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Generate impression based on findings. | Clinical question: Follow-up on hydrocephalus. Signs and symptoms: As above. Nonenhanced head CT:The examination demonstrates interval decreased size of the supratentorial ventricular system cyst exam. The trigone augments lateral ventricle which measured 30-mm in size on prior study has decreased to approximately 23 mm.Trigone of right lateral ventricle measured at 20-mm on prior exam has decreased to approximately 16.5 minute and on current study. Combined measurements of bilateral frontal horns at the level of foramen of Monro has decreased from 29-mm on prior study to 22-mm on current exam. A right-sided frontal approach ventricular catheter with the tip in the right frontal horn demonstrate no change. Parenchymal hemorrhage along the course of the right frontal catheter demonstrate no interval change.Dissecting acute hematoma in the left thalamus and is associated hemorrhage in the lateral, third and the fourth ventricle demonstrate no significant change. This hemorrhage also as was noted on prior exam extends inferiorly from the thalamus into the left cerebral peduncle and midbrain and the fourth ventricle without significant change.Extensive opacification and including air fluid level within the paranasal sinuses and extensive opacification of nasal passage and nasopharynx is secondary to intubation similar to prior exam. Bilateral mastoid air cells and middle ear cavities remain well pneumatized similar to prior exam. | 1.Interval decreased size of supratentorial ventricular system cyst right study.2.Stable acute hemorrhage in the left thalamus and dissection into the ventricular system as detailed.3.Stable intraventricular hemorrhage since prior exam. |
Generate impression based on findings. | Reason: rule out PE History: shortness of breath PULMONARY ARTERIES: Exam was repeated to improve contrast within the pulmonary arteries. Second exam was improved, however, remains limited with decreased contrast in the distal pulmonary arteries. Pulmonary embolism excluded to the level of the first bifurcation. More distally, there is less contrast and there are questionable filling defects in the left lower lung (series 10 image 166) and at the level of the bifurcation of the right interlobar artery (series 10 image 138).Main pulmonary is dilated which is non-specific and could be pulmonary hypertension or related to emboli. LUNGS AND PLEURA: Left lower lobe and lingular streaky opacities consistent with atelectasis versus scarring. No consolidation or pleural effusion.Mild bronchial wall thickening and scattered micronodules, nonspecific.MEDIASTINUM AND HILA: Heart size within normal limits. No lymphadenopathy.CHEST WALL: Moderate multilevel degenerative changes in the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality in this limited evaluation of the upper abdomen. | Questionable bilateral filling defects versus artifact, see description provided. Findings discussed with Dr. Shyy via telephone at 11:00 AM on 11/20/2013 by Dr. McCann. |
Generate impression based on findings. | Female 47 years old Reason: NF lesion- Large soft tissue mass which has both intraspinal and paraspinal/iliac fossa components, eval lesion for preop planning History: LE pain, weakness.Additional history from pathology report of 6/26/09 right pelvic mass malignant peripheral nerve sheath tumor grade 2. The exam is not sensitive for detecting lesions in the solid organs of vasculature due to the lack of intravenous contrast. Given that limitation, the following observations are made:ABDOMEN:LUNG BASES: Mass in the right posterior costophrenic region measured on series 4 image 18/148, 5.6 x 3.5 cm.This is also seen on the CT of 2/22/10 fluid measured 5.4 x 3.5 seen on series 2 image 39/112. On the 2/22/10 scan there was also a mass in the right lung base laterally which apparently resected with no evidence of recurrence of the mass. No other lung nodules are seen in the lung bases.LIVER, BILIARY TRACT: Cholelithiasis without biliary dilatation. No evidence of fatty liver or focal lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: 1.4 x 1.1 cm right adrenal mass, measures 43 Hounsfield units, most consistent with a metastasis. On the 2/22/10 CT which is contrast-enhanced is better visualized and measures 1.8 x 1.5 cm on series 2 image 51.The left adrenal gland is normal.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Mass inseparable from an enlarging the right psoas muscle that is seen in the pelvis.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: Calcified lesion 2.8 x 2.3 cm consistent with a fibroid series 4 image 105.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Mass-like enlargment of the right psoas muscle, measured for baseline purposes just below the pelvic inlet, series 4 image 75/148, 5.2 x 4.6 cm.A second mass in the right iliac fossa is measured on series 4 image 93, 5.9 x 4.1 cm. This mass extends caudally to the right groin.The aforementioned masses are also well seen on coronal series 8030 image 53/117. They abut each other and cause some mass effect on the right ureter but without causing hydronephrosis. There is loss of fat plane between iliac fossa mass in the abutting distal ileum on series 4 image 86OTHER: No significant abnormality noted | Right iliac fossa and right psoas masses.Stable right adrenal mass. Stable left posterior costophrenic angle mass. Status post resection of right lower lobe mass without evidence of recurrence.Cholelithiasis. |
Generate impression based on findings. | 54-year-old male with lung cancer CHEST:LUNGS AND PLEURA: Bilateral pleural effusions appear similar to the prior study. Postsurgical/radiation changes and volume loss in the right upper lobe are again noted. Right upper lobe atelectasis with improved aeration. New nodular opacity in the medial left upper measures 6 x 5 mm (image 43 series 5). Interval resolution of right lower lobe nodular opacities.MEDIASTINUM AND HILA: Small pericardial effusion. Coronary arterial and aortic calcifications.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Calcified splenic granuloma.ADRENAL GLANDS: A left adrenal nodule measuring 2.1 x 3.0 cm and previously measuring 1.7 x 2.2 cm is mildly increased in size (image 93, series 3).KIDNEYS, URETERS: Hypoattenuating lesions, too small to characterize, but likely representing cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the abdominal 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. Postoperative changes and atelectasis of the right upper lobe. 2. New left upper lobe nodule. This may be metastatic and continued follow-up is recommended. 2. Unchanged bilateral pleural effusions.3. Enlarging left adrenal nodule. |
Generate impression based on findings. | 56-year-old male with right tonsil cancer, pre-screening. Brain: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 suspicious contrast enhancement. Left frontal developmental venous anomaly.The orbits are unremarkable. Mild mucosal thickening of the right maxillary sinus, otherwise the paranasal sinuses and mastoid air cells are clear. Neck:Interval decrease in the size of a right palatine tonsil lesion which measures 1.6 x 1.2 cm (series 7 image 27), previously measured 2.4 x 1.6 cm. Right level 2a necrotic lymph node which abuts the submandibular gland and is inseparable from portions of the sternocleidomastoid muscle measures 3.5 x 3.0 cm (series 7 image 29), previously measured 3.5 x 3.0 cm. No additional pathologically enlarged by CT criteria lymph nodes are present.The oral cavity, oro/nasopharynx, hypopharynx, larynx and subglottic airways are unremarkable/patent. The epiglottis, vallecula, piriform sinuses, and vocal cords are normal. The parotid, submandibular, and thyroid glands are unremarkable. The carotid arteries and jugular veins are patent. Multilevel degenerative changes of the cervical spine without suspicious osseous lesions.Partially visualized right chest port catheter. The visualized lung apices are clear. Please see dedicated chest CT from today's date for further details. | 1. Interval decrease in size of right palatine lesion.2. No interval change in necrotic enlarged right level 2a lymph node.3. No intracranial metastases are present. |
Generate impression based on findings. | 54 year old female with shortness of breath, evaluate ILD LUNGS AND PLEURA:. Mosaic attenuation pattern with air trapping. Mild basilar predominant traction bronchiectasis and subpleural reticulation suggesting mild fibrosis. No honeycombing or groundglass opacities. Few small subpleural micronodules.MEDIASTINUM AND HILA: Mild coronary arterial calcification. The heart size is normal. No mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Postoperative changes in the stomach with small hiatal hernia. | Diffuse mosaic attenuation of the lungs with basilar predominant traction bronchiectasis and subpleural reticulation, compatible with small airways disease or possible hypersensitivity pneumonitis. |
Generate impression based on findings. | 47 year old female with malignant peripheral nerve sheath tumor, NF-1, evaulate for metastases. LUNGS AND PLEURA: Postsurgical changes in the right lower lobe with resection of previously identified nodule. Centrilobular and paraseptal emphysema.MEDIASTINUM AND HILA: Stable prominent left AP window mediastinal lymph node, unchanged since 2009. No hilar lymphadenopathy. CHEST WALL: Unchanged left posterior chest wall/pleural soft tissue, mass.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Small hypoattenuating right renal lesion likely represents a cyst. | Stable left paraspinal mass. No new sites of disease identified. |
Generate impression based on findings. | 77-year-old male with history of high grade ureteral cancer. ABDOMEN:LUNG BASES: Nodules in right middle lobe and right lower lobe are unchanged, suspected to represent intrapulmonary lymph nodes (series 6, image 9 and 15).LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Hypoattenuating lesion in head of pancreas measures 11 mm, unchanged (series 7, image 49); not specific but may represent IPMN.ADRENAL GLANDS: Nonspecific thickening of left adrenal gland unchanged. Right adrenal unremarkable.KIDNEYS, URETERS: Atrophic right kidney. Punctate calcifications in the renal hila bilaterally may represent vascular calcifications. No suspicious renal lesions identified.No hydronephrosis. No evidence of filling defects within collecting system on delayed images.RETROPERITONEUM, LYMPH NODES: Extensive atherosclerotic calcifications in aorta and its branches, with significant narrowing at celiac and SMA origins (sagittal series image 65). No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Extensive degenerative changes in the lumbar spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy.BLADDER: The distal left ureter appears to have been resected, with reimplantation into bladder. The pulled up portion of left aspect of bladder appears circumferentially thickened over length of 6 cm, with bladder wall thickness measuring approximately 6 mm; this may be postsurgical in nature and is likely not significantly changed since prior exam given difference in technique (coronal series 8084, image 42). LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Extensive degenerative changes in the lumbar spine.OTHER: No significant abnormality noted | 1.Postsurgical changes in distal left ureter and bladder. Circumferential thickening of pulled up portion of bladder wall may be post-surgical in nature and is likely not significantly changed since prior exam.2.No without evidence of metastatic disease.3.Stable hypoattenuating lesion in head of pancreas is not specific but may represent IPMN. |
Generate impression based on findings. | 59-year-old female with ARDS, cough, evaluate for infection versus ILD LUNGS AND PLEURA: Patchy bilateral groundglass and dense air space opacities with basilar consolidation. Bilateral small pleural effusions, right greater than left. No evidence of interstitial lung disease or cavitation.MEDIASTINUM AND HILA: Right intravenous catheter tip distends the cavoatrial junction. Cardiomegaly. ET tube 3 cm above the carina.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Enteric tube is coiled in the stomach.. | Patchy bilateral groundglass opacities and consolidation with small pleural effusions suspicious for aspiration/infection. No evidence of interstitial lung disease or cavitation. |
Generate impression based on findings. | Male 66 years old; Reason: please evaluate for recurrence of upper urinary tract cancer by performing a CT urogram without contrast first, then with IV contrast only, and last please perform delayed images History: s/p TURBT for bladder tumor, non-muscle invasive ABDOMEN:LUNGS BASES: No significant abnormality noted.Corner artery calcifications are identified.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Moderate fatty involution of the pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No evidence of mass, obstruction, or nephrolithiasis. Bilateral renal vascular calcifications identified. No filling defect of the ureters bilaterally.RETROPERITONEUM, LYMPH NODES: Moderate atherosclerotic calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: The bladder fills partially with contrast without evidence of mass.LYMPH NODES: Scattered, non-pathologically sized small lymph nodes in the pelvis.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No evidence of recurrence, adenopathy, or metastatic disease. |
Generate impression based on findings. | 62-year-old male with shortness of breath, evaluate ILD LUNGS AND PLEURA: Bilateral diffuse centrilobular nodules, septal thickening and subpleural reticulation. Bronchiolar wall thickening. No honeycombing or groundglass opacities. Air trapping at the bases.MEDIASTINUM AND HILA:. Moderate coronary arterial calcification. Scattered mildly prominent mediastinal lymph nodes. The heart size is normal..CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Small splenule. | Diffuse centrilobular nodules, septal thickening and bronchiolar wall thickening, compatible with small airways disease, which may be related to acute hypersensitivity pneumonitis or RB-ILD if there is a history of smoking. |
Generate impression based on findings. | Female 52 years old Reason: s/p 10 cycles of chemo. please evaluate for disease and compare with previous scans History: lung cancer. CHEST:LUNGS AND PLEURA: Reference irregular shaped left upper lobe mass extending and difficult to separate from the hilum, series 5 image 52, 4.9 x 1.9 cm. Previously 4.8 x 2.1 cm.Reference lobular ill-defined left lower lobe mass along the fissure, series 5 image 73 measures 4.4 x 2.3 cm. Previously 4.4 x 2.2 cm.Consolidation in the posterior costophrenic angle increased.MEDIASTINUM AND HILA: Reference pretracheal node measures 1.5 x 1.4 cm series 3 image 38. Previously 1.3 x 1 cm.CHEST WALL: Redemonstration of sclerotic vertebral body lesions.ABDOMEN:LIVER, BILIARY TRACT: Presumed hepatic cysts unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No hypodense lesion in the pancreatic neck unchanged.ADRENAL GLANDS: Right adrenal nodule ill-defined probably measures 1.4 x 1.4 cm series 3 image 100. Previously 2 x 1.7 cm.Left adrenal gland normal.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Surgical changes. No pathologic size lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multifocal sclerotic metastases in the vertebral bodies are unchanged.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Atrophic or surgically absent.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multifocal sclerotic metastases in the sacrum, iliac bones and right femur unchanged.OTHER: No significant abnormality noted. | No new sites of disease. Measurements as above.Increasing consolidation left lower lobe. |
Generate impression based on findings. | Clinical question: Evaluate for hemorrhage, mass/emboli. Signs and symptoms: AMS. Unenhanced head CT:No detectable acute intracranial process CT however is insensitive for early detection of acute non-hemorrhagic ischemic strokes.There are mild periventricular low attenuation of white matter which considering patient's stated age of 81 could represent age indeterminate small vessel ischemic strokes.Cortical sulci and ventricular system is less CSF spaces remains within normal for patient stated age.Mild bilateral cavernous carotid and intracranial vertebral artery calcification is noted.Calvarium and soft tissues of the scalp as well as orbits, visualized paranasal sinuses and mastoid air cells are unremarkable. | Mild age indeterminate small vessel ischemic strokes. |
Generate impression based on findings. | Clinical question: Evaluate for CVA: Signs and symptoms: Intermittent left-sided headache with right hand numbness for several days. Nonenhanced head CT:Examination demonstrate a focus of low-attenuation off the cortex and subcortical white matter of left occipital lobe with suggestion of subtle mass effect and effacement of recent cortical sulci. The finding is highly suspected of late acute to early subacute nonhemorrhagic ischemic stroke.Very minimal left hemispheric subcortical low attenuation of white matter is also suspected of age indeterminate small vessels ischemic strokes. Unremarkable exam otherwise.Unremarkable calvarium, soft tissues of the scalp, orbits, paranasal sinuses and mastoid air cells.The findings on this exam were reported by phone to Padela Assim # 9040 from the emergency medicine department at the time of review of the study. | 1.Late acute to early subacute left occipital cortical nonhemorrhagic stroke.2.Very minimal age indeterminate small vessel ischemic strokes is also suspected. 3.Unremarkable exam otherwise. |
Generate impression based on findings. | Male 29 years old; Reason: 29 y/o male with h/o crohn's colitis now with colon cancer noted on surveillance scope. Evaluate for metastasis. History: colon cancer ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted. No focal lesions to suggest metastatic disease.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: Patient's known colon cancer is not visible by CT. No pericolonic fat infiltration. No free or loculated intraperitoneal fluid. Small nodes in the right lower quadrant mesentery consistent with history of inflammatory bowel disease. The largest node measures 1.2 x 1.1 cm seen on coronal image 65.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Although oral contrast has not reached the distal ileum, all bowel appears normal with no evidence of wall thickening or fat stranding in the adjacent mesentery to suggest inflammation. May be some subtle submucosal fat deposition in the left colon consistent with a history of inflammatory bowel disease. No free or loculated intraperitoneal fluid.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No definite evidence of metastatic disease. Small nodes right lower quadrant mesentery may be related to history of inflammatory bowel disease. |
Generate impression based on findings. | Reason: r/o PNA; tumor burden History: DOE; SOB; cough LUNGS AND PLEURA: Large left pleural effusion with associated compressive atelectasis in the left lower lobe.Multiple bilateral pulmonary metastases, the largest of which in the left upper lobe measures 25 mm in diameter.MEDIASTINUM AND HILA: Right paratracheal, bilateral internal mammary and cardiophrenic angle lymphadenopathy compatible with metastatic disease.Anterior pericardial thickening or loculated effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Limited evaluation showing extensive abnormalities compatible with advanced metastatic disease, including ascites and a large gastric mass. There is also extensive peritoneal carcinomatosis and probable tumor involvement of the anterior abdominal wall.. Status post right nephrectomy and adrenalectomy. | Extensive metastatic disease but no sign of pneumonia. |
Generate impression based on findings. | Male, 25 years old, history of adenocarcinoma, with headaches. The cerebral and cerebellar hemispheres and brainstem are normal in attenuation and morphology. No masses or enhancing lesions are detected.No intracranial hemorrhage or abnormal extra-axial fluid collection is seen. There is no evidence of mass effect or midline shift. The ventricles and basal cisterns are patent and normal in size. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.The bones of the calvarium and skull base are intact. | Unremarkable evaluation. |
Generate impression based on findings. | 63 year old female with history of acute onset back pain. Rule out dissection. CHEST:LUNGS AND PLEURA: Air space opacities are present in the posterior right upper lobe which are suggestive of aspiration or possibly pneumonia. Bibasilar atelectasis/scarring is present. No pleural effusions.MEDIASTINUM AND HILA: Cardiomegaly is present appearing similar to the prior study. Postoperative changes of prior CABG and prosthetic mitral valve are again noted. ICD leads are present in the right ventricle and right atrial appendage. Severe coronary arterial calcifications are present. There is no pericardial effusion.Atherosclerotic calcifications of the thoracic aorta. No aneurysmal dilatation or dissection of the thoracic aorta is present.CHEST WALL: Sternal fixation hardware is again noted. An ICD generator is present in the left chest wall.ABDOMEN:LIVER, BILIARY TRACT: The visualized portions of the liver are normal in attenuation. No biliary ductal dilatation is present.SPLEEN: Heterogeneous attenuation of the posterior aspect of the spleen is felt to represent phase of contrast enhancement. No focal splenic lesions are identified.PANCREAS: The main pancreatic duct is mildly prominent. No focal pancreatic lesions are identified.ADRENAL GLANDS: The adrenal glands are symmetric in size and attenuation.KIDNEYS, URETERS: The visualized portions of the kidneys are normal in size and attenuation. There is no hydronephrosis evident.RETROPERITONEUM, LYMPH NODES: The visualized portions of the abdominal aorta are normal in caliber.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.No aortic dissection as clinically questioned.2.Right upper lobe airspace opacities may represent the sequela of aspiration or possibly pneumonia in the correct clinical setting. |
Generate impression based on findings. | Female, 63 years old, sinus drainage. The frontal sinuses are small and they, along with the frontoethmoidal recesses, are completely opacified. The right sphenoid sinus is opacified with obscuration of the sphenoethmoidal recess. The left sphenoid sinus is largely clear though the sphenoethmoidal recess is obscured. The ethmoid air cells are nearly completely opacified.The maxillary sinuses are partially opacified, left more than right, with hyperdense fluid/debris perhaps representing inspissated secretions. The maxillary outflow pathways are obscured by soft tissue thickening bilaterally. The walls of the maxillary sinuses are mildly sclerotic suggesting long-standing inflammation.The nasal septum is intact. The superior aspect of the nasal cavity is opacified but most of the nasal cavity is clear. The turbinates are unremarkable. | Significant mucosal inflammatory findings affecting multiple paranasal sinuses as discussed above. |
Generate impression based on findings. | 61-year-old male with history of head and neck cancer. Dysphagia and odynophagia. CHEST:LUNGS AND PLEURA: Punctate micronodules in right upper and middle lobes unchanged, likely benign in nature (series 5, image 64). Thickening along left major fissure unchanged, likely intrapulmonary lymph node. No new or suspicious nodules. No consolidation or pleural effusions.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Several punctate, subcentimeter hypodensities in the liver are unchanged, likely benign cysts. Ill-defined area of peripheral, wedge-shaped hyperenhancement most compatible with transient perfusion abnormality (series 3, image 96). No suspicious lesions identified.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Multiple hypoattenuating lesions in the left adrenal appear unchanged, compatible with adenomas. Right adrenal unremarkable.KIDNEYS, URETERS: Stable cyst in the inferior pole of right kidney.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy. Scattered atherosclerotic calcifications in aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No evidence of metastatic disease or findings to account for dysphagia. |
Generate impression based on findings. | Male 54 years old; Reason: peritoneal mesothelioma. please evaluate for disease and comapre with previous scan after 3 doses of immunotherapy. please use same reference lesions History: peritoneal mesothelioma CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: Numerous hypodense lesions in the liver have increased in number. Reference lesion in the right lobe measures 1.2 cm (series #3, image 91), previously measuring 0.8 cm. Progression likely represents worsening metastatic disease.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral hypodense cystic renal lesions are redemonstrated, grossly stable in size and appearance. Remain incompletely characterized, though suspicion for malignancy is low.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Moderate ascites and diffuse peritoneal thickening is redemonstrated, consistent with history peritoneal mesothelioma, and increased from prior study. No measurable lesion is identified. For reference, the peritoneal thickness at the level of the calcification near the umbilicus measures 1.8 cm.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Increased diffuse peritoneal thickening and ascites.2.Hypodense liver lesions are more numerous with interval growth of reference lesion in the right lobe, likely representing progression of metastatic disease.3.Bilateral cystic renal lesions remain incompletely characterized, though suspicion for malignancy is low. |
Generate impression based on findings. | Reason: pt with T1aNoMo 1A lung ca s/p RUL: wedge resection and also T3No 11B RLL lobectomy History: doing well now needs disease evaluation compare to previous scans and comment CHEST:LUNGS AND PLEURA: Left upper lobe part solid groundglass nodule measuring 25 x 14 mm, not significantly changed from the previous scan when using comparable measurements, but increased in density since 6/19/2012, highly compatible with primary adenocarcinoma (series 4 image 26).Elongated nodular opacity in the right lower lobe most likely a postsurgical scar, unchanged (series 4 image 48), but further follow-up is recommended.The previously described small anterior right upper lobe nodule has resolved.Postsurgical scarring and mild emphysema unchanged.Increased tree in bud opacity in the right lower lung anteriorly, suggestive of microaspiration and infection.MEDIASTINUM AND HILA: No significant lymphadenopathy.Severe coronary artery calcification.CHEST WALL: Postoperative findings in the right breast and chest wall as previously described.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: Very small right adrenal nodule unchanged.KIDNEYS, URETERS: Severe left hydronephrosis/hydroureter is again seen. The left kidney with severe cortical thinning. Hypodense lesion in the right kidney is unchanged and likely represents a cyst.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Aortic atherosclerosis.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. | Highly suspicious left upper lobe part solid nodule, increased in density since 2011 compatible with indolent primary adenocarcinoma. No evidence of metastases. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Male, 80 years old, neutropenic fever, history of fungal pneumonia, shortness breath, blurred optic disks and evidence of leukemic retinopathy, evaluate for an infiltrative or compressive lesion. Head:The cerebral and cerebellar hemispheres and brainstem are normal in attenuation and morphology. Within the limitations of a noncontrast examination, no mass or infiltrative process is seen.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 are clear. The frontoethmoidal recesses are also unobstructed, an improvement over the prior exam where the left frontoethmoidal recess was obstructed.Mucosal thickening/debris partially fills the left sphenoid sinus, improved from prior. The left sphenoethmoidal recess is obscured. The right sphenoid sinus is clear, an improvement over prior. The right sphenoethmoidal recess is patent. There is mild mucosal thickening through the ethmoid air cells but no significant mucosal inflammation.Peripheral mucosal thickening is evident within both maxillary sinuses, left more than right. On the left, this thickening has mildly improved. On the right, it is not significantly changed. The bilateral maxillary outflow pathways remain patent.The nasal septum is intact. The nasal cavity is clear. Pneumatization of the middle nasal turbinates is again seen. | 1. Within the limitations of a noncontrast head CT, no intracranial mass or infiltrative process is detected to account for the patient's symptoms.2. Mucosal inflammatory findings affecting several paranasal sinuses as above with some mild improvement from the prior exam. |
Generate impression based on findings. | 57 year old female with right hand numbness and unequal blood pressure in the upper extremities. VASCULATURE: No evidence of aortic dissection or aneurysm involving the thoracic or abdominal aorta. Mild calcification of the aortic arch. A focal dissection of the right common iliac artery is noted (series 12, image 197) without evidence of flow limiting stenosis. CHEST:LUNGS AND PLEURA: A 5-mm nodule is present in the right upper lobe (lung series, image 30). Additionally, scattered semisolid nodules are present (such as lung series image 21, 36, and 40) which are nonspecific. Bibasilar atelectasis/consolidation. MEDIASTINUM AND HILA: There is classical configuration the aortic arch without evidence of dissection or aneurysmal dilatation. The heart size is within normal limits. No pericardial effusion is present.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size and attenuation. No biliary ductal dilatation.SPLEEN: Heterogeneous attenuation of the spleen reflects phase of contrast. No focal splenic lesions are identified.PANCREAS: The pancreas appears within normal limits. No focal pancreatic lesions are identified.ADRENAL GLANDS: Symmetric in size and attenuation.KIDNEYS, URETERS: Subcentimeter left upper pole hypodensity too small to characterize but most compatible with a benign cyst. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy. BOWEL, MESENTERY: Submucosal fat attenuation within the wall of the cecum and proximal ascending colon may represent the sequela of chronic inflammation. Correlate with clinical history. No areas of active inflammation are identified. The visualized portions of the small bowel appear within normal limits.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Focal dissection of the right common iliac artery. No evidence of dissection of the thoracic or abdominal aorta. 2.5-mm pulmonary nodule and scattered semisolid nodules as described above, for which continued follow-up is recommended.3.Results were discussed with Dr. Skjei by phone at 12:15 p.m. |
Generate impression based on findings. | 77 year old female with bladder cancer. Baseline exam prior to starting new systemic oral therapy. Lack of IV contrast limits evaluation of solid organs and vasculature.CHEST:LUNGS AND PLEURA: Moderate centrilobular emphysema. Left upper lobe nodular opacity is unchanged and measures approximately 7 x 5 mm, previously measured 7 x 4 mm (series 6, image 20). Punctate micronodule in left lower lobe also unchanged. Left upper lobe cyst without evidence of nodular component appears unchanged (series 6, image 30).No new suspicious nodules.MEDIASTINUM AND HILA: Bilateral thyroid nodules. No mediastinal adenopathy. Severe coronary artery and aortic calcifications. Heart size within normal limits. Trace pericardial effusion unchanged.CHEST WALL: Multiple lytic and sclerotic lesions are again seen throughout the osseous structures; the majority of these appear not significantly changed however, lesion in T11 vertebral body appears more lytic compared to prior exam (sagittal series image 61).ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts; previously seen complex left renal cyst is not well evaluated on current exam due to lack of IV contrast but similar in size. Hyperattenuating lesion arising from left kidney and containing internal calcifications unchanged.No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Extensive atherosclerotic calcifications in aorta and its branches. No significant retroperitoneal adenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multiple lytic and sclerotic lesions throughout the osseous structures not significantly changed.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Multiple large calcified fibroids arising from the uterus.BLADDER: Nodular soft tissue in the left bladder base is again noted, most likely representing known bladder cancer (series 4, image 176).LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Large amount of stool in the rectum with associated laxity of pelvic floor.BONES, SOFT TISSUES: Large destructive sacral mass is difficult to accurately evaluate without IV contrast but appears mildly increased in size and measures 8.0 x 7.2 cm, previously measured 7.1 x 7.0 cm (series 4, image 162).Multiple other lytic and sclerotic lesions are seen throughout the osseous structures of the pelvis, some of which are also increased in size (series 4, image 134 and image 183).OTHER: No significant abnormality noted. | 1.Increase in size of several osseous metastases, the largest located in the sacrum.2.Nodular soft tissue in the left bladder base consistent with known bladder carcinoma.3.No significant change in left upper lobe lung nodule. |
Generate impression based on findings. | Neutropenic fever, history of fungal pneumonia (aspergillus). LUNGS AND PLEURA: Mild emphysema. Scattered air space opacities bilaterally slightly improved from previous, becoming more linear in appearance and slightly decreased in size. No new lesions. Mild dependent atelectasis at the lung bases.MEDIASTINUM AND HILA: Mild cardiomegaly. Native coronary arteries are heavily calcified. Numerous mediastinal clips. Left PICC tip at the SVC just cranial to the right atrium. No significant lymphadenopathy. Main pulmonary artery enlarged measuring 3.9-cm in transverse dimension, consistent with pulmonary hypertension. Atherosclerotic calcification of the aorta and its branches.CHEST WALL: Sternotomy wires. Left upper extremity PICC.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. Subcentimeter hypoattenuating lesion in the left hepatic lobe too small to characterize possibly a cyst, unchanged. | Slight improvement in pulmonary opacity is consistent with resolving fungal pneumonia. Signs of pulmonary hypertension. |
Generate impression based on findings. | Check for metastatic disease. Malignant neoplasm of lower limb LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Markedly enlarged bilateral thyroid with questionable numerous nodules, greater on the right. No lymphadenopathyCardiac coronary calcifications without interval change. Pericardium and cardiac appearance otherwise stable. Questionable small hiatal herniaCHEST WALL: Scattered thoracic degenerative changes without new suspicious lytic or blastic lesions observedUPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Persistent enlargement and nodularity of the left adrenal gland, incompletely visualized. | No evidence of pulmonary metastatic disease. Stable multinodular goiter |
Generate impression based on findings. | 55-year-old female patient with history of carcinoid of the lung status post resection. Doing well and needs disease evaluation. Please compare to prior scans. CHEST:LUNGS AND PLEURA: Postsurgical changes status post left upper lobectomy. Multiple pulmonary nodules are unchanged.Reference right upper lobe nodule measures 3 mm (series 5 image 18), unchanged.Reference right middle lobe nodule measures 6 mm (series 5 image 42), unchanged.Reference right lower lobe nodule measures 7 x 7 mm (series 5 image 52), previously unchanged.Additional right lower lobe nodule measures 7 x 7 mm (series 5 image 60), previously unchanged.Fat containing lesion in the left upper lobe is unchanged (series 5 image 36).MEDIASTINUM AND HILA: Cardiac size within normal limits without pericardial effusion. No mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Mild multilevel degenerative changes in the thoracic spine.OTHER: No significant abnormality noted. | No significant interval change in multiple pulmonary nodules. |
Generate impression based on findings. | 63-year-old female with metastatic breast cancer and worsening cough, restaging exam. CHEST:LUNGS AND PLEURA: Unchanged left upper lobe cyst with associated small nodule (image 37, series 5). Right apical post radiation changes and scar like opacity is unchanged (image 18, series 5).MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Nonspecific hypoattenuating left thyroid lesion.CHEST WALL: Status post right axillary lymph node dissection.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Hypoattenuating lesion adjacent to the gallbladder is increased in size, measuring 1.5 x 1.2 cm and previously measuring 0.6 x 0.5 cm. Additional hypoattenuating lesions, too small to characterize, are unchanged.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Enlarging hepatic lesion adjacent to gallbladder suspicious for metastatic disease. 2. Unchanged left upper lobe nodule.Findings discussed with Dr. Nanda (pager 2337) at the time of dictation. |
Generate impression based on findings. | S.O.B. Lung transplant evaluation. Idiopathic pulmonary fibrosis. LUNGS AND PLEURA: Suture line in the left lung base presumably from prior biopsy. Apical predominant emphysema, moderate to severe.Near circumferential subpleural reticulation, mild peripheral bronchiectasis/bronchiolectasis and honeycombing consistent with UIP. At the lung bases, there is mild superimposed groundglass opacity, left greater than right which is suggestive of NSIP. New 13 x 11 mm subpleural opacity in the posterior aspect of the left lower lobe. This cannot be identified on the prior examination, though comparison is difficult due to the thicker slice collimation on the outside examination (1 mm compared to 5-mm on the outside study). This lesion persists on prone positioning of the patient however it appears fairly flat on the sagittal images (series 8021, image 84), favoring scarring over neoplasia.Ovoid scarlike nodular opacity at the left lung base measuring 9-mm (4/49) probably unchanged. No pleural fluid or pneumothorax. Allowing for differences in technique, there is no significant change compared to the previous study.Expiration sequence shows only in minimal amounts of air trapping in the periphery of the right lower lobe near the costophrenic angle.MEDIASTINUM AND HILA: Main pulmonary artery measures approximately 3.1-cm in transverse dimension, consistent with pulmonary hypertension. Mild bilateral mediastinal and hilar lymphadenopathy appears slightly improved.Mild cardiomegaly. Native coronary arteries are heavily calcified. Right ventricle appears mildly dilated with straightening of the intraventricular septum, suggesting an element of right heart strain.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. 22 x 17 mm hypoattenuating lesion in the left hepatic lobe slightly increased in size compared to the previous examination where it measured approximately 18 mm in diameter. This is slightly hyperattenuating relative to simple fluid density. Additional subcentimeter hypoattenuating lesions in the liver are too small to accurately characterize but present previously. Cholelithiasis without signs of cholecystitis. | 1. Pulmonary fibrosis in a pattern compatible with UIP. In the left lung base superimposed groundglass opacity is suspicious for a component of NSIP.2. Mild mediastinal and hilar lymphadenopathy, slightly improved.3. Nodular opacities in the left lung, one of which may be new, appear flat and most likely reflect post inflammatory lesions or scar, these may be followed on the patient's subsequent exams for change, nonspecific.4. Incompletely characterized lesion in the left hepatic lobe incompletely characterized but most likely benign.5. Signs of pulmonary hypertension and enlarged right ventricle suspicious for right heart strain. |
Generate impression based on findings. | Reason: ILD protocol - abnormal PFTs; chronic RA - eval for ILD; recently worsening SOB History: as above; LUNGS AND PLEURA: Small subpleural scar like and nodular opacities in the lower lung zones but no evidence of diffuse interstitial lung disease.Mild bronchial thickening and no significant air trapping.MEDIASTINUM AND HILA: Soft tissue in the anterior mediastinum compatible with residual thymic tissue.No significant lymphadenopathy.No pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Mild bronchial thickening but no sign of diffuse interstitial lung disease. |
Generate impression based on findings. | Mesothelioma, follow-up CHEST:LUNGS AND PLEURA: Patient is status post a left pneumonectomy with placement of diaphragmatic mash overlying the diaphragm. Diffuse pleural thickening with mild nodularity is again observed it better identified as compared to prior study due to differences in technique. Overall gross stability compared to 9/3/13 and 11/8/12. The appearance is nonspecific and although possibly postsurgical thickening, recurrence is of concern, the reference measurements are as follows:1. At the level of the aortic arch (image 29 series 3), at 4 o'clock and 6 o'clock measuring 9 and 8 mm unchanged2. At the level of the pulmonary artery (image 36 series 3), the two o'clock and 7 o'clock lesions measuring 6 and 10 mm unchanged3. At the level of the left ventricle (image 52 series 3), a 7 o'clock measurement measures 6 mm unchangedThe right lung otherwise is clear other than minimal scattered micronodules. No effusion or suspicious central pulmonary abnormalitiesMEDIASTINUM AND HILA: No lymphadenopathyThe cardiac and pericardium are within limits other than a mild coronary calcifications. Minimal surgical clips in the left hilar region and artifact from a right central line. Midline sternotomy. Associated moderate right to left midline shift and volume loss within the left hemithorax.Small hiatal hernia suspectedCHEST WALL: Of particular note is questionable new tumor outside of the ribs involving the posterior left chest wall (image 63 series 3). This 2 x 1 cm focus is not clearly identified on prior studies, however this also may be partially due to differences in confusion and scan techniques.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Mild splenomegaly.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Status post left pleurectomy with diffuse residual and mildly irregular heterogeneous pleural thickening. Reference measurements are stable since 2012 grossly given differences in technique, see measurements provided. Of particular note however is the questionable new left chest wall tumor involvement not clearly identified on prior studies, again possibly secondary to differences in technique. |
Generate impression based on findings. | Reason: enlarged lymph nodes History: PET positive; possible surgical eval LUNGS AND PLEURA: Moderate bronchial thickening compatible with bronchitis. No sign of emphysema.Multiple micronodules compatible with a lymph nodes and previous infection.Focal subsegmental atelectasis in the lingula.No suspicious nodules.MEDIASTINUM AND HILA: Multiple small cysts and calcifications in the thyroid gland.Markedly enlarged lower right paratracheal lymph nodes measuring up to 17 mm in short axis diameter and moderately enlarged right hilar node.Calcified left hilar node compatible with previous infection.Moderately severe coronary artery calcifications.Small sliding hiatal hernia.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Enlarged right hilar and lower right paratracheal lymph nodes, but no suspicious pulmonary nodules. |
Generate impression based on findings. | Male, 61 years old, base of tongue cancer, surveillance scan. No mass effect, focal edema or suspicious enhancement is seen to suggest brain parenchymal metastatic disease. The bones of the calvarium and skull base are intact. A previously referenced enhancing focus at the left base of tongue is no longer discretely visualized on today's study. Hyperemia/edema of the base of tongue tonsillar tissues as well as of the supraglottic mucosa is again seen, slightly progressed. The left piriform sinus is effaced, more than on the prior exam.A left level 2 reference node measures 5 mm short axis (image 29 series 6), previously 8 mm short axis. No evidence of pathologically enlarged or progressing lymphadenopathy is seen.The salivary glands and thyroid are free of focal lesions. Cervical vessels remain patent. No concerning osseous lesions are detected. Degenerative disk disease is again seen at C3-4, C5-6 and C7-T1 with posterior disk-osteophyte complex formation. | 1. Increasing treatment related mucosal edema/hyperemia. The previously referenced left tongue base lesion is no longer distinctly visualized.2. Continued interval decrease in size of a referenced left level 2 lymph node. No pathologic or progressive adenopathy.3. No intracranial metastatic disease. |
Generate impression based on findings. | S.O.B. history lung infiltrates, history of active CA. Rule-out PE, further eval of multifocal lung lesions question pneumonia versus infarct versus mets. PULMONARY ARTERIES: Adequate infusion the study. No signs of pulmonary embolus.LUNGS AND PLEURA: Moderate left and small right pleural fluid collections with associated atelectasis mild emphysema. No visible pulmonary metastases.MEDIASTINUM AND HILA: Hiatal hernia. Small circumferential pericardial fluid collection. Left atrium is enlarged, increased in size compared to the prior examination with dilatation of the left atrial appendage. Left ventricle is also enlarged. Right jugular catheter tip in the right atrium. The esophagus appears to have very mild circumferential wall thickening, nonspecific as to the etiology. Mild stranding of the anterior mediastinal fat. Left brachiocephalic vein is unopacified however contains internal calcifications suggesting chronic thrombus, progressed compared to the previous examination. Enlarged 11-mm right cardiophrenic lymph node (11/205), unchanged.CHEST WALL: Right chest port. Bilateral axillary clips and signs of bilateral mastectomy. No significant lymphadenopathy. Mild subcutaneous fat stranding suggests anasarca. Anterior wedging of the T6 vertebral body present previously on a scan from 2009.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. Ascites. Thickening of the undersurface of the diaphragm consistent with known peritoneal carcinomatosis. | No evidence of acute pulmonary embolus. Moderate volume of pleural fluid with associated atelectasis but no specific signs of pneumonia and no visible pulmonary or pleural metastases. Left heart chambers are enlarged. Small pericardial fluid collection with mediastinal fat stranding and thickening of the esophagus suggestive of edema. Anasarca and ascites. Right cardiophrenic lymph node enlargement unchanged compared to the most recent examination but new compared to 5/15/13 and may be metastatic. |
Generate impression based on findings. | Shortness of breath and fever. History of RA, connective tissue disease and hypersensitivity pneumonitis. LUNGS AND PLEURA: Patchy areas of ground glass opacity associated with volume loss adjacent to lobular areas of sparing and air trapping are consistent with chronic hypersensitivity pneumonitis, slightly improved compared to the prior examination. Small subpleural lymph nodes adjacent to the fissures. No pleural fluid or pneumothorax. Mild peripheral bronchiectasis and bronchiolectasis. Suture line from prior wedge biopsy in the right upper lobe. Scattered septal nodular densities with angular margins are most consistent with intrapulmonary lymph nodes, probably unchanged.MEDIASTINUM AND HILA: Mild cardiomegaly. Atherosclerotic calcification of the aorta and its branches. Mediastinal lipomatosis. Mediastinum is slightly shifted rightward, unchanged. Interval resolution of subaortic and left paratracheal lymphadenopathy. Left hilar region lymph node also decreased in size, 9-mm compared to 12-mm previously (4/34). Hilar lymphadenopathy also stable to improved. Main pulmonary artery appears mildly enlarged but cannot be accurately measured due to motion artifact.CHEST WALL: Mild thoracic scoliosis.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. Cholecystectomy clips. No significant abnormalities. | 1. Mild improvement in the pulmonary opacities since the previous examination which may have represented postinfectious or postinflammatory change superimposed upon changes of chronic hypersensitivity pneumonitis. The appearance is only slightly worsened compared to the exam of 12/14/11 in the upper lung zones.2. Improvement in mild lymphadenopathy.3. Probable pulmonary hypertension.4. Mild subpleural reticulation is nonspecific in appearance but likely reflects previously biopsy proven component of UIP. |
Generate impression based on findings. | 44 year-old female with metastatic uterine cancer. Reason: Uterine leiomyosarcoma. Evaluate for progression. CHEST:LUNGS AND PLEURA: Postoperative changes of bilateral upper and lower lobe wedge resections. No suspicious nodules or masses are evident. No focal air space opacities or pleural effusions.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. No pericardial effusion.CHEST WALL: No axillary lymphadenopathy. Right chest port tip in the distal SVC.ABDOMEN: LIVER, BILIARY TRACT: No focal hepatic lesions. Normal appearance of the gallbladder.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Surgically absent. 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. | Stable examination without evidence of metastatic disease. |
Generate impression based on findings. | Female, 79 years old, high-grade carotid stenosis on duplex ultrasound. Periventricular hypoattenuation is a non-specific finding which most commonly represents age-indeterminate small vessel ischemic disease.No intracranial hemorrhage or abnormal extra-axial fluid collection is seen. There is no evidence of mass effect or midline shift. The ventricles and basal cisterns are patent and normal in size. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. The bones of the calvarium and skull base are intact.Imaging through the neck is significant for multiple thyroid nodules which would be better assessed on ultrasound. Severe degenerative disk disease is seen at C6-7 with loss of the disk space and bulky posterior osteophyte formation. The facet complexes through the cervical spine are largely fused and there may be fusion of the vertebral bodies at the the uncovertebral joints.ANGIOGRAPHIC | 1. Atherosclerotic narrowing at the origin of the right ICA with approximately 50% stenosis by NASCET criteria. The origin of the right ECA is also moderately narrowed.2. Atherosclerotic narrowing at the origin of the left ICA with approximately 60% stenosis by NASCET criteria.3. Few scattered areas of mild to moderate intracranial vascular narrowing as above.4. Incidental note is a focal outpouching off the communicating segment of the right ICA. This could represent an aneurysm or infundibulum. Given that no discrete vessel is seen arising from the apex of this outpouching, an aneurysm is favored.5. Multiple thyroid nodules for which ultrasound would provide a better assessment. |
Generate impression based on findings. | Male 57 years old; Reason: eval fluid collections, duodenal obstruction. History: gastric outlet obstruction, high G tube output. ABDOMEN:LUNG BASES: Bilateral pleural effusions with compressive atelectasis are stable.LIVER, BILIARY TRACT: No focal hepatic lesions. Pneumobilia is again noted. A metallic CBD biliary stent is unchanged in position, extending to the duodenum. Air is again noted within the gallbladder.SPLEEN: No significant abnormality notedPANCREAS: Loculated fluid collection containing gas abutting the uncinate process of the pancreas contains a drain and has decreased in size and now measures 1.5 x 3 cm (image 57, series 3). The inferior extension of this collection along the paracolic gutter measures 1 x 1.5 cm (image 92, series 3). The heterogeneously attenuating collection superior to the drain abutting the inferior surface of the liver is slightly smaller (image 51, series 3). Status post placement of a pigtail drainage catheter. ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left simple cyst is again noted. Moderate right hydronephrosis persists similar to the prior study, likely related to partial ureteral obstruction from adjacent inflammatory fluid collection. Extensive perinephric fluid collections are stable when compared to previous, with loculated fluid collections along the posterior aspect of the right kidney. Symmetric renal cortical enhancementRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post removal of the NG tube. There is stable positioning of an enteric tube in the jejunum. Postsurgical changes from prior duodenojejunostomy.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Skin staples in the abdominal wall midline have been removed. PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Overall mild improvement with decrease size of multiple fluid collections. 1. Mild interval decrease in size in right perinephric fluid collection with stable placement of percutaneous drain.2. Smaller size of the heterogeneous collection superior to the drain, and inferior to the liver/gallbladder containing hemorrhage and foci of gas, with stable placement of pigtail catheter. |
Generate impression based on findings. | Male; 83 years. Reason: Pt is an 83 y/o male with metastatic prostate cancer, evaluate for worsening disease History: met prostate cancer, rising PSA CHEST:LUNGS AND PLEURA: Stable postsurgical changes in the left hemithorax. Left apical bullae. Mild emphysema and groundglass opacities are unchanged. Stable micronodules.MEDIASTINUM AND HILA: Coronary calcifications. Stable borderline enlarged mediastinal lymph nodes, some of which are calcified. CHEST WALL: Bones are diffusely demineralized, with innumerable sclerotic metastases, slightly progressed compared to prior.ABDOMEN:LIVER, BILIARY TRACT: Mild nodular gallbladder wall thickening with wall calcifications come unchanged compared to prior. SPLEEN: Hypoattenuating lesion in the posterior aspect, unchanged. Calcified granulomata.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable renal cysts.RETROPERITONEUM, LYMPH NODES: Moderate vascular plaque.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Bones are diffusely demineralized, with innumerable sclerotic metastases, slightly progressed compared to prior.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Nodular enlarged prostate.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Bones are diffusely demineralized, with innumerable sclerotic metastases, slightly progressed compared to prior.OTHER: No significant abnormality noted | Diffuse osseous metastases, slightly progressed compared to prior. |
Generate impression based on findings. | Retroperitoneal mass (probable sarcoma) appears to be communicating with abdominal wall on OSH CT scan. Need CT to clear chest. Cough. LUNGS AND PLEURA: Mild bronchial wall thickening and scattered small foci of emphysema. Faint diffuse centrilobular groundglass opacity bilaterally with an upper zone distribution. Few subtle centrilobular nodules, 1 to 2-mm in size. No pleural fluid or pneumothorax.MEDIASTINUM AND HILA: Normal heart size. Atherosclerotic calcification of the coronary arteries. Mild thickening of distal esophagus near the GE junction, nonspecific. No significant lymphadenopathy.CHEST WALL: Scattered small axillary lymph nodes are nonspecific in appearance. Pin or screw in the left scapula, the head of the object is located approximately a 13-mm anterior to the cortex; correlate with surgical history. Although not included in the scanning range there are several small low cervical lymph nodes present bilaterally measuring up to 6-mm.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. The anterior aspects of the left hemidiaphragm is thickened measuring 5-mm ( sagittal image 90). Mildly enlarged portocaval lymph node, 12-mm (3/24). | 1. No specific evidence of pulmonary metastases. 2. Diffuse centrilobular/peribronchiolar groundglass opacities in the result of hypersensitivity pneumonitis or drug reaction in the appropriate clinical setting. Respiratory bronchiolitis is considered less likely as the appearance is atypical but may be considered if the patient is a current smoker. Given history of malignancy, comparison with remote outside examinations may be of use if they can be obtained and submitted by the referring clinical service. If no outside exams are available, short term CT follow-up in 2 to 3 months is suggested to exclude other etiologies and assess for resolution.3. Thickening of the left hemidiaphragm incompletely assessed; metastatic disease cannot be entirely excluded.4. Small lymph nodes in the neck and a mildly enlarged portocaval lymph node are nonspecific. |
Generate impression based on findings. | Neuroblastoma. CHEST:LUNGS AND PLEURA: Stable appearance of micronodules of the lungs as well as right middle lobe non-dependent atelectases. Bibasilar atelectasis has are normal no visualizedMEDIASTINUM AND HILA: Right paratracheal subcentimeter lymph node is no longer visualized. Left subclavian central line again noted. No pericardial effusion. Mild distal esophageal dilatation and mucosal enhancement.CHEST WALL: Recent irrigation of multiple thoracic spine vertebral bodies metastases.ABDOMEN:LIVER, BILIARY TRACT: No focal liver lesions or intra-or extrahepatic biliary duct dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Status post left atherectomy. Normal right adrenal glandKIDNEYS, URETERS: Stable right-sided grade 2 hydronephrosis.RETROPERITONEUM, LYMPH NODES: Stable retroperitoneal mass containing calcifications and encasing the celiac artery and SMA as well as partially the aorta as well. Previously described mass is measuring 4.75 by 2.69 cm in two dimensions (image 55, series 5) and appears to be unchanged.BOWEL, MESENTERY: Diffuse bowel enhancement and duodenum dilatation as well as stable ascites is noted as well. Since last examination a round calcific density foci located at the right lower abdominal quadrant (image 83, series 5) is noted and may represent appendicolith, less likely phlebolith or foreign body.BONES, SOFT TISSUES: Multifocal sclerotic and lucent lesions are again seen in the spine.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Distended bladder with no bowel wall thickening.LYMPH NODES: Please refer to the abdominal paragraphBOWEL, MESENTERY: Please refer to the abdominal paragraphBONES, SOFT TISSUES: Please refer to the abdominal paragraphOTHER: No significant abnormality noted | Retroperitoneal abdominal mass unchanged.Stable multiple osseous metastases.Right hydronephrosis.Diffuse bowel edema mainly from the esophagus to the distal duodenum.Stable lung micronodules and atelectasis of the right middle lobe. |
Generate impression based on findings. | Female 79 years old; Reason: atypical carcinoid, evaluate for progression CHEST:LUNGS AND PLEURA: Post surgical changes from prior left lower lobectomy, stable.Reference right lower lobe ground glass of solid nodule abutting the fissure is unchanged in size, measuring 5 mm (series 5/image 49).Right lower lobe atelectasis/scarring appears similar to prior exam.MEDIASTINUM AND HILA: Mild cardiomegaly is unchanged. No pericardial effusion. Coronary artery calcifications. Stable borderline mediastinal lymph nodes.CHEST WALL: Degenerative changes in the spine.ABDOMEN: Absence of IV contrast material markedly limits sensitivity forabdominal pathology. LIVER, BILIARY TRACT: Bilobar, hypodense hepatic metastases appear slightly enlarged. For example, index lesion in the lateral segment left lobe of the liver measures 3.6 x 3.2, previously 2.6 x 3.0cm (series 3 image 86). Other non-reference lesions appear larger. Lack of IV contrast limits the exact measurement.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Ill-defined left renal hypodensity measures water density is stable in size, now measuring 2.2 x 1 .8 cm, previously 2.0 x 2.3 cm (series 3, image 98). This has enlarged since 5/11 in which it measured 1.4 x 1.1 cm. This does measure near water density and may represent a benign enlarging cyst, however without IV contrast, definitive characterization cannot be made and exclude neoplasm -- Dedicated renal imaging with IV contrast could characterize this lesion as clinically warranted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the abdomen.BOWEL, MESENTERY: No gross abnormalities noted.BONES, SOFT TISSUES: Severe degenerative changes in the lumbar spine.OTHER: No significant abnormality noted. | 1. Persistent right lower lobe sub-solid ground glass nodule in which is unchanged in size. This is compatible with diagnosis of metastatic atypical carcinoid.2. Interval increase in the size and conspicuity of the hepatic metastases.3. Left renal hypodensity enlarging over two year period -- Consider dedicated renal imaging as clinically warranted. |
Generate impression based on findings. | 84 year old female. Reason: Please assess for hydronephrosis and bowel obstruction. NO PO OR IV contrast History: rising creatinine, nausea, vomiting ABDOMEN:LUNG BASES: Stable cardiomegaly and pericardial effusion. Left lower lobe consolidation / volume loss. Atelectasis at the right lung base. LIVER, BILIARY TRACT: Stable cholelithiasisSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: New moderately severe bilateral hydronephrosis and hydroureter. Stable renal cystsRETROPERITONEUM, LYMPH NODES: Stable abdominal aortic aneurysm.BOWEL, MESENTERY: Right lower quadrant parastomal hernia with multiple bowel loops. There is no associated abnormal dilatation of the urinary reservoir. New partial small bowel obstruction with decompressed colon. Transition is at or near the ostomy site. NG tube with distal tip in the stomach. BONES, SOFT TISSUES: No significant abnormality notedOTHER: Abdominal aortic aneurysm at the iliac bifurcation measures 4.5 cm in diameter.PELVIS:UTERUS, ADNEXA: Uterus absent or atrophicBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Decompressed colon due to SBO. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Parastomal hernia is probable site of new partial small bowel obstruction.Interval resolution of moderately severe bilateral hydronephrosis and hydroureter Interval resolution of obstruction and distention of urinary reservoir. Infrarenal fusiform abdominal aortic aneurysm with 4.5 cm diameter. |
Generate impression based on findings. | Lung cancer, follow-up CHEST:LUNGS AND PLEURA: The spiculated large right lower lobe nodule remains 2.5 x 1.3 cm (image 65, series 4) unchanged when measured similarly. Associated pleural thickening along the adjacent fissures and pleural surfaces. Reference pleural thickening measurement remains 4 mm (image 66 series 3) unchanged given differences in patient breathing and gantry angle. No effusions. No new intrapulmonary abnormalitiesMEDIASTINUM AND HILA: Stable lymphadenopathy, the reference prevascular lymph node (image 21 series 3) remained unchanged at 12 mm. Stable cardiophrenic lymph nodes and borderline lymphadenopathy. Calcified hilar and subcarinal lymph nodes unchanged.The cardiac and pericardium remain within limits. Minimal coronary calcificationsCHEST WALL: Stable internal mammary chain lymphadenopathy on the right. Right axillary clipsABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Splenic granulomaADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small stable left renal cystsPANCREAS: 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. DiverticulosisBONES, SOFT TISSUES: Moderate degenerative changes without interval change or findings to suggest metastatic diseaseOTHER: No significant abnormality noted. | Interval stability in the reference lymphadenopathy and right lower lobe spiculated nodule. |
Generate impression based on findings. | Male 75 years old; Reason: L PV thrombus, hemangioma - please follow up; evaluate for PSC (cannot obtain MRI due to pacer) History: ulcerative colitis ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Left portal vein thrombosis is identified. A contiguous dilated umbilical vein also does not fill likely due to extension of thrombosis. Caliber of left portal vein is narrower one compared with the prior study, suggesting retracting chronic clot. No intra-or extrahepatic biliary ductal dilatation.A 5.7 x 3.9 cm segment two lesion demonstrates nodular peripheral arterial enhancement with progressive fill-in on portal venous and delayed images, characteristic of a hemangioma.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple right renal cyst is identified. A hypoattenuating subcentimeter cystic lesion of the left kidney is too small to further characterize.Bilateral accessory arteries are incidentally noted.RETROPERITONEUM, LYMPH NODES: Moderate atherosclerotic calcification of the abdominal aorta and its branches is noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Grade 1 anterolisthesis of L5 on S1.OTHER: No significant abnormality noted. | 1.Left portal vein thrombosis with likely extension into dilated umbilical vein.2.No evidence of PSC, as clinically questioned.3.Unchanged segment two hepatic hemangioma.4.Grade 1 anterolisthesis of L5 on S1. |
Generate impression based on findings. | 70 year-old female with unstable angina and prior CABG Exam limited in evaluation of vasculature due to the lack of IV contrast.LUNGS AND PLEURA: Bilateral pleural effusions. Multiple bilateral scattered ground glass nodular opacities. Mosaic attenuation.MEDIASTINUM AND HILA: Marked coronary arterial calcification. LAD stent. Status post CABG. Moderate atherosclerotic calcifications of the thoracic aorta. Right central venous catheter tips at the cavoatrial junction. Aortic and mitral valve annular calcifications.CHEST WALL: Sternal fixation devices. Bilateral subclavian stents.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Cholelithiasis. Atherosclerotic calcification of the abdominal aorta and its branches. | Status post CABG. Marked coronary arterial calcifications. Without intravenous contrast evaluation of the vasculature is limited. |
Generate impression based on findings. | 17 year-old male evaluate mass at posterior mandible, patient has nasopharyngeal lymphoma, just completed radiation therapy, tender Limited intracranial and orbital views are unremarkable. The visualized paranasal sinuses and mastoid air cells are clear.No mandibular masses are present but there are prominent submandibular space lymph nodes on the right. The underlying mandible is intact.Borderline enlarged cervical bilateral level IIa lymph nodes. The largest is a right 2a lymph node which measures 1.2 x 1.6 cm (series 4 image 31). The submandibular, parotid and thyroid glands are within normal limits. No exophytic mass or focal effacement of the aerodigestive tract. No soft tissue masses are present in the neck. The major cervical vasculature is patent bilaterally.Residual thymic tissue similar to the prior. The visualized lung apices are clear. Partially visualized left central venous catheter. No suspicious osseous lesions are present. | 1. Borderline enlarged level 2a lymph nodes, some of which appear fuller than on the prior examination.2. Prominent right submandibular space lymph nodes. |
Generate impression based on findings. | Follow-up lung cancer status post chemo RT for hilar recurrence. Remote history of breast CA. CHEST:LUNGS AND PLEURA: Postsurgical changes of a left lower lobectomy and left upper lobe wedge resection.Interval worsening of groundglass opacities and micronodules in the paramediastinal left upper lobe extending from the apex to the level of the aortic arch. Subtle associated septal thickening in this area. This most likely represents bronchiolitis with superimposed radiation pneumonitis.Numerous new peripheral semicircular or wedge-shaped areas of groundglass opacity are seen bilaterally, with poorly defined margins and internal regions of intralobular septal thickening but no discrete cavitation. Previously seen left upper lobe lesion at the level of left main pulmonary artery is unchanged measuring 14-mm in long axis (4/113). Spherical nodules in the right upper lobe near the level of the takeoff of the bronchus intermedius are similar in size measuring 5-mm (4/111, unchanged) and 10 x 10 mm compared to 9 x 10 mm (4/112). The larger groundglass lesion has developed and a peripheral solid nodular component along its lower margin (5/39). A few tree in bud opacities with peripheral groundglass are present in the right upper lobe abutting the minor fissure (5/42).No pleural fluid or pneumothorax.MEDIASTINUM AND HILA: Improved amount of minimal thrombus in situ in the distal left main pulmonary artery. Adjacent lymphatic tissue appears improved as the lymphatic tissue at the left lower lobe bronchial stump is now aerated, previously occluded. Summation of wall thickness is is approximately 8mm compared to 12-mm previously (3/41).Left hilar lymphatic tissue at the bifurcation of the left main bronchus is also subjectively improved. Interval development of mild mediastinal pleural thickening adjacent to the descending thoracic aorta which could be related to radiation therapy (3/24).Calcified mediastinal lymph nodes are unchanged.CHEST WALL: Bilateral mastectomy with prostheses in place. Small internal mammary chain small vascular structure or less likely lymph nodes are unchanged, too small to accurately characterize. Clip or calcification in the left lateral chest wall below the axilla.High right axillary lymph node slightly smaller, 7-mm compared to 9-mm previously (3/4).ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Granuloma.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Cortical thinning left kidney. Large calculus measuring 8 x 17 mm in the collecting system and proximal ureter with surrounding the soft tissue inflammatory change similar to previous. Subtle increase in size of a subcentimeter cortical lesion atypical in density for a cyst measuring 7 mm, previously 6-mm (3/07). Left lower pole calculus unchanged.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the aorta and ostium of the left renal artery.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: L4 vertebral body hemangioma.OTHER: No significant abnormality noted. | 1. Interval development of several ground glass nodules most consistent with radiation pneumonitis.2. Numerous micronodules in the left upper lobe are suspicious for bronchiolitis due to infection or inflammation. Micronodules from endobronchial spread of tumor are considered unlikely.3. Improvement in mild lymphadenopathy.4. Right upper lobe nodules suspicious for adenocarcinoma and left upper lobe lesion not significantly changed. |
Generate impression based on findings. | 62 year-old female with serous ovarian cancer, and soft tissue sternal mass CHEST:LUNGS AND PLEURA: Moderate left and trace right pleural effusions. Multiple nodules along the pleura are now compatible with metastatic disease. For reference, large lesion in the right measures 5-mm (7/149). Right basilar scarring.MEDIASTINUM AND HILA: Numerous subcentimeter soft tissue nodules in the pericardial and epicardial fat are presumably metastatic and unchanged. Mildly enlarged left hilar lymph node is new from previous (image 42, series 401). No pericardial fluid, however pericardial nodularity is noted. Right chest port tip at the SVC.CHEST WALL: Small left cervical lymph node incompletely included in the scanning range. Subcutaneous soft tissue lesion adjacent to the skin surface in the posterior left shoulder (image 9) unchanged. An enlarged left axillary lymph node measures 12 mm short axis, previously 11-mm.Several left parasternal and anterior intercostal soft tissue nodules extend along the fascial planes anterior and posterior to the left sternum causing thickening and nodularity. Some of the lesions extend through the bony thorax and cause mass effect upon the medial aspect of the pectoralis and intercostal musculature (images 36 and 51). Largest lesion measures 3.3 x 2.7 cm (image 51), previously 3.3 x 2.4 cm.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Hypoattenuating hepatic lesion likely represents a cyst. Status post cholecystectomy. No new hepatic lesions. The previously described right posterior hepatic surface lesion is no longer measurable.SPLEEN: Small splenule.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Studding of the mesentery consistent with peritoneal carcinomatosis, unchanged. Numerous small mesenteric lymph nodes, about the same. Soft tissue nodule adjacent to the gastric antrum unchanged.BONES, SOFT TISSUES: Right lower abdominal wall port with catheter extending within the peritoneum. Nodularity of the peritoneum, consistent with metastatic disease. Soft tissue nodules within the rectus sheath on the left (image 81) may been present previously, now visible. Nearby subcentimeter soft tissue nodules in the subcutaneous fat as well as intramuscular nodules of the left anterior abdominal wall are also larger, visible previously only given the benefit of retrospect (axial series soft tissue windows images 75-95)Degenerative changes of the thoracolumbar spine.OTHER: Enhancing soft tissue nodule in the pre-hepatic space and soft tissue nodules anterior to the liver at the level of the transverse colon (image 111) are unchanged. | 1. Bilateral pleural metastatic disease with extension to the chest wall and epicardium. Although no pericardial effusion is present, studding of the pericardium is highly suspicious for pericardial metastatic disease.2. Left hilar and axillary lymphadenopathy.3. Peritoneal and mesenteric metastases.4. Spread of tumor along the rectus sheath on the left. |
Generate impression based on findings. | Female, 54 years old, intracranial hemorrhage. Left basal ganglia acute hematoma has not significantly changed in size or morphology. On axial images, the hematoma measures 3.9 x 1.8 cm. As before, there is minimal surrounding parenchymal edema and minimal regional mass effect in the form of a sulcal effacement and slight effacement of the left lateral ventricle.No new intracranial hemorrhage is demonstrated. Periventricular hypoattenuation is a non-specific finding which most commonly represents age-indeterminate small vessel ischemic disease.The bones of the calvarium are intact. The visualized left maxillary sinus remains opacified. | Stable left basal ganglia parenchymal hematoma. No new hemorrhage is seen. |
Generate impression based on findings. | Male, 59 years old, intense headache photophobia, vomiting. Periventricular and scattered white matter 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 visualized paranasal sinuses and mastoid air cells are normally pneumatized. The bones of the calvarium and skull base are intact. | 1. No acute intracranial abnormality or other specific findings to account for the patient's symptoms.2. Mild age indeterminate small vessel ischemic disease. |
Generate impression based on findings. | cervicalgia There are several nodules present in the soft tissues of the lower neck . There is no convincing evidence for parathyroid adenoma. There is a nodule to the right of the trachea at the level of the thoracic inlet which stands out but follows contrast uptake similar to lymph node Houndsfield units through nodules (0seconds, 25 seconds, 55 seconds, 85 seconds):(37.9HU, 58.4HU, 61.64HU, 72.96HU)CT neck:Within the suprahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated. Within the infrahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated.Within the visceral space the thyroid gland appears intact.The airway appears patent.The visualized intracranial structures which include the posterior fossa are intact. The visualized portions of the orbits and paranasal sinuses are intact. The mastoid air cells are clear. There is mild mucosal thickening in the right maxillary sinus. The ethmoid air cells are clear. The frontal sinuses partially included on this exam and are clear to the extent of visualization.The parotid and the submandibular glands appear intact.The visualized lung apices demonstrate a 10 mm nodule in the right lung which is calcified in a "popcorn" pattern.The carotid and vertebral vasculature visualized on this exam appears intact.The cervical vertebral bodies in general are intact with no evidence for canal stenosis. The patient is status post C5-C6 anterior fusion with bone plug. There is mild facet hypertrophy present on the right side at C5-6.There is a right sided large anterior osteophyte at C6-7 adjacent to foramen transversarium with a pseudoarthrosis appearance.There is an old T1 spinous process fracture present.There is a bone island along the left mandible. | 1.Status post anterior fusion at C5-6. There is no evidence for spinal stenosis or neural foramen encroachment in the cervical spine.2.There are large right sided anterior osteophytes at C6-7 with a pseudoarthrosis appearance.3.Calcified nodule in the right lung most likely represents a granuloma in the absence of a known primary malignancy.4.It is not clear why a contrast enhanced 4D CT was performed rather than a non contrast CT of the cervical spine. An addendum, will be provided when additional information becomes available. |
Generate impression based on findings. | Female 75 years old; Reason: patient with history of urothelial cancer, s/p 3 cycles of chemotherapy, please assess for disease progression History: urothelial cancer CHEST:LUNGS AND PLEURA: Few micronodules are noted throughout the lungs, largest in the lingula measuring 4 mm (series 5 image 42). Pleural spaces are clear.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Too small to characterize hypoattenuating lesion in segment 7.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: 4.3 cm cystic lesion measuring water density noted in pole right kidney. No hydronephrosis, mass lesion, or perinephric fluid collections technique.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: S-shaped scoliosis noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Enlarged lymph node measuring 0.9 x 2.1 cm (series 3 image 180) is noted adjacent to the mass. No distant adenopathy detected..BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: 4.8 x 3.8 cm heterogeneous mass is noted in the expected location of the ureterovesicular junction. | 4.8 x 2.8 cm mass at the UV junction, worrisome for urothelial carcinoma with likely satellite lymph node. No distant metastatic disease detected. |
Generate impression based on findings. | 60 year-old female with history of chest pain. Evaluate for dissection. VASCULATURE: Note that arterial phase imaging was only acquired in the chest due to technical malfunction during image acquisition. Allowing for these limitations, no aortic aneurysm or dissection is identified.Moderate coronary calcifications are noted along the left anterior descending coronary artery.Mild atherosclerotic calcifications are noted along the aortic arch and distal abdominal aorta and its branches with poorly visualized mural thrombus.The left common carotid artery arises from the brachiocephalic trunk, a normal anatomic variant.CHEST:LUNGS AND PLEURA: Mild centrilobular emphysema. Bibasilar dependent atelectasis.MEDIASTINUM AND HILA: Enlarged heterogeneous nodular left thyroid lobe. Mildly heterogeneous right thyroid lobe. Prominent mediastinal lymph node measuring 1.2 cm in short axis. The heart size is within normal limits. No pericardial effusion is present.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Postoperative changes of cholecystectomy are present. A plastic biliary stent is noted in the distal common bile duct and extending into the proximal duodenum with its tip just to the left of midline. The proximal common bile duct is mildly dilated. Foci of gas are noted within intrahepatic biliary system compatible with can be seen in the setting of stent placement.SPLEEN: Multiple hypodense foci are noted in the spleen, the largest in the inferior spleen measuring 1.3 cm in diameter (series 13, image 139). These foci are incompletely evaluated on this examination due to the suboptimal contrast enhancement.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Contrast opacifies the collecting system compatible with delayed phase of contrast administration at the time of image acquisition. No renal lesions are identified.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy is present.BOWEL, MESENTERY: A plastic biliary stent is noted in the distal common bile duct and extending into the proximal duodenum with its tip just to the left of midline. BONES, SOFT TISSUES: Moderate facet arthropathy at the L4-L5 level. OTHER: No significant abnormality noted. | 1.Suboptimal evaluation as arterial phase imaging was only acquired in the chest due to technical malfunction during image acquisition. Allowing for these limitations, no aortic aneurysm or dissection identified.2.A plastic biliary stent is noted in the distal common bile duct and duodenum of unclear clinical indication. Correlate with the patient's clinical history.3.Hypoattenuating nonspecific splenic foci which are incompletely evaluated on this examination.4.Atherosclerotic coronary and aortic calcification as described. |
Generate impression based on findings. | 42 year old male. Hypercholesterolemia. Clinical trial. Reason: rule out cad. History: chest pain. Calcium Score:LM: `0LAD: 0LCx: 0RCA: 0Total: 0, This represents the 0% for this patient's age and gender.CARDIAC | 1. Normal ventricular volume and morphology.2. No significant coronary artery disease.3. Total Calcium score was 0; 0% for age and gender. |
Generate impression based on findings. | Female 63 years old; Reason: eval for abdominal mass History: tender supraumbilical mass. Patient has history of sarcoidosis. ABDOMEN:LUNGS BASES: Posterior mediastinal adenopathy is partly imaged, with a large calcified lymph node and a second enlarged lymph node measuring 2.0 x 1.1 cm.LIVER, BILIARY TRACT: Innumerable subcentimeter round, well-defined, hypodense liver lesions are appreciated. Likely represents hepatic sarcoid, given the patient's history of sarcoidosis. Metastatic disease or lymphoma are far less likely differential considerations.SPLEEN: Multiple round, well-defined, hypodense splenic lesions are seen. While non-enlarged, the spleen demonstrates interval increase in size.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Prominent lymph node identified in the gastric ligament measuring 2.7 x 1.2 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Innumerable hepatic and multiple splenic hypodense lesions likely representing sarcoidosis, given the patient's clinical history. Lymphoma and metastatic disease are far less likely differential considerations. |
Generate impression based on findings. | Female, 63 years old, neck pain status post cervical fusion. Posterior spinal fusion hardware is redemonstrated including bilateral transpedicular screws at C1 and C2. These are fixed with bilateral stabilization rods. As before, there is evidence of mild lucency surrounding the C2 screws which could reflect loosening. The appearance is similar to prior.Fracture through the dens remains visible and similar to prior. Alignment of the fracture fragments is unchanged. No definite evidence of C1-C2 bony fusion is yet seen. Amorphous bone graft material is evident along the posterior elements through these levels.No evidence of new fracture or acute malalignment is seen. There remains a grade 1 anterolisthesis of C3 relative to C4. Posterior disk osteophytic complexes are also redemonstrated at all levels most conspicuously affecting C3-4, C5-6 and C6-7. Scattered neuroforaminal narrowing is again seen most severely affecting C5-6 on the right. | 1. Posterior spinal fusion hardware is redemonstrated at C1 and C2. Mild lucency surrounding the C2 screws persists and is similar to prior. No other evidence of hardware complication is seen.2. Fracture through the dens remains visible. Alignment of the fracture fragments is unchanged.3. Multilevel degenerative disk disease is unchanged. |
Generate impression based on findings. | Lung cancer, follow-up. CHEST:LUNGS AND PLEURA: Stable upper lobe scarring with staples unchanged. The residual area of presumed scarring in the left upper lobe and towards the hilar region remains 1.3 cm in similar measurement (image 30 series 5). Diffuse emphysema without additional new suspicious nodules or effusion.MEDIASTINUM AND HILA: No lymphadenopathySevere coronary artery calcification without additional pericardial or cardiac abnormalityCHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Absent gallbladder and suspected cholecystectomy. Liver otherwise unremarkableSPLEEN: No significant abnormality noted.ADRENAL GLANDS: Mildly enlarged left adrenal gland without discrete nodule or mass, unchanged. Right adrenal unremarkableKIDNEYS, URETERS: No significant abnormality noted.PANCREAS: Stable small pancreatic neck discrete hypoattenuation, probable cyst. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No evidence of local recurrence or metastatic disease |
Generate impression based on findings. | 73-year-old female patient with interstitial lung disease, aortic stenosis with worsening shortness of breath. Evaluate for pulmonary embolism. PULMONARY ARTERIES: No evidence of pulmonary embolism to the subsegmental level.LUNGS AND PLEURA: Slight interval increase in subpleural, predominantly basal reticulation and septal thickening.Upper lobe honeycombing and basilar traction bronchiectasis is not significantly changed. Moderate centrilobular emphysema. Two right lung suture lines secondary to previous biopsies. Mild basal airtrapping on expiratory images, stable.There is a new 1.3-cm subpleural nodule in the left upper lobe(series 7 image 33). In the right upper lobe lesion measuring 1.1 cm (series 7 image 38). MEDIASTINUM AND HILA: Enlarged mediastinal lymph nodes, reference prevascular lymph node measures 1.4 cm (series 6 image 90), previously 13mm when remeasured, not significantly changed compared to prior examination. Distribution is somewhat atypical given the presence of posterior compartment lymphadenopathy.Cardiac size within normal limits. Severe coronary artery calcifications.CHEST WALL: Multilevel degenerative changes in the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Atherosclerotic changes in the abdominal aorta. | Interval worsening of pulmonary fibrosis due two new nodular lesions. Correlate for signs of infection. Follow-up CT in 3 months recommended.No evidence of pulmonary embolus.No significant change in lymphadenopathy, however pattern is somewhat atypical, correlate for possibility of lymphoma. |
Generate impression based on findings. | Reason: evaluation of R-sided pleural effusion s/p PleurX drain placement History: right sided diffuse chest pain with coughing LUNGS AND PLEURA: Interval reduction in the large right-sided pleural effusion with placement of a right Pleurx catheter at the right lung base.Consolidation and atelectasis involving the right middle and lower lobes.Diffuse septal thickening and nodularity throughout the visualized right lung.Some debris identified in the bronchus intermedius.The left lung is clear.MEDIASTINUM AND HILA: Mediastinal lymphadenopathy unchanged.Cardiac enlargement with small moderate pericardial effusion similar in appearance to prior exam.Large pulmonary artery compatible with pulmonary to hypertension.Severe coronary artery calcification.CHEST WALL: Healing anterior bilateral rib fractures.Left chest Port-A-Cath with its tip in the SVC.Sclerotic foci in multiple vertebrae compatible with metastatic disease.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Stable right adrenal nodule. | 1.Interval placement of a right Pleurx catheter with significant decrease in right pleural effusion.2.Consolidation/atelectasis in the right middle and lower lobes with diffuse nodular septal thickening throughout the visualized right lung.3.Stable lymphadenopathy.4.Stable sclerotic foci within multiple vertebrae and healing bilateral anterior rib fractures.5.Stable adrenal nodule.6.Cardiomegaly with persistent small pericardial effusion. |
Generate impression based on findings. | Male 41 years old; Reason: h/o HNC, CRT, compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality noted. Numerous axillary lymph nodes noted on previous PET scan are not enlarged by CT criteria.OTHER: ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: 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 noted. Numerous inguinal nodes seen on previous PET scan are not enlarged by CT criteria.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.No evidence metastatic disease. |
Generate impression based on findings. | Female, 84 years old, history of stroke, evaluate for carotid stenosis. Fairly extensive periventricular and patchy white matter hypoattenuation is seen likely indicating age indeterminate small vessel ischemic disease. There are patchy areas of lucency in the thalami and the cerebellum likely representing a combination of acute evolving stroke (as seen on recent MRI) and age indeterminate small vessel ischemic disease.The sulci and ventricles are prominent particularly in the parietal and temporal regions compatible with volume loss. No intracranial hemorrhage is seen. No mass effect is detected.The calvarium is intact and unremarkable. The paranasal sinuses and mastoid air cells are clear.Imaging through the neck is significant for scattered hypodense thyroid nodules. There is also evidence of degenerative disk disease at multiple levels in the cervical spine.ANGIOGRAPHIC | 1. 60% atherosclerotic stenosis at the left ICA origin.2. 60% stenosis of the right cavernous ICA. Mild stenoses affect the left cavernous ICA.3. Fusiform dilatation of the post stenotic ophthalmic segment of the right ICA with a luminal caliber measuring up to 8 mm.4. Severe atherosclerotic disease of the vertebro-basilar system. The distal V4 segments show only thready opacification, and the basilar artery fails to opacify from its origin to just proximal to the SCAs. 5. The bilateral PCAs are of small caliber and difficult to follow distally.6. Scattered mild to moderate focal stenoses affecting the more distal ACA and MCA vessels. |
Generate impression based on findings. | 74-year-old female with shoulder dislocation. Evaluate for glenoid fracture. Glenohumeral joint alignment is within normal limits. There is a joint effusion. A 14-mm ossific density anterior inferior to the glenoid and a 5-mm ossific density inferior to the glenoid are consistent with Bankart fracture fragments. There is also a small Hill-Sachs deformity. | Bankart fracture fragments and small Hill-Sachs deformity. |
Generate impression based on findings. | Right upper lobe nodule, check for lung cancer LUNGS AND PLEURA: Stable mildly spiculated subcentimeter nodule in the right upper lobe (image 23 series 6) remaining 6 x 8 mm. The finding remains adjacent to a small cyst or bulla unchanged.The other benign-appearing pulmonary and micro-nodules and calcified granulomas are all unchanged. Moderate centrilobular emphysema. No effusions.MEDIASTINUM AND HILA: Stable 1.8-cm precarinal lymph node. No additional new lymphadenopathy.Large central pulmonary arteries with an enlarged diameter measuring up to 4.1 cm (image 37 series 5), essentially unchanged. The cardiac and pericardium are otherwise significant for moderate calcifications and a small pericardial effusion anteriorly.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Benign-appearing left adrenal nodule partially visualized on the last image. No additional abdomen is observed in the upper abdomen in this limited evaluation | Essentially stable right upper lobe peripheral nodule adjacent to a cyst. Again given the size, serial follow up imaging is recommended in a high risk patient at 9 to 12 months from original detection. |
Generate impression based on findings. | 80 year-old female patient with tachycardia and fever. Evaluate for lung mass seen on chest x-ray. Exam limited by patient movement.LUNGS AND PLEURA: Lobulated solid mass in the left upper lobe along the major fissure measures 3.7 cm (series 4 image 18). There is an irregularly shaped lesion in the right upper lobe that measures 9 mm (series 4 image 34).Additional mass in the left lower lobe abutting the descending thoracic aorta. Mild bronchiolitis on the right.MEDIASTINUM AND HILA: Bilateral hilar lymphadenopathy. On the left this causes compression of the proximal lobar airways. A subcarinal lymph node measures 14 mm.Mild to moderate coronary artery calcifications versus stent. Scattered atherosclerotic calcifications.CHEST WALL: Soft tissue lesion extending from the area of the thyroid into the mediastinum (series 3 image 10). The lack of IV contrast limits complete evaluation of this lesion and is most likely a nodule arising from the third gland. Multilevel spinal stenosis due to osteophytes and ossification of the posterior longitudinal ligament.Scattered sclerotic lesion in the spine, largest lesion is in L2 vertebral body.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Cholelithiasis. | 1. Multiple pulmonary nodules and masses may represent fungal pneumonia if the patient is neutropenic. However, the metastatic disease cannot be excluded without follow-up CT. Recommend follow-up in 6 weeks.2. Mediastinal and hilar lymphadenopathy3. Sclerotic skeletal lesions, one of which appears atypical in for degenerative change and may be a metastases. |
Generate impression based on findings. | Male 42 years old; Reason: abd pain, guarding, rule out intra abd process History: abd pain, distension ABDOMEN:LUNGS BASES: Heart size is enlarged. Cardiac pacer leads.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No nephrolithiasis or hydronephrosis in either kidney.RETROPERITONEUM, LYMPH NODES: Stable retroperitoneal lymph nodes mostly within the pelvis. For example, a left common iliac lymph node measures 1.2 x 0.8cm previously 1.3 x 0.9 cm (image 103/series 3). No retroperitoneal hematoma.Abdominal aorta is normal in caliber.BOWEL, MESENTERY: Small bowel is normal in caliber. Appendix is normal in caliber in the right lower abdomen without surrounding inflammatory changes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: Interval placement of a Foley catheter with decompressed bladder..LYMPH NODES: Multiple small pelvic and inguinal nodes.BOWEL, MESENTERY: Small ventral abdominal hernia containing a loop of small bowel without obstruction, unchanged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Normal caliber of the abdominal aorta without retroperitoneal hematoma.2.No findings of appendicitis.3.No renal or ureteral calculi.4.Multiple small pelvic and retroperitoneal lymph nodes which are abnormal in number. |
Generate impression based on findings. | Tachycardia. Check for PE. Chest pain. PULMONARY ARTERIES: Adequate contrast enhancement of the pulmonary arterial system. No findings to suggest pulmonary embolusLUNGS AND PLEURA: Small bilateral pleural effusions greater on the left. Moderate central lobular emphysema with scattered micronodules. Specifically no focal intrapulmonary nodules or masses. Minimal basilar atelectasis on the left.MEDIASTINUM AND HILA: A large anterior lobulated mass with extension from the thoracic inlet inferiorly. Direct invasion to the pericardium is suspected. The mass measures 10.4 by 9.9 cm (image 153 series 7) with moderate mass displacement of the mediastinal structures posteriorly. Specifically the right pulmonary artery is compressed and the mass is indistinguishable from the great vessels including the descending aorta and portions of the pulmonary trunk.Of particular note is a small punctate gas collection anterior to the aortic arch in the anterior mediastinum (image 99 series 7). This is of uncertain significance or source and likely from the IV placement with gas in a small collateral vein (discussed with Dr Funaki who agrees).No discrete lymphadenopathy yet small lymph nodes are observed in the anterior pericardial fat of uncertain significance.Moderate pericardial effusion yet the thickening is largely of soft tissue density. The cardiac outline is otherwise grossly intact unremarkable.Small hiatal hernia.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Scattered suspected hepatic cysts. No additional upper abdominal abnormality this limited evaluation. | 1. Massive anterior mediastinal mass with questionable invasion of critical adjacent structures, see detailed provided. Concern for an invasive malignant thymoma or lymphoma in the absence of additional sites of involvement. 2. The small focus of gas likely represents gas in a collateral from the IV access. |
Generate impression based on findings. | Clinical question: Evaluate for intracranial pathology. Signs and symptoms: AMS. Nonenhanced head CT:No detectable acute intracranial process, CT however he is insensitive for early detection of acute nonhemorrhagic ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system and CSF spaces for patient of stated age of 70.Unremarkable calvarial, soft tissues of the skull, paranasal sinuses, mastoid air cells and partially visualized orbits. | Unremarkable nonenhanced head CT. |
Generate impression based on findings. | Clinical question: Patient fell and hit head head, please evaluate for abnormalities. Signs and symptoms: Headache. Unenhanced head CT:No detectable acute posttraumatic intracranial, calvarial or soft tissues of the scalp findings.Unremarkable cerebral cortex, cortical sulci, ventricular system and the CSF spaces for patient of stated age of 33.Unremarkable calvarium and soft tissues of the scalp.Unremarkable orbits.On the right side is a sinuses and bilateral mastoid air cells and middle ear cavities remain well pneumatized. | No acute posttraumatic findings. |
Generate impression based on findings. | Clinical question: Intracranial hemorrhage. Signs and symptoms: As above. Nonenhanced head CT:No convincing evidence of any new hemorrhage or increased previously known hemorrhage since prior study. Hypertensive hematoma in the left thalamus with extension inferiorly through the left cerebral peduncle and into the fourth ventricle remains similar to prior exam.There is a slight interval further decrease in the size of the supratentorial ventricular system with a stable right frontal approach ventricular catheter.Slight interval decrease in the intraventricular hemorrhage since prior exam in the right lateral ventricle.Findings a age indeterminate small vessel ischemic strokes grossly similar to prior study.Stable hemorrhage along the course of right frontal approach ventricular catheter. | 1.Further decreased size of supratentorial ventricular system.2.No convincing evidence of any change of hypertensive hemorrhage in the left thalamus and its extension.3.Several interval decreased hemorrhage in the right lateral ventricle and stable intraventricular hemorrhage otherwise.4.Stable hemorrhage along the course of the right frontal ventricular catheter. |
Generate impression based on findings. | 57-year-old female with CLL with enlarging stomach mass. Question of tumor burden. CHEST:LUNGS AND PLEURA: The numerous pulmonary nodules have decreased in size and conspicuity bilaterally with the reference nodule in the left lower lobe measuring 0.5 cm previously 0.7 cm in series 6 image 70.MEDIASTINUM AND HILA: The extensive mediastinal adenopathy has also decreased in the interim. For example, reference pretracheal node measures 0.8 x 0.5 cm (image 29 series 4) previously 3.5 x 3.1 cm. Interval resolution of the numerous cardiophrenic nodes.CHEST WALL: The previously seen axillary adenopathy is markedly decreased, with none enlarged by CT standards.ABDOMEN:LIVER, BILIARY TRACT: There is a hypodense, subcentimeter lesion within segment IVa of the liver which is too small to characterize although stable.SPLEEN: There is a stable splenic artery pseudoaneurysm measuring 1.5 cm with peripheral calcifications at the splenic hilum.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Too small to characterize lesions on the kidneys bilaterally. Peri-pelvic cysts bilaterally.RETROPERITONEUM, LYMPH NODES: A the extensive previously seen retroperitoneal adenopathy has markedly decreased in the interim. For example, reference lymph node near the celiac trunk previously measured 3.6 x 5.9 cm, now 1.5 x 1.3 cm. All other non-reference adenopathy has also decreased with interval resolution of the large mesenteric conglomerate mass..BOWEL, MESENTERY: Hiatal hernia. 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: The previously seen diffuse lymphadenopathy within the pelvis has markedly decreased. For example, reference left inguinal lymph nodes measures 3 x 0.9 cm, previously 2.9 x 5.3 cm (image 175, series 3).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Marked interval decrease in the diffuse lymphadenopathy of the chest, abdomen, and pelvis. |
Generate impression based on findings. | Clinical question: Fall rule hematoma size. Signs and symptoms: As above. Unenhanced head CT:Stable acute left hemispheric basal ganglia hematoma measuring at 39 times 20 mm size in its transaxial dimensions. Very subtle surrounding vasogenic edema is noted without change.No significant mass effect or midline shift. Grossly stable findings of age indeterminate small vessel ischemic strokes.Stable normal size of ventricular system and without evidence of intraventricular hemorrhage. | Stable acute left basal ganglia hematoma with minimal surrounding edema and no appreciable mass effect or midline shift. |
Generate impression based on findings. | 57-year-old female patient with history of lung cancer presented with chest pain and shortness of breath. Evaluate for pulmonary embolus. PULMONARY ARTERIES: Good quality study with no pulmonary embolus to the subsegmental level. There is attenuation of the left upper lobe artery secondary to tumor encasement.LUNGS AND PLEURA: Left upper lobe spiculated, stranding mass measures 3.8 x 2.3 cm (series 10 image 39), consistent with patient's known primary lung cancer. Multiple scattered nodules bilaterally consistent with metastatic disease. Right upper lobe with bronchial wall thickening and nodular opacities, suggestive of inflammation versus peribronchial spread of cancer. Right lower lobe focus of ground-glass opacity (series 10 image 77) is likely inflammatory in nature.Bilateral moderate pleural effusions, left greater than right.MEDIASTINUM AND HILA: Large pericardial effusion, new compared to chest film on 11/2/13.Prominent pretracheal node measuring 1.2 cm (series 7 image 74).CHEST WALL: Right-sided port with catheter tip at the cavoatrial junction. No sclerotic osseous foci.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.No evidence of a pulmonary embolus.2.New large pericardial effusion.3.Mass in the left upper lobe with scattered nodules consistent with metastatic cancer.4.Bilateral moderate pleural effusions.5.Foci of bronchial thickening and nodular opacities in the right upper lobe likely inflammatory in nature. |
Generate impression based on findings. | 64-year-old female with flank pain, hematuria, history of renal stones. Evaluate for nephrolithiasis, diverticulitis, pyelonephritis ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: The gallbladder is surgically absent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No evidence of renal calculi, perinephric stranding, or perinephric fluid collection, or hydronephrosis. The previously identified left lower pole calculi are not seen on this exam, limited in evaluation of nephrolithiasis due to administration of contrast.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Orally administered contrast passes quickly through the bowel without evidence of obstruction or ileus. No evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Complex, heterogeneous low-density collection versus mass in the uterine cavity has markedly grown in size. First noted 8/29/2011 and relatively stable in size through previous exam dated 9/24/2013. May represent an obstructing lesion in the cervix or cervical stenosis of benign etiology with proximal obstructive changes, or alternatively may represent a diffuse infiltrating endometrial carcinoma. BLADDER: Small pocket of air identified. Correlate with history of recent instrumentation. Tiny bladder calculi likely represent passed previously seen kidney stones.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.Tiny bladder calculi likely represent passed stones.2.No evidence of diverticulitis, perinephric stranding or fluid collection, or nephrolithiasis, as clinically questioned, though contrast exam is limited in detection of small stones.3.Significant interval growth of uterine lesion. May represent obstructive changes due to cervical stenosis from benign or neoplastic etiology. Alternatively, may represent diffuse infiltrating endometrial neoplasm. Close follow-up with transvaginal ultrasound would be recommended next step if imaging evaluation would be helpful. |
Generate impression based on findings. | Clinical question: Status post TPA. Signs and symptoms: Status post TPA. Nonenhanced head CT:No evidence of acute intracranial process in particular no evidence of hemorrhage is detected. CT is insensitive for early detection of acute nonhemorrhagic ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and grade I right-sided differentiation. | No acute intracranial process. |
Generate impression based on findings. | Facial trauma. There is a skin defect in the left upper lip, consistent with a laceration. There is nearly horizontal fracture of ADA 9 with pulp exposure. There are also carious ADA 18 and 32 with associated periapical lucencies. There is no evidence of radio-opaque foreign body or nasal fracture. The paranasal sinuses are clear. The orbits appear to be intact. The partially imaged intracranial contents are grossly unremarkable. | 1. Laceration of the left upper lip with associated fracture of ADA 9, but no evidence of nasal fracture or radio-opaque foreign body.2. Carious ADA 18 and 32 with associated periapical lucencies that may represent abscesses. |
Generate impression based on findings. | -year-old female with peritoneal dialysis catheter placement 11/14 -- bleeding around catheter. 3-g hemoglobin drop. Evaluate for intra-abdominal bleeding. Abdominal pain, nausea. Within the limits of a non-IV contrast-enhanced examination which limits ability to evaluate solid organ parenchyma and vascular structures, the following observations can be made:ABDOMEN:LUNG BASES: Bibasilar atelectasis.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No change is noted in the right lower pole renal mass lesion, which now has some mild increased density, which may represent small hematoma or calcification developing. Mass size is unchanged (1.9 x 2.3 cm) (series 3, image 64).No other significant abnormalities or changes seen. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Peritoneal dialysis catheter appears to have similar course as demonstrated on 5/9/13 examination. Small amount of free scattered peritoneal fluid is seen, but no loculations of fluid are seen. Scattered pinpoint foci of air are seen. The peritoneal space come, most likely relating to peritoneal dialysis procedures. No evidence of any sizable fluid collections were high density collection seen to suggest hematoma.No intrinsic abnormality seen in the intestinal tract.BONES, SOFT TISSUES: No significant abnormality noted -- no evidence of any abnormal collections about the course of the dialysis catheter through the subcutaneous fat.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Peritoneal dialysis catheter appears to have similar course as demonstrated on 5/9/13 examination. Small amount of free scattered peritoneal fluid is seen, but no loculations of fluid are seen. Scattered pinpoint foci of air are seen. The peritoneal space come, most likely relating to peritoneal dialysis procedures. No evidence of any sizable fluid collections were high density collection seen to suggest hematoma. Small and large bowel appear normal.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Peritoneal dialysis catheter with expected course and appearance without evidence of abnormal fluid collections to suggest complication or hematoma. 2. No change in appearance of right lower pole small renal mass. |
Generate impression based on findings. | Female 65 years old; Reason: Metastatic cervical cancer on chemotherapy with decline in performance status. Evaluate for progression. History: Fatigue, generalized weakness. CHEST:LUNGS AND PLEURA: Slight interval increase in size and conspicuity bilateral pulmonary metastases. Although there is decrease in the reference right middle lobe nodule (image 51; series 4) which measures 9 x 7 mm previously 9 x 8 mm numerous other left apical joules are new or have grown in the interim. For example nodules measuring 6 and 5 mm in the left apex were previously not seen, (series 4 image 25. Numerous other non-reference nodules are new or have markedly grown since the previous, including a left lingular pleural-based nodule (series 4 image 59). MEDIASTINUM AND HILA: Stable left thyroid nodules. Replaced right subclavian artery. Stable to slightly improved mediastinal adenopathy. For reference purposes, a node interposed between the aorta and left main stem bronchus (image 43; series 3) measures 1.5 x 1 .4 cm, previously 2.0 x 2.0 cm.CHEST WALL: The right-sided chest Port-A-Cath is stable.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis. No focal hepatic lesion.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Stable right adrenal nodule measuring 2.2 x 1.6cm previously 2.3 x 1.6 cm (series 3, image 89). Left adrenal gland is normal. KIDNEYS, URETERS: No significant abnormality noted. No hydronephrosis. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Hiatal hernia. The previously seen pancolitis has resolved in the interim. No evidence of thickening or pericolic abscess noted.BONES, SOFT TISSUES: Multiple mixed sclerotic and lytic lesions in the spine are similar to prior exam.OTHER: Subcutaneous emphysema is seen in the body wall, likely from injection sites.PELVIS:UTERUS, ADNEXA: Low attenuation, heterogeneous endometrium is unchanged. Soft tissue mass centered in the cervix is again seen.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Interval resolution of the previously seen pancolitis. No loculated fluid collection/abscess is evident.BONES, SOFT TISSUES: Multiple mixed sclerotic and lytic lesions in the spine are similar to prior exam.OTHER: Soft tissue induration in the presacral space and pericolic and perirectal fat likely present radiation change. | 1.Interval resolution of the previously seen colitis.2.Interval increase in size and conspicuity of the numerous pulmonary metastases.3.No new areas of metastasis in the abdomen or pelvis. 4.Stable left indeterminate adrenal nodule. |
Generate impression based on findings. | 27 year old female, hemoptysis, evaluate for PE. PULMONARY ARTERIES: The quality of this examination is excellent for the evaluation of pulmonary embolism to the subsegmental level. No pulmonary embolus is present.LUNGS AND PLEURA: There is redemonstration of two small foci of ground glass in the right lower lobe with associated cystic areas. The ground glass opacities have decreased in size, however, the cystic areas representing dilated bronchioles have increased in size. Subcentimeter cystic focus in left lower lobe is unchanged (image 84, series 10).MEDIASTINUM AND HILA: Cardiac size is normal, without pericardial effusion. There is no mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.No evidence of pulmonary emboli.2.Since the prior exam, the foci of ground glass have decreased in size, with increasing cystic components. These are of unclear etiology, but may represent sequela of prior infection or inflammation, however, given the chronicity vasculitis is also a consideration, although we would expect this to be more multifocal. Neoplasm is considered a more remote possibility given the patient's age, however 1 year follow up with low dose CT of the chest is advised. |
Generate impression based on findings. | 39-year-old male with a history of tongue cancer. Now with jaundice, nausea, vomiting, and weight loss. Foreign travel. CHEST:LUNGS AND PLEURA: Biapical scarring stable and unchanged. No lung nodules or masses are parenchymal air space disease. No pleural abnormality seen.MEDIASTINUM AND HILA: No, adenopathy or masses.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Marked decreased attenuation of the liver is seen, new since the prior examinations and represents diffuse hepatic steatosis. No mass lesions are seen in the liver, however, the presence of fat can obscure underlying followed lesions and if concern for liver lesions. Exists, ultrasound or MR would be recommended.Gallbladder is contracted and presumably represents nonfasting state. No intrahepatic or extra hepatic biliary duct dilatation is seen to suggest biliary obstruction. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Scattered normal sized periaortic, retroperitoneal lymph node seen, unchanged over prior examinations.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. No evidence for metastatic disease. 2. Interval development of diffuse hepatic steatosis. |
Generate impression based on findings. | Right vocal cord SCCa in 2008 s/p laser treatment in remission, bilateral carotid stenosis s/p R CEA who is being worked-up for stage 4 H/N cancer with unknown primary, currently on chemotherapy. Head: There are no enhancing masses to suggest intracranial metastases. There is a left frontal lobe developmental venous anomaly. There are hypoattenuating foci in the bilateral basal ganglia. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is complete opacification of the left maxillary sinus with extension into the middle meatus with an osteomeatal complex pattern of obstructed secretions. There is periodontal lucency of ADA 14.Neck: There is minimal asymmetry of the vocal cords that may be attributable to prior laser treatment. Otherwise, there is no exophytic mass with in the larynx. The laryngeal cartilages, anterior commissure, and paraglottic fat appear unremarkable. There is a mildly prominent right level 1B lymph node that measures 9 x 12 mm and a right paratracheal lymph node that measures 8 x 14 mm. However, these lymph nodes are not hypermetabolic and there is no significant cervical lymph adenopathy otherwise. There are postoperative findings related to right carotid endarterectomy with mild stenosis of the mid-internal carotid artery distal to the endarterectomy site. However, there is moderate to severe atherosclerotic plaque at the left carotid bifurcation. There is a right internal jugular venous catheter in position. The thyroid gland and major salivary glands are unremarkable. There is multilevel degenerative spondylosis, but no suspicious lytic or blastic lesions. The imaged portions of the lungs are clear. | 1. No evidence of locoregional tumor recurrence in the larynx and no significant cervical lymphadenopathy.2. No evidence of intracranial metastases. The hypoattenuating foci in the bilateral basal ganglia likely represent lacunar infarcts of indeterminate age. These can be further evaluated via MRI.3. Moderate to severe stenosis of the left carotid bifurcation. 4. Probable left antromeatal polyp with osteomeatal complex obstruction, perhaps related to periodontal disease affecting ADA 14. |
Generate impression based on findings. | Female 45 years old s/p wash-out and debridement of abdominal wound yesterday. R/O entero-cutaneous fistula. Pt has metastatic colon ca, undergoing chemotherapy. ABDOMEN:LUNGS BASES: Small bilateral pleural effusions are noted with bibasilar atelectasis.LIVER, BILIARY TRACT: Multiple metastatic liver lesions are redemonstrated and are unchanged from study 11/16/2013, which demonstrated a mixed response of these lesions and notably interval growth of left lobe lesions. Largest left lobe lesion measures 2.3 x 2.2 cm. Index lesion of the right lobe measures 1.9 by 1.4 cm. Stable left lobe biliary ductal dilatation.The gallbladder remains contracted.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: Prominent gastrohepatic ligament node is redemonstrated measuring 1.5 x 1.1 cm.BOWEL, MESENTERY: Status post right hemicolectomy. Orally administered contrast passes freely throughout the bowel without evidence of obstruction or ileus.BONES, SOFT TISSUES: Orally administered contrast is seen pooling in the abdominal wound, consistent with an enterocutaneous fistula. Though not directly visualized, the fistulous indication is likely from matted small bowel loops in close proximity behind the rectus muscle. Interval surgical opening of the wound is noted with reduction in size of anterior abdominal wall fluid and gas collection.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: IUD redemonstrated. Unchanged right adnexal complex fluid collection. Tampon noted within the vaginal cavity.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: Bilateral breast implants. | 1.Enterocutaneous fistula, likely from matted small bowel loops behind the rectus.2.Interval decrease in anterior wall fluid and gas collection.3.Metastatic lesions of the liver are redemonstrated. |
Generate impression based on findings. | 75-year-old female with hip pain.? Hip abscess. ABDOMEN:LUNG BASES: Bilateral pleural effusions and basilar atelectasis.LIVER, BILIARY TRACT: 4.7 x 3.5 cm hypoattenuating mass seen in the superior liver, segment 8 (series 3, image 19), unchanged since 11/6/13. Limited screening evaluation cannot characterize this lesion and if concern over this lesion exists, MR examination is recommended as it has nonspecific imaging characteristics on today's examination. No other parenchymal lesions are seen. Gallbladder lumen is of high attenuation, presumably vicarious excretion of contrast material from prior examinations. No evidence for biliary obstruction. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Atrophic kidneys bilaterally, consistent with chronic renal disease. Multiple scattered small hypo-or attenuating lesions. Most of which appear consistent with cysts, but some are too small to characterize in the enhancement of parenchyma is too limited to provide definitive characterization. No other abnormalities.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Administered oral contrast progresses through normal stomach and small bowel to the colon without abnormality. Colon is feces filled and shows diffuse sigmoid diverticulosis without complication and without any other significant abnormality seen. No abnormal mesenteric abnormality seen.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: Administered oral contrast progresses through normal stomach and small bowel to the colon without abnormality. Colon is feces filled and shows diffuse sigmoid diverticulosis without complication and without any other significant abnormality seen. No abnormal mesenteric abnormality seen.BONES, SOFT TISSUES: No significant abnormality noted about the right hip subcutaneous fat or muscles to suggest abnormal fluid collection or abscess. Soft tissues bony structures all appear normal.OTHER: No significant abnormality noted | 1. No evidence for right hip abscess or abnormal fluid accumulation. 2. Bilateral pleural effusions. 3. No change in appearance in nonspecific right hepatic lobe liver lesion, which cannot be characterized further on today's screening CT examination. |
Generate impression based on findings. | Clinical question of history of ETV and Rickham; evaluate ventricles. Signs and symptoms cord and a pitch from incision site and headaches. Nonenhanced head CT:Examination demonstrates slightly decreased size of fourth ventricle since prior study. Cystic and patchy areas of low attenuation of cerebellum and vermis consistent with patient's known metastatic lesions are again noted. A previously noted left cerebellar cyst measures at 20.7 times 14-mm compared to current exam measurements of 21 x 15. This minimal interval change could be due to slice positioning. A second cystic metastatic lesion in the left cerebellum demonstrate decreased size of its cystic component since prior exam.There is a slight better visualization of the quadrigeminal plate cistern which may indicate decreased mass effect.Images through supratentorial space demonstrate decreased size of ventricular system. Interval complete resorption of previously noted intraventricular air. No change in the position of right frontal approach ventricular catheter with the tip in the right frontal horn.No convincing evidence of any extracranial fluid accumulation at the site of insertion of the catheter. No detectable osseous changes of the calvarium and in particular at the site of insertion of the catheter since prior exam.A previously noted metastatic lesion in high convexity left parietal lobe demonstrate increased edema and with resultant subtle effacement of adjacent cortical sulci. There is however no mass effect on the lateral ventricle or midline shift. | 1.Interval decreased size of ventricular system since prior study and with maintained the midline.2.Stable right frontal approach ventricular catheter with the tip in the right frontal horn.3.No detectable bony changes or fluid accumulation at the site of insertion of catheter of the right frontal bone.4.Interval increased peritumoral edema and with resultant regional mass-effect of the left parietal lobe tumor. 5.Interval decreased size of cystic component of one of the left cerebellar metastases lesions since prior exam. |
Generate impression based on findings. | Male 42 years old; Reason: met CRC restaging History: met CRC restaging on chemo CHEST:LUNGS AND PLEURA: Scattered micronodules are unchanged. No evident suspicious pulmonary nodules. Incidentally noted is an aberrant azygos and azygos lobe, normal variant.MEDIASTINUM AND HILA: No enlarged mediastinal or hilar lymph nodesCHEST WALL: Right chest port with catheter tip in the superior vena cava.ABDOMEN:LIVER, BILIARY TRACT: Numerous hepatic metastases are stable. Reference left hepatic lobe lesion measures 3.2 x 3.4 cm (series 3 image 95) previously 3.7 x 3.3 cm . Other nonreference bilobar hepatic metastatic lesions are also stable. Patent portal vein.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Stable portacaval lymph node and nonreference periportal and portacaval lymph nodes.BOWEL, MESENTERY: The transverse and ascending colon are mildly dilated and filled with stool, which has progressed since the previous. Area of focal stricturing noted just distal to the dilation (series 80220, image 95, 96) is noted, and when compared to the previous appears similar. Although this could just be peristalsis, the fact that it appears similarly to previous scan, suggest that this may be a stricture related to neoplasm, although CT is not sensitive in detecting colorectal cancer.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No ascitesPELVIS: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. Hepatic metastatic lesions are overall stable.2. Small area of stricturing in the transverse colon which appears similar to previous exam with new increased marked dilation of the colon. Although nonspecific, this could represent an area of neoplasm. Direct visualization with endoscopic exam advised.3. No evidence of thoracic metastatic disease with stable appearance of numerous micronodules. |
Generate impression based on findings. | 63-year-old female with bilateral flank pain and hematuria with history of stones -- also epigastric pain with history pancreatitis. Assess for kidney stones. Within the limits of a non-IV contrast enhanced examination limiting evaluation of solid parenchymal organs and vascular structures, the following observations can be 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: Multiple, nonobstructing renal calculi are seen in both kidneys, largest of which is in the left inferior pole calix and measures 1.2 x 0.7 cm (series 3, image 62). No evidence of hydronephrosis is seen. Ureters are not dilated. No perinephric fluid collections are seen. Small right renal approximately 1 cm low attenuation is seen (series 3, image 54). It most likely represents benign cyst, however, without IV contrast cannot be completely characterized. No other abnormalities. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small hiatal hernia. Stomach, small bowel, and colon show no other abnormalities.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality noted in small or large bowel. No free mesenteric fluid or other abnormality seen.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Bilateral, nonobstructing renal stones as described above. 2. No evidence of obstructing stones or hydronephrosis. 3. No other significant abnormality seen. |
Generate impression based on findings. | 62-year-old male with history of lung adenocarcinoma. Rule out hematoma, reevaluate for peritoneal implants/masses. ABDOMEN:LUNGS BASES: Moderate bilateral effusions with associated compressive atelectasis, new from prior study.LIVER, BILIARY TRACT: Scattered subcentimeter hypodensities are nonspecific though unchanged.SPLEEN: Wedge-shaped hypodensity of the superior aspect of the spleen likely represents infarction. Mild splenomegaly measuring 15.0 cm, previously measuring 13.5 cm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The anterolateral half of the right kidney demonstrates lack of enhancement in a wedge shaped fashion, consistent with infarct.RETROPERITONEUM, LYMPH NODES: Scattered mesenteric lymph nodes remain subcentimeter and unchanged.BOWEL, MESENTERY: Scattered nodular thickening of the omentum demonstrates interval increased confluence in some areas (for example anteriorly in the upper pelvis on image 112, series #3). New additional foci are also appreciated, lateral to the ascending colon. Findings suggest worsening peritoneal disease. Small amount of ascites has also slightly increased, tracking around the liver and also inferiorly in the pelvis. Oral contrast passes freely through the bowel without evidence of obstruction or ileus.BONES, SOFT TISSUES: Sclerotic bone metastases of L1 and the lower thoracic vertebra are unchanged.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Omental thickening and ascites, described in detail above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Slight increase in omental thickening and ascites, suggestive of worsening worsened peritoneal disease.2.New right kidney and splenic infarcts.3.New bilateral moderate-sized pleural effusions.4.Unchanged sclerotic vertebral lesions. |
Generate impression based on findings. | 76-year-old male with obstructing mass seen on colonoscopy -- anemia. Staging CT examination. CHEST:LUNGS AND PLEURA: Scattered micronodules nonspecific, however, larger nodules are densely calcified and these all most likely represent changes from prior granulomatous disease. No suspicious lung nodules to suggest metastases are seen. No foci of air space consolidation or pleural disease seen..MEDIASTINUM AND HILA: Mildly enlarged lymph nodes, but with calcifications seen in several and these most likely reflect changes from prior granulomatous disease. No significant enlargement of nodes seen to suggest metastatic disease. Diffuse coronary artery calcification.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Nearly the entire parenchyma of segments 5 and 6 in the right lobe and extending into segment 4 is replaced by solid and hypoattenuating mass or aggregate of masses that most likely represents metastatic disease. Maximal measurement of this aggregate is 8.2 x 14.0 cm (series 3, image 111). Second isolated lesion in the isthmus to the caudate lobe (series 3, image 96) is poorly defined, but appears to measure 3.6 x 3.4 cm. ill-defined hypodensity in the posterior aspect of segment two (series 3, image 91) most likely represents additional metastatic disease -- the remainder of segments two and 3 did not appear to show parenchymal mass lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Apical scar. Calcification seen diffusely in the aorta and iliac vessels. No retroperitoneal adenopathy or other masses seen.BOWEL, MESENTERY: Oral administered contrast progresses through normal appearing stomach and small bowel to the right colon. Cecum/right colon shows diffuse wall thickening in the ascending colon, most likely site of known cancer. Adjacent mesenteric enlarged lymph nodes are seen, the largest of which measures 1.9 x 1.5 cm (series 3, image 145) and is worrisome for metastatic disease. More distal transverse colon and descending/sigmoid colon show no abnormalities, however, this examination was not prepared in a protocol to evaluate the colon itself.No abnormal mesenteric disease or fluid collections are 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: Oral administered contrast progresses through normal appearing stomach and small bowel to the right colon. Cecum/right colon shows diffuse wall thickening in the ascending colon, most likely site of known cancer. Adjacent mesenteric enlarged lymph nodes are seen, the largest of which measures 1.9 x 1.5 cm (series 3, image 145) and is worrisome for metastatic disease. More distal transverse colon and descending/sigmoid colon show no abnormalities, however, this examination was not prepared in a protocol to evaluate the colon itself.No abnormal mesenteric disease or fluid collections are seen.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Cecum/right colon mass with associated adjacent enlarged peritoneal lymph nodes. 2. Extensive mass lesions in liver, most consistent with diffuse metastatic disease. 3. No other significant abnormality seen. |
Generate impression based on findings. | Chronic lymphoid leukemia, now on study of BR and ibrutinib. There is considerable interval decrease in size of the diffuse cervical lymphadenopathy. For example, a left level 2 lymph node measures 7 x 5 mm, previously 18 x 16 mm and a right level 5 lymph node measures 6 x 4 mm, previously 17 x 12 mm. The Waldeyer structures are unremarkable and the airways are patent. Thre is an unchanged punctate calcification in the left thyroid lobe. The major salivary glands are unremarkable. The major cervical vessels are patent and there is a retropharyngeal course of the right internal carotid artery. There is degenerative spondylosis at C5-6 with endplate sclerosis and Schmorl node formation and incomplete fusion of the posterior arch of C1. There is periapical lucency associated with with a treated ADA8. The partially imaged intracranial structures are unremarkable. There is an unchanged punctate calcification in the left lung apex. The imaged portions of the lungs are otherwise clear. | Considerable interval decrease in size of the cervical lymphadenopathy, indicting treatment response. |
Generate impression based on findings. | Fever. Concern for central process as cause. There is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is scattered paranasal sinus opacification. The imaged mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. | No evidence of intracranial hemorrhage, mass, or cerebral edema.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Female 60 years old; Reason: HCV cirrhosis and abdominal pain History: abdominal epigastric pain ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver contour: The liver contour is nodular. The liver is enlarged measuring 20 cm in the right.Patient is status post cholecystectomy with no evidence of intra-or extrahepatic biliary ductal dilation Portal vein: Patent Hepatic veins: PatentHepatic artery: Patent with conventional anatomyLesions: No definite lesions are noted to suggest HCC. No ascitesSPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic disease of the aorta and iliac vessels are noted. Numerous expected portacaval nodes are noted, related to chronic liver disease.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Cirrhotic morphology with no evident of lesion to suggest HCC. |
Generate impression based on findings. | Neutropenic fever. The paranasal sinuses and nasal cavity are clear. There is interval decrease in the right mastoid air cells opacification, now minimal. There are bilateral lens implants. The imaged portions of the intracranial structure are grossly unremarkable. The overlying soft tissues of the face are also unremarkable. | No evidence of sinusitis. |
Generate impression based on findings. | Neutropenic fever. There is minimal mucosal thickening within the alveolar recesses of the bilateral maxillary sinuses. The paranasal sinuses and nasal cavity are otherwise clear. There are multiple maxillary dental caries with associated mild periodontal lucencies. The orbits and the partially imaged intracranial structures are grossly unremarkable. The overlying facial soft tissues are also unremarkable. | 1. No evidence of sinusitis.2. Extensive maxillary dental disease. |
Generate impression based on findings. | Cervical spondylosis with myelopathy. Patient motion artifact limits detail. There is rotary scoliosis. The vertebral body heights are essentially intact and there no evidence of acute fractures. There is intervertebral disk height loss at multiple levels with vacuum disc phenomenon. There are prominent anterior osteophytes from C2-T1 with multilevel pseudoarthroses. Additional findings by level:C2-3: There is a disc-osteophyte complex, including the uncovertebral osteophytes in addition to facet arthropathy resulting in moderate-severe neural foraminal stenosis bilaterally without significant canal stenosis.C3-4: This disc-osteophyte complex and facet arthropathy which results in mild bilateral neural foraminal stenosis and mild spinal canal stenosis. C4-5: There is a prominent disc-osteophyte complex possibly with superimposed posterior longitudinal ligament calcification and bilateral facet osteoarthropathy resulting in severe spinal canal stenosis, mild left neural frontal stenosis and moderate right neural foraminal stenosis.C5-6: There is a disc-osteophyte complex which results in mild canal stenosis and mild bilateral neural foraminal stenosis. C6-7: There is a disc-osteophyte complex causing mild to moderate canal stenosis with asymmetric facet degenerative change resulting in mild-moderate right neural foraminal stenosis. There is no significant left neural foraminal stenosis.C7-T1: There is mild degenerative change of the facets without significant spinal or neuroforaminal stenosis.There appears to be a 2.5 cm outpouching in the aortic arch exophytic from the left wall at the most inferior image of the study (axial image 77). This could potentially represent pseudoaneurysm and should be investigated with designated angiogram of the chest. A small area of encephalomalacia within the right cerebellar hemisphere likely represents a chronic infarct. There is a partially imaged cardiac pacer device, apical septal thickening and lucencies, and pulmonary emphysema, partial mastoid opacification and soft tissue thickening within the left maxillary sinus. | 1.Extensive multilevel spondylosis of the cervical spine, most prominent at the C4-5 level where there is severe spinal canal and moderate-to-severe right neural foraminal stenosis.2.Neural foraminal stenosis demonstrated at each level from C2-3 through C6-7 as described.3.Contour irregularity of the aortic arch, which is not fully characterized on this noncontrast examination. This should be investigated with CTA of the aorta.4.Focal encephalomalacia within the right cerebellar hemisphere that likely represents a chronic infarct. This can be further investigated with designated brain imaging.A verbal report of these findings was issued to Dr. Mok at 10:23 a.m. 11/21/2013. |
Generate impression based on findings. | 63 year old male. Neutropenic fever, evaluate for pulmonary source. LUNGS AND PLEURA: Subpleural atelectasis in the right lower lobe is increased from prior exam. There is no focal lung consolidation or pleural effusion. Micronodules are unchanged.MEDIASTINUM AND HILA: Central venous catheter with tip in the SVC. Cardiac size is normal, without pericardial effusions. Moderate coronary artery calcifications are again noted. There is no mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Status post cholecystectomy. Otherwise, unremarkable visualized upper abdomen. | Increased subsegmental atelectasis, but no evidence of acute infection. |
Generate impression based on findings. | Hypoxia, r/o sinusitis. There is right maxillary sinus alveolar recess retention cyst that measures up to 15 mm. The paranasal sinuses and nasal cavity are otherwise clear. The frontal sinuses are not pneumatized. The mastoid air cells are clear. There are numerous partially imaged maxillary dental caries with associated periodontal lucencies. The orbits and partially imaged intracranial structures are grossly unremarkable. | 1. No evidence of acute sinusitis.2. Extensive, but partially imaged dental disease. |
Generate impression based on findings. | 58-year-old male. Neutropenic patient with fevers despite antibiotic coverage, evaluate for pulmonary source. LUNGS AND PLEURA: Since the prior exam, there is been development of extensive patchy airspace and interstitial opacities throughout the right lower lobe, with a focus is along the right middle lobe. There is also ground glass opacity involving the right lower lobe. There is a new pulmonary nodule on the left lung (image 44, series 5), otherwise, the left lung is clear. There is also very solid masslike component adjacent to the right hilum. There is a small right pleural effusion. Diffuse centrilobular emphysema is again present. MEDIASTINUM AND HILA: Central venous catheter with tip at the caval junction. Cardiac size is normal, without pericardial effusion. Prominent mediastinal lymph nodes are again noted with fatty hilum. Subcarinal nodules are slightly increased in size as seen on coronal images.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. | Development of extensive patchy airspace, interstitial and ground glass opacities throughout the right lower lobe with a focus in the right middle lobe. There is also additional masslike component adjacent to the right hilum. These findings are compatible with bacterial or fungal infection. The ground glass component in the right lung base could be due to hemorrhage . |
Generate impression based on findings. | Headaches and prior hemispherectomy and VP shunt with abdominal pseudocyst. There are postoperative findings related to left hemispherectomy. There is also an unchanged left transparietal ventricular shunt that terminates superior tip the cerebral aqueduct. However, there has been progressive increase in size of ventricles since 9/26/13 with additional possible slight interval increase in size since 11/7/13. There is no acute intracranial hemorrhage or edema. There is midline shift to the left and inferior extension of the cerebellar tonsils by up to 8 mm, which are not significantly changed. The skull and imaged extracranial structures also appear unchanged. | Progressive increase in size of the ventricular system since 9/26/2013. |
Generate impression based on findings. | Female 37 years old; Reason: intermittent chronic RUQ, RLQ and LLQ abdominal pain and iron deficiency anemia. please evaluate for possible etiology. History: chronic intermitten abdominal pain ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Physiologic changes are noted in the uterus. Left corpus luteal cyst noted. The right adnexa is physiologic.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 acute intra-abdominal pathology detected. |
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