal lymph node (401, image 47) measures 2.2 x 1.4 cm. CHEST WALL: No significant abnormality noted..ABDOMEN:LIVER, BILIARY TRACT: Benign liver cysts again seen scattered throughout the liver without evidence of solid metastatic disease. Vessels all appear normal. Gallbladder and biliary tract appearsSPLEEN: No significant abnormality noted..PANCREAS: No significant abnormality noted..ADRENAL GLANDS: No significant abnormality noted..KIDNEYS, URETERS: No significant abnormality noted..RETROPERITONEUM, LYMPH NODES: Enlarged enhancing lymph nodes are seen diffusely in the retroperitoneal space throughout. The abdomen. Largest of these (series 401, image 105) measures 1.5 x 1.3 cm.BOWEL, MESENTERY: No significant abnormality noted..BONES, SOFT TISSUES: No significant abnormality noted..OTHER: No significant abnormality noted..PELVIS:UTERUS, ADNEXA: Post hysterectomy. No significant abnormality noted.BLADDER: No significant abnormality noted..LYMPH NODES: No significant abnormality noted..BOWEL, MESENTERY: No significant abnormality noted..BONES, SOFT TISSUES: No significant abnormality noted..OTHER: No significant abnormality noted.. | 1. No change diffuse left lung air space consolidation representing atelectasis distal to the presumed left hilar tumor. 2. Increasing pericardial effusion. 3. Increasing left pleural effusion. 4. Diffuse retroperitoneal enhancing lymph nodes, most likely, metastatic disease. |
Generate impression based on findings. | Clinical question: Stroke? Signs and symptoms: Pinpoint pupils and lethargic. Nonenhanced head CT:No detectable acute intracranial process CT however is intensity for early detection of acute nonhemorrhagic ischemic strokes.Mild to moderate periventricular and subcortical low attenuation or white matter grossly similar to prior exam and likely secondary to age indeterminate small vessel ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system and CSF spaces otherwise.Unremarkable calvarium, soft tissues of the scalp.Noted in bilateral maxillary sinuses and minimally in the right chamber on the sphenoid sinus with partial opacification of bilateral ethmoid air cells is a new finding since prior exam | No acute intracranial process. Please see above comments. |
Generate impression based on findings. | Clinical question: Evaluate for hemorrhage. Signs and symptoms: Trauma to head after fall. Nonenhanced head CT:No detectable acute posttraumatic intracranial, calvarial or soft tissues of the scalp findings.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation.Unremarkable calvarium, soft tissues of the scalp, orbits and visualized paranasal sinuses/mastoid air cells. | Negative nonenhanced head CT. |
Generate impression based on findings. | Clinical question: Rule out acute stroke. Signs and symptoms: Weakness and aphasia. Nonenhanced head CT:No detectable acute intracranial process however CT is insensitive for early detection of acute nonhemorrhagic ischemic strokes.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. | Clinical question: Acute left-sided weakness and sensory loss. Signs and symptoms: Acute left-sided weakness. Nonenhanced head CT:No detectable acute intracranial process CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.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. | Negative nonenhanced head CT. |
Generate impression based on findings. | 8 year old female with history of abdominal pain multiple surgeries. Assess for obstruction, acute process. ABDOMEN:LUNG BASES: The lung bases are without evidence of consolidation or effusion. No pericardial effusion is seen.LIVER, BILIARY TRACT: No focal hepatic lesions are identified. Old dilatation is seen. The portal vasculature is patent. The gallbladder is normal in appearance.SPLEEN: The spleen is normal in appearance.PANCREAS: The pancreas is normal in appearance.ADRENAL GLANDS: The adrenal glands are symmetric and normal in appearance.KIDNEYS, URETERS: The kidneys enhance symmetrically without evidence of a focal lesion.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy is seen.BOWEL, MESENTERY: A gastrostomy tube is in place. Postsurgical changes from sub total colectomy with a left lower quadrant ileostomy are noted. There is no evidence of bowel obstruction. There is a thick walled collection containing foci of air in the pelvis (image 92, series 4) that measures 2.4 x 3.4 cm in axial dimension. It appears round on all three imaging planes. This may represent normal bowel, however an abscess should also be considered given its appearance. Further evaluation of this collection is limited by the lack of an oral contrast agent.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: Postsurgical changes with a left lower quadrant ileostomy are noted. There is a thick walled collection containing foci of air in the pelvis (image 92, series 4) that measures 2.4 x 3.4 cm in axial dimension. It appears round on all three imaging planes. This may represent normal bowel, however an abscess should also be considered given its appearance. Further evaluation of this collection is limited by the lack of an oral contrast agent.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Thick walled collection containing foci of air in the pelvis as discussed above may represent normal bowel, however an abscess is also possible given its appearance. No evidence of bowel obstruction. |
Generate impression based on findings. | 54-year-old male with abdominal pain, pancreatitis versus progression of known mass. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Ill-defined, linear hypoattenuating area in inferior right lobe appears slightly increased (series 3, image 61); this may perfusion difference. The previously seen hypoattenuating foci in the left lobe are not well seen on current exam. Status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: Interval increase in fat stranding around enlarged pancreatic head. Several hypoattenuating foci throughout the pancreas, most compatible with pseudocysts, are not significantly changed; the previously measured pancreatic head cyst measures 16 mm, previously measured 14 mm (series 3, image 43). Previously measured uncinate process cyst measures 15 mm, previously measured 21 mm (series 3, image 52).Stable appearing dilation of the pancreatic duct measuring 10 mm in maximal diameter. Several punctate calcifications again noted. Multiple enlarged lymph nodes are seen around the pancreas, not significantly changed; previously measured node between the IVC and pancreatic head measures 9 mm, previously measured 9 mm (series 3, image 52).There is stable mild narrowing of the distal superior mesenteric vein and at confluence of SMV and splenic vein (series 3, image 38). There is apparent ill-defined area of hypoattenuation within the SMV more inferiorly, which most likely represents flow artifact/mixing (series 3, image 61). No evidence of well-defined filling defect to suggest thrombus.No evidence of pseudoaneurysm.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Hypoattenuating lesions in both kidneys are not significantly changed, compatible with cysts.RETROPERITONEUM, LYMPH NODES: Multiple enlarged upper retroperitoneal nodes are noted.Atherosclerotic calcifications in aorta and its branches.BOWEL, MESENTERY: Significant wall thickening of the duodenum adjacent to the pancreatic head. Small amount of free fluid is seen in the right paracolic gutter. Otherwise, no significant abnormality is 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 | Interval increase in extensive stranding around pancreatic head and uncinate process with associated multiple well-defined, hypoattenuating foci consistent with pseudocysts; findings are most consistent with progression of chronic pancreatitis. |
Generate impression based on findings. | Celiac artery compression consistent with median arcuate ligament syndrome (MALS)? Please render 3D images as well. History: Post prandial abdominal 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: There is mass effect on the bowel from what appears to be a right retroperitoneal mass which is predominantly fatty (image 75 series 7). The inferior extent of this mass is below the field of view. The size of the mass is difficult to approximate; at minimum it measures 3.8 x 5.5 x 6.5 cm (image 75 series 7 and image 43 series 80568). The mass is circumscribed and the margins of the adjacent structures appear preserved.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER/VASCULATURE: On expiratory arterial phase images there is "J" configuration (narrowing and downward displacement secondary to mass effect) of the celiac artery (images 50 series 80465) just distal to its origin which resolves on inspiration venous phase images. | 1. Large right retroperitoneal fatty mass which is incompletely imaged. Differential includes lipoma and liposarcoma. A MRI of the abdomen and pelvis is recommended to better characterize this lesion.2. "J" configuration of the celiac artery on expiration compatible with celiac artery compression syndrome in the appropriate clinical setting.The exam was reviewed and discussed with radiologist Dr. Feinstein and Dr. Stacy. Findings were discussed with Chris Speaker(9883) of the referring service at the time of dictation along with recommendations for further imaging evaluation of the retroperitoneal mass. |
Generate impression based on findings. | Clinical question: CVA. Signs and symptoms: CVA. Nonenhanced head CT:No detectable acute intracranial process CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.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. | Clinical question: Evaluate for focal abnormality. Signs and symptoms: Evaluate for focal abnormalities. Nonenhanced head CT:Small focus of low attenuation in the right cerebellum is believed to represent a small focus of age indeterminate cerebellar stroke.Focus of encephalomalacia in the right occipital lobe consistent with a chronic cortical stroke. Periventricular and subcortical low attenuation of white matter and bilateral basal ganglial consistent with age indeterminate small vessel ischemic strokes.CT is insensitive for early detection of acute nonhemorrhagic ischemic strokes.Mild prominence of lateral ventricles and cortical sulci for patient's stated age. Midline is maintained. Calvarium and soft tissues of the scalp are unremarkable.Images through the orbits, paranasal sinuses and mastoid air cells are unremarkable. | Mild to moderate age indeterminate small associated strokes as detailed. |
Generate impression based on findings. | 84 year-old female with abdominal pain and worsening diarrhea. ABDOMEN:LUNG BASES: Focus of consolidation in lingula likely represents atelectasis/scarring.LIVER, BILIARY TRACT: Status post cholecystectomy. Mild intrahepatic biliary ductal dilation in the left lobe, and to a lesser degree in the right lobe, not significantly changed. No evidence of common bile duct dilation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Nodular thickening of left adrenal gland, of unclear significance.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diverticulosis without diverticulitis. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: Extensive streak artifact from orthopedic spine hardware and a right hip prosthesis somewhat limits evaluation of pelvis.UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diverticulosis without diverticulitis.BONES, SOFT TISSUES: Orthopedic hardware noted in the lower spine and right hip. OTHER: No significant abnormality noted | 1.No acute abnormality to account for patient's symptoms.2.Status post cholecystectomy, with mild intrahepatic biliary ductal dilation, of doubtful clinical significance and not significantly changed since 2011. |
Generate impression based on findings. | Clinical question: Evaluate for acute stroke, hemorrhage, edema or evolution of intracranial metastatic disease. Signs and symptoms: History of lung adenocarcinoma with known brain metastases status post recent WB RT (ending 11 -- 12). Nonenhanced head CT:There is no detectable acute intracranial hemorrhage, midline shift or hydrocephalus.CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.There is interval increased peritumoral vasogenic edema in the right posterior parietal since prior exam from February 7. There is resultant effacement of adjacent cortical sulci however without any mass-effect on the right lateral ventricle.There is no convincing evidence of any new foci of vasogenic edema.Subtle nonspecific subcortical and periventricular low attenuation of white matter remains grossly similar to prior study.Calvarium and soft tissues of the scalp are unremarkable.Images through the orbits, paranasal sinuses are unremarkable. New since prior exam is subtle patchy opacification of left mastoid air cells. | 1.No evidence of acute intracranial process CT however is insensitive for detection of acute nonhemorrhagic ischemic strokes.2.Slight interval increased peritumoral vasogenic edema in the right parietal lobe with resultant regional mass-effect as detailed above.3.No convincing evidence of any new foci of echogenic edema.4.Grossly stable subtle periventricular and subcortical nonspecific low-attenuation white matter. |
Generate impression based on findings. | 63 year old female with abdominal pain. Evaluate for mesenteric ischemia. The following observations are made given limitations of an arterial weighted study.ABDOMEN:LUNG BASES: Probable left lower lobe pulmonary embolus (image 7; series 11). This finding was communicated to the clinical service (Dr. Moses Kim) prior to this dictation by the radiology resident on call (Dr. R. Lo). Left basilar atelectasis.LIVER, BILIARY TRACT: Hypodense liver probably represents fatty infiltration. Possible gallbladder sludge. Gallstones.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Indwelling inferior vena cava filter.BOWEL, MESENTERY: Multiple dilated loops of small bowel with air-fluid levels measuring up to 3.1 cm in diameter compatible with small bowel obstruction. Transition point noted in the right lower quadrant (image 90; series 6). Interloop fluid raises the possibility of ischemia. Colonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: The celiac axis, superior mesenteric artery, and inferior mesenteric artery are all widely patent.PELVIS: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: Pelvic ascites. | High-grade small bowel obstruction. Probable left lower lobe pulmonary embolus; chronicity is unclear and the patient has an indwelling IVC filter. Abdominal and pelvic ascites. Gallstones.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 56 year old female status post gastric fistula and abscess status post failed endoscopic repair of sleeve gastrectomy. ABDOMEN:LUNG BASES: Small left pleural effusion. Elevation of right hemidiaphragm due to large subdiaphragmatic fluid collection, described below. There is associated atelectasis/consolidation in partially visualized right lung base.LIVER, BILIARY TRACT: Large, loculated fluid collection below right diaphragm with the peripherally enhancing thick wall and multiple foci of internal gas, consistent with abscess. A percutaneous drain is present within this collection.Large area of hypoattenuation in the right lobe may be due to focal fat infiltration and/or perfusion abnormality. The vessels course through this abnormality and there is no evidence of mass effect.SPLEEN: Status post splenectomy.PANCREAS: Mild inflammatory change around pancreatic tail due to postsurgical changes in the left upper quadrant. Pancreatic duct caliber is within normal limits.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Multiple enlarged lymph nodes in the upper retroperitoneum. Atherosclerotic calcifications in aorta and its branches.BOWEL, MESENTERY: Extensive postsurgical changes around the stomach and in left upper quadrant consistent with history of failed sleeve gastrectomy. Extraluminal fluid collection in the left upper quadrant measures 5.3 x 5.5 cm; this contains fluid and high attenuation material consistent with contrast, indicating fistulous communication from the stomach which can be best appreciated on series 3, image 40. There is also linear inflammation extending from this fluid collection to the lateral abdominal wall, suggestive of prior fistulous tract or catheter tract (series 3, image 48).BONES, SOFT TISSUES: Multiple round soft tissue attenuation foci in the anterior abdominal wall, some containing small foci of gas, likely representing injection granulomas. Postsurgical changes in anterior abdominal wall.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Enhancing lesion in right aspect of the uterus consistent with fibroid (series 3, image 143). Several other subcentimeter height in relation foci within the uterus are most consistent with small fibroids as well.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Severe degenerative changes affect the lower lumbar spine.OTHER: No significant abnormality noted | 1.Large subdiaphragmatic fluid collection in the right upper quadrant containing multiple foci of gas and percutaneous drain, consistent with abscess. 2.Extensive postsurgical changes in around stomach consistent with history of sleeve gastrectomy. Extraluminal fluid collection in left upper quadrant containing contrast, indicating fistulous communication to stomach.3.Large area of hypoattenuation within right lobe of the liver may represent combination of fat infiltration and perfusional abnormality. |
Generate impression based on findings. | 40 year-old female with right lower quadrant pain. Rule out worsening ovarian cyst hemorrhage versus appendicitis. ABDOMEN:LUNG BASES: Mild bibasilar atelectasis.LIVER, BILIARY TRACT: Two gallstones are identified in the gallbladder, one at the gallbladder neck. Partial volume averaging likely accounts for pericholecystic haziness rather than true pericholecystic fluid. No definite gallbladder wall thickening. The gallbladder is hydropic and there is no biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Mild atherosclerotic calcification of the abdominal aorta and its branches. BOWEL, MESENTERY: Orally administered contrast progresses rapidly through the bowel without evidence of obstruction or ileus. The appendix is visualized, nondilated, without evidence of inflammation.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Right ovarian follicle without evidence of hemorrhage.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 appendicitis or hemorrhagic ovarian cyst.2.Cholelithiasis without specific evidence of cholecystitis. Pericholecystic fluid is equivocal. If there is clinical concern for cholecystitis, right upper quadrant ultrasound would be recommended. |
Generate impression based on findings. | 54-year-old female with intracranial hemorrhage Brain CTA: There is opacification of the distal internal carotid arteries, the distal vertebral arteries and the proximal anterior middle and posterior cerebral arteries. No aneurysms or intracranial stenosis is appreciated. There are minimal calcifications of the cavernous carotid artery.The anterior communicating artery is not well visualized. The posterior communicating arteries are identified and are intact.CT head:Acute hematoma in the left basal ganglia is unchanged in size measuring 2.0 x 3 .6 cm, previously 1.9 x 3.4 cm. Minimal surrounding edema is unchanged. There is subtle regional mass effect with minimal (2 mm) rightward midline shift, unchanged. No intra-ventricular hemorrhage, extra-axial collections or new hemorrhage. There is slight mass effect on the frontal horn of the lateral ventricle, otherwise the ventricles are normal in size. A cavum septum pellucidum is noted.Mild periventricular hypodensity is unchanged and likely represents age indeterminate small vessel ischemic disease. No intracranial masses are identified. The pituitary gland appears prominent. Opacification of the left maxillary sinus with sinus wall thickening and extension into the middle meatus and middle turbinate is unchanged. The mastoid air cells are clear. The visualized portions of the orbits are intact. A frontal subcutaneous nodule is unchanged. | 1.Acute hematoma in the left basal ganglia is stable in size and likely hypertensive in etiology. There is mild local mass effect and minimal midline shift, unchanged. No aneurysms are identified.2.Mild age indeterminate small vessel ischemic disease.3.Opacification of the left maxillary sinus is unchanged and likely related to chronic sinus disease, however an underlying polyp cannot be excluded. |
Generate impression based on findings. | Female, 50 years old, history of leukemia with fevers and headache. The frontal sinuses and frontoethmoidal recesses are clear. The sphenoid sinuses and sphenoethmoidal recesses are clear. The ethmoid air cells are clear.The maxillary sinuses are free of significant mucosal thickening and debris. The maxillary outflow pathways are patent.The nasal septum is intact. The middle nasal turbinates are pneumatized. The nasal cavity is clear. | No evidence of active sinus disease. |
Generate impression based on findings. | Staging for new prostate cancer. CHEST:LUNGS AND PLEURA: Scattered micronodules should be followed. No dominant masses.MEDIASTINUM AND HILA: Small mediastinal lymph nodes. For reference purposes, a precarinal node measures 1.7 x 1.1 cm (image 38; series 3).CHEST WALL: A few bony sclerotic areas in the spine should be correlated with bone scan.ABDOMEN:LIVER, BILIARY TRACT: Redemonstrated multiple, scattered hypodense lesions in the liver. Some of the lesions are too small to accurately characterize. The reference lesion has enlarged and currently measures 1.4 x 1.4 cm (image 78; series 3).SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No evidence of renal stones. Unchanged bilateral subcentimeter hypodense lesions which most likely represent cysts. No evidence of hydronephrosis. Unchanged angiomyolipoma.RETROPERITONEUM, LYMPH NODES: Stable retroperitoneal adenopathy. The index left para-aortic node measures 1.5 x 1.1-cm (image 131; series 3).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Possible bony metastases. Correlate with bone scan.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostate gland remains heterogeneous and enlarged.BLADDER: No obvious wall thickening or a mural lesion arising from the bladder.LYMPH NODES: Stable pelvic adenopathy. The index necrotic left sided pelvic node measures 2.2 x 2.3 cm (image 170; series 3)BOWEL, MESENTERY: Perirectal adenopathy is again noted.BONES, SOFT TISSUES: Possible bony metastases. Correlate with bone scan.OTHER: No significant abnormality noted | Slight interval progression of disease with growth of reference liver metastasis. Adenopathy is roughly stable. Possible bony metastases; correlate with bone scan. Measurements are given above paired |
Generate impression based on findings. | Female, 70 years old, with headache and sinus pain. Head:Periventricular and patchy subcortical hypoattenuation is a non-specific finding which most commonly represents age-indeterminate small vessel ischemic disease.No intracranial hemorrhage or abnormal extra-axial fluid collection is seen. There is no evidence of mass effect or midline shift. The ventricles and basal cisterns are patent and normal in size. The bones of the calvarium and skull base are intact. Sinuses:The frontal sinuses and frontoethmoidal recesses are opacified, more so than on the prior exam. The sphenoid sinuses and the sphenoethmoidal recesses are clear. There is patchy opacification of the right ethmoid air cells in the vicinity of the ostiomeatal unit.The right maxillary sinus is partly filled with bony material demonstrating a groundglass morphology. The bones of the right maxillary alveolar ridge demonstrate a similar texture. The residual right maxillary sinus is completely opacified with soft tissue material and the outflow pathway is obstructed similar to prior. The left maxillary sinus is clear and the left maxillary outflow pathway is unobstructed.The nasal septum is intact. The nasal cavity is clear. The turbinates are unremarkable. | 1. Age indeterminate small vessel ischemic disease. No acute intracranial abnormality.2. Groundglass proliferative bony change involving the right maxillary sinus, similar to prior. This may represent fibrous dysplasia. The small residual right maxillary sinus remains completely opacified.3. Complete opacification of the frontal sinuses is also seen slightly progressed from the prior study. |
Generate impression based on findings. | 79-year-old male with altered mentation and dehydration. ABDOMEN:LUNG BASES: Subsegmental bilateral basilar atelectasis. LIVER, BILIARY TRACT: Cholelithiasis. No suspicious liver lesions.SPLEEN: No significant abnormality notedPANCREAS: Hypoattenuating lesion in tail of pancreas measures 1.4 x 1.1 cm; nonspecific but may represent a cystic pancreatic neoplasm such as IPMN (series 4, image 29).ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: A subcentimeter hypoattenuating focus in right kidney too small to characterize but most likely represents benign cyst (series 4, image 41).RETROPERITONEUM, LYMPH NODES: IVC filter noted. Extensive atherosclerotic changes in aorta with eccentric plaque in the partially visualized descending thoracic aorta and abdominal aorta; several foci of sharp and irregular plaque contour raise suspicion of ulceration (series 4, image 12, 14, 32).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Foley catheter in place. Air in bladder likely due to instrumentation.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Moderate amount of stool in the rectum. No bowel obstruction. No free fluid.BONES, SOFT TISSUES: Oval shaped, heterogeneous lesion in right buttock with internal areas of high attenuation most consistent with hematoma measuring 4.4 x 7.9 cm (series 4, image 108).OTHER: No significant abnormality noted | 1.Right buttock hematoma.2.Hypoattenuating lesion in tail of pancreas nonspecific but may represent cystic neoplasm such as IPMN.3.Extensive atherosclerotic changes in the aorta with eccentric plaque appearing sharply contoured in several areas, raising suspicion for ulceration.4.Cholelithiasis. |
Generate impression based on findings. | Reason: r/o worsening ILD History: dyspnea LUNGS AND PLEURA: Reticular, groundglass opacities with areas of mild honeycombing most prominent in the lower lungs is consistent with history of ILD and is not significantly changed from prior. Pleural thickening at the anterior aspect of the right lung is stable with new pleural thickening in the posterior right lung.Moderate upper lung predominant emphysema. No evidence of air trapping on expiratory images. Right lower lobe surgical changes noted. Left upper lobe granuloma.MEDIASTINUM AND HILA: Slight interval increase in prominent mediastinal lymph nodes with right paratracheal node measuring 12 mm (series 3 image 26), previously 10 mm. Severe LAD calcifications versus stent. Heart size within normal limits without pericardial effusion.CHEST WALL: Scattered calcifications within the thyroid are nonspecific. Mild multilevel degenerative changes in the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.Interval increase in posterior right lung pleural thickening.2.Stable interstitial lung disease pattern.3.Slight interval increase in mediastinal lymph node size. |
Generate impression based on findings. | 36-year-old female with a question of widened mediastinum on recent chest radiograph. CHEST:VASCULATURE: There is no evidence of aortic dissection or aneurysm. The thoracic aorta is otherwise unremarkable.LUNGS AND PLEURA: There is no evidence of focal consolidation, pleural effusion, or pneumothorax.MEDIASTINUM AND HILA: Note is made of a soft tissue density in the right paratracheal region, measuring 2.4 cm in the short axis, likely representing lymphadenopathy (30; series 3). There is a calcification in the inferior pole of the left lobe of the thyroid. Note is made of a prominent right hilar lymph node not enlarged by CT criteria.CHEST WALL: No significant abnormality noted.ABDOMEN:VASCULATURE: There is no evidence of aortic dissection or aneurysm. The abdominal aorta is otherwise unremarkable.LIVER, BILIARY TRACT: The patient is status post cholecystectomy. Surgical clips in the right upper quadrant.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is a subcentimeter hypodensity in the inferior pole of the right kidney which is too small to characterize, but may represent a simple cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Subcentimeter right adnexal lesion with peripheral high attenuation may represent a physiologic corpus luteal cyst. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. No evidence of aortic dissection or aneurysm.2. Nonspecific right paratracheal lymphadenopathy as described above. The differential diagnosis would include reactive lymphadenopathy, lymphoproliferative disorders, or metastatic disease. |
Generate impression based on findings. | Female, 30 years old, history of paraganglioma syndrome status post resection of bilateral carotid body tumors. Evaluate for abnormal masses. An enhancing left carotid space mass is reidentified measuring 3.3 x 2.2 cm (image 18 series 7), previously 3.2 x 1.8 cm. This lesion displaces the internal carotid artery medially, but the artery is patent throughout. The internal jugular vein fails to opacify above the level of this tumor similar to prior.An enhancing mass is present within the right carotid space which is somewhat difficult to distinguish from the immediately adjacent internal jugular vein but which probably measures about 1.2 x 1.0 cm (image 18 series 7). This lesion previously measured 0.8 x 0.6 cm.No pathologic adenopathy is detected in the neck by size criteria. The salivary glands and the thyroid are free of focal lesions. Except as above, cervical vessels are unremarkable. No concerning osseous lesions are detected. | Mild interval increase in size of bilateral carotid space masses. |
Generate impression based on findings. | 67 year-old female with colon cancer. Evaluate for metastatic disease. Polyps removed on colonoscopy 10/29/2013, one came back malignant in sigmoid colon. CHEST:LUNGS AND PLEURA: Bibasilar atelectasis. A right upper lobe micronodule is identified. Left upper lobe calcified focus is consistent with prior granulomatous disease.MEDIASTINUM AND HILA: A prevascular lymph node measures 1.1 x 0.7 cm.CHEST WALL: No significant abnormality noted.ABDOMEN: LIVER, BILIARY TRACT: Liver enhances homogeneously without evidence of focal lesion. Contracted gallbladder.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral renal cystsPANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic calcification of the abdominal aorta. No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted. A large filling defect of the descending colon likely represents stool given the recent history of colonoscopy.BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spineOTHER: Right thyroid nodule. | No evidence of metastatic disease, as clinically questioned. |
Generate impression based on findings. | Female 73 years old; Reason: bladder cancer with lung mets and retroperitoneal adenopathy please measure measurable lesions using recist criteria History: pre chemo ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Cholecystectomy clips. Nonspecific irregular shaped hypoattenuating focus in segment 8 of uncertain significance measures 1.1 x 0.7 cm on series 2 image 87. This does not appear to be hot on the PET scan of 9/11/13.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Nonspecific thickening left adrenal gland.KIDNEYS, URETERS: Status post left nephrectomy. Right kidney is normal.RETROPERITONEUM, LYMPH NODES: Retroperitoneal nodes and surgical clips seen within the region of the nodes in the left paraortic area. For baseline purposes the cluster of nodes measured on series 3 image 108/214, encompassing the clips, and measures 2.6 x 2.1 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Pulmonary metastasis. Retroperitoneal nodes. Status post left nephrectomy. Other findings as above. |
Generate impression based on findings. | 56-year-old male with tonsillar cancer CHEST:LUNGS AND PLEURA: Few scattered nonspecific micronodules.MEDIASTINUM AND HILA: Central venous catheter extends to the SVC. No mediastinal or hilar lymphadenopathy. Mild coronary arterial calcification. Small hiatal hernia.CHEST WALL: Right chest wall port.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 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.Small hiatal hernia.BONES, SOFT TISSUES: Age indeterminate compression fracture of L1.OTHER: No significant abnormality noted. | No evidence of metastatic disease. Age indeterminate L1 vertebral body compression fracture. |
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