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Generate impression based on findings. | Reason: evaluation of a left lower lobe lung nodule History: lung nodule CHEST:LUNGS AND PLEURA: Mild scarring/discoid atelectasis in the left upper lobe related to previous site of a chest tube.6 mm x 6 mm somewhat spiculated nodule medially in the left lung base (image to 30 series 6) is similar appearance the prior exam. This appears to have decreased in size compared to the prior exam dated 10/3/13 (image 53 series 4) measuring 12 mm x 10 mm. No other pulmonary nodules identified.Interval resolution of the right pleural effusion and basilar atelectasis.MEDIASTINUM AND HILA: Multiple mediastinal lymph nodes noted within the mediastinum without evidence of pathologic enlargement.Persistent left-sided SVC. Cardiac size is normal without evidence of a pericardial effusion.CHEST WALL: Bilateral breast implants.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: Stabilization hardware extending from L4 through S1.OTHER: No significant abnormality noted. | 6-mm left lower lobe nodule appears decreased in size compared to an outside exam dated 10/3/13. Continued follow -up in 3 to 6 months is recommended. |
Generate impression based on findings. | Significant head swelling at surgical site. There are postoperative findings related to left frontotemporal craniotomy and right temporal microcraniotomy with interval removal of the electrode grids. There is low attenuation subgaleal fluid collection overlying the left craniotomy site that measures up to 13 mm in width. There is also an extradural fluid collection deep to the craniotomy site that measures up to 13 mm with small foci of pneumocephalus. There appears to be a defect in the otherwise thickened of the dura in the region of the left craniotomy. There is 3 mm low attenuation fluid collection overlying the right microcraniotomy as well as a 3 mm fluid collection deep to the craniotomy. There is apparent mild diffuse left cerebral hemisphere periventricular leukomalacia. There is no midline shift of evidence of hydrocephalus. There is diffuse hyperattenuation of the bilateral thalami, but no evidence of acute intracranial hemorrhage. | 1. Subgaleal and extra-axial fluid collections associated with the bilateral craniotomy sites, left larger than right, may represent residual post-operative fluid collections or CSF leak. Superimposed infection cannot be excluded. A brain MRI with contrast may be useful for further interrogation.2. Extensive left cerebral hemisphere periventricular leukomalacia that appears similar as on the prior MRI, accounting for differences in technique. |
Generate impression based on findings. | 56-year-old female patient with history of interstitial lung disease and worsening shortness of breath. Evaluate for changes in ILD. LUNGS AND PLEURA: Bibasilar traction bronchiectasis and mild architectural distortion is slightly decreased compared to prior. No ground-glass opacities. Scattered right upper lobe subpleural reticulations and septal thickening, stable.Redemonstration of scattered micronodules, some of which are calcified.Stable postsurgical changes in the left upper and lower lobes.No honeycombing.No evidence of air trapping on the expiratory images.MEDIASTINUM AND HILA: Mild cardiomegaly without pericardial effusion.Calcified mediastinal lymph nodes consistent with prior granulomatous disease.No hilar or mediastinal lymphadenopathy.Heterogeneously enlarged thyroid gland.CHEST WALL: Mild multilevel degenerative changes in the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Nonspecific pulmonary fibrosis pattern with slight interval decrease in bibasilar traction bronchiectasis. Stable subpleural reticular pattern. |
Generate impression based on findings. | 71-year-old male. Known HCC. Reassess for HCC. ABDOMEN:LUNG BASES: Interval resolution of the previously described bilateral pleural effusions. Noted are multiple pulmonary micronodules, appearing similar to the prior study.LIVER, BILIARY TRACT: Cirrhotic liver morphology is again seen. Reference heterogeneous arterially enhancing lesion in the left hepatic lobe measures 5.8 x 5.4 cm, previously 6.5 x 6.0 cm (series 9, image 31). The lesion partially washes out on postcontrast imaging and is consistent with patient's known history of HCC. Satellite foci are again noted. There is interval development of a 1.5-cm lesion in the left lobe of the liver (24; series 9). There are also multiple new lesions in the right lobe of the liver with the largest measuring 1.0 cm (51; series 9). Cholelithiasis, without evidence of acute cholecystitis. Parasplenic collateral vessels consistent with portal hypertension.SPLEEN: No significant abnormality notedPANCREAS: Pancreatic calcifications. Subcentimeter cystic lesion in the tail of the pancreas which is too small to characterize but may represent a branch type IPMN.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Unchanged renal hypodense foci, likely cysts.RETROPERITONEUM, LYMPH NODES: Note is made of numerous prominent gastrohepatic lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the lumbar spine.OTHER: Calcified atherosclerotic disease of the abdominal aorta and its branches. Small fat containing ventral hernia.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes of the lumbar spine.OTHER: No significant abnormality noted | Interval decrease in size of dominant reference left hepatic lobe HCC, however, there is interval development of a new bilobar lesions in the liver, as described above. |
Generate impression based on findings. | 72-year-old male patient with history of head and neck cancer. LUNGS AND PLEURA: There is a 5-mm lung nodule in the superior segment of the right lower lobe (series 4 image 53). Scattered bilateral micronodules, some of which are calcified.MEDIASTINUM AND HILA: Heart size within normal limits. Severe coronary artery calcifications. Moderate atherosclerotic changes in the aorta.Scattered mediastinal lymph nodes, the largest of which is subaortic and measures 1.2 cm (series 3 image 46). No hilar adenopathy.Right-sided port with catheter tip at the cavoatrial junction.CHEST WALL: Multilevel degenerative changes in the thoracic spine.Left axillary lymphadenopathy, largest of which measures 2.2 cm (series 3 image 36).UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Moderate atherosclerotic changes in the abdominal aorta and its branches. Colonic diverticulosis without evidence of diverticulitis. | 1.5-mm right lower lobe nodule. Recommend continued follow-up given history of cancer.2.Prominent mediastinal lymph nodes.3.Left axillary lymphadenopathy. |
Generate impression based on findings. | Female 45 years old; Reason: STAGE III RECTAL CANCER S/P RESECTION. SURVEILLANCE SCAN. History: RECTAL CANCER CHEST:LUNGS AND PLEURA: The lungs are clear. The pleural spaces are clear. The central airways are patent.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. No pathologically enlarged mediastinal lymph nodes, with decrease in size of all previously reference nodes.CHEST WALL: Hypodense left thyroid nodule is .ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. Probable perfusion defect in segment 4 B. of the liver. Probable cyst in segment two of the liver is stable. No suspicious hepatic lesions. Hepatic and portal veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cyst. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes none pathologically enlarged by CT criteria. The previously reference para-aortic node is not well visualized on this examination.BOWEL, MESENTERY: Patient is status post resection with right lower quadrant ostomy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Enlarged heterogeneous uterus with thickened endometrium.BLADDER: No significant abnormality noted.LYMPH NODES: No evident lymphadenopathy. The previously referenced sigmoid mesentery node is not well visualized on this examination..BOWEL, MESENTERY: Soft tissue induration in the presacral space and perirectal fascia is likely related to radiation changes. Patient status post resection with surgical sutures noted in the rectal vault.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Status post resection with right lower quadrant ostomy, and no evident metastatic disease detected. |
Generate impression based on findings. | 75 year old female. Check for source of infection. ABDOMEN:LUNGS BASES: Small bilateral pleural effusions, right greater than left, with associated compressive bibasilar atelectasis and consolidation.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: Status post right nephrectomy. Atrophic left kidney measuring 7.4 cm, containing multiple cystic lesions. Complex left upper pole cystic lesion is incompletely characterized, unchanged, though malignancy cannot be excluded.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Balloon retained G-J-tube is identified with balloon outside the gastric lumen, interposed between the anterior gastric wall and anterior abdominal wall. The catheter remains intraluminal, extending to the duodenal bulb. Large amount of intraperitoneal free air is identified. There are multiple gas-containing fluid collections surrounding the anterior, inferior, and lateral aspects of the greater curvature of the stomach. Fluid extends throughout the mesentery.Status post colectomy with right lower quadrant ostomy and nondilated Hartmann pouch noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Balloon of the GJ tube is extraluminal between the stomach and abdominal wall with large amount of intraperitoneal free air.2.Several gas-containing fluid collections around the stomach.3.Small bilateral pleural effusions with associated bibasilar atelectasis/consolidation.4.Cystic lesion in the upper pole of the left kidney is incompletely evaluated. Malignancy cannot be excluded. |
Generate impression based on findings. | Male 70 years old; Reason: assess for recurrence, h/o pancreatic cancer s/p resection History: h/o pancreatic cancer CHEST:LUNGS AND PLEURA: Subpleural reticular changes at the upper lobes. No dominant lung lesion.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. Coronary calcifications.CHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesions. Hepatic and portal veins are patent. Intrahepatic pneumobilia from hepaticojejunostomy. No biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: Post resection of the pancreatic head/uncinate mass. The remainder of the pancreas shows age related pancreatic atrophy. No pancreatic ductal dilatation. Soft tissue in the pancreatic (uncinate process) bed posterior to the portal vein and superior mesenteric artery is stable and may be postoperative. It measures 2.8 x 0 .9 cm, previously 3.3 x 1.2 cm (image 102/series 12). ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No retroperitoneal or mesenteric lymphadenopathy.BOWEL, MESENTERY: Post operative changes in the small bowel. No bowel obstruction.Nonspecific bowel wall thickening in the ascending and transverse colon, correlate for prior history of colitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No pelvic or retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Status post resection of the mass in the uncinate. Soft tissue in expected location of the uncinate process bed may be postsurgical and is stable. No definite evidence of metastatic disease.2.Nonspecific thickening of the ascending and transverse colon, correlate for previous colitis |
Generate impression based on findings. | 74-year-old female with cholangiocarcinoma -- restaging following 4 cycles of treatment. CHEST:LUNGS AND PLEURA: Changes of prior inflammatory, old granulomatous disease without nodules or masses, suspicious for metastatic disease. No pleural abnormality seen.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Port-A-Cath in the right anterior chest wall with tip of catheter in the distal superior vena cava. No other abnormalities.ABDOMEN:LIVER, BILIARY TRACT: Patient is status post right hepatectomy. Two benign cysts in segment 4 and post operative changes at the resection margin are seen, unchanged since prior outside CT examination. No mass lesions are seen in the remaining liver parenchyma to suggest recurrence or metastatic disease.Patient is status post cholecystectomy. No biliary tract dilatation is seen to suggest obstruction.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: Orally administered contrast rapidly progresses through normal appearing stomach and small bowel to the right lower quadrant. No intrinsic small bowel abnormality is seen and no sign of obstruction is present. There may be slight thickening of the a sending colon or this may be accentuated by lack of distention -- this slightly increased peritoneal fluid in this region does raise the question of mild inflammation.Scattered amounts of free mesenteric fluid are seen, greatest in the right flank and in the dependent pelvis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Uterus, is not visualized and there is a pessary in position. No other abnormalities.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Orally administered contrast rapidly progresses through normal appearing stomach and small bowel to the right lower quadrant. No intrinsic small bowel abnormality is seen and no sign of obstruction is present. There may be slight thickening of the a sending colon or this may be accentuated by lack of distention -- this slightly increased peritoneal fluid in this region does raise the question of mild inflammation.Scattered amounts of free mesenteric fluid are seen, greatest in the right flank and in the dependent pelvis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Status post right hepatectomy with stable appearance to the remaining liver, without evidence of recurrent or metastatic disease. 2. Interval development of moderate amount of free peritoneal fluid -- no discrete masses are seen however, to suggest identifiable metastatic disease. 3. Slight thickening of the right colon, which may be accentuated by lack of distention, however, mild changes of inflammatory colitis cannot be excluded. |
Generate impression based on findings. | T4aN2bM0 right piriform sinus cancer, status post chemoradiation in March 2013, and subsequent right carotid pseudoaneurysm leading to blowout treated with covered stent. Head: There is no abnormal intracranial enhancement or mass lesions to suggest brain metastatic disease. There is disproportionate cerebellar volume loss. The calvarium and skull base are intact. The orbits are unremarkable. There is persistent partial opacification of the right mastoid air cells and a right maxillary sinus retention cyst. Neck: There are post-treatment findings related to tracheostomy, laryngectomy, voice prosthesis, partial thyroidectomy, and right neck dissection. The neopharynx appears unchanged without evidence of discrete mass lesions. There is no significant cervical lymphadenopathy. The major salivary glands and residual left thyroid lobe are unremarkable. There is a right internal carotid artery stent, which appears grossly patent. There is a right subclavian venous catheter and persistent nonopacification of the right internal jugular vein. The osseous structures are unremarkable. There is unchanged scarring in the lung apices. | 1.Stable extensive posttreatment findings without evidence of locoregional tumor recurrence or significant cervical lymphadenopathy.2.No evidence of intracranial metastases. |
Generate impression based on findings. | 76 show female with history of radiofrequency ablation of left renal mass in 2009. ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable postprocedural changes of the upper pole of the left kidney from prior RFA. No evidence of recurrence or residual tumor.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Stable postprocedural changes of the left kidney. No evidence of recurrence or metastatic disease. |
Generate impression based on findings. | 55 year old female with NHL -- reevaluate. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted. Patient is status post cholecystectomy without other biliary abnormality seen. Liver parenchyma is homogeneous and without mass.SPLEEN: No change in appearance or size in the single low attenuation focus (series 3, image 84) since prior examination 5/23/13, which now measures 1.0 cm compared with 1.5 cm, previously. This has markedly decreased since scans of 2011 when this measured 2.4 cm. No new lesions are seen.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy or other significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Scattered small hypodensities in uterus, most consistent with fibroid tumors -- these appear unchanged. No other abnormalities.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted without lymph node enlargement seen.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. No evidence of lymphadenopathy in the chest, abdomen or pelvis. 2. Stable appearance to solitary hypodense focus in the, spleen, when compared with 5/23/13, but markedly decreased from no remote scans. 3. No other abnormality seen. |
Generate impression based on findings. | Gross hematuria; history of Leydig cell tumor 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: 2-mm nonobstructing left renal stone. No renal mass, acute inflammatory process, or hydronephrosis. Unremarkable collecting systems bilaterally. Incidental note is made of partial right collecting system duplication with single distal ureter.RETROPERITONEUM, LYMPH NODES: Mild aneurysmal dilatation the distal aorta with maximal AP diameter of 2.2 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Nonobstructing 6-mm left UVJ stone.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Nonobstructing 6-mm left UV junction stone. Nonobstructing subcentimeter left renal stone. No evidence for acute inflammatory or neoplastic process.Mild aneurysmal dilatation of distal aorta. |
Generate impression based on findings. | 46 year old male. T3N0 non small cell lung cancer (SCC), status post chemotherapy. CHEST:LUNGS AND PLEURA: Interval decrease in size of right infrahilar mass, now measuring 2.4 x 1.3 cm (image 53, series 3) previously 5.2 x 3.5 cm. Interval resolution of right pleural effusion. Right middle lobe subsegmental atelectasis is noted.Development of right upper lobe centrilobular nodules and early tree in bud opacities with associated bronchial wall thickening, compatible with bronchiolitis.MEDIASTINUM AND HILA: Cardiac size is normal without pericardial effusion. Right hilar lymph node measures 12 mm in short axis (image 44, series 3), and in retrospect measured 14 mm in short axis on prior exam. Previously referenced left hilar lymph node measures 6 mm in short axis ( image 47, series 3) previously 10 mm. CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Subcentimeter hypoattenuating hepatic foci are unchanged, most likely represent cysts.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. Significant decrease in size of the right infrahilar mass, and resolution of right pleural effusion. Decreased hilar lymphadenopathy.2. Development of right upper lobe centrilobular nodules and early tree in bud opacities with associated bronchial wall thickening, compatible with bronchiolitis, which may be due to aspiration or infection/inflammation. |
Generate impression based on findings. | 63-year-old female patient with history of lung nodules. LUNGS AND PLEURA: Redemonstrated are postoperative changes from left upper lobectomy.Multiple nonspecific bilateral pulmonary nodules. Reference nodule in the right middle lobe measures 11 x 7 mm (series 5 image 62), stable. Pleural based nodule in the left lung base measures 17 x 13 mm (series 5 image 58), stable compared to recent studies. However, there is slight increase in size compared to examination on 5/4/2012 (measured 13 x 11 mm). Remaining nodules are stable. No new nodules identified.MEDIASTINUM AND HILA: Heart size within normal limits without pericardial effusion. Trace pericardial thickening is unchanged. Moderate coronary artery calcifications. Mild atherosclerotic changes in the thoracic aorta.Scattered, nonenlarged mediastinal lymph nodes.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Hypoattenuating lesions scattered in the liver parenchyma are incompletely evaluated and grossly stable. Punctate calcification at the dome of the liver, stable.Linear, course calcification at the head of the pancreas is stable compared to prior, may represent vascular calcification and cannot be completely evaluated in this noncontrast examination.Mild atherosclerotic changes in the abdominal aorta. | Stable nonspecific pulmonary nodules compared to recent examinations. Given slight increased size of pleural based left lung base nodule since 5/4/2012, recommend PET scan versus repeat CT scan in 6 months. |
Generate impression based on findings. | Male 69 years old; Reason: eval for progression History: metasttic RCC in 3rd line therapy CHEST:LUNGS AND PLEURA: Subcentimeter nodule in the right middle lobe, unchanged (series 7, image 49). No new suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Stable mediastinal lymphadenopathy. Reference subcarinal lymph node now measures 4 x 3 .5 cm, previously 4.0 x 3.3 cm (image 53, series 3). Hilar adenopathy also appears stable, with reference right hilar node 4 x 2.8 cm (series 6 image 58). Mild coronary artery calcifications. Cardiac size is normal. Small amount of pericardial fluid, unchanged.CHEST WALL: Gynecomastia. ABDOMEN:LIVER, BILIARY TRACT: Multiple hypoattenuating lesions within the liver, some of which are too small to characterize, are unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Status post right adrenalectomy. Left adrenal mass has increased in size, measuring 5.2 x 5 .8 cm, previously 5.0 x 4.6 cm (image 94, series 6). This previously measured at 3.9 x 3.4 cm on 6/13. This lesion measures 37 Hounsfield units on precontrast, 90 Hounsfield units on portal venous phase, and 63 Hounsfield units on delayed phase imaging. This is approximately 50% washout, which does not meet the criteria for a benign adenoma.KIDNEYS, URETERS: Status post right nephrectomy. Left lower pole probable renal cyst, unchanged.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification abdominal aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Right obturator lymph node has not significantly changed in size, measuring 1.2 x 0.8 cm, previously 1.3 x 0.9 cm (image 172, series 3).BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes of the spine.OTHER: No significant abnormality noted | 1. Interval stability in mediastinal lymphadenopathy.2. Interval increase in size of left adrenal nodule which does not meet the criteria for an adrenal adenoma. |
Generate impression based on findings. | Colon carcinoma CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Stable cardiomegaly; no change in severe coronary artery calcificationCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Stable fissural prominenceSPLEEN: 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: Slight interval increase in size of referenced left mesenteric mass as seen on image 71 of the coronal projection measuring 2.6 x 2.1 cm; this is in comparison to 1.6 x 2.1 cm on 11/15/2012.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 | Slight interval increase in size of reference mesenteric mass/adenopathy; otherwise stable exam. |
Generate impression based on findings. | Reason: high resolution CT, ILD protocol to evaluate pulmonary nodules History: shortness of breath LUNGS AND PLEURA: Significant progression of upper lobe predominant bronchus and bronchocentric nodular opacities that now coalesce in the apices in to dense consolidation. There are no pleural effusions.Calcified granulomata are unchanged. MEDIASTINUM AND HILA: There is no significant lymphadenopathy.Severe coronary artery calcifications are present.Calcified mediastinal lymph nodes are unchanged.CHEST WALL: Degenerative abnormalities affect the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Significant worsening of upper lobe predominant nodular opacities with new areas of consolidation. The differential diagnosis includes worsening fungal infection, mycobacterial infection although not miliary TB, and even sarcoidosis. |
Generate impression based on findings. | Reason: 53yo M with COPD, OSA now with ILD found on August 2013 CT scan. Please reevaluate. Please do ILD protocol. History: DOE, SOB LUNGS AND PLEURA: Moderately severe apical paraseptal and centrilobular emphysema.Diffuse interstitial disease with fine reticulonodular opacities and focal areas with scarring and traction bronchiectasis.Small areas of focal atelectasis and consolidation that were present on the previous scan have partially resolved.Very mild groundglass opacity at the lung bases and minimal subpleural microcystic changes.MEDIASTINUM AND HILA: Interval decrease in mediastinal lymphadenopathy. A right lower paratracheal lymph node now measures 13 mm, decreased from 18 mm previously.Markedly enlarged main pulmonary artery measuring 43 mm.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.Diffuse nonspecific interstitial lung disease without significant apical basilar gradient or overt honeycombing.As previously indicated the findings are consistent with atypical UIP or fibrosing NSIP, and the presence of significant upper zone emphysema suggests CPFE (combined pulmonary fibrosis and emphysema). The presence of lymphadenopathy also raises the question of sarcoidosis. Some focal areas of atelectasis have resolved and there has been a significant decrease in lymphadenopathy.2. Pulmonary hypertension. |
Generate impression based on findings. | ? stenosis of celiac artery/MALS syndrome or other vascular anomoly mesenteric ultrasound suggestive of MALS. History: Upper GI series with positional partial compression of 3rd portion of duodenum, ultrasound from outside with anatomical reversal of SMA and SMV ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER/VASCULATURE: On expiratory arterial phase images there is "J" configuration (narrowing and downward displacement secondary to mass effect) of the celiac artery (images 62 series 80785) just distal to its origin which resolves on inspiration venous phase images.Conventional hepatic vasculature without evidence of a replaced or accessory hepatic artery. Two right and two left renal arteries.The SMV is antero-right lateral to the SMA. There is no evidence of malrotation and the 3rd portion of the duodenum is courses between the SMA-aorta; the cecum is incompletely visualized but appears to be in the right lower quadrant. | Mild narrowing and "J" configuration of the celiac artery on expiration with some normalization on inspiration suggestive of celiac artery compression syndrome in the appropriate clinical setting. |
Generate impression based on findings. | Male 74 years old; Reason: 74 M with gallbladder cancer s/p surgery, please eval for evidence of disease recurrence. History: none CHEST:LUNGS AND PLEURA: Multiple calcified and noncalcified micronodules bilaterally, unchanged over last two exams. No suspicious lesions. Lungs are otherwise clear.MEDIASTINUM AND HILA: No significant hilar or mediastinal lymphadenopathy. No cardiomegaly or pericardial effusion. Stable thyroid nodules.CHEST WALL: No axillary lymphadenopathy.ABDOMEN:LIVER, BILIARY TRACT: Normal size and appearance of the liver. Status-post cholecystectomy. Vague soft tissue focus within the gallbladder fossa continues to decrease in size on the current examination. SPLEEN: Stable perisplenic nodularityPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable bilateral renal cystsRETROPERITONEUM, LYMPH NODES: Aortobiiliac atherosclerosis.BOWEL, MESENTERY: Again seen is anterior mesenteric soft tissue nodularity which is increased in number and size. The reference lesion in this area measures 0.8 x 1.2, previously 0.6 x 1.0-CM (series 3, image 111). New soft tissue nodule in the left upper quadrant measures 2.2 x 1 .2 cm, previously not seen (series 3 image 145). A few more anterior mesenteric nodes are new since previous exam.Postsurgical changes adjacent to the umbilicus.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy. No change in the left prostatic bed soft tissue focus over multiple exams, most likely represents postsurgical changes.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Interval increase in size and number of the omental/anterior mesenteric nodes, As referenced above. |
Generate impression based on findings. | Reason: 85 y/o w/ mesothelioma s/p pleurectomy/decortication needs restaging ct; please assess for disease progression History: dyspnea CHEST:LUNGS AND PLEURA: Small right anterior loculated hydropneumothorax, not significantly changed.Marked interval progression in nodular pleural thickening in the right hemithorax with reference measurements as follows:Reference nodule at the right base now 17 mm, increased from 9 mm previously (series 5 image 42).Reference pleural nodule posterolaterally now 13 mm, increased from 9 mm previously (series 5 image 33) .Multiple other pleural nodules have similarly increased in size.MEDIASTINUM AND HILA: Moderate subcarinal lymphadenopathy, unchanged.Severe coronary artery calcification.No pericardial effusion.CHEST WALL: Right diaphragmatic mesh graft and healed postsurgical rib fractures.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts including a right inferior pole cyst that measures 14 cm in diameter.PANCREAS: Pancreatic atrophy.RETROPERITONEUM, LYMPH NODES: Aortic atherosclerosis and left common iliac archery aneurysm measuring 24 mm in diameter, unchanged.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. | Marked interval increase in multiple right pleural nodules, consistent with disease progression. |
Generate impression based on findings. | Clinical question: Evaluate 2 mm left posterior communicating artery aneurysm seen on 9 -- 11 CTA. Signs and symptoms: Headache. Nonenhanced head CT:Examination demonstrates no evidence of acute intracranial process in particular no evidence of hemorrhage. CT however is insensitive for early detection of acute non-hemorrhagic ischemic strokes.Very subtle periventricular and subcortical low attenuation of white matter considering patient's age of 78 likely representing age indeterminate mild small vessel ischemic strokes. This finding remains grossly similar to prior exam from 2012.The cerebral cortex demonstrate normal density and unremarkable.Cortical sulci and ventricular system as well as gray -- white matter differentiation is otherwise unremarkable.Unremarkable calvarium and soft tissues of the scalp.Unremarkable images through the orbits.All visualized paranasal sinuses and bilateral mastoid air cells/middle ear cavities remain well pneumatized.Neck CTA:Very limited view of the aortic arch is visualized and unremarkable.The origins of major vessels arising from the aortic arch were unremarkable.The brachial cephalic and bilateral subclavian arteries are unremarkable.Right common carotid artery including its origin and is within normal.Right internal carotid artery demonstrates minimal atherosclerotic calcific disease and unremarkable otherwise.Right external carotid artery is unremarkable.Left common carotid artery is unremarkable.Left internal carotid artery demonstrate minute calcific plaque and unremarkable otherwise.Vertebral arteries are symmetrical in size. There is calcific atherosclerotic plaque at the origin of right vertebral artery with moderate vascular lumen compromise which appears slightly worsened since prior exam.Unremarkable left vertebral artery and its origin.Brain CTA:Unremarkable bilateral intracranial segments of vertebral arteries and bilateral pica branches. Normal visualization of bilateral aica branches.Basilar artery is patent and unremarkable. Bilateral superior cerebellar arteries and posterior cerebral as are unremarkable.The left internal carotid artery is unremarkable across the skull base and in its supraclinoid segment. There is a cone shaped outpouching of vessel lumen at the the origin of a small left posterior communicating artery (which arise from its dome). IT remains identical to prior study and representing an infundibulum (anatomical radiation) and not an aneurysm. The left anterior and middle cerebral arteries are unremarkable.Anterior communicating artery is unremarkable.The right internal carotid artery is unremarkable and patent across the skull base and in the supraclinoid segment. Right posterior communicating artery is visualized and unremarkable. Right anterior and middle cerebral arteries are visualized and unremarkable. | 1.Nonenhanced head CT demonstrate mild age indeterminate small vessel ischemic strokes and unremarkable otherwise. Please see above comments.2.CTA of neck demonstrate calcific plaque at the origin of the right vertebral artery with moderate vascular lumen compromise. There is slight interval worsening of this finding since prior exam from 2011. Minimal atherosclerotic calcific changes of other vasculature however without any region of vascular lumen compromise.3.CTA of intracranial vasculature demonstrate a small infundibulum at the origin of a small left posterior communicating artery and without convincing evidence of an aneurysm. This finding is identical in size and morphology to prior exam from 2011. A small posterior communicating artery is identified arising from the dome of this conical shape infundibula. Unremarkable CTA of intracranial circulation otherwise. |
Generate impression based on findings. | 45-year-old female with history of metastatic anal cancer CHEST:LUNGS AND PLEURA: Index left upper lobe pulmonary nodule measures 5 x 2 mm on image number 35 series. Number 5, smaller compared to previous study.MEDIASTINUM AND HILA: Partially calcified right pretracheal lymph node measures 1.6 by 1.3 cm on image number 30, series number 4, smaller compared to previous study. Again noted invasion of this lymph node into the adjacent lung parenchyma.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Index right lobe hypodense lesion with calcifications, now measures 2.2 by 1.7-cm on image number 92, series number 4, not significantly changed from previous study. There is a new fluid density lesion in the left hepatic lobe measuring 2.3 by 2.5-cm image number 99, series number 4.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Interval minimal decrease in the size of the index left upper lobe nodule and pretracheal lymph nodes. Patient's known hepatic metastatic lesion is unchanged. However, there is a new cystic lesion. The left lobe of the liver. Although the lesion appears fluid density, since is new from previous study suspicious for metastatic disease. This cystic lesion may also represent postsurgical changes in the location of the previous metastatic lesion detected on PET. CT on 8/29/2013 |
Generate impression based on findings. | Reason: pt with pleural mesothelioma s/p 4 cycles of chemotherapy History: doing well now needs disease evaluation any abnormalities? Please comment on all areas etc. CHEST:LUNGS AND PLEURA: Mild diffuse pleural thickening and volume loss with scarring in the left hemithorax. It is not clear whether any of the pleural disease represents residual tumor or whether there has been a previous pleurectomy and that this is all residual scarring.The following measurements are provided for reference but it is not clear whether they represent tumor or scarring:1. In the lower left hemithorax at the level of the coronary sinus (series 401 image 62): 8 mm at 4 o'clock and 3 mm at 6 o'clock.2. Medially at the left base (series 401 image 68): 4 mm at 9 o'clock.Minimal amount of loculated pleural effusion at the left base.Bilateral calcified pleural plaques compatible with previous asbestos exposure.MEDIASTINUM AND HILA: No significant lymphadenopathy.No pericardial effusion.Catheter tip in the right atrium.CHEST WALL: No evidence of chest wall or diaphragmatic invasion.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Hyperdense nodule in the left lobe of the liver (series 401 image 79) compatible with a hemangioma, unchanged. Status post cholecystectomy.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Several small subcentimeter lymph nodes which are nonspecific.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. | Nonspecific mild pleural thickening and scarring in the left hemithorax with a small loculated pleural effusion. |
Generate impression based on findings. | Right lower quadrant abdominal pain. ABDOMEN:LUNG BASES: Dependent opacities are present bilaterally, right greater. These are most likely atelectasis.LIVER, BILIARY TRACT: Normal enhancement. Distended gallbladder. No biliary ductal dilatation.SPLEEN: Normal in size and appearance.PANCREAS: Normal in appearance.ADRENAL GLANDS: Normal.KIDNEYS, URETERS: Symmetric cortical enhancement. No pelvicaliceal dilatation. Bilateral extrarenal pelves.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Duodenojejunal junction is normally positioned.BONES, SOFT TISSUES: A left lumbar curve is present.OTHER: Small amount of free peritoneal fluid is identified between the liver and ascending colon.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Very distended and normal in appearance.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: The appendix is enlarged with a maximum diameter of 0.9-cm and contains two appendicoliths. Inflammation is identified around the appendix. No fluid collection is seen.BONES, SOFT TISSUES: A left lumbar curve is present.OTHER: Right paracolic free fluid is noted. | Appendicitis. |
Generate impression based on findings. | Female 35 years old; Reason: pt with h/o pertioneal mesothelioma h/o pleural effusion too History: now with increasing pressure in abdomen any abnormalities please compare to previous scan and comment CHEST:LUNGS AND PLEURA: Small residual right pleural effusion is noted, markedly decreased from previous examination. Drainage catheter seen in the right lung. No nodule or mass detected.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Left Port-A-Cath is in proper position with its tip in the cavoatrial junction.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter Hypoattenuating lesion in segment 5 is stable. No other hypoattenuating lesion detected. The liver is enlarged measuring 22 cm in craniocaudal height.SPLEEN: No significant abnormality noted. Accessory splenule 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: Progression of the haziness noted in the mesentery, with no measurable conglomerate nodal mass or soft tissue lesion seen. The haziness is best seen anterior to the hepatic flexure on series 4 image 128 and along the transverse colon on series 4 image 116. No small bowel or pathology detected.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Haziness of the mesentery as best seen on series 4 image 167/8 has progressed since previous exam. No measurable conglomerate mass detected. No small bowel or colonic pathology detected theBONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace pelvic ascites is noted, which is new since previous exam. | 1.Progression of the haziness in the mesentery without a measurable conglomerate node or mass as referenced above, compatible with patient's known history of peritoneal mesothelioma.2.Interval decrease in the size of the right-sided pleural effusion.3.No new metastatic lesions detected. |
Generate impression based on findings. | Duodenal carcinoid CHEST:LUNGS AND PLEURA: Moderate to severe centrilobular emphysema, unchanged.MEDIASTINUM AND HILA: Dilated esophagus throughout its course, unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Arterially enhancing lesions in the right lobe of the liver are again noted, consistent with patient's known history of carcinoid tumor. There are slightly more prominent compared to previous study. Index lesion in the right lobe measures 7 x 7 mm image number 33, series number 6. It does, previously measuring 6 x 7 mm on image number 32, series number 7.SPLEEN: No significant abnormality notedPANCREAS: Cystic lesion in the uncinate process of the pancreas, likely representing a branch type IPMN and is unchanged, measuring 1.6 by 1.1 cm, image number 39, series number 6.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Patient's known duodenal carcinoid measures 1.9 x 1 .2 cm, image number 28, series number 6, not significantly changed from previous study. Distal to the mass in the second portion of duodenum is significantly dilated, measuring up to 8 cm on image number 141, series number 7. The etiology is unknown. The transition is at the level of the third portion of duodenum. Further evaluation of this area with upper endoscopy is recommended.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 | Patient's known duodenal carcinoid tumor is grossly unchanged. Arterially enhancing metastatic lesions are slightly more prominent compared to previous study.Interval progression of the dilatation of the second portion of duodenum with transition point in the third portion of the duodenum. Further evaluation of this finding with upper endoscopy is recommended.Dilated esophagus, unchanged.Emphysema, unchanged. |
Generate impression based on findings. | 68-year-old male status post proctectomy, presenting with rising PSA CHEST:LUNGS AND PLEURA: Emphysema. Spiculated nodule in the right lower lobe, measuring 1.2 x 2 .8 cm, image number 62, series number 4, suspicious for primary or metastatic neoplasm.More anterior to this nodule. There is a focal ground glass opacity measuring 1.2 x 1 .2 cm, image number 64, series number 4, nonspecific.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral small renal cysts, unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Right lower lobe spiculated lung nodule, suspicious for primary or metastatic malignant neoplasm. |
Generate impression based on findings. | Female 31 years old; Reason: eval for hernia, sbo, fluid collection History: s/p tummy tuck, abd distention ABDOMEN: The absence of intravenous contrast limits evaluation of the solid organs. Given these limitations, the following observations were made: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: Nonspecific dilation of jejunal loops in left upper quadrant, not pathologically dilated.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Post surgical changes in the intra-abdominal wall, compatible with previous surgical intervention.PELVIS:UTERUS, ADNEXA: The uterus is markedly enlarged and incompletely characterized given lack of IV contrast.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 acute intra-abdominal pathology detected. No fluid collections, bowel obstruction, or inflammatory reaction detected. |
Generate impression based on findings. | Rectal cancer, status post robotic lower abdominal resection 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: Predominantly fat density lesion in the lower pole of the left kidney measuring 3.8 x 2.2 cm on image number 67, series number 3 likely represents an angiomyolipoma.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Right lower quadrant ostomy.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Bladder wall is significantly thickened.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Postsurgical changes secondary to recent lower abdominal resection. There is small amount of fluid in the pelvis and small amount of free air. The fluid demonstrates local collections largest measuring 3.3 by 4.7 cm, image number 133, series number 3. These may represent normal postsurgical changes, however, an abscess cannot be excluded.BONES, SOFT TISSUES: Nonspecific sclerotic lesions in the iliac bones.OTHER: No significant abnormality noted | Postsurgical changes in the pelvis. Small amount of fluid with air fluid levels and loculations. These may represent postsurgical changes, however, an abscess cannot be excluded.Significantly thickened bladder wall. This may represent cystitis.Possible left renal angiomyolipoma. |
Generate impression based on findings. | Reason: pulmonary embolism and lung cancer History: shortness of breath PULMONARY ARTERIES: Technically adequate examination with no sign of pulmonary embolism.Dilated main pulmonary artery measuring 37 mm, suggestive of pulmonary hypertension.LUNGS AND PLEURA: Moderate predominantly paraseptal emphysema in the upper lung zones.Diffuse chronic interstitial disease with architectural distortion, ground glass and reticular opacity suggestive of fibrosis.No sign of pleural effusion nor pulmonary edema.MEDIASTINUM AND HILA: Moderately enlarged nonspecific mediastinal and hilar lymph nodes measuring up to 14 mm in short axis diameter.Severe calcification in the left coronary artery with a stent in the circumflex branch.No pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. There is small hepatic and renal hypodensities most consistent with cysts. | 1. No sign of pulmonary embolism.2. Emphysema and chronic interstitial lung disease of uncertain etiology. |
Generate impression based on findings. | Evaluate for kidney stone ABDOMEN:LUNG BASES: Atelectasis at the lung bases.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal stones without evidence of hydronephrosis. Largest stones are in the right upper pole and left upper poleRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Bladder stone.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Bilateral renal stones and bladder stone. |
Generate impression based on findings. | Male 27 years old; Reason: Lymphoma Restaging History: None CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Heterogeneous left thyroid and right thyroid lobe nodules.CHEST WALL: Extensive right axillary and subpectoral adenopathy is relatively stable. The reference lesion measures 4.7 x 2.8 cm previously 4.8 x 3.2 cm image number 18, series number 3.ABDOMEN:LIVER, BILIARY TRACT: The previously seen hypodensity in the posterior aspect of the liver is not visualized on this examination.SPLEEN: Spleen measures 11 x 7 .2-cm, borderline enlarged.PANCREAS: 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: Right obturator lymph node is stable.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Stable right axillary and right subpectoral adenopathy. |
Generate impression based on findings. | Chronic sinusitis. There are postoperative findings related to partial bilateral middle turbinectomy. There is a 9 x 12 mm defect in the posterior inferior nasal septum and a 3 x 4 mm defect in the anterior inferior nasal septum, perhaps related to septoplasty. There is mild nasal septal deviation to the left. The nasal cavity is clear. There is mild mucosal thickening within the alveolar recess of the the left maxillary sinus. The paranasal sinuses are otherwise clear and there is no sclerosis or thickening of the paranasal sinus walls. The ethmoid roofs are symmetric and intact. The carotid grooves and optic canals are covered by bone. The intracranial structures are grossly unremarkable. The mastoid air cells are clear. The orbits are unremarkable. | Postoperative findings related to bilateral partial middle turbinectomy and probable septoplasty with defects in the nasal septum. No evidence of acute or chronic sinusitis. |
Generate impression based on findings. | Reason: h/o HNC, compare to previous, measurements pls, s/p CRT History: none CHEST:LUNGS AND PLEURA: Biapical scarring, unchanged.4-mm micronodule in the left upper lobe, unchanged compatible with a lymph node or a healed granuloma.Basilar scarring and atelectasis, slightly improved.No suspicious nodules.MEDIASTINUM AND HILA: Tracheostomy and a voice prosthesis in place.No significant lymphadenopathy.Moderate coronary artery calcification.Catheter tip in the inferior right atrium.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: Punctate left renal calculus without obstruction.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.Gastrostomy tube in place.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Mild basilar atelectasis and scarring. No sign of metastases. |
Generate impression based on findings. | 27-year-old female with undulating right flank pain. History of 9 stones. ABDOMEN: Within the limits of a non-IV contrast enhanced examination which limits ability to evaluate solid parenchymal organs and vessels, structures, the following observations can be made:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality noted in the liver. Patient is status post cholecystectomy. No evidence of dilated bile ducts are seen to suggest biliary obstruction.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: RIGHT KIDNEY: Normal size and morphology without evidence of mass, although lack of IV contrast limits ability to evaluate parenchyma. No abnormal calcifications are seen. No hydronephrosis. No perinephric fluid collections.LEFT KIDNEY: Multiple punctate calculi seen in the left kidney in the lower pole calyces without obstruction. No hydronephrosis is seen. No perinephric fluid collections are seen. Kidney shows normal morphology, although small masses cannot be excluded due to lack of IV contrast.No ureteral dilatation is seen and no calcifications in the expected course of the ureters.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality noted -- no urinary calculus seen.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Multiple punctate, nonobstructing left renal calyceal calculi. 2. No evidence of hydronephrosis, no urinary tract obstruction. |
Generate impression based on findings. | Nasal congestion and discharge. History of sinus surgery. There are postoperative findings related to endoscopic sinus surgery, including left maxillary antrectomy, partial middle turbinectomy, and partial ethmoidectomy. The left maxillary sinus, neoinfundibulum, and middle meatus are nearly completely opacified. There is also opacification of the left frontal and anterior ethmoid sinuses in a osteomeatal complex pattern. There is neosoteogenesis of the remaining left ethmoid septations. There is trace mucosal thickening within the pterygoid process of the left sphenoid sinus. The right maxillary, ethmoid, sphenoid and frontal sinuses are clear. There is no significant nasal septal deviation. The optic nerve canals and carotid grooves are covered by bone. The orbits are unremarkable. There is a mild periapical lucency associated with the bilateral second molars. There is unchanged bilateral basal ganglia mineralization. | 1. Postoperative findings related to left endoscopic sinus surgery with persistent left osteomeatal complex unit opacification.2. Unchanged bilateral basal ganglia mineralization, beyond expected for age, which may be related to a metabolic process. MRI of the brain may be useful for further evaluation. |
Generate impression based on findings. | Metastatic thyroid CA s/p thyroidectomy/RAI/CRT and piriform sinus CA, s/p laryngectomy 10/31, who presented to clinic with presumed nasopharyngeal leak and likely aspiration and wound breakdown. There are interval postoperative findings related to laryngectomy, neck dissection, and tracheostomy with flap reconstruction and enteric tube insertion. There are foci of gas within the soft tissues extending from the left peristomal region to the neopharynx, which may represent a fistula. Otherwise, there is no evidence of residual mass or significant cervical lymphadenopathy. The vertebral bone marrow appears diffusely heterogeneous. The partially imaged intracranial structures are grossly unremarkable. The paranasal sinuses are clear. There are multiple nodules within the partially imaged lungs, which have increased in size. There is also partially imaged consolidation with air-bronchograms in the right upper lobe with associated volume loss. | 1. Interval laryngectomy and tracheostomy with air tracking from the left peristomal region to the neopharynx, which may represent a fistula due to wound breakdown. Otherwise, no evidence of gross residual tumor or significant cervical lymphadenopathy.2. Partially imaged pulmonary metastases appear to have increased in size. Refer to the separate chest CT report for additional details. 3. The vertebral bone marrow appears diffusely heterogeneous, which may be related to treatment and less likely metastases, although a bone scan may be useful for further evaluation. |
Generate impression based on findings. | 48 year-old female with left tongue cancer, tip and lateral border, evaluate Limited intracranial views are unremarkable. The visualized paranasal sinuses and mastoid air cells are clear.Along the lateral aspect of the mid to distal tongue, there is a region of increased enhancement measuring approximately 3.0 x 1.0 cm (series 80268 image 24). This region of enhancement is difficult to accurately measure due to streak artifact from the adjacent osseous structures. The base of the tongue is not involved. The adjacent mandible is intact. No lymphadenopathy by CT size criteria. The parotid, submandibular and thyroid glands are within normal limits. No soft tissue masses are present in the neck. No exophytic masses or focal effacement of the aerodigestive tract.The major cervical vasculature is patent. Degenerative changes of the cervical spine most pronounced at C5-C6 and C6-C7 including uncovertebral hypertrophy, osteophyte formation and disk space narrowing resulting in at least moderate left neuroforaminal narrowing as well as central canal stenosis.The visualized lung apices are clear. Please see dedicated chest CT from today's date for further details. | Isolated enhancing left lateral tongue lesion without cervical lymphadenopathy. |
Generate impression based on findings. | Reason: several weeks of cough and wheezing not responsive to antibiotics, prednisone, bronchodilators History: several weeks of cough and wheezing not responsive to antibiotics, prednisone, bronchodilators LUNGS AND PLEURA: Mild bronchial wall thickening with scattered areas of mucous plugging.Scarring/discoid atelectasis in the lingular segment of the left upper lobe and both lung bases.Bilateral apical pleural parenchymal scarring. No pleural effusions.No evidence of interstitial lung disease.No suspicious pulmonary nodules or masses.No no evidence of air trapping.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy. Calcified mediastinal and hilar lymph nodes are compatible with prior granulomatous disease.Cardiac size is normal without evidence of a 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 wall thickening and scattered areas of mucous plugging compatible with bronchitis. No evidence of significant air trapping or interstitial lung disease. |
Generate impression based on findings. | 74 year old male. History of lymphoma, COPD. CHEST:LUNGS AND PLEURA: Severe centrilobular emphysema is again noted. Right lower lobe pulmonary nodule is unchanged in size (image 57, series 5). Linear scarlike opacity in the right apex is similar to prior exam.MEDIASTINUM AND HILA: Right chest port with tip in the cavoatrial junction. Cardiac size is normal. There is no pericardial effusion. Small hiatal hernia is again noted. There is no mediastinal or hilar lymphadenopathy.CHEST WALL: Stabilization devices are again noted in the spine. Extruded cement in the spinal canal and the right at the level of T8 is unchanged.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: The gallbladder is absent.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts are unchanged in size.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the abdominal aorta.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Small fat-containing ventral hernia is unchanged.OTHER: No significant abnormality noted. | Stable appearance of severe emphysema, and apical scarring. |
Generate impression based on findings. | 74-year-old female with stage IIIB ovarian cancer. Elevated CA-125. Concern for recurrence. 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: Bilateral subcentimeter hypodense cystic lesions of the kidneys, incompletely evaluated though stable in size.RETROPERITONEUM, LYMPH NODES: Moderate atherosclerotic disease of the abdominal aorta and its branches.BOWEL, MESENTERY: Large hiatal hernia is redemonstrated.BONES, SOFT TISSUES: Moderate degenerative changes of the thoracolumbar spine.OTHER: No ascites present.PELVIS:UTERUS, ADNEXA: Status post hysterectomy. A round, well-circumscribed, heterogeneous hypodense lesion is identified in the mid right pelvis demonstrating nodular peripheral enhancement and measures 2.7 x 2.3 cm (image 102, series #3). This lesion is not confidently seen on the previous exam and is concerning for recurrent disease.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. Nodular progressive changes in the omentum in the far left lateral aspect of the mid abdomen and (series #3, image 65) are seen over approximately a 5 x 3 cm region.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | New 2.7-cm lesion in the right mid pelvis and progressive nodular changes in the omentum, concerning for disease recurrence. |
Generate impression based on findings. | 75-year-old female patient with history of known infiltrate breast carcinoma and pulmonary nodules. Evaluate for metastatic disease. LUNGS AND PLEURA: Slightly lobulated, smooth solid nodule in the medial right lower lobe measures 25 x 20 mm (series 5 image 67). Right upper lobe posterior segment with nodule measuring 8 mm (series 5 image 35).Nodules are highly suspicious for metastatic disease.Pleural-based solid nodule with central calcification in the left lower lobe (series 5 image 65) is consistent with a granuloma.Multiple nonspecific scattered micronodules, some of which are calcified.MEDIASTINUM AND HILA: Heart is within normal limits without pericardial effusion. No mediastinal or hilar lymphadenopathy. Calcified subcarinal lymph nodes.Left thyroid lobe with calcification.CHEST WALL: There is a hyperattenuating lesion in the right breast (series 4 image 40). Scarring and clips within the right breast tissue. Surgical clips in the right axilla without significant lymphadenopathy.Mild multilevel degenerative changes in the thoracic spine with anterior fusion of the T6 and T7 vertebral bodies and sclerotic focus at the inferior T7 endplate that likely represents degenerative changes.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Small hiatal hernia.Numerous hypoattenuating foci within the incompletely visualized liver parenchyma. Many of these lesions are too small to characterize, are nonspecific and may represent cysts.Gallbladder with sludge versus gallstones. Intraluminal eccentric, hyperattenuating thickening along the gallbladder fundus wall is incompletely visualized and may represent adenomyomatosis.Partially visualized left kidney with multiple hypoechoic lesions are too small to characterize and likely represent cysts.Left adrenal nodule is indeterminate and most likely represents an adenoma. | 1.At least 2 pulmonary nodules, which are highly suspicious for metastatic disease from known breast carcinoma. 2.Additional indeterminate abnormalities within the abdomen. |
Generate impression based on findings. | 69 year old male, status post laryngectomy, with chest wound and drainage. LUNGS AND PLEURA: Numerous bilateral pulmonary nodules are unchanged since prior exam. Reference left upper lobe pulmonary nodule measures 1.6 cm (image 20, series 4) previously 1.6 cm. Reference right lower lobe pulmonary nodule measures 3.0 x 2.0 cm (image 61, series 3), unchanged. Right paramediastinal fibrosis and volume loss, presumably related to radiation therapy is again noted. Right basilar atelectasis appears similar or slightly decrease from prior exam.MEDIASTINUM AND HILA: There is marked coronary artery calcification. The main pulmonary artery measures 4.0 cm (image 43 series 3) suggestive of pulmonary hypertension. Mediastinal lymphadenopathy is unchanged. Reference right paratracheal node measures 1.6 cm (image 35, series 3) unchanged.CHEST WALL: There is a 20 x 15 mm left subpectoral fluid collection, which extends into the muscle itself (image 24, series 3). Additionally, there is a 10 x 10 mm fluid collection in the anterior abdominal wall (image 47, series 3) which is continuous with multiple subcutaneous foci of air tracking superiorly in the chest. There is no intrathoracic extension seen.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Cholelithiasis without evidence of cholecystitis. Enteric tube tip in the stomach. Bilateral renal cysts are unchanged. | 1.Multiple small fluid collections in the left anterior chest wall, without evidence of intrathoracic extension. These could be post procedural in etiology, however, infection cannot be excluded.2.Stable size of pulmonary metastases.3.Stable mediastinal lymphadenopathy. |
Generate impression based on findings. | Reason: 63 year old woman with LLL early stage NSCLC treated with SBRT c/b radiation pneumonitis. Please evaluate for interval change History: lung cancer posttreatment surveillance CHEST:LUNGS AND PLEURA: Severe upper lobe predominant centrilobular emphysema.Previously noted nodule in the superior segment left lower lobe (image 49 series 4) is similar in appearance to prior exam. Accurate measurements are distorted by the underlying emphysema and associated surrounding scarring/fibrosis. Currently this measures 14 mm x 6 mm previously measuring 10 mm x 10 mm.Right upper lobe nodule ( image 25 series 4) measuring 3 mm is unchanged.No new suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Stable small mediastinal lymph nodes without evidence of pathologic enlargement.Cardiac size is normal without evidence of a pericardial effusion.Redemonstration of a hiatal hernia.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Stable 10-mm hepatic hypodensity inferiorly in the right lobe (image 102 series 3) most likely representing a cyst.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: Stabilization hardware in the lower lumbar spine.OTHER: No significant abnormality noted. | 1.Stable left lower lobe nodule and associated scarring/fibrosis. 2.No evidence of metastatic disease.3.Severe centrilobular emphysema. |
Generate impression based on findings. | Hematuria ABDOMEN:LUNG BASES: Extensive coronary artery calcificationLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: 4 millimeter too small to characterize low attenuation focus within the body of the pancreas best seen on image 35 of series 8.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple bilateral subcentimeter cysts, some demonstrating intrinsic but nonenhancing intermediate attenuation consistent with benign complex cysts. No worrisome mass, inflammation, or obstruction. Unremarkable collecting systems bilaterally.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Uterus absent or atrophicBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Bilateral subcentimeter benign appearing renal cysts, some demonstrating intrinsic intermediate attenuation consistent with benign complex cyst. No worrisome mass, acute inflammatory process, or obstruction.Extensive coronary arterial calcification.Too small to characterize subcentimeter low attenuation focus within the pancreatic body. If surveillance scanning is planned, would pay special attention to this focus. |
Generate impression based on findings. | Recent left tympanoplasty related to recurrent osteoma on 11/12, presents with right facial droop. There is no evidence of acute intracranial hemorrhage or mass. There is minima scattered nonspecific cerebral white matter hypoattenuation. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. There are postoperative findings related to recent left tympanoplasty with opacification of the external auditory canal. | 1. No evidence of acute intracranial hemorrhage. Non-contrast CT is not sensitive for the detection of acute non-hemorraghic infarction and MRI can be performed for further evaluation if there are no contraindications.2. Postoperative findings related to recent left tympanoplasty. A dedicated temporal bone study can be performed for further evaluation of the facial nerve in this region if clinically warranted. |
Generate impression based on findings. | 46-year-old male with DLBC lymphoma status post 4 cycles of treatment. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No adenopathy or other significant abnormality notedCHEST WALL: Right anterior chest wall Port-A-Cath system with the tip of the catheter at the superior vena cava -- right atrial junction. No other abnormalities.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral benign renal cysts, unchanged. Kidneys otherwise appear unremarkable with no hydronephrosis.RETROPERITONEUM, LYMPH NODES: Marked retroperitoneal diffuse adenopathy has decreased since prior outside examination. Reference left periaortic lymph node (series 3, image 132) now measures 4.2 by 2.8 cm, previously 5.6 x 3.2 cm. Second referenced retrocaval lymph node (series 3. Comminuted 134) is markedly decreased in size, measuring 0.8 x 1 .2 cm, previously 2.4 x 2.9 cm.BOWEL, MESENTERY: Mesenteric lymphadenopathy has decreased in size. Reference lymph node (series 3 count image 122) now measures 1.0 x 1 .6 cm, previously 1.6 x 2.9 cm.Orally administered contrast rapidly progresses through stomach, normal. Small bowel to the right lower quadrant. No IntraStent or masses seen. The small bowel or the colon. Stomach with is diffusely thickened, but this may be due to lack of distention and cannot be evaluated on this examination.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Marked reduction in size of diffuse retroperitoneal adenopathy, but with residual significantly enlarged lymph nodes remaining. 2. Reduced size of mesenteric lymph nodes with mild residual remaining. 3. No adenopathy seen in the chest or pelvis. |
Generate impression based on findings. | History of olfactory neuroblastoma resection. Facial pain and swelling. There multiple findings related to prior surgeries including a right bifrontal craniotomy with deformity of the anterior cranial fossa floor which is associated with stable/intervally improved intracranial extra-axial soft tissue density. There has also been right ethmoidectomy, and bilateral antrectomy. There has been interval improvement of aeration within the left ethmoid and frontal sinuses with persistent opacification of the left sphenoid sinus. There is nonspecific soft tissue thickening associated with the walls of the right maxillary and ethmoid sinus cavity which is improved slightly since the prior MRI. The left maxillary sinus is clear. Mastoid cells are clear. There is no subcutaneous air or stranding. There are no aggressive appearing bony lesions. | 1.Postoperative changes which are stable since the prior MRI examination.2.Nonspecific soft tissue within the right maxillary and ethmoid cavities which is improved somewhat since the prior MR.3.Persistent opacification of sphenoid sinuses and partial opacification of left ethmoid sinuses. |
Generate impression based on findings. | Non-Hodgkin's lymphoma CHEST:LUNGS AND PLEURA: Stable micronodulesMEDIASTINUM AND HILA: No change in extensive coronary arterial calcificationCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Stable right lobe benign hemangiomas.SPLEEN: Stable subcentimeter low-attenuation focusPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant change in exophytic enhancing mass within the superior posterior aspect of the right kidney best seen on image 99 of series 5 measuring 1.7 x 1.5 cm.Stable bilateral cysts. Stable nonobstructing subcentimeter right renal stone.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable left inguinal herniaOTHER: 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 change in worrisome exophytic right renal mass; a primary renal malignancy is favored.No new adenopathy. |
Generate impression based on findings. | Change in mental status, on Coumadin, falling recently, concern for hematoma. There are unchanged postoperative findings related to left parasagittal meningioma resection with hypoattenuation in the left paracentral lobule. Although no gross mass is identified, non-contrast CT has limited sensitivity for the assessment of small tumors. There is no evidence of acute intracranial hemorrhage. There is unchanged moderate cerebral white matter hypoattenuation that likely represent microangiopathy. The ventricles are stable in size and configuration. There is no midline shift or herniation. The partially imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. | No evidence of acute intracranial hemorrhage. |
Generate impression based on findings. | 52-year-old male with Burkitt's lymphoma. Completed chemotherapy 4/2013 -- restaging. CHEST:LUNGS AND PLEURA: Bilateral pleural effusions. No parenchymal air space and moderate size pericardial effusion again seen. No air space consolidation, nodules or masses seen.MEDIASTINUM AND HILA: Enlargement is seen in the prior reference left paratracheal lymph node (series 4, image 41), which now measures 1.5 x 1 .3 cm, previously 1.4 x 1.0 cm. The prior reference aortopulmonary window lymph node (series 4, image 41) is also increased in size and now measures 1.3 x 1 .2 cm, previously 0.9 x 0.9 cm.CHEST WALL: Right chest Port-A-Cath with the tip of the catheter in the distal superior vena cava.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right kidney appears normal. Left kidney shows a focal left upper pole resection of prior noted renal mass with expected postoperative scarring. In a, andRETROPERITONEUM, LYMPH NODES: Mildly enlarged left para-aortic lymph nodes are again seen -- largest of these measures 1.6 x 1.2 cm (series 4, image 130) unchanged since 7/29/13, but appears slightly larger when compared to 1/14/13 when this measured approximately 1.2 x 0.7 cm. BOWEL, MESENTERY: Small amount of scattered ascites without loculation. Orally administered contrast progresses rapidly through normal. Stomach, small bowel to the colon without abnormality seen. Colon is feces throughout and shows diffuse sigmoid diverticulosis, but without other complication. Small anterior ventral wall hernia containing only mesenteric fat, unchanged.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No adenopathy.BOWEL, MESENTERY: Small amount of scattered ascites without loculation. Orally administered contrast progresses rapidly through normal. Stomach, small bowel to the colon without abnormality seen. Colon is feces throughout and shows diffuse sigmoid diverticulosis, but without other complication.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Slight increase in size of mediastinal lymph nodes. 2. Status post left renal partial nephrectomy. 3. Slightly enlarged left periaortic lymph nodes, stable since 7/29/13, but increased in size when compared to original presentation, CT scans. 4. Small amount of scattered ascites. |
Generate impression based on findings. | 76-year-old male with hematuria. 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: A hypodense left adrenal lesion meets criteria for a benign adenoma.KIDNEYS, URETERS: Simple cyst in the upper pole the right kidney. No evidence of nephrolithiasis or mass lesion in the kidneys. No perinephric stranding or fluid collection bilaterally. No lesion is identified in the proximal two thirds of the ureters. The distal one third of the ureters bilaterally are not opacified, limiting their evaluation.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic calcification of the abdominal aorta and its branches is noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: The prostate is markedly enlarged measuring 5.9 x 5.5 centimeters.BLADDER: A 4-mm hyperattenuating focus in the bladder may represent a bladder stone.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the lumbar spine are noted.OTHER: Bilateral inguinal hernias containing only mesenteric fat. | 1.4 mm stone in the bladder.2.Markedly enlarged prostate gland. |
Generate impression based on findings. | 48-year-old female patient with left tongue cancer. Evaluate for metastatic disease to the chest. LUNGS AND PLEURA: Right lower lobe cyst. Scattered bilateral micronodules are nonspecific. No suspicious pulmonary lesions.MEDIASTINUM AND HILA: Heart size within normal limits without pericardial effusion. No mediastinal or hilar lymphadenopathy.CHEST WALL: Mild multilevel degenerative changes in the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Status post cholecystectomy. Biliary ductal dilatation, not unexpected given prior cholecystectomy. | No evidence of metastatic disease. |
Generate impression based on findings. | 70 year-old male with pancreatic neuroendocrine tumor, restaging. CHEST:LUNGS AND PLEURA: Scattered micronodules without other abnormalities to suggest metastatic disease. Foci of tree and bud nodularity is seen in the right lower lobe suggestive of inflammatory disease. No other abnormalities are seen. No pleural effusions.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Too many to count enhancing foci are seen throughout the liver. Diffusely most of which demonstrate washout on portal venous phase imaging. Typical of neuroendocrine tumor metastases. Some of these lesions show central areas of necrosis and cystic change -- these necrotic/cystic changes can be seen tumors before treatment and conversely can also be seen post treatment as a sign of response to treatment. Without old examinations for comparison, therefore, the effect of treatment and potential for response cannot be ascertained. Reference measurements:Segment 4 anteriorly (series 6, image 29) 2.6 x 1.9 cm seen best on arterial phase imaging.Right lobe segment 5/6 (series 6, image 50, 1) 1.6 x 1 .8 cm, seen best on arterial phase imaging.SPLEEN: No significant abnormality noted -- there is, however, loss of the splenic vein with gastroepiploic collateral veins. The vein is most likely affected by a tumor in the, pancreas, as described in pancreas section below.PANCREAS: No tumor mass is seen in the pancreas, although punctate calcification is seen in the body of the pancreas which may represent scarring or could be calcifications within the small neuroendocrine tumor not a distorting the contour of the pancreas. In addition, there may be some encasement of vessels in this region on the arterial phase (series 6, image 36, which may identified this is the site. The more proximal pancreas in the tail is not visualized, which may represent atrophy from an obstructing lesion. Rarely, pancreatic tail surgery has been done, leaving a spleen in place and this may have harbored the source of primary tumor. Without old films, this is not possible to elucidate.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Diffuse degenerative changes throughout. The bony skeleton with hardware fixation in the posterior elements areOTHER: 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: Diffuse degenerative changes.OTHER: No significant abnormality noted | 1. Abnormalities in the body of the pancreas suggestive of situs tumor with encasement of arterial vessels and splenic vein occlusion, but not definitively identifying the tumor. Disrupting pancreatic parenchyma. Comparison with old films would help evaluate this further. 2. Extensive hepatic metastases. |
Generate impression based on findings. | 71 year-old female with locally advanced breast cancer and lung nodules seen on CT scan from 6/2013. Follow-up examination to evaluate nodule stability. CHEST:LUNGS AND PLEURA: The reference pleural based nodule within the right upper lobe measures 3 mm, previously 3 mm (31; series 4). The reference pulmonary nodule within the superior segment of the right lower lobe measures 3 mm, previously 4 mm (40; series 4). Lungs are otherwise clear. No pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar adenopathy. The thyroid gland is enlarged and there is a 1.2-cm diameter nodule within the left lobe. There is diffuse atherosclerotic calcification of the aorta and coronary arteries. No pericardial effusion.CHEST WALL: There is interval resection of the previously described lobulated mass involving the upper medial left breast. There is interval resection of the previously described left axillary adenopathy. A surgical drain is in place with the tip terminating in the soft tissues along the anterior left hemithorax near the apex of the left lung. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The kidneys are normal in appearance. The reference left perirenal soft tissue mass measures 10 x 10 mm, previously 12 x 11 mm (series 3, image 103).RETROPERITONEUM, LYMPH NODES: No significant adenopathy. Diffuse aortic atherosclerosis.BOWEL, MESENTERY: Mild colonic diverticulosis.BONES, SOFT TISSUES: Diffuse degenerative changes of the spine and scattered areas of calcification within the disks. There is interval development of sclerotic lesions in the T7 and T4 vertebral bodies suspicious for metastatic disease. OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Again seen is nodularity along the anterior aspect of the transverse colon, appearing similar to the prior study, which may represent carcinomatosis, however, this is equivocal. BONES, SOFT TISSUES: Scattered small sclerotic foci within the pelvis, likely represent bone islands. Lumbosacral transitional anatomy and degenerative changes.OTHER: No significant abnormality noted. | 1. Postoperative changes of left breast mass and left axillary lymphadenopathy resection, as described above. There is interval development of multiple sclerotic lesions in the vertebral bodies of the thoracic spine consistent with progression of disease. 2. No significant interval change in right upper and right lower lobe pulmonary micronodules.3. Persistent left perirenal mass of uncertain etiology. |
Generate impression based on findings. | 67-year-old female with history of cirrhosis. HCC screening. ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver contour: The caudate lobe is enlarged with widening of the hepatic fissures. Mild atrophy of the right lobe is appreciated. Features of portal hypertension: None. Portal vein: Patent with normal caliber. Hepatic veins: Patent with normal caliber.Hepatic artery: Normal left hepatic artery. Right hepatic artery is replaced, arising from the SMA.Lesions: No significant hepatic lesions. The liver enhances homogeneously. A 2-3 mm hypodensity in segment 6 is too small to fully characterize, though likely of benign etiologyA gallstone is identified in the gallbladder neck.SPLEEN: The spleen is enlarged measuring approximately 15 cm in its maximal diameter measured axially.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic calcification of the abdominal aorta and its branches is noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Cirrhotic morphology of the liver with no evidence of HCC as clinically questioned.2.Mild splenomegaly.3.Cholelithiasis. |
Generate impression based on findings. | Clinical question:? intracranial metastasis. Signs and symptoms: Metastatic thyroid cancer. Unenhanced head CT:There is no evidence of intracranial intracranial abnormalities.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray- white matter differentiation.There is no evidence of metastatic disease on this nonenhanced exam. Lack of intravenous contrast however significantly reduces the sensitivity of the exam for detection of small parenchymal or leptomeningeal metastatic disease. Unremarkable calvarium and soft tissues of scalp.Unremarkable orbits, paranasal sinuses and the mastoid air cells. | Negative nonenhanced head CT. Lack of intravenous contrast reduces sensitivity of the exam for detection of small parenchymal or leptomeningeal metastasis. |
Generate impression based on findings. | 70 year-old male with recurrent tonsillar/base of tongue cancer status post 5 cycles of chemotherapy, reevaluate Brain:No mass effect, focal edema or suspicious enhancement is present to suggest brain parenchymal metastatic disease. Unchanged focal hypodensity in the right basal ganglia. The bones of the calvarium and skull base are intact. Chronic right orbital floor blowout fracture without entrapment.Neck:Soft tissue thickening and enhancement at the left aspect of the base of the tongue and tonsillar pillar appears fuller on the axial images than the prior examination. This lesion measures slightly larger on today's exam, 2.7 x 1.1 x 2.5 cm (series 8044 image 46, series 6 image 24), previously measured 2.6 x 1.4 x 2.0 cm.Necrotic right level 2/3 lymph nodes are again present with reference node measuring 0.8 x 1.0 cm (series 6 image 34), previously measured 0.9 x 1.1 cm. Similar to the prior, there is ill-defined enhancement within the right sternocleidomastoid muscle. No pathologic adenopathy is detected in the left neck.Evidence of treatment related change is present including mucosal hyperemia, infiltration of the fascial planes and a thin retropharyngeal effusion.The parotid glands are unremarkable. The sublingual and submandibular glands are mildly hyperemic, but otherwise unremarkable. Small hypoattenuating thyroid nodules, unchanged.Atherosclerotic vascular calcifications at the carotid bifurcations. Small amount of noncalcified atherosclerotic plaque is present in a right common carotid artery. Similar to the prior, the right internal jugular vein does not opacify. Prominent posterior collateral cervical veins are present. The remaining major cervical vasculature is patent. Multilevel degenerative changes of the visualized cervicothoracic spine, most pronounced from C5 through C7 resulting in neuroforaminal narrowing, without evidence of suspicious osseous lesions.Biapical scarring/fibrosis. Extensive centrilobular and paraseptal emphysema. Scattered pulmonary micronodules. Please see dedicated chest CT from today's date for further details. | 1. Slight interval increase in size of left base of tongue/tonsillar pillar mass.2. No significant interval change in necrotic cervical lymphadenopathy.3. No intracranial metastatic disease. |
Generate impression based on findings. | 24 year-old female with syncope, headache and vision change. NONCONTRAST CT HEADThe ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear except for partial opacification of the sphenoid sinus. CTA HEAD There is normal contrast opacification through anterior circulation (bilateral petrous/cavernous/supraclinoid internal carotid arteries, anterior and middle cerebral arteries), posterior circulation (vertebral-basilar, posterior-inferior cerebellar, anterior-inferior cerebellar, superior cerebellar, and posterior cerebral arteries), and distal intracranial vasculature. There is normal contrast opacification through a complete circle-of-Willis with a patent anterior communicating artery and bilateral posterior communicating arteries. No evidence of aneurysm, significant stenosis, occlusive thrombus, dissection, or vascular malformation is noted.There is normal superficial and deep intracranial venous drainage. | 1. No acute intracranial abnormality. 2. No evidence of aneurysm, significant stenosis, occlusive thrombus, dissection, or vascular malformation. |
Generate impression based on findings. | Male 58 years old; Reason: H/O Follicular NHL s/p 2 cycels of lenalidomide Rituxan now in need of re imaging. Please compare to prior. History: H/O Follicular NHL s/p 2 cycels of lenalidomide Rituxan now in need of re imaging. Please compare to prior. CHEST:LUNGS AND PLEURA: Scattered areas of atelectasis. No dominant lung lesion. The pleural spaces are clear.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. Few scattered mediastinal lymph nodes.CHEST WALL: Left thoracic inlet node measures 0.7 x 0.4 cm, previously 1.5 x 0.9 cm (series 3 image 4).ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesion. Hepatic and portal veins are patent.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: There is mild to moderate atrophy of the right kidney. The retroperitoneal soft tissue extends along the hilum of the right kidney and partially into the right posterior aspect of the right kidney.No hydronephrosis in either kidney. Small nonobstructive right renal calculus.RETROPERITONEUM, LYMPH NODES: Stable retroperitoneal conglomerate soft tissue representing lymphadenopathy encases the aorta, IVC and renal vasculature. The conglomerate soft tissue at the level of the transverse portion of the duodenum measures 6.7 x 3 .8 cm, previously 7.1 x 3.6 cm (image 122/series 3). There is ill-defined soft tissue adjacent to the appendix and ileum in the right lower abdomen.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: Right retroperitoneal nodal mass adjacent to the right ilium measures 3.2 x 1 .1 cm, previously 2 x 4 cm (image 151/series 3) has decreased in size since the prior exam. Stable ill-defined right lower quadrant mesenteric soft tissue lesion at image 152/series 3 is stable. OTHER: No significant abnormality noted | 1.Stable lymphadenopathy in the retroperitoneum and mesentery.2.Decreased lymphadenopathy in the right iliac fossa.3.Decreased left thoracic inlet lymphadenopathy. |
Generate impression based on findings. | 80 year-old female with pain and a remote above-the-knee amputation. Evaluate bone and muscle. Fat stranding is seen in the subcutaneous tissues around the left femoral amputation. The osteotomy margin is sharp. Diffuse cortical irregularity in the distal femur is likely secondary to osteopenia. The bone marrow attenuation is normal fatty. A small amount of heterotopic bone formation is seen posterior to the osteotomy margin. There is no specific CT evidence of osteomyelitis. No loculated fluid collection is noted to suggest abscess. Moderate osteoarthritis affects the left hip.Surgical clips and dystrophic calcifications are seen in the medial tissues of the right thigh. Atherosclerotic calcifications are seen the visualized vessels. | Left femoral amputation, as described above, with no evidence of osteomyelitis. |
Generate impression based on findings. | 70 year-old male, with head and neck cancer, metastases to lung, recurrence. CHEST:LUNGS AND PLEURA: There is a new 5-mm, noncalcified, only nodule in the right upper lobe (image 45, series 7). Right middle lobe nodular opacity is unchanged in size (image 75, series 7). PET avid left upper lobe sub pleural nodule measures 9 x 6 mm (image 30, series 7) previously 8 x 4 mm. Clusters of centrilobular nodules in the lung bases are unchanged, and remains suggestive of aspiration. Severe centrilobular emphysema is again seen. Additional scattered micronodules and calcified granulomas are unchanged.MEDIASTINUM AND HILA: Cardiac size is normal without pericardial effusion. Right chest port with tip at the cavoatrial junction. Coronary artery calcifications. There is no mediastinal or hilar lymphadenopathy. Stable, nonenlarged lower mediastinal lymph node (image 88, series 5).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: Renal cysts are unchanged.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Dense atherosclerotic calcification of the abdominal aorta.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Interval increased size of left upper lobe PET avid pulmonary nodule. New 5-mm right upper lobe pulmonary nodule.2.Stable right middle lobe nodular opacity. |
Generate impression based on findings. | Clinical question: History of kidney cancer with recent syncopal episodes; rule out metastases; give contrast if needed. Nonenhanced head CT:No detectable acute intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus.No evidence of a metastatic disease on this nonenhanced head CT. Lack of intravenous contrast reduces the sensitivity of the exam for detection of small parenchymal metastatic lesions or leptomeningeal metastases. Consider follow up at the posterior enhanced exam. There are minute subcortical and periventricular low-attenuation white matter and small foci of low attenuation in the left paramedian pons likely representing age indeterminate mild small vessel ischemic strokes.Cerebral cortex, cortical sulci, ventricular system, CSF spaces antegrade and white matter differentiation remains in normal.Negative calvarium. Unremarkable orbits, paranasal sinuses, mastoid air cells and middle ear cavities. | 1.Negative nonenhanced head CT for metastatic disease.2.Mild age indeterminate small vessel ischemic strokes.3.Follow-up with an MRI or enhanced head CT to exclude possibility of small metastatic lesions which can be missed on nonenhanced head CT. |
Generate impression based on findings. | Reason: concern for hypersensitivity pneumonitis vs other ILD. ILD PROTOCOL History: shortness of breath, cough LUNGS AND PLEURA: Diffuse patchy ground glass opacity with some basilar predominance.Mild bronchial thickening but no significant air trapping on the expiration scan.Several small subpleural nodules of which some have resolved and others are new.No significant air trapping on the expiration scan.MEDIASTINUM AND HILA: Moderately enlarged mediastinal and axillary lymph nodes, unchanged.Dilated main pulmonary artery measuring 39 mm in diameter, suggestive of pulmonary hypertension.No pericardial effusion.CHEST WALL: Degenerative disease in the spine.UPPER ABDOMEN: Absence of IV and enteric contrast material and morbid obesity markedly limits sensitivity for abdominal pathology. Status post cholecystectomy. | Bronchial thickening and patchy ground glass opacity, slightly improved or possibly unchanged allowing for differences in technique. The findings are nonspecific but compatible with hypersensitivity pneumonitis. |
Generate impression based on findings. | 42 old male, lung transplant evaluation. Shortness of breath. LUNGS AND PLEURA: There is bronchiectasis and architectural distortion, as well as subpleural reticular opacities, and bilateral honeycombing seen, with a basilar predominance. Additionally, there are small areas of focal ground glass opacities throughout both lungs.MEDIASTINUM AND HILA: Heart size is top normal. There is no pericardial effusion. There are multiple small, nonenlarged mediastinal lymph nodes. The main pulmonary artery measures 3.1 cm (image 42 series 3) suggestive of pulmonary artery hypertension.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Basilar predominant honeycombing with associated diffuse subpleural reticular opacities, bronchiectasis, and architectural distortion, compatible with a UIP pattern. |
Generate impression based on findings. | 70 year-old female patient with history of bronchiectasis and two lung nodules with 30+ pack year smoking history. Evaluate right anterior and lower lobe nodules after initiating NTM therapy. LUNGS AND PLEURA: Minimal interval decrease in size of anterior right upper lobe nodule, currently measuring 10 x 10 mm (series 4 image 144), previously 12 x 10 mm. This lesion is flat and smooth on coronal images, suggesting a benign etiology. No evidence of new suspicious nodules.Nodular and tree in bud opacities with thickened bronchioles and mild bronchiectasis. There are scattered areas of improvement and areas of increased bronchiectasis.Mild centrilobular emphysema.MEDIASTINUM AND HILA: Cardiac size within normal limits without pericardial effusion. Moderate coronary artery calcifications.CHEST WALL: Moderate multilevel degenerative changes in the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.Stable to slight decreased size of benign appearing right upper lobe pulmonary nodule. No new suspicious nodules.2.Some areas of improvement and areas of worsening mild bronchiectasis with tree in bud opacities. The pattern is suspicious for infectious etiologies such as MAI. |
Generate impression based on findings. | Male 47 years old; Reason: Pre-Kidney Transplant Evaluation, assess aorta and iliac vessels for renal transplant History: pt had 2 previous kidney transplant 1982 and 1992 ABDOMEN: The absence of intravenous and oral contrast limits evaluation of the solid organs and of the bowels. Given these limitations, the following observations were made:LUNGS BASES: Linear atelectasis seen in the bilateral lung bases. No nodule or mass detected.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: Transplant kidney is noted in the left lower quadrant. No perinephric fluid collection or kidney stone detected. No mass lesion detected. Transplant kidney in the right lower quadrant is atrophic. No mass lesion detected.The bilateral native kidneys are atrophic. 4.9 x 4.6 cm cyst noted superior pole right kidney. Another lesion in the lower pole right kidney measures water density, also likely a cyst. No hydronephrosis or mass lesion detected. No renal stone detected.RETROPERITONEUM, LYMPH NODES: No significant calcifications are noted in the abdominal aorta. Moderate (approximate 180 degrees) atheromatous calcifications are noted in the right common iliac vessel on the posterior medial portion of the vessel.Moderate (approximately hundred 80 degrees) atheromatous calcifications are noted in the left common iliac vessel on the posterior medial portion of the vessel.Very mild calcifications are noted in the external and internal iliac vessels, approximately 90 degrees.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Surgical clips noted in right lower quadrant along the iliac vascular chain. | 1.Status post two renal transplants with vascular calcifications as above. |
Generate impression based on findings. | Male 74 years old; Reason: 74 y/o w/ recent dx of non small cell lung cancer; needs staging please History: cough ABDOMEN:LUNGS BASES: Small right pleural effusion. The heart is markedly enlarged and is status post CABG. Vascular congestion noted.LIVER, BILIARY TRACT: Cholelithiasis. The liver morphology is normal without focal lesion. SPLEEN: Granulomas noted in spleen.PANCREAS: Presentation has a pancreas noted.ADRENAL GLANDS: The bilateral adrenal glands are mildly nodular, nonspecific.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Moderate to severe atheromatous locations of the aorta and iliac vessels noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.No definite metastatic disease detected. |
Generate impression based on findings. | Neutropenia with sepsis and abdominal pain; history of CML ABDOMEN:LUNG BASES: Small bilateral pleural effusions again noted.LIVER, BILIARY TRACT: Moderately distended gallbladder with pericholecystic fluid. Periportal edema.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diffuse wall thickening as well as mild dilatation of the colon. No bowel obstruction or abscess. Trace ascitesBONES, SOFT TISSUES: Stable mixed sclerotic and low-attenuation bony findings. Stable anasarcaOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diffuse wall thickening involving the distal colon and rectum. Trace ascitesBONES, SOFT TISSUES: No change in diffuse mixed sclerotic low-attenuation bony findings. Stable anasarca.OTHER: No significant abnormality noted | Diffuse colonic wall thickening consistent with pancolitis. An infectious etiology is favored. Moderately distended gallbladder with pericholecystic fluid. While this probably is due to the diffuse ascites, acute inflammation cannot be completely excluded. Recommend correlation with ultrasound.Other chronic findings unchanged.Dr. Kallepalli informed of these findings 11/21/2013; 4:30pm |
Generate impression based on findings. | 60 year-old male. Evaluate right renal mass with IVC thrombus.? Cranial extent of thrombus. Question lung metastases. Question bone metastases CHEST:LUNGS AND PLEURA: Nonspecific subpleural micronodules (series 13, image 49) without other parenchymal abnormalities. No pleural disease seen.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right kidney shows a solid heterogeneously enhancing abnormal mass lesion, measuring 8.1 x 6 .5 cm, compatible with known renal cell carcinoma. There is mass extension into the right renal vein which extends is well into the inferior vena cava and extends proximally for approximately 4 cm. The extension ends as the IVC approaches. The liver and well before the hepatic veins.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal, periaortic lymph nodes are seen scattered, and while these do not achieve sized typically seen to diagnose metastatic disease, there is contrast enhancement (see series 10, image 58) in a lymph node that measures 0.7 x 0.7 cm and is worrisome for metastatic disease. Other slightly larger. Lymph nodes are seen anterior to the inferior vena cava (series 10, image 47) that measure 1.1 x 1.0 cm thatBOWEL, MESENTERY: No significant abnormality noted in the abdomen. Pelvis shows sigmoid colon in left inguinal hernia..BONES, SOFT TISSUES: Diffuse bony degenerative changes without focal abnormality.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Left inguinal hernia containing sigmoid colon without complication. No other abnormality seen in the bowel, or mesentery.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Large right renal mass with renal vein and inferior vena cava invasion. 2. Enlarged and small, but enhancing lymph nodes in retroperitoneum, most likely indicating metastatic disease. 3. Nonspecific micronodules seen in right lung without definite evidence for metastatic disease. |
Generate impression based on findings. | 57 year old female. Hemoptysis, evaluate for PE. PULMONARY ARTERIES: The quality of this examination is excellent for the evaluation of pulmonary embolism. No pulmonary embolus is present.LUNGS AND PLEURA: No pleural effusion or focal air space opacity are seen. Minimal bibasilar dependent atelectasis.MEDIASTINUM AND HILA: Cardiac size is normal without pericardial effusion. There are multiple small, nonenlarged mediastinal lymph nodes, without any enlarged by CT criteria.CHEST WALL: Small, sclerotic foci in the T3 and T5 vertebral bodies are unchanged in appearance and size. Mild degenerative changes are again noted in the spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | No evidence of PE, or significant abnormality |
Generate impression based on findings. | 66-year-old male with history of lung cancer presenting with dyspnea ABDOMEN:LUNG BASES: Chest CT is dictated separately.LIVER, BILIARY TRACT: Fatty infiltration of the liver. No focal liver lesions. Cholelithiasis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate gland.BLADDER: Significantly distended bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Significant distended bladder superiorly to the level of the umbilicus. Enlarged prostate. Cholelithiasis. |
Generate impression based on findings. | 66-year-old male with shortness breath, history of lung cancer, history of SVC thrombus. PULMONARY ARTERIES: The quality of this examination is excellent for the evaluation of pulmonary embolism. No pulmonary embolus is present.LUNGS AND PLEURA: There is right basilar atelectasis and right lower lobe mucus plugging, new from prior exam. Mild centrilobular emphysema is again noted.Reference right upper lobe pulmonary nodule measures 9 x 6 mm (image 57 series 11) previously 9 x 8 mm. Reference right lower lobe pulmonary nodule measures 14 x 10 mm (image 8 series 11) previously 12 x 11 mm. Additional right lower lobe reference pulmonary nodule measures 17 mm (image 115, series 9) previously 15 mm. MEDIASTINUM AND HILA: Heart size is normal without pericardial effusion. Reference right hilar lymph node measures 1.3 cm (image 115, series 9), unchanged. Marked coronary artery calcifications. Hiatal hernia is again noted.CHEST WALL: Degenerative changes are noted in the spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Reference paraesophageal lymph node measures 10 mm (image to 15, series 9), previously 11 mm. Cholelithiasis. | 1.No evidence of PE.2.Stable to slight increase in size of reference pulmonary nodules.3.Right basilar atelectasis and right lower lobe mucus plugging. |
Generate impression based on findings. | Assess for persistent right hydronephrosis CHEST:LUNGS AND PLEURA: Multiple lung nodules in the right middle lobe. An index nodule measures 6-mm in diameter image number 45, series number 6.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Hepatomegaly. Fatty infiltration of the liver. Liver, findings are suspicious for chronic liver disease.SPLEEN: Mild splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal stone without evidence of hydronephrosis. A punctate stone is present in the upper pole of the left kidney.There is a 5 mm stone in the right distal ureter, best seen on image number 162, series number 8, causing mild right-sided dilated ureter. Mild right-sided caliectasis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Large ventral abdominal hernias containing nonobstructive bowel loops and large amount of fat.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Enlarged uterus. Pelvic ultrasound may be helpful for further evaluation.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. | Mild right-sided hydronephrosis and hydroureter caused by right distal ureteral stone.Left upper pole stone without evidence of hydronephrosis.Hepatomegaly and fat infiltration. CT findings are concerning for chronic liver disease.Multiple right middle lobe nodules. Follow-up chest CT in 6 months is recommended.Enlarged uterus. Pelvic ultrasound is recommended to exclude endometrial carcinoma. |
Generate impression based on findings. | 44 year-old female with right upper quadrant pain. ABDOMEN:LUNG BASES: Minimal basilar atelectasis.LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Multiple small retroperitoneal lymph nodes, of unclear clinical significance.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: IUD in place. Heterogeneous attenuation and nodular morphology of uterus, most likely due to multiple small fibroids.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No specific abnormalities to account for symptoms. |
Generate impression based on findings. | 55-year-old female with a complex surgical history of Roux-en-Y bypass. Evaluate enterocutaneous fistula. ABDOMEN:LUNG BASES: Left base nodule is stable to slightly decreased in size, measuring 2.4 x 1 .3 cm, previously measured 2.4 x 1.7 cm (series 4, image 7). Atelectasis in right base.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications affect the aorta and its branches.BOWEL, MESENTERY: Postsurgical changes including Roux-en-Y gastric bypass and bilateral ostomies. Left lower quadrant colostomy is associated parastomal herniation of mesenteric fat.Again seen are multiple small bowel loops adherent to the right anterior abdominal wall, with evidence of contrast collecting in the open abdominal wound, consistent with enterocutaneous fistula, not significantly changed since prior exam.No loculated fluid collections to suggest abscess.Gastrostomy tube in place.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: Soft tissue attenuation extends from the bladder dome to the inferior aspect of the abdominal wound (series 3, image 136); this may represent developing fistulous tract from bladder to wound.BONES, SOFT TISSUES: Again noted orthopedic hardware and left femur.OTHER: No significant abnormality noted | 1.Persistent enterocutaneous fistula to the open abdominal wound. No evidence of abscess.2.Linear soft tissue extending from dome of bladder to the anterior abdominal wall, suspicious for developing fistulous tract. |
Generate impression based on findings. | Diagnosis: Infection and inflammatory reaction due to nervous system device, implant, and graft. Hydrocephalus watch The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of status post left-sided ventriculostomy tube placement. A ventriculostomy tube enters the left parietal bone course of the left parietal lobe and into the left lateral ventricle with tip in the region of the junction of the body of the left lateral ventricle and the trigone. A ventriculostomy tract with a couple air bubbles exists along the right parietal lobe. Some edema surrounds the ventriculostomy tube.The lateral ventricles are small. Compared to prior exam the lateral ventricles are somewhat smallerThe visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.Status post a left-sided ventriculostomy tube placement. The lateral ventricles are nondilated and slightly smaller than on the prior exam. |
Generate impression based on findings. | Diagnosis: Infection and inflammatory reaction due to nervous system device, implant, and graft. Hydrocephalus watch The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post recent removal of a right-sided ventriculostomy tube.The patient is a status post left-sided ventriculostomy tube placement. A ventriculostomy tube enters the left parietal bone course of the left parietal lobe and into the left lateral ventricle with tip in the region of the junction of the body of the left lateral ventricle and the trigone. A ventriculostomy tract exists along the right parietal lobe. Some edema surrounds the ventriculostomy tube.There is redemonstration of calcification along the right tentorial leaf .The lateral ventricles are small. Compared to prior exam the lateral ventricles are somewhat larger but are not dilated.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.Status post a left-sided ventriculostomy tube placement and a right sided vetriculostomy tube removal. The lateral ventricles are nondilated and slightly larger than on the prior exam. |
Generate impression based on findings. | 57-year-old male with fever after recent urologic procedure. Also status post drains for abdominal fluid collections. ABDOMEN:LUNGS BASES: New bilateral small pleural effusions with associated compressive atelectasis.LIVER, BILIARY TRACT: Two enhancing masses in the left lobe measuring 2.0 x 2.4 cm (image 48, series #4) and 1.8 x 1.3 cm (image 21, series #4) are redemonstrated, and grossly stable in size and likely represent hemangiomas. Multiple scattered bilobar hypodensities are too small to further characterize. The gallbladder is surgically absent with cholecystectomy clips in the gallbladder fossa.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: An ill-defined, heterogeneous, hypodense lesion in the interpolar region of the right kidney measuring 3.6 x 2.7 cm with associated mild perinephric fat stranding (image 52 to 58, series #4) is grown in size from outside study dated 11/19/2013. No loculated perinephric fluid collection. No hydronephrosis or detectable renal calculi bilaterally.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic calcification of the abdominal aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: Status post prostatectomy.BLADDER: Status post cystectomy.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Postsurgical changes from cystoprostatectomy. A surgical drain and two pigtail drains terminate in the mid to low pelvis. The previous seen fluid collections are nearly resolved with only a small residual collection remaining. A Foley is seen presumably in a decompressed neobladder. | 1.Findings consistent with early abscess formation of the right kidney.2.New small bilateral pleural effusions.3.Near-resolution of the pelvic fluid collections.4.Two stable enhancing left lobe liver lesions likely represent hemangiomas. |
Generate impression based on findings. | 44-year-old male with history of pain. Assess size of pancreatic pseudocyst. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: There is stranding around the pancreatic head consistent with pancreatitis. A lobulated hypoattenuating lesion within the pancreatic head and uncinate process measures 3.2 x 1.8 cm, most compatible with pseudocyst (series 3, image 40).No significant pancreatic ductal dilation. No evidence of vascular pseudoaneurysm. The vasculature around the pancreas appears patent, without evidence of thrombus.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Large amount of fluid and food material is present in the stomach. Contrast passes into distal small bowel, without evidence of obstruction. Mild dilation of duodenum adjacent pancreatic head likely focal ileus caused by pancreatitis.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 | Stranding around pancreatic head with lobulated hypoattenuating collection in the pancreatic head, most consistent with pancreatitis with associated pseudocyst. |
Generate impression based on findings. | Diagnosis: Infection and inflammatory reaction due to nervous system device, implant, and graft. Hydrocephalus watch The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post recent removal of a right-sided ventriculostomy tube.The patient is a status post right-sided ventriculostomy tube placement. A ventriculostomy tube enters the right parietal bone courses through the right parietal lobe and into the right lateral ventricle with tip in the frontal horn. There is associated shunt tubing present along the right occipital scalp.There is redemonstration of calcification along the right tentorial leaf .The lateral ventricles are small. Compared to prior exam the lateral ventricles are stable.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.Examination was performed for the purpose of stereotactic guidance. This ventriculostomy tube in place |
Generate impression based on findings. | 78 year-old male with persistent nausea and vomiting. ABDOMEN:LUNG BASES: Calcified granuloma left lower lobe. Upper termination of retroperitoneal fat through left diaphragmatic defect, consistent with Bochdalek hernia.LIVER, BILIARY TRACT: Multiple date granulomas. No biliary ductal dilation. Several subcentimeter hypodensities are too small to characterize but most likely represent benign cysts (series 3, image 20).SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Moderate hiatal hernia. Moderate grade partial small bowel obstruction with maximum small bowel diameter measuring up to 3.7 cm (series 3, image 48). There is a large left inguinal hernia containing several loops of small bowel, however, this does not appear to be main point of the obstruction. More proximally, there is abnormal configuration of the mesentery and adjacent loops (series 3, image 46; sagittal series image 42; coronal series image 64), raising suspicion for internal hernia. Associated abnormal soft tissue attenuation in mesenteric fat in the right hemiabdomen (series 3, image 47) is suspected to represent small amount of fluid and inflammatory change, possibly mesenteric ischemia. Contrast passes distally into collapsed small bowel loops.There is wall thickening in a segment of jejunum in the left hemiabdomen, of unclear etiology (coronal series image 61).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: Left inguinal hernia containing several small bowel loops.BONES, SOFT TISSUES: Severe degenerative changes affect the lower lumbar spine, with posterior disk osteophyte complexes at L4-5 and L5-S1.OTHER: No significant abnormality noted | 1.Moderate grade partial small bowel obstruction, which may be related to internal hernia given abnormal configuration of mesentery in the midabdomen. Associated abnormal soft tissue attenuation in mesentery and right hemi-abdomen suspected to represent associated inflammation, possibly ischemia. No significant free fluid. 2.Large left inguinal hernia containing multiple bowel loops; this does not appear to be main point of obstruction. Findings were discussed with Dr.Darren Bryan at the 9:11 a.m. on 11/22/2013. |
Generate impression based on findings. | 20 year-old male with elevated d-dimer and chest pain PULMONARY ARTERIES: Technically adequate study without evidence of pulmonary embolus. LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Normal heart size. Soft tissue in the anterior mediastinum with mildly convex borders, most consistent with residual thymus tissue.CHEST WALL: Irregularity of the sternomanubrial joint is noted, likely normal variant anatomy.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | No pulmonary embolus or other specific findings to explain the patient's symptoms. |
Generate impression based on findings. | eval s/p brain surgery There is intracranial air throughout the anteriorly located subarachnoid spaces and within the perimesencephalic cistern and along the posterior fossa. The patient is status post resent a burr hole placements along the left occipital calvarium. There is a small hyperdense focus present in the left cerebellar hemisphere measuring 7 mm in size which is centered within the 24-mm lesion better seen on the recent MRI.There is a redemonstration of a left-sided brainstem lesion better seen on the recent MRI located in the left midbrain and pons extending down to the medulla.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.The patient is status post recent left cerebellar surgery with attendant postoperative changes. A small focus of blood is present at the surgical site centered within a lesion. Please refer to recent MRI of the brain for further details.2.Left brainstem lesion is better seen on recent MRI |
Generate impression based on findings. | Post procedural dizziness. There is no intracranial mass, hemorrhage or edema. The midline is intact. Ventricles and cisterns demonstrate normal size and morphology. There are no bony lesions and the orbits are unremarkable. Partial opacification of a few scattered ethmoid and sphenoid air cells. | No acute intracranial abnormality. Scattered fluid/soft tissue density within the ethmoid/sphenoid sinuses. |
Generate impression based on findings. | Type 1 diabetes status post islet cell transplant. Known hematoma by ultrasound. Lateral quadrant pain. ABDOMEN:LUNG BASES: Minimal basilar atelectasis and trace bilateral pleural effusions.LIVER, BILIARY TRACT: Status post cholecystectomy. 3.1 x 10.1 cm perihepatic hematoma (image 30; series 6). Portal vein is patent. No intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Trace abdominal ascites.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Pelvic ascites. | Perihepatic hematoma. Abdominal and pelvic ascites. Trace bilateral pleural effusions. Status post cholecystectomy. |
Generate impression based on findings. | Female; 14 years old. Reason: 14 year old female with pleuritic chest pain and elevated d-dimer History: pleuritis PULMONARY ARTERIES: Due to multiple factors including contrast injection rate and body habitus, opacification of the pulmonary arteries is technically adequate for detection of pulmonary embolus only through the distal segmental arteries. Within this limitation, no pulmonary embolus is evident. The main pulmonary artery is normal in caliber.LUNGS AND PLEURA: Mild left basilar subsegmental atelectasis. No suspicious pulmonary nodules or masses. Trace left pleural effusion.MEDIASTINUM AND HILA: The heart is normal in size. No pericardial effusion. No mediastinal or hilar lymphadenopathy.CHEST WALL: No axillary lymphadenopathy. No suspicious osseous lesions.UPPER ABDOMEN: No significant abnormality noted in the partially visualized upper abdomen. | 1. No pulmonary embolus is evident through the level of the distal segmental arteries.2. Mild left basilar subsegmental atelectasis and trace left pleural effusion. |
Generate impression based on findings. | Intraoperative CT The examination is obtained with a stereotactic frame in place. The patient is known to have a left cerebellar lesion which is subtle on this exam measuring approximately 24 mm in diameter. Additionally a left brain stem lesion is present which is better seen on recent MRI .The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.Examination obtained for stereotactic evaluation. There is a left cerebellar mass present as well as a left brain stem lesion better seen on recent MRI. Stereotactic frame is in place. |
Generate impression based on findings. | 22-year-old female with history of lupus, connective tissue disease, restrictive lung disease, evaluate for ILD. LUNGS AND PLEURA: Mild diffuse bronchial wall thickening and subtle centrilobular groundglass opacities.MEDIASTINUM AND HILA: Scattered prominent but subcentimeter mediastinal lymph nodes. CHEST WALL: Multiple axillary lymph nodes with normal fatty hila.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Mild diffuse bronchial wall thickening and subtle centrilobular groundglass opacities. While bronchial wall thickening is nonspecific, the groundglass opacities suggest hypersensitivity pneumonitis. No specific evidence of UIP or NSIP patterns. |
Generate impression based on findings. | Fall after seizure with right forehead hematoma; known seizure disorder. There is a right frontal scalp hematoma that measures up to 7 mm in width. There is also a left parietal scalp hematoma that measures up to 5 mm in width. There is no evidence of acute intracranial hemorrhage, mass, or cerebral edema. The ventricles are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. There is no evidence of skull fracture. | Small right frontal and left parietal scalp hematomas, but no evidence of acute intracranial hemorrhage or skull fracrture. MRI is recommended for the evaluation of potential seizure foci, if there are no contraindications. |
Generate impression based on findings. | Male 71 years old; Reason: staging CT, history of lung adeno with mets to spine History: back pain, lung cancer CHEST:LUNGS AND PLEURA: Spiculated mass in the left lung apex measures 1.3 x 1.5 cm (series 4 image 18). Ground glass attenuation is noted around the lesion with extensive interlobular septal beading and thickening, worrisome for lymphangitic carcinomatosis. Pleural-based cavitating lesion is noted on series 4 image 38, compatible with metastatic disease. Tiny subcentimeter satellite nodularity is seen. Amorphous 2.4 x 1.3 cm lesion in the right lower lobe is noted, which is incompletely characterized, although worrisome for metastatic disease. Multiple other nodules are seen (series 4 image 26).MEDIASTINUM AND HILA: Borderline mediastinal adenopathy measuring up to 8 mm in short axis is noted.CHEST WALL: Numerous lytic lesions are noted throughout the cervical thoracic spine, compatible with metastatic disease.OTHER: Right Port-A-Cath is in proper position with its tip in the cavoatrial junction.ABDOMEN:LIVER, BILIARY TRACT: Numerous hypoattenuating lesions are noted in the liver including an index lesion in the hepatic dome measuring 1.8 x 1.7 cmSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: A cyst noted midpole right kidney measuring 4.8 cm. Other too small to characterize lesions in the kidneys bilaterally. No hydronephrosis or perinephric fluid collections detected.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Lytic lesions are noted throughout the lumbosacral spine including a pathologic wedge compression fracture at L4 with approximately 66% loss of height. Posterior elements appear impinging the spinal bony canal, although incompletely characterized on a CT examination. Lytic lesions throughout the pelvis including a large lesion with a soft tissue component along the right iliac bone (series 3 image 149) measuring 4.8 x 2.1 cm are noted. These are all compatible with metastatic disease.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Markedly enlarged measuring 6.4 x 6.0cm.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Lytic lesions throughout the pelvis including a large lesion with a soft tissue component along the right iliac bone (series 3 image 149) measuring 4.8 x 2.1 cm are noted. These are all compatible with metastatic disease.OTHER: No significant abnormality noted | 1.Primary lung adenocarcinoma with metastatic disease to the lungs, liver and spine with a pathologic compression fracture at L4 with likely cord compression at L4. |
Generate impression based on findings. | 60 year-old male with metastatic colon cancer for restaging. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: There is a port present in the right chest with associated gas but be due to recent placement. Tip of the venous catheter is in superior vena cava.ABDOMEN:LIVER, BILIARY TRACT: Low-attenuation mass in the right lobe of the liver is unchanged in size measuring 2.3 x 2.3 cm on image 102/209. No other hepatic abnormalities.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The previously noted small bowel dilatation has improved, although there is suggestive of stasis of bowel contents and the distal small bowel. No obvious colonic mass is identified post partial colectomy.BONES, SOFT TISSUES: Involving the low anterior abdominal wall at midline there is low attenuation which represent a small amount of postsurgical fluid is noted on image 144/209, measuring 2.5 x 3.3 cm. There is no internal gas identified.OTHER: The perihepatic implants are not well visualized on today's study and, and this may partly be due to slight interval enlargement of the liver but I cannot exclude more significant infiltration of the perihepatic fat. Implants are again noted in the right paracolic gutter, not easily compared to prior exam due to disease and ascites at that time. For reference a nodule on image 141/209 measures 0.7 x 1 cm. Ascites has resolved.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Small common iliac and inguinal nodes bilaterally.BOWEL, MESENTERY: The previously noted small bowel dilatation has improved, although there is suggestive of stasis of bowel contents and the distal small bowel. No obvious colonic mass is identified post partial colectomy.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Stable liver metastasis.2. Peritoneal nodules not easily compared with prior exam.3. Presumed fluid collection involving the anterior abdominal wall. |
Generate impression based on findings. | Male, 55 years old, left arm weakness, numbness and tingling. The cerebral and cerebellar hemispheres and brainstem are normal in attenuation and morphology. 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. | No acute intracranial abnormality. No specific findings to account for the patient's symptoms. |
Generate impression based on findings. | 29-year-old female with suspicion for sarcoidosis, neurological symptoms, and high ACE, evaluate for mediastinal lymphadenopathy LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. The heart size is normal.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Normal exam, without evidence of sarcoidosis. |
Generate impression based on findings. | 55-year-old male patient with pleuritic chest pain, S1Q3T3 on EKG. Evaluate for a pulmonary embolus. PULMONARY ARTERIES: Technically adequate study without evidence of a pulmonary embolus.LUNGS AND PLEURA: Bilateral trace pleural effusions with associated atelectasis. Right lower lobe nodule measures 5 mm (series 9 image 78). 5-mm nodule in the right upper lobe (series 9 image 45). There is a flat nodule in the minor fissure (coronal series 80611 image 31), and likely represents an intrapulmonary lymph node.Nonspecific scattered micronodules are again noted.MEDIASTINUM AND HILA: Heart size with a normal limits without pericardial effusion. Scattered, small mediastinal lymph nodes. Right hilar region lymph nodes. Minimal atherosclerotic changes of the thoracic aorta.CHEST WALL: Moderate multilevel degenerative changes in the thoracic spine. Redemonstrated are multiple, scattered sclerotic foci within the thoracic spine, ribs and sternum. These foci correlate with increased radiotracer uptake on a nuclear medicine bone scan.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Hypoattenuating foci within liver parenchyma, better characterized on recent CT scan of the chest abdomen and pelvis. | 1.No evidence of acute pulmonary embolus.2.Redemonstration of osseous metastases.3.Nonspecific scattered micronodules; unable to exclude metastases. |
Generate impression based on findings. | Headache, dizziness. Evaluate for mass. There is patchy hypoattenuation within the periventricular and subcortical white matter most likely keeping with sequela of chronic small vessel ischemic disease. There is diffuse ventricular and sulcal prominence in keeping with age.There is no intracranial mass, hemorrhage or edema. The midline is intact. There is moderate mucosal thickening within ethmoid sinuses and rounded soft tissue attenuation in the right maxillary likely representing retention cyst or polyp. Mastoids air cells are clear. There are no bony lesions and the orbits are unremarkable. | No acute intracranial abnormality. Nonacute findings include findings suggestive of paranasal sinus disease and chronic small vessel ischemic disease. |
Generate impression based on findings. | Abdominal pain. Ulcerative colitis. Elevated lipase with abdominal pain. Rule out pancreatitis. ABDOMEN:LUNG BASES: Minimal subsegmental atelectasisLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Minimal, equivocal peripancreatic inflammation which may reflect underlying pancreatitis. There is no evidence of pancreatic necrosis, pseudocyst, or pseudoaneurysm. Splenic vein and portal vein are patent.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: 1.3 x 1.0 cm left para-aortic lymph node (image 70; series 6)BOWEL, MESENTERY: There is concentric thickening of the rectum, sigmoid, and left colon compatible with history of ulcerative colitis.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 | Probable mild pancreatitis. Small retroperitoneal lymph node. Changes in the distal colon, sigmoid, and rectum compatible with ulcerative colitis. |
Generate impression based on findings. | 80 year-old female with abdominal pain and leukocytosis. ABDOMEN:LUNG BASES: Partially visualized diffuse pulmonary nodular opacities not significantly changed.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Nonspecific left adrenal nodule measures 1.2 cmKIDNEYS, URETERS: Left renal cysts. Mild dilation of collecting system bilaterally.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications affect the aorta and its branches. No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Marked dilation of the urinary bladder, which extends into the lower abdomen.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Marked dilation of urinary bladder causing mild dilation of collecting system bilaterally.2.Extensive nodularity in partially visualized lung bases, better appreciated on recent chest CT.3.Nonspecific left adrenal nodule measures 1.2 cm. |
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