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Generate impression based on findings.
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58-year-old male with right shoulder pain Moderate osteoarthritis affects the right AC joint. A benign bone island is again noted within the humeral head/neck. Minimal degenerative changes affect the glenohumeral joint.Mild osteoarthritis affects the left AC joint. Minimal osteoarthritic changes affect the glenohumeral joint.
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Degenerative arthritic changes as described above.
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Generate impression based on findings.
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45-year-old female with pain There is approximately 5 degrees varus alignment of the knee relative to the neutral mechanical axis. Moderate to severe osteoarthritis affects the knee.
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Osteoarthritis and mild varus alignment.
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Generate impression based on findings.
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53-year-old female status post left TKA Hardware components of a total knee arthroplasty device are situated in near-anatomic alignment without evidence of complication. Gas, drain and staples within the soft tissues reflect recent surgery.
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TKA, without evidence of complication.
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Generate impression based on findings.
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38-year-old female with knee pain and swelling Sharpening of the tibial spines and small tibiofemoral osteophytes consistent with osteoarthritis. No fracture or malalignment.No evident effusion.
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Mild osteoarthritis without fracture or malalignment.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.
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Generate impression based on findings.
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10-year-old female with newly diagnosed polyarticular juvenile idiopathic arthritis.VIEWS: Right hand AP/lateral, left hand AP/lateral (4 views) 01/29/15 Soft tissue swelling about the PIP joints bilaterally. No specific evidence of arthritis is seen. Alignment is anatomic. No acute fracture or malalignment.
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Soft tissue swelling about the PIP joints without additional specific evidence for arthritis.
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Generate impression based on findings.
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38 years, Male. Reason: 38M with ? bowel angioedema, peritonitis; concern for free air History: eval for free air Redemonstration is gas-filled dilated loops of small bowel compatible with small bowel obstruction. Faint lucency along the liver edge is likely fat deposition and is not free air. No gross intraperitoneal free air is identified. Continue serial imaging as clinically indicated.Enteric tube side port is in the esophagus as mentioned in the previous report. Recommend advancing 7 to 10 cm.
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1.No gross intraperitoneal free air is identified. Continue serial imaging as clinically indicated.2.Enteric tube side port is in the esophagus as mentioned in the previous report. Recommend advancing 7 to 10 cm.
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Generate impression based on findings.
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62-year-old male with history of T-cell non-Hodgkin's lymphoma, status post transplant in suspected CR. Compared to CT neck dated 4/9/2012, there is interval development of bilobed mass versus two adjacent ovoid masses involving the superficial lobe of the right parotid gland. This mass measures in total 27 x 15 x 15 mm in the AP, transverse, and craniocaudal dimensions.No other salivary gland lesions. No parapharyngeal masses. No cervical lymphadenopathy. There is a 8mm hypodense nodule involving the right lobe of the thyroid gland, possibly present on prior study but is more apparent.There are scattered subcentimeter lymph nodes which are nonspecific. No pathologically enlarged or necrotic lymph nodes are seen in the remainder of the neck. The airway remains patent. The major cervical vessels are patent. No suspicion osseous lesions are seen. Degenerative changes are seen in the cervical spine.The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear.
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1. Single bilobed mass versus two adjacent ovoid masses involving the right superficial parotid gland. Finding is new since 4/9/2012. Differentials include pathologic intraparotid lymphadenopathy versus primary parotid gland neoplasm. May consider MRI, ultrasound, or tissue sampling as clinically appropriate.2. No other neck masses or significant cervical lymphadenopathy. 3. Subcentimeter right thyroid lobe nodule which can be further assessed with ultrasound as clinically indicated.
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Generate impression based on findings.
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Female, 47 years old, with history of breast cancer and possible supraclavicular adenopathy. Nodular soft tissue is evident within the superior mediastinum measuring 23 x 14 mm (image 67 series 8). This may represent a lymph node, or less likely, fluid within a pericardial recess.Also noted is an ill-defined area of soft tissue thickening within the left supraclavicular fossa which measures 16 x 11 mm (image 55 series 8). This could represent a treated lymph node, or scarring or even a vascular structure.No pathologic adenopathy is detected elsewhere in the neck by size criteria. The mucosal surfaces are unremarkable. The salivary glands and thyroid are free of focal lesions. The cervical vessels enhance normally. Groundglass opacities are partially visualized in the right upper lobe.The C6 vertebral body is diffusely sclerotic and demonstrates loss of height centrally. The T1 vertebral body is partially sclerotic. A sclerotic focus is also demonstrated within the manubrium. Findings are compatible with bony metastatic disease.
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1. A well-circumscribed nodular soft tissue process within the superior mediastinum is suspected to represent a lymph node. This could also reflect a pericardial recess, though this is felt to be less likely given its relatively high position in the mediastinum.2. Also noted is an ill-defined area of soft tissue thickening within the left supraclavicular fossa. This could represent a treated lymph node, scarring or even a vascular structure.3. Evidence of bony metastatic disease.4. Groundglass opacity in the right upper lobe is nonspecific but could be infectious or inflammatory in nature.
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Generate impression based on findings.
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66 year old female s/p placement of right femoral triple lumen catheter. Exam limited by patient motion. Right femoral central venous catheter tip at L5/S1 level, likely in the right common iliac vein. Nonobstructive bowel gas pattern. Multiple calcified uterine fibroids as seen on prior CT. Extensive vascular calcifications. Small right pleural effusion, please see same day chest radiograph report for further details.
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Right femoral catheter tip at L5/S1 level, likely in the right common iliac vein.
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Generate impression based on findings.
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Male 8 years old Reason: renal clear cell sarcoma; assess for progression of disease LIVER: The liver measures 9.4 cm in length and demonstrates appropriate parenchymal echogenicity without evidence of intrahepatic biliary ductal dilatation or focal mass lesion. The main portal vein is patent demonstrating hepatopetal flow with a peak velocities of 0.1 m/sec.GALLBLADDER, BILIARY TRACT: There is no evidence of cholelithiasis or choledocholithiasis.PANCREAS: No significant abnormality noted.SPLEEN: The spleen measures 8.1 cm in length.KIDNEYS: The right kidney is absent and there is no soft tissue within the nephrectomy bed to suggest local regional disease recurrence. The left kidney measures 7.9 cm in length there is no evidence of hydronephrosis. ABDOMINAL AORTA: Patent with appropriate waveform.INFERIOR VENA CAVA: Thrombus is again seen in the infrarenal IVC.OTHER: No significant abnormality noted.
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1.Persistent infrarenal IVC thrombus.2.No evidence of disease recurrence within the nephrectomy bed.
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Generate impression based on findings.
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54 years, Female. Reason: Please evaluate for constipation, ileus, other cause of nausea, distention, abdominal pain, and hard stools. Moderate stool burden. Nonobstructive bowel gas pattern. Scattered pelvic phleboliths.
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Moderate stool burden. Nonobstructive bowel gas pattern.
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Generate impression based on findings.
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Patient with increased swelling in the face and neck concern for SVC syndrome LUNGS AND PLEURA: Biapical radiation changes. New bilateral pleural effusions. Reference right lower lobe pulmonary nodule measures 7 mm (series 4, image 41), previously 7 mm. Basilar ground-glass opacities with foci of more dense consolidation are compatible with aspiration.MEDIASTINUM AND HILA: The superior vena cava is patent. Reference subcarinal lymph node measures 15 mm in the short axis (series 3, image 81). No coronary artery calcifications. No significant pericardial effusion.CHEST WALL: Redemonstration of infiltrative soft tissue in the right lower neck. There is marked attenuation of the jugular veins centrally, right greater than left (series 3, image 41 and 48). However, the jugular veins appear patent throughout their course. Additionally there is marked attenuation of the right subclavian vein, which is possibly occluded at the thoracic inlet (series 3, image 53) A tracheostomy is noted. A left chest wall Port-A-Cath tip in the right atrium. Degenerative changes of the cervicothoracic spine.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Probable right kidney cyst. Percutaneous gastrostomy tube.
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1.Infiltrative soft tissue in the right neck with markedly attenuated but patent jugular veins centrally. Additionally there is possible occlusion of the right subclavian vein at the thoracic inlet. The SVC is patent. 2.New bilateral pleural effusions. 3.Basilar pulmonary opacities compatible with aspiration. 4.Stable right lower lobe pulmonary nodule.
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Generate impression based on findings.
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Sinus pain and pressure, which temporarily improves with antibiotic and steroids, occurring repeatedly over the last year. There is moderate mucosal thickening in the alveolar recess of the right maxillary sinus. There scattered opacification of the ethmoid sinuses bilaterally. There is minimal mucosal thickening in the left maxillary sinus, inferior left frontal sinus, and left sphenoid sinus. The right frontal and right sphenoid sinuses are clear. There is opacification of the left nasal cavity, with effacement of the left nasal vestibule. There is mild nasal septal deviation and spur formation directed towards the right. The mastoid air cells are clear. The lamina papyracea, skull base, and nasolacrimal ducts are intact. The nasopharynx, orbits, and imaged intracranial structures are unremarkable.
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Scattered paranasal and nasal cavity opacification in a sporadic pattern that is compatible with rhinosinusitis.
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Generate impression based on findings.
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Male 83 years old; Reason: eval for metastases History: prostate cancer, rising PSA No abnormal osseous foci are identified to indicate metastatic disease.Focus of increased activity in the left mandible likely related to periodontal disease. Increased activity throughout the cervical and thoracic spine is likely degenerative in nature.
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No evidence of bone metastases.
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Generate impression based on findings.
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19 year-old female with history of recurrent pelvic abscess seas and terminal ileal inflammation. Drain was removed on 1/19/15, evaluate for abdominal abscess/pelvic abscess and terminal ileal inflammation. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Significant inflammation involving the terminal ileum sigmoid colon and small bowel loops in the pelvis is again noted. There is likely a fistulous convocation between these bowel segments. Again noted multiloculated abscesses in the pelvis. Right-sided collection measures 3.1 x 2.6 cm, slightly smaller compared to previous study. Small amount of ascites. Left-sided fluid collection in the pelvis is also smaller.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: Please see discussion aboveBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Significant inflammation involving the TI, distal ileum, pelvic small bowel loops and sigmoid colon causing fistulous communications between these bowel loops and abscesses in the pelvis. Small amount of ascites. Inflammation of the bowel loops as worsened but the collections has decreased in size within the interval.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.
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Generate impression based on findings.
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71-year-old with history of left breast cancer status post mastectomy. No current complaints. Three standard views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in the right breast. Numerous benign calcifications are present in the right breast, many arterial and fibroadenomatous in etiology. Area of focal asymmetry in the right upper inner breast does not appear significantly changed compared to the prior studies.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram is recommended annually. Given the patient's breast density, a screening automated whole breast ultrasound could be considered. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.
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Generate impression based on findings.
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Reason: recurrent squamous cell carcinoma of the head/neck History: squamous cell carcinoma of the head/neck CHEST:LUNGS AND PLEURA: No significant abnormality noted, with no evidence of pulmonary or pleural metastases. MEDIASTINUM AND HILA: There is no mediastinal or hilar lymphadenopathy.A right jugular catheter terminates at the SVC/RA junction level.Severe coronary calcifications are present, but the heart and pericardium otherwise appear normal.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Very small hepatic cyst like hypodensities, too small to characterize but most likely benign.SPLEEN: Status post splenectomy.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post bilateral nephrectomy, with a transplanted kidney partially visualized in the left pelvic region.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Abdominal aortic calcifications with irregular mural thrombus just above the bifurcation extending into the proximal iliac arteries.
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1. No evidence of metastases. 2. Status post splenectomy, bilateral nephrectomy and renal transplant.3. Aortoiliac irregular mural thrombus.
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Generate impression based on findings.
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Male 67 years old; Reason: eval for mets History: prostate cancer, rising PSA No abnormal osseous foci are identified to indicate metastatic disease.Slight interval increased activity of the left mandibular focus compared to prior bone scan. Increased activity in the bilateral shoulders, knees, ankles and spine is likely degenerative in nature.
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1. No suspicious osseous foci are identified to indicate metastatic disease.2. Left mandibular focus with slight interval progression is likely related to progression of periodontal disease or conceivably osteonecrosis. Clinical correlation is requested.
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Generate impression based on findings.
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History of right mastectomy in 2011 for invasive ductal carcinoma and DCIS. Patient received tamoxifen. History of breast cancer in sister and paternal cousin. Three standard views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. A linear marker was placed on the scar overlying the left breast. Stable postsurgical architectural distortion is present. A percutaneously placed clip in the upper outer quadrant is unchanged in position. A stable mass with internal calcifications is present in the left upper outer quadrant. No new masses or suspicious microcalcifications are present. Stable lymph nodes project over the left axilla.
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Stable postsurgical changes of the left breast. Stable left breast mass. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, left unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.
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Generate impression based on findings.
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Female 38 years old Reason: history of sertoli-leydig tumor in past s/p resection now with elevated testosterone History: constitutional only 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.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: There is a multicystic mass with solid component in the left on measuring 4.5 x 4.3 cm image number 149, series number 3. Right ovary is not well seen and cannot be differentiated from the surrounding ascites.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small amount of ascites in the pelvis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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New, left adnexal multicystic mass with solid component. Right ovary cannot be well evaluated with the CT. Pelvic ultrasound and/or MRI may be helpful for better characterization of left adnexal mass and right ovary. Small amount of fluid in the pelvis.
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Generate impression based on findings.
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Male 2 years old Reason: evaluate healing fracture History: right ankle fractureVIEWS: Right ankle AP lateral and oblique (3 views) 1/29/2015 Overlying cast material obscures fine bone detail. Oblique fracture of the distal tibial diaphysis with persistent lateral displacement of the distal fracture fragment, without significant interval change in alignment.
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Distal tibial fracture as above.
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Generate impression based on findings.
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64 year old female with abdominal bruit and pulsatile mass on exam, evaluate for abdominal aortic aneurysm. LIMITED ABDOMEN:ABDOMINAL AORTA: The abdominal aorta is normal in size and appearance, measuring 2.4 cm in its maximum diameter. There is no evidence of abdominal aortic aneurysm. There are atherosclerotic calcifications of the abdominal aorta. ILIAC ARTERIES: The imaged portions of the common iliac arteries are normal in appearance without evidence of aneurysm.
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No evidence of abdominal aortic aneurysm.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.
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Generate impression based on findings.
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History of squamous cell carcinoma with recurrence. There is now a large heterogeneous mass centered in the left submental space, along the edge of the reconstruction flap, measuring greater than 4.5 cm in the craniocaudal dimension. This mass appears to infiltrate the soft tissues of the floor of the mouth. A large, necrotic left level III and IV lymph node conglomerate measures 16 x 14 x 28 mm in the anteroposterir, transverse, and craniocaudal dimensions, respectively. There is redemonstration of extensive postsurgical changes, including flap reconstruction in the left submandibular space, soft palatectomy, and reconstruction of the soft palate. There is severe diffuse osteopenia and significant degenerative changes of the visualized osseous structures including moderate to severe cervical disc narrowing and anterior osteophyte formation. There is a new compression deformity of the T2 vertebra with 25% loss of height, but no evidence of associated spinal canal narrowing. The remaining salivary glands are unchanged. The thyroid is unremarkable. There is atherosclerotic calcification at the carotid bifurcations, left greater than right. A small retention cyst is present in the right inferior maxillary sinus. There is a significant amount of secretions in the nasopharynx, which is likely contributing to fluid within the left middle ear cavity, which is completely opacified. There is also complete opacification of the left mastoid air cells and partial opacification of the right mastoid air cells. Debris is present in the left external auditory.
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1. Recurrent tuimor in the left submental space, which insinuates along the reconstruction flap and infiltrates the soft tissues of the floor of the mouth, which is compatible with disease recurrence.2. New conglomerate left level III/IV necrotic lymph nodes, consistent with metastatic disease.3. Diffuse osteopenia and degenerative changes of the spine with a new compression fravture of the T2 vertebra.4. Secretions in the nasopharynx likely contribute to complete opacification of the left middle ear and left mastoid air cells.
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Generate impression based on findings.
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17 year-old male with history of scoliosis and hardware failureVIEWS: Thoracolumbar spine PA/lateral (two views) 01/29/15 Exam is performed in a brace. Redemonstration of marked kyphosis at the thoracolumbar junction measuring approximately 110 degrees, previously 116 degrees. The rib strut in the upper lumbar spine appears similar to the prior exam.
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Unchanged postoperative changes with thoracolumbar kyphosis and levoscoliosis.
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Generate impression based on findings.
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Female 7 years old Reason: evaluate healing of fracture History: left supracondylar fracture status post pinningVIEWS: Left elbow AP oblique and lateral (3 views) 1/29/2015 Three K wires affix a supracondylar fracture in near-anatomic alignment. Overlying cast material obscures fine bone detail.
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Supracondylar fracture and hardware as above.
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Generate impression based on findings.
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Male 57 years old Reason: Evaluate for RUQ pain in pt with previous history of constipation ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: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
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Unremarkable study.
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Generate impression based on findings.
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Male 78 years old; Reason: hypercalcemia, likely hyperparathyroidism, eval for abnl parathyroids There is a small focus of subtle persistent activity just inferior to the left thyroid lobe compatible small parathyroid adenoma.The right thyroid lobe appears to measure 4.2 cm and the left lobe 4.4 cm in length.
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Small parathyroid adenoma just inferior to the left thyroid lobe.
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Generate impression based on findings.
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s/p 14 months R thoracotomy, RLL and intermediate bronchial sleeve for T1aN0 stage IA poorly differentiated adenocarcinoma, 6 mo f/u LUNGS AND PLEURA: Right hemithorax volume loss status post right lower lobectomy. Stable right pleural effusion.MEDIASTINUM AND HILA: No lymphadenopathy. Mild coronary calcifications. No pericardial effusion.CHEST WALL: Left thyroid lobe calcification, unchanged. Healed right rib fractures.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Scattered subcentimeter hepatic hypodensities are too small to further characterize by CT. Low attenuation renal foci are stable.
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Postoperative changes without evidence of disease recurrence.
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Generate impression based on findings.
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52-year-old male status post lumbar fusion Posterior rods and screws affix the L3 and L4 vertebral bodies. A new left lateral plate with screws affixes L2 and L3. Bone graft is noted within the L2/3 intervertebral disk space. No evidence of hardware complication. There is redemonstration of the bilateral L2 pars defect and sacralization of the L5 vertebral body. Postoperative changes of laminectomy again noted. Moderate degenerative disk disease is noted at L4/L5.
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Lumbar fixation as described above without evidence of hardware complication.
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Generate impression based on findings.
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Female 45 years old Reason: pelvic absess, patient s/p IR drain at OSH History: gluteal and abdominal pain 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: Presumed hemangioma, best seen on image number 102, series number 3 is unchanged. Mild hepatomegaly, unchanged.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: Please see discussion belowBONES, 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: Proximal small bowel loops are mildly dilated measuring up to 2.6 cm likely due to the focal ileus caused by areas again noted and multiloculated abscess extending to both sides in the pelvis. There is a pigtail catheter within this abscess.. On the left side measures 6.2 x 2 cm on image number 176 on series number 3. There is diffuse fat stranding and small amount of ascites. On the right side, the loculation measures 6.6 x 2.7 cm. there is extensive fat stranding and small amount of ascites in the pelvis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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Multiloculated pelvic abscess with internal drainage. Mild dilatation of the proximal small bowel loops is likely due to focal ileus involving the small bowel segments in the pelvis.
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Generate impression based on findings.
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Recurrent squamous cell carcinoma of head/neck History: recurrent squamous cell carcinoma of head/neck. Temporal Bones: There are post-treatment findings in the left preauricular region with parotidectomy. There is an infiltrative lesion in the preauricular subcutaneous tissues with extension into the tragus, external auditory canal, temporomandibular joint with erosion of the posterior aspect of the mandibular condyle, and lateral aspect of the parapharyngeal space in the region of the Eustachian tube. Overall, the lesion measures up to approximately 2 x 4 cm. There may be minimal erosion of the lateral aspect of the anterior wall of the left bony external auditory canal. There is thickening of the tympanic membrane and partial opacification of the left middle ear and mastoid air cells. The left ossicular chain and inner ear structures are intact. The right temporal bones are unremarkable. Neck: There is denervation atrophy of the left masticator muscles and left facial muscles. There is no evidence of significant lymphadenopathy in the neck by size criteria. There is prominence of the pterygopalatine vasculature. There is mild scattered paranasal sinus opacification. The remaining salivary glands and thyroid are unremarkable. The imaged intracranial structures and orbits are unremarkable. There is a right internal jugular venous catheter. The major cerebral arteries are grossly patent. There is incomplete fusion of the posterior C1 arch and partial retrosomatic cleft on the right side of C1. There is also congenital fusion of C5 and C6 and a posterior disc-osteophyte complex at C4-5. There are nodules in the right anterior chest wall subcutaneous tissues.
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1. Post-treatment findings in the left preauricular region with evidence of an ill-defined tumor recurrence that extends into a portion of the auricle, external auditory canal with possible minimal erosion of the, and temporomandibular joint with erosion of the posterior aspect of the mandibular condyle. 2. Denervation atrophy of the left masticator muscles and left facial muscles suggests compromise of the trigeminal and facial nerves, respectively, perhaps due to perineural tumor involvement and/or treatment effects. 3. Partial opacification of the left middle ear and mastoid air cells is likely attributable to mass effect upon the left Eustachian tube.4. No evidence of significant lymphadenopathy in the neck by size criteria.5. Nodules in the right anterior chest wall subcutaneous tissues may represent sequela of prior port insertion, although metastases are not entirely excluded based on imaging alone.
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Generate impression based on findings.
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Evaluate fracture. Three views of the left foot reveal oblique fractures of the fourth and fifth metatarsals. Fracture lines are indistinct consistent with healing. No change in position from the previous. Note is made of a hallux valgus deformity
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Healing fourth and fifth metatarsal fractures
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Generate impression based on findings.
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Male 67 years old; Reason: pt with a hx of prostate cancer; now with biochemical recurrence, needs surveillance CT scans History: urinary incontinence There is a large uninterrupted region of moderately increased activity throughout the right ischium and a portion of the right ilium which correlates with the cortical and trabecular thickening of the right hemipelvis seen on comparison CT. There is also diffuse mild activity of the mid and distal femur also uniformly in a cortically based configuration. There are degenerative changes of the thoracic spine.
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Large abnormal osteoblastic activity involving the right hemipelvis and left femur. Both bone scan and CT correlation are more suggestive of Paget's disease, although metastatic disease cannot be excluded. Plain films of the left femur may be obtained for further evaluation as the lower extremities were beyond the field-of-view of comparison CT.
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Generate impression based on findings.
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Male 4 months old Reason: evaluate healing fracture left proximal humerus History: left proximal humerus fractureVIEWS: Left humerus AP and lateral (two views) 1/29/2015 Again seen is the transverse fracture through the proximal humeral diaphysis with increasing sclerosis and periosteal reaction consistent healing. The fracture line appears more lucent. There is slight posterior angulation of distal fracture fragment, improved from the prior examination.
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Healing proximal humeral fracture.
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Generate impression based on findings.
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Female 59 years old; Reason: 59y/o female with right breast IDC; check for metastatic disease No abnormal osseous foci are identified to indicate metastatic disease.
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No evidence of bone metastases.
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Generate impression based on findings.
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Male 32 years old; Reason: DOE, Lung Transplant Evaluation The comparison chest radiograph performed on 1/10/2015 demonstrates upper lobe airspace opacity. The ventilation images show patchy decreased ventilation bilaterally on single breath images, more notable in the lower lobes with eventual equilibration. There is abnormal retention of Xe-133 during the wash-out phase in the bilateral lower lobes. The perfusion images show a matched heterogeneous distribution of pulmonary perfusion. There are no definite mismatch defects identified.Quantitation of relative single breath ventilation (using the posterior image):Left lung: 52% (upper lung 14%; middle lung 24%; lower lung 14%)Right lung: 48% (upper lung 20%; middle lung 19%; lower lung 8%)Quantitation of relative pulmonary arterial perfusion (using anterior and posterior geometric means):Left lung: 56.5% (upper lung 14%; middle lung 26%; lower lung 16%)Right lung: 43.5% (upper lung 12%; middle lung 23%; lower lung 9%)
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Heterogeneous bilateral matched ventilation perfusion defects, right slightly worse than left, as quantified above.
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Generate impression based on findings.
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Male, 65 years old, with history of metastatic renal cell cancer, baseline exam prior to starting new systemic therapy. No evidence of mass effect, edema or pathologic enhancement is seen to suggest intracranial metastatic disease.Minimal periventricular hypoattenuation is seen compatible with age indeterminate microvascular ischemic disease. Also noted is a region of hypoattenuation affecting the left caudate head which could represent a lacunar infarction, also age indeterminate but probably old.No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. Ventricular size and morphology are within normal limits.Mild mucosal thickening is partially visualized in the left maxillary sinus. Remaining paranasal sinuses and mastoid air cells are clear. No destructive osseous lesions are demonstrated.
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1.No evidence to suggest intracranial metastatic disease.2.Age indeterminate microvascular ischemic disease.
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Generate impression based on findings.
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Male 65 years old Reason: baseline exams prior to starting systemic therapy; please provide bi-dimensional measurements History: metastatic renal cell cancer CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Multiple liver metastases. Index lesion in the right lobe measures 3.8 x 3.1 cm on image number 84, series number 4. There is a partially calcified lesion in the left lobe of the liver on image number 84, series number 4, all unknown etiology and significance.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post right nephrectomy. Left kidney is unremarkable except for multiple small simple cysts.RETROPERITONEUM, LYMPH NODES: Postsurgical changes involving the inferior vena cava. There is nonocclusive thrombus at the infrahepatic inferior vena cava. There are unopacified small bowel loops in the right nephrectomy bed which limits optimal evaluation of the nephrectomy bed.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Enhancing soft tissue nodule in the right lower quadrant measuring 1.3 x 1.2 cm on image number 138, series number 4, compatible with metastatic disease.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Metastatic liver lesions and right lower quadrant soft tissue nodule.Nonocclusive thrombus in the infrahepatic IVC. Due to the postsurgical changes involving the IVC and nonopacified small bowel loops in the right nephrectomy bed, evaluation of the nephrectomy bed and IVC is suboptimal. MRI may be helpful for better evaluation of these areas.
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Generate impression based on findings.
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Male 20 years old Reason: left hand injury History: left hand injury There is a comminuted fracture of the metaphysis of the third metacarpal. There is mild palmar angulation. No intra-articular extension. There is soft tissue swelling.
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Comminuted third metacarpal fracture as detailed above.
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Generate impression based on findings.
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78 year old female with gross ankle dislocation Ankle: There is an oblique fracture of the distal fibula, a transverse fracture of the medial malleolus and oblique posterior malleolus fracture with proximal displacement of the fracture fragment and cortical step off along the joint. Widening of the of the medial tibiotalar joint is also noted. Marked soft tissue swelling about the ankle.Tibia and fibula: The proximal tibia and fibula are intact.Knee: Severe osteoarthritis affects the knee. No fracture.
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Ankle fractures as described above.
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Generate impression based on findings.
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Male 66 years old pain Moderate osteoarthritis affects the right shoulder joint with developing osteophytes and joint space loss. No acute fracture or dislocation.Mild osteoarthritis affects the right AC joint. Incidental note is made of a right lower lobe lung opacity.
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1.Right shoulder osteoarthritis.2.Right lung mass.
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Generate impression based on findings.
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57 years, Male. Reason: gj tube position, was pulled out some, had to readvance, feel tension History: none GJ tube tip project over the fundus. Nonobstructive bowel gas pattern. Heavy vascular calcification.
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GJ tube tip project over the fundus.
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Generate impression based on findings.
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Reason: pulmonary nodule seen 1/2014, need 12-mo f/u. Likely hamartoma History: none LUNGS AND PLEURA: This marginated right upper lobe 6-mm nodule (series 4/32) unchanged over the past 12 months, compatible with a hamartoma or intrapulmonary lymph node. However there is no reliable evidence of calcification or internal fat from the current scan.3-mm micronodular left lower lobe (series 4/40) also unchanged.Additional left lower lobe micronodule (series 4/60) also unchanged.MEDIASTINUM AND HILA: Multinodular goiter, unchanged.No significant lymphadenopathy.Severe coronary artery calcification.No pericardial effusion.Small sliding hiatal hernia. CHEST WALL: Degenerative disease in the spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted.
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Stable 6-mm right upper lobe nodule with benign morphology compatible with a hamartoma or intrapulmonary lymph node, and additional stable micronodules compatible with postinfectious granulomas or lymph nodes.No further CT follow-up is recommended for these findings.
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Generate impression based on findings.
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Male, 16 years old, with abnormal movements. The cerebral and cerebellar hemispheres and brainstem are normal in attenuation and morphology. No intracranial hemorrhage or abnormal extra-axial fluid is seen. There is no evidence of mass effect or parenchymal edema. The lateral ventricles are normal in size and morphology as is the third ventricle. The fourth ventricle may be mildly prominent versus normal variation.The visualized paranasal sinuses and mastoid air cells are clear. The bones of the calvarium and skull base are intact.
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No acute intracranial abnormality.
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Generate impression based on findings.
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Male 85 years old; Reason: history of bladder cancer, please evaluate with interval CT History: history of bladder cancer, please evaluate with interval CT CHEST:LUNGS AND PLEURA: Granuloma right lower lobe. No other lung nodules. Mild pleural thickening is little posterior aspect of the right chest.MEDIASTINUM AND HILA: Heavy coronary artery calcifications. Calcifications in the left AV valve, aortic root and arch. Descending aorta has extensive soft tissue plaques and areas suggestive of ulcerated plaques. No evidence of aneurysm.Clusters of small middle mediastinal nodes seen in the paratracheal and prevascular and anterior mediastinal spaces. Largest individual node in the right paratracheal area series 5 image 25 measures 1.3 x 1 cm.CHEST WALL: Gynecomastia.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Fatty replaced particularly in the head.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral nephroureteral catheters. Mild symmetric perinephric fat stranding. No focal renal lesions. Delayed images show bilateral excretion with no filling defects and no hydronephrosis or hydroureter.RETROPERITONEUM, LYMPH NODES: Atherosclerotic disease in several areas of soft plaque. Heavy calcification at the takeoff of the celiac, SMA. No pathologic size nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Mild wall thickening. Scans of nephroureterostomy stent seen. Air is seen in a bladder diverticulum along the dome of the bladder. See sagittal series #80496 image #64/145. Correlate clinically as to whether there is due to instrumentation or if there is any clinical suspicion of fistula. This probably present on 7/1/14 CT.LYMPH NODES: A few small nodes. None suspicious for metastatic disease.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Heavy atherosclerotic disease and ectasia and iliac vasculature.
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Clusters of small mediastinal nodes. Heavy atherosclerotic disease chest abdomen pelvis. Right pleural thickening. Gynecomastia. Bilateral nephroureteral stents. Presumed small bladder diverticulum with air. No definite evidence of metastatic disease.
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Generate impression based on findings.
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Female 12 years old Reason: Et tube in place? History: intubatedVIEW: Chest AP (one view) 1/29/2015 The left upper shunt a PICC terminates in the superior vena cava. The endotracheal tube is at the level of the carina. The NG tube tip terminates in the body of the stomach with the side-port at the level of the junction. The cardiothymic silhouette is top normal in size. No focal air space opacity is seen. There is mild gaseous distention of the stomach.
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Endotracheal tube tip at the level of the the carina.
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Generate impression based on findings.
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Female, 36 years old s/p right adrenalectomy. RFO trigger: Multiple surgical teams, counts correct. No unexpected radiopaque foreign body. Right upper quadrant surgical clips and skin staples. Nonobstructive bowel gas pattern.
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No unexpected radiopaque foreign body. Findings were discussed with the attending physician, Dr. Angelos, via telephone on 1/29/2015 at 14:15.
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Generate impression based on findings.
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50 year old with palpable left breast mass. Three standard views of both breasts and left spot compression views were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Enlarged obscured masses are present in the left upper outer breast and right outer breast. Other bilateral areas are similar to prior studies, compatible with stable dense tissue with underlying cysts. No suspicious microcalcifications or areas of architectural distortion in either breast. ULTRASOUND
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Bilateral cysts. No mammographic evidence of malignancy. The patient will be seeing Dr. Chhablani after this exam for consideration of aspiration. As long as the patient's physical examination remains stable, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: B - Surgical Consultation.
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Generate impression based on findings.
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53-year-old male with history of leg pain status post chronic trauma. Left tibia/fibula: There is intra-medullary rod with multiple screws affixing a healed comminuted fracture of the proximal tibial diaphysis in anatomic alignment. There is no evidence of hardware complication. There are additional healed fractures of the fibular diaphysis in anatomic alignment.Right tibia/fibula: There is an intra-medullary rod with multiple screws affixing a healed comminuted fracture of the proximal tibial diaphysis in anatomic alignment. There is no evidence of hardware complication. There are additional healed fractures of the fibular diaphysis in anatomic alignment.Left knee: Again seen are the aforementioned post surgical changes in the tibia. The knee is otherwise unremarkable.Right knee: Again seen are the aforementioned post surgical changes in the tibia. There is a small focus of heterotopic bone in the distal quadriceps tendon.
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Postsurgical changes without evidence of hardware complication.
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Generate impression based on findings.
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Reason: 38 y.o female with PH of Right breast cancer 2 x2 cm mass, completed chemo TCHPRADIOPHARMACEUTICAL: The right breast was prepared in a sterile manner. A total of 0.5 mCi Tc-99m filtered sulfur colloid was injected subcutaneously. Following injection, intraoperative probe localization was performed. No images were acquired.
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Successful right breast injection for intraoperative identification of sentinel lymph node.
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Generate impression based on findings.
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72-year-old female with history of knee pain. There are tricompartmental osteophytes as well as severe joint space narrowing especially in the lateral compartment compatible with severe osteoarthritis. There is a small joint effusion as well as a slight genu valgus deformity. Moderate osteoarthritis affects the left knee as seen on the frontal view.
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Osteoarthritis as above.
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Generate impression based on findings.
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Reason: 41 y.o female with multicentric Right breast cancer, lesion barely palpable, need lymph for SLBX surgery on 1-30-2015 History: Rt breast cancerRADIOPHARMACEUTICAL: The right breast was prepared in a sterile manner. A total of 1.1 mCi Tc-99m filtered sulfur colloid was injected in four periareolar injections. A focus of increased activity is noted in the right axilla, representing the sentinel node(s). This region was marked with an indelible marker.
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Sentinel node identified in the right axilla.
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Generate impression based on findings.
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Painless scrotal swelling on right side, evaluate for hydrocele or other pathology RIGHT TESTIS: Measures 4.1 x 3.4 x 3 cm. No focal parenchymal lesion. Symmetric parenchymal flow, no evidence of acute orchitis or torsion.LEFT TESTIS: Measures 3.9 by 2.8 x 2.2 cm. No focal parenchymal lesion. Symmetric parenchymal flow, no evidence of acute orchitis or torsion.RIGHT EPIDIDYMIS: Unremarkable.LEFT EPIDIDYMIS: Left epididymal cyst, measuring up to 4 mm.OTHER: Large right-sided hydrocele and small left-sided hydrocele. Left-sided varicocele.
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Right greater than left hydroceles.Left-sided varicocele.
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Generate impression based on findings.
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Again seen are postsurgical changes of prior endoscopic sinus surgery including bilateral uncinectomies and bilateral ethmoidectomies. There is trace mucosal thickening involving the left frontal and right maxillary sinuses. The frontal and maxillary sinuses are otherwise clear. The ethmoid cavity and residual ethmoid air cells are clear. The ostiomeatal units are widely patent. The sphenoid sinus and bilateral sphenoethmoidal recesses are clear. The superior, middle, and inferior turbinates are small. Nasal septum is midline. The nasal cavity is clear.The lamina papyracea are intact. The roof of the ethmoids is relatively symmetric. Visualized brain parenchyma is unremarkable. Orbits and visualized soft tissues are also unremarkable.
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No significant paranasal sinus disease. There is trace mucosal thickening in the right maxillary and left frontal sinuses; paranasal sinuses are otherwise clear.
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Generate impression based on findings.
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Male 53 years old; Reason: Please evaluate residual function in both kidneys. History: Plan for nephrectomy prior to renal transplant due to polycystic kidneys. There is no visualized perfusion bilaterally and neither kidney demonstrates visible uptake or excretion. Although there is no demonstrable uptake or excretion in either renal parenchyma or upper collecting systems, there is trace amount of excreted urine visualized in the lower pelvis.
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There is no demonstrable flow or function in either renal parenchyma or upper collecting systems. Note a trace amount of excretory urine activity is visualized in the lower pelvis.
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Generate impression based on findings.
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2-cm palpable mass at the 9 o'clock position of the right breast. BILATERAL DIGITAL DIAGNOSTIC MAMMOGRAM: Three standard views of both breasts and 3 right spot compression views were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. The right MLO view is limited as the patient has a frozen shoulder and could not lift his arm above his head. A triangular marker was placed on the skin at the site of palpable concern. Normal glandular tissue is present in both retroareolar areas, right slightly more prominent than left.No discrete masses, suspicious microcalcifications or areas of architectural distortion are present in either breast. RIGHT BREAST ULTRASOUND: On physical examination, the patient has symmetric fibroglandular tissue in both retroareolar regions. A targeted right breast ultrasound was performed for the area of clinical concern. Normal glandular tissue is present without discrete mass.
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Bilateral gynecomastia, right slightly more prominent than left. No mammographic evidence for malignancy. Patient's gynecomastia should be managed clinically. Results and recommendations were discussed with the patient and his wife.BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter.
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Generate impression based on findings.
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57 year old with left breast mass and tenderness. Three standard views of both breasts and two spot compression views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Obscured round masses under the palpable marker on the left upper outer breast are noted. There are regionally distributed bilateral calcifications which do not appear significantly changed. Many of these, if not all, are compatible with benign milk of calcium given their appearance. No suspicious microcalcifications or areas of architectural distortion in either breast. ULTRASOUND
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Simple cysts at the site of palpable concern. Cyst aspiration for symptomatic relief was discussed with the patient, and that can be an option based on her symptoms. Otherwise, routine mammography should be performed in one year. If there is any question of change of cyst size here or for any other area in her breasts, that mammogram could be a diagnostic exam rather than screening.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram.
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Generate impression based on findings.
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History of fall with loss of consciousness. There is a region of encephalomalacia with surrounding hypoattenuation of the left medial inferior temporal lobe, lateral to the quadrigeminal cistern, which suggests age-indeterminant infarction. There is no evidence of intracranial hemorrhage or mass. Aside from ex vacuo dilatation of the left temporal horn, 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. The skull and scalp soft tissues are unremarkable.
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1. No evidence of intracranial hemorrhage or skull fracture.2. Encephalomalacia and surrounding hypoattenuation in the medial left inferior temporal lobe is suggestive of a chronic left posterior cerebral artery infarct.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.
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Generate impression based on findings.
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32-year-old female with history of finger pain. There is no acute fracture or dislocation. Alignment is anatomic. The soft tissues are unremarkable.
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No radiographic findings to account for the patient's symptoms.
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Generate impression based on findings.
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Female 59 years old Reason: 59y/o female with right breast IDC; check for metastatic disease History: 59y/o female with right breast IDC; check for metastatic disease CHEST:LUNGS AND PLEURA: Nonspecific right posterior lower lobe subpleural nodule likely representing atelectasis (series 4, image 6). Additional nonspecific micronodule along the right major fissure (series 4, image 72) which likely represent postinfectious sequela or intrapulmonary lymph nodes.No pleural effusion.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy. Normal heart size without pericardial effusion. No coronary artery calcifications are visualized.CHEST WALL: Right lateral breast mass is noted with several enlarged, heterogeneous draining right axillary lymph nodes. The largest lymph node measures up to 13 mm in the short axis (series 3, image 22). The lymph nodes are possibly necrotic and suspicious for metastatic disease.ABDOMEN: Absence of enteric contrast material 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 limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No evidence of bone metastasis.OTHER: No significant abnormality noted.
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Right breast mass with enlarged, likely necrotic, right axillary lymph nodes consistent with metastatic disease.No specific evidence for lung metastasis.
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Generate impression based on findings.
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Lung adenocarcinoma follow-up CHEST:LUNGS AND PLEURA: Postoperative changes of right lower lung wedge resection with residual soft tissue thickening along the suture line. Mixed solid and ground glass nodule in the left upper lobe measures 22 x 18 mm (series 4, image 52), unchanged. Interval resolution of reticular opacity in the anterior left upper lobe. Basilar scarring is unchanged.MEDIASTINUM AND HILA: Calcified mediastinal and hilar lymph nodes compatible with prior granulomatous disease. Cardiomegaly without pericardial effusion. Moderate calcification of the coronary arteries and mitral valve annulus.CHEST WALL: Partial fusion of the T10 and T11 vertebral bodies.ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Calcified hepatic granulomata.SPLEEN: Calcified splenic granulomata. Round low-density foci posteriorly within the spleen are stable in appearance.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic native kidneys with bilateral low attenuation renal foci incompletely characterized by CT.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: The infrarenal abdominal aorta is ectatic. There are severe calcifications of the abdominal aorta and its branches. Calcified abdominal lymph nodes.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Partial fusion of the T10 and T11 vertebral bodies.
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1.Mixed solid and ground-glass left upper lobe nodule is unchanged dating back to 2012 but remains suspicious for indolent adenocarcinoma.2.Interval resolution of anterior left upper lobe reticular opacity.3.No evidence of metastatic disease.
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Generate impression based on findings.
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61 year old female with history of pancreas cancer. Evaluate and compare to prior. Status post Whipple on 12/18/2014. CHEST:LUNGS AND PLEURA: Mild apical emphysema and scarring. Minimal bibasilar atelectasis. MEDIASTINUM AND HILA: Heart size within normal limits, and there is no pericardial effusion. No significant mediastinal or hilar lymphadenopathy. Mild coronary artery calcifications. Right chest Port-A-Cath tip is at the superior cavoatrial junction. Heart size within normal limits, and there is no pericardial effusion.CHEST WALL: Right chest dual lumen Port-A-Cath with adjacent subcutaneous emphysema, correlate with recent procedure.ABDOMEN:LIVER, BILIARY TRACT: Cholecystectomy clips and mild associated extrahepatic biliary dilatation. Hepatic steatosis is again noted.SPLEEN: No significant abnormality noted.PANCREAS: Postoperative findings of Whipple have improved over the interval, with mildly decreased mesenteric stranding. The previously described fluid collection near location of the pancreatic head (3/119) measures 5.2 x 4.6 cm, previously 4.6 x 7 cm.There is loss of the fat plane between the pancreas and the stomach, similar to prior. Atrophy of the pancreatic tail with ductal dilatation is unchanged. A focus of soft tissue density between the pancreatic tail and the superior mesenteric artery (3/11) measures 1.5 x 1 cm, previously 1.6 x 1 cm.There is persistent encasement of the celiac axis and superior mesenteric artery. The superior mesenteric vein is attenuated, and the splenic vein appears occluded.The reference aortocaval lymph node (3/111) measures 8 x 6 mm, previously 9 x 7 mm.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Scattered subcentimeter retroperitoneal lymph nodes are seen. Aortocaval lymph node as measured above, unchanged.BOWEL, MESENTERY: Slight interval decreased mesenteric stranding. No small bowel obstruction or free air.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.
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1.Postoperative findings of Whipple procedure have decreased somewhat over the interval, with less mesentery stranding and slightly smaller fluid collection in the surgical bed.2.Pancreatic mass and reference lymph nodes are not significantly changed in size.
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Generate impression based on findings.
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Frontal sinus: There is partial opacification of the left frontal ethmoidal recess. The frontal sinus and frontoethmoidal recesses are otherwise clear.Anterior ethmoids: There is mild mucosal thickening in the left anterior ethmoid air cells. The right anterior ethmoid air cells are clear.Maxillary sinuses: The maxillary sinuses are clear. The ostiomeatal units are clear.Posterior ethmoids: The posterior ethmoid air cells are clear.Sphenoid sinus: The sphenoid sinus and bilateral sphenoethmoidal recesses are clear. There is no significant nasal septal deviation, with 3-mm rightward directed bony spur. There is a focal defect within the mid nasal septum inferiorly consistent with known history of septal perforation. There is paradoxical configuration of the middle turbinates. The nasal cavity is clear. The roof of the ethmoids is slightly higher on the left andPostoperative changes are seen along the right posterior mandible with multiple screws and connecting plate. There is a anteriorly directed impacted left mandibular molar. There is evidence of extracted teeth along the left posterior maxilla, with a residual root or root canal, and additional periapical lucency along ADA number 13. There is a chronic left lamina papyracea deformity, with mild medial bowing of the left medial rectus muscle. Orbital fat is noted along the defect.
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1. No significant sinus inflammatory changes.2. Chronic left lamina papyracea fracture.3. Postoperative changes along the right mandible with scattered dental findings.4. Septal perforation.
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Generate impression based on findings.
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61-year-old female with history of pain and stiffness. There is no acute fracture or dislocation. Alignment is anatomic.
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No radiographic findings to account for the patient's pain.
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Generate impression based on findings.
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Cough, smoking history, COPD LUNGS AND PLEURA: Moderate centrilobular emphysema. Right lower lobe subpleural nodule measures 6 mm (series 5, image 81).MEDIASTINUM AND HILA: No lymphadenopathy. Severe coronary artery and thoracic aorta calcifications. No pericardial effusion.CHEST WALL: Flowing ossification along the vertebral bodies of the midthoracic spine suggestive of diffuse idiopathic skeletal hyperostosis.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted.
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Emphysema and 6-mm right lower lobe nodule. Follow up CT is recommended in 6 months in this high-risk patient.
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Generate impression based on findings.
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31-year-old male with history of ORIF. Hardware components of plate and screw devices are seen affixing a spiral fracture of the distal humeral diaphysis in near-anatomic alignment. We see no evidence of hardware complication. Continued callus formation indicates interval healing.
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Orthopedic fixation of a distal humerus fracture as above.
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Generate impression based on findings.
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50 year-old male with history of trauma and difficulty with extension. There are multiple tiny metallic fragments about the knee joint. There is no evidence of acute fracture. Tricompartmental osteophytes and joint space narrowing especially in the lateral compartment with bone-on-bone apposition compatible with severe osteoarthritis.
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Degenerative arthritic changes as above without acute abnormality.
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Generate impression based on findings.
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Reason: history of multiple scca with recurrence dermal under chin and on chest wall History: history of multiple scca with recurrence dermal under chin and on chest wall LUNGS AND PLEURA: Biapical scarring compatible with radiation reaction.Subpleural nodular scar like opacity in the superior segment of the right lower lobe (series 5/37) unchanged since at least 9/15/2013.Mild focal reticulonodular opacity at the left posterior costophrenic angle, likely related to mild aspiration.No suspicious nodules.MEDIASTINUM AND HILA: No significant lymphadenopathy.Severe coronary artery calcification.No pericardial effusion.CHEST WALL: Degenerative disease in the spine with loss of height in several thoracic vertebrae, not significantly changed from previous.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Extensive vascular calcifications in the upper abdomen.Gastrostomy tube in place.
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No evidence of metastatic disease.
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Generate impression based on findings.
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54 years, Female. Reason: please comment stool burden History: constipation and abdominal pain Prominent loops of small bowel seen in the upper quadrant, which may represent developing ileus or partial SBO. Moderate to large stool burden similar to prior CT study.
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Prominent loops of small bowel seen in the upper quadrant, which may represent developing ileus or partial SBO. Moderate to large stool burden. Continued follow up suggested.
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Generate impression based on findings.
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16-year-old male with left ankle fractureVIEWS: Left ankle AP/lateral (two views) 01/29/15 Overlying cast material obscures fine bone detail. A single screw traversing the distal epiphysis of the left tibia is again seen without hardware complication. A triplane fracture through the tibia and oblique fracture through the fibula are again seen with periosteal reaction suggestive of healing.
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Healing fractures and orthopedic screw placement without evidence of hardware complication.
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Generate impression based on findings.
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Metastatic breast cancer, rheumatoid arthritis on methotrexate LUNGS AND PLEURA: Right upper lobe micronodule measures 3 mm (series 4, image 43). There are additional scattered pulmonary micronodules, some calcified. Subpleural reticulation in the anterior left upper lobe secondary to radiation. Bilateral lower lobe and right middle lobe bronchiectasis.MEDIASTINUM AND HILA: No lymphadenopathy. Mild coronary artery calcifications. Small pericardial effusion.CHEST WALL: Status post left breast lumpectomy and axillary lymph node dissection. Right axillary lymph nodes are normal. Bilateral Bochdalek hernias. Degenerative changes of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Evidence of prior granulomatous disease.
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1.Post radiation changes in the left lung without specific evidence of metastatic disease.2.3 mm right upper lobe pulmonary micronodule likely represents a benign intrapulmonary lymph node. Recommend follow up CT in 3 to 6 months to confirm stability.
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Generate impression based on findings.
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Female 64 years old Reason: Metastatic ovarian cancer needs re-evaluation and compare to previous OSH scan. Measurements when applicable. History: Metastatic ovarian cancer needs re-evaluation and compare to previous OSH scan. Measurements when applicable. CHEST:LUNGS AND PLEURA: Scattered, nonspecific micronodules.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: There are a few, new hypodense liver lesions which are not seen on previous CT dated 7/2013. PET/CT studies noncontrast, therefore cannot be used for comparison. An index liver lesion near the dome measures 7 by 10 mm on image number 73, series number 4.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple appearing renal cysts.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: Index pararectal lymph node measures 11 x 9 mm on image number 107, series number 4. This has not changed from PET/CT.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of presacral soft tissue which may be secondary to surgery. Follow-up is recommended. It has not significantly changed from previous PET/CT.
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New, small hypodense liver lesions near the dome. These cannot be optimally characterized with this single phase CT. However, given that they are new from July 2013, metastatic disease cannot be excluded. MRI of the liver may be helpful for further characterization of these lesions, if clinically indicated.
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Generate impression based on findings.
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History of right lumpectomy 4/2014 with reconstruction for invasive ductal carcinoma associated with an encapsulated papillary carcinoma and DCIS. Patient received radiation and is on hormonal therapy. No new breast complaints. Three standard views of both breasts, right laterally exaggerated CC view, two right spot magnification views and two left spot compression views were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Linear markers were placed on scars overlying the right breast. Postsurgical volume loss, architectural distortion and multiple surgical clips are present in the lumpectomy bed. Focal asymmetry at the 12 o'clock position of the left breast, posterior depth, disperses into normal breast parenchyma with spot compression imaging.No new masses or suspicious microcalcifications are present in either breast. Benign lymph nodes are projected over the left axilla.
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Expected postsurgical changes of the right breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram.
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Generate impression based on findings.
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The ventricles and sulci are within normal limits. There is no midline shift or mass effect. There is no intracranial hemorrhage. Hypodensity in the white matter laterally adjacent to the left basal ganglia is nonspecific. There is no extraaxial fluid collection. Minimal mucosal thickening of the right maxillary and sphenoid sinuses. There is deformity of the left lamina papyracea which is likely due to old trauma. An empty sella is present and there is symmetric dilatation of the optic nerve sheaths.The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.
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1.An empty sella and dilatation of the optic nerve sheaths are nonspecific findings but can be seen in the setting of pseudotumor cerebri. Please correlate clinically, and MRI may be obtained as clinically indicated.2.Minimal white matter hypodensity in left external capsule is nonspecific.3.No evidence of stenosis or aneurysm on CTA.
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Generate impression based on findings.
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History of squamous cell carcinoma with recurrence. There is now a large heterogeneous mass centered in the left submental space, along the edge of the reconstruction flap, measuring greater than 4.5 cm in the craniocaudal dimension. This mass appears to infiltrate the soft tissues of the floor of the mouth. A large, necrotic left level III and IV lymph node conglomerate measures 16 x 14 x 28 mm in the anteroposterior, transverse, and craniocaudal dimensions, respectively. There is redemonstration of extensive postsurgical changes, including flap reconstruction in the left submandibular space, soft palatectomy, and reconstruction of the soft palate. There is severe diffuse osteopenia and significant degenerative changes of the visualized osseous structures including moderate to severe cervical disc narrowing and anterior osteophyte formation. There is a new compression deformity of the T2 vertebra with 25% loss of height, but no evidence of associated spinal canal narrowing. The remaining salivary glands are unchanged. The thyroid is unremarkable. There is atherosclerotic calcification at the carotid bifurcations, left greater than right. A small retention cyst is present in the right inferior maxillary sinus. There is a significant amount of secretions in the nasopharynx, which is likely contributing to fluid within the left middle ear cavity, which is completely opacified. There is also complete opacification of the left mastoid air cells and partial opacification of the right mastoid air cells. Debris is present in the left external auditory.
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1. Recurrent tumor in the left submental space, which insinuates along the reconstruction flap and infiltrates the soft tissues of the floor of the mouth, which is compatible with disease recurrence.2. New conglomerate left level III/IV necrotic lymph nodes, consistent with metastatic disease.3. Diffuse osteopenia and degenerative changes of the spine with a new compression fracture of the T2 vertebra.4. Secretions in the nasopharynx likely contribute to complete opacification of the left middle ear and left mastoid air cells.
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Generate impression based on findings.
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Male 35 years old Reason: HBV, eval for HCC History: HBV LIVER: Liver measures 14.4 cm. Coarse echotexture of the liver. No focal liver lesions.BILIARY TRACT: Subcentimeter gallbladder polyps unchanged. No evidence of intra-or extrahepatic biliary dilatation.PANCREAS: Not well visualized due to overlying bowel gas.SPLEEN: No significant abnormalities noted. Spleen measures 11 cm.RIGHT KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.
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Coarse echotexture of the liver. Subcentimeter gallbladder polyps.
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Generate impression based on findings.
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History of benign left breast aspiration. Large keloids present between both breasts. Intermittent left breast pain. History of breast cancer in sister. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. On physical examination, the patient has a large sebaceous cyst at the 12 o'clock position of the left breast. This cyst is seen on the mammogram measuring 3 cm in diameter. Percutaneously placed clip at the 12 o'clock position of the left breast is unchanged in position. Benign intramammary and axillary lymph nodes are present bilaterally. A large keloid projected over the medial aspect of both breasts is unchanged.No new masses, suspicious microcalcifications or areas of architectural distortion are present in either breast.
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Bilateral intramammary lymph nodes and left sebaceous cyst. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram.
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Generate impression based on findings.
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4-month-old male with nonaccidental traumaEXAMINATION: Skull AP/lateral, thoracolumbar spine AP/lateral, right humerus AP, left humerus AP, right forearm AP, left forearm AP, right hand PA, left hand PA, ribs right oblique/left oblique, right femur AP, left femur AP, right tibia fibula AP, left tibia fibula AP, right foot AP, left foot AP (18 views) 01/29/15 No acute fracture or malalignment is evident. Bone mineralization and mottling is within normal limits.
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Normal examination.
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Generate impression based on findings.
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History of right breast pain 3 weeks ago which has subsequently subsided. No current breast complaints. History of breast cancer in maternal grandmother and maternal great aunt. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. A round marker was placed on a skin lesion overlying the right breast. A benign intramammary lymph node is present in the left upper outer quadrant. No discrete masses, suspicious microcalcifications or areas of architectural distortion are present in either breast.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended beginning at age 40. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram.
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Generate impression based on findings.
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69 year old status post aspiration and biopsy of the right breast. Interval imaging for clip evaluation and for a residual lesion. Three standard views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. In the right upper outer quadrant at posterior depth there is a 2.3-cm round mass with an associated biopsy clip. No suspicious microcalcifications or areas of architectural distortion in either breast. No additional masses are seen. Normal morphology lymph node projects in the right axilla.ULTRASOUND
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Cystic and solid mass at the site of previous aspiration/biopsy. An associated biopsy clip is noted. Findings were discussed with Dr. Chhablani. A palpably guided excision will be discussed with the patient given the pathology results from this institution.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.
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Generate impression based on findings.
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Reason: history of bladder cancer, please evaluate with interval CT History: history of bladder cancer, please evaluate with interval CT LUNGS AND PLEURA: 4-mm micronodules adjacent to the right major fissure (series 6/47) unchanged, compatible with an intrapulmonary lymph node.Small calcified granulomas in the right lower lobe, unchanged.Minimal right pleural effusion or pleural thickening, new from previous.No suspicious nodules.MEDIASTINUM AND HILA: Scattered mildly enlarged lymph nodes, unchanged.Severe coronary artery calcification.Dense calcification in the mitral annulus.No pericardial effusion.CHEST WALL: Degenerative disease in the spine.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. The abdominal portion of the examination will be described in a separate report.
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No evidence of metastatic disease in the chest.
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Generate impression based on findings.
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Female 8 years old Reason: r/o pulm process History: chest painVIEWS: Chest PA/lateral (two views) 1/29/2015 Small right middle lobe opacity likely reflects atelectasis. The cardiothymic silhouette is normal. No pleural effusion or pneumothorax is seen.
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Small right middle lobe opacity likely reflects atelectasis.
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Generate impression based on findings.
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Male 12 years old Reason: R/O TORSION History: Acute pain and tenderness right testis s/p struck on the testis by a ball during a dodgeball game, no bruises, cremasteric reflex ++ RIGHT TESTIS: The right testicle measures 3.1 x 1.9 x 1.6 cm demonstrates homogeneous parenchymal echogenicity, without evidence of edema, fracture or hematoma.LEFT TESTIS: The left testicle measures 2.9 x 2.1 x 1.4 cm and demonstrates homogeneous parenchymal echogenicity, without evidence of edema, fracture or hematoma.RIGHT EPIDIDYMIS: No significant abnormalities noted.LEFT EPIDIDYMIS: No significant abnormalities noted.OTHER: No significant abnormalities noted.DOPPLER
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Normal examination.
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Generate impression based on findings.
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12-year-old female with joint pain, evaluate for erosion or synovitisVIEWS: Left foot AP/oblique/lateral, left ankle AP/oblique/lateral, right wrist AP/oblique/lateral, cervical spine AP/lateral neutral, extension, flexion, odontoid view (14 views) 01/29/15 No acute fracture or malalignment is evident. No soft tissue swelling. No erosions, joint space narrowing, or other specific evidence of arthritis. No acute fracture or subluxation in the cervical spine. Vertebral body heights, disk spaces, and alignment are preserved in neutral, flexion, and extension views.
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Normal examination.
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Generate impression based on findings.
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Female 33 years old Reason: evaluate for bony abnormality History: fall on ice, decreased ROM No joint effusion. Alignment is anatomic. No acute fractures evident.There is mild sharpening of the tibial spines suggestive of early osteoarthritis.
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No acute fracture or dislocation.
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Generate impression based on findings.
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61-year-old female with history of prior ankle fracture. Assess for new fracture. The bones are demineralized. There is a plate and screw device affixing a distal fibular fracture. Additionally, there are two screws affixing a medial malleolar fracture. Alignment is anatomic. There is no evidence of hardware complication. There is extensive soft tissue swelling about the ankle.
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Postsurgical changes and soft tissue swelling without acute fracture.
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Generate impression based on findings.
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History of headache. There is no evidence of acute intracranial hemorrhage. The ventricles appear smaller than expected and there is a partially empty sella. There is no mass effect or herniation. There is moderate mucosal thickening of the left sphenoid sinus, left posterior ethmoid air cells, with resultant opacification of the left sphenoethmoidal recess. There is an air-fluid level is present in the left maxillary sinus. There is mild opacification of the left ostiomeatal complex. There is mild septal deviation to the left with a septal bony spur which touches the left inferior turbinate. The mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable.
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1. No evidence of acute intracranial hemorrhage.2. Smaller than expected ventricular system along with a partially empty sella, is suggestive of pseudotumor cerebri. 3. Findings suggestive of acute sinustis.4. Mild septal deviation to the left with a septal bony spur which touches the left inferior turbinate. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.
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Generate impression based on findings.
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Male 72 years old Reason: Pleural mesothelioma please evaluate for baseline RECIST criteria. History: Pleural mesothelioma CHEST:LUNGS AND PLEURA: Diffuse pleural thickening with associated pleural fluid.-At the level of the aortic arch, there is pleural thickening measuring up to 13 mm (series 3, image 30) at the 10 o'clock position.-At the level of the right main pulmonary artery, there is thickening measuring 27 mm at the 12 o'clock position and measuring 6 mm at the 5 o'clock position (series 3, image 45).-At the level of the right pulmonary vein, there is thickening measuring 18 mm at the 2 o'clock position (series 3, image 76).Pleural thickening extends inferior to the left costophrenic sulcus without direct invasion into the peritoneum. Interval placement of PleurX catheter with decrease in left pleural effusion. Interval increase in right upper lobe nodule (series 5, image 23) now measuring 10 mm which previously measured 6 mm. Other right lung nodules, some of which are calcified and characteristic of granulomas, are similar in size.MEDIASTINUM AND HILA: There is a small amount of pericardial fluid with probable pericardial involvement adjacent to the left ventricle. No mediastinal or hilar lymphadenopathy. Rightward shift of the mediastinum.Partially calcified right hilar nodes. Diffuse atherosclerotic calcifications of the aorta and its branches with severe coronary artery calcifications.CHEST WALL: Chest wall invasion measuring up to 27 mm is present which abuts and is indistinguishable from the the pectoralis major. In the left lateral chest wall, there is a multilobular mass measuring 42 x 68 mm along the tract of the PleurX catheter consistent with extrapleural tumor spread (series 3, image 70). Inferiorly, anasarca is noted. Marked degenerative changes of the thoracic spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Hypodense lesion within the right lobe of the liver measuring 24 x 19 mm (series 3, image 84) which could represent metastatic disease. 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 limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted. No evidence of bone metastasis.OTHER: No significant abnormality noted.
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1. Left pleural mesothelioma with measurements as above. Pericardial and chest wall involvement, and extension into the costophrenic sulcus without direct peritoneal invasion.2. Several nonspecific right sided pulmonary nodules, some of which are characteristic of granulomas. One nodule has increased in size and could represent metastatic disease.
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Generate impression based on findings.
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53 year old with history of left simple mastectomy with palpable areas of concern in the left axilla and near a left breast surgical scar. A targeted left ultrasound was performed for the two clinical areas of concern. At the more inferior area, near the surgical scar, a heterogeneous collection measuring 2.1 x 2.1 cm is seen. There is no internal vascularity within the collection. This is decreased in size compared to the prior study and compatible with postoperative fat necrosis and resolving seroma. Further superiorly, in the axilla, at the second palpable area of concern, no suspicious cystic or solid lesion could be identified. No abnormal lymph node was seen. Normal axillary tissues were noted.
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No suspicious axillary finding. The patient will have follow-up clinically with Dr. Chhablani today.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.
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Generate impression based on findings.
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There are postsurgical changes of MCA and Acom aneurysm clippings including a right frontal craniotomy defect with underlying pneumocephalus and extra-axial fluid. There is extensive streak artifact resulting aneurysm clippings. There may be a small amount of layering blood adjacent to the craniotomy defect as well as along the falx and within the ambient cisterns. There is suggestion of ill-defined hypoattenuation within the underlying right frontal lobe which is new with local mass effect, effacement of the frontal horn of the right lateral ventricle, and 9 mm right to left midline shift. There is also new hypoattenuation within the right temporal lobe adjacent to the clips (80481/41). Small focal areas of hypoattenuation within the right anterior temporal lobe and left insular subcortical white matter are unchanged. Hypoattenuation in the right posterior frontal lobe likely represents artifact.A left paramedian suboccipital approach catheter traversing the left cerebellum is unchanged in position with its tip in the inferior lateral left ventricle. Mild mucosal thickening of the ethmoid sinuses.2-mm outpouching at the right ICA terminus seen previously is obscured due to streak artifact. An outpouching near the right posterior communicating artery origin is also not well visualized. The left middle cerebral artery is intact. Distal branches of the right MCA appear intact. There is mild irregularity and narrowing of the left V4 segment just proximal to the origin of the PICA which is new from the prior exam. No new aneurysms are identified.
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1.Regions of hypoattenuation within the right frontal lobe and right temporal lobe adjacent to the MCA aneurysm clip may represent post-operative edema, although developing ischemia cannot be excluded. 9 mm right to left midline shift with localized mass effect. Continued follow-up is recommended.2.New mild narrowing and irregularity of the immediate pre-PICA left V4 segment.3.Expected postsurgical changes relating to aneurysm clippings in ACOM and right MCA bifurcation regions. 4.No new aneurysms identified.Findings discussed by Dr. Baad via telephone with Dr. Bradley at 5:15 p.m. on 1/29/2015.
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Generate impression based on findings.
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Female 7 years old Reason: assess for ETT placement, ARDS History: ARDSVIEW: Chest AP (one view) 1/29/2015, 15:58 ET tube is below the thoracic inlet and above the carina. The NG tube tip is in the body of the stomach. The vagal stimulator device overlies the left chest. Mild rightward curvature to the thoracolumbar spine is again evident.The cardiothymic silhouette is normal. There are persistent bilateral small layering pleural effusions, slightly decreased in size. Streaky bibasilar opacities suggest atelectasis.
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ET tube below thoracic inlet and above the carina. Slightly decreased bilateral small pleural effusions.
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Generate impression based on findings.
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Female 38 years old Reason: Right 1.9 cm nodule, please FNA this nodule. The left nodule has already been biopsied RIGHT LOBE MEASUREMENTS: 5.8 x 2.7 x 2.2 cmLEFT LOBE MEASUREMENTS: 7.6 x 4.2 x 2.9 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: A 1.8 x 1.7 x 1.2 cm mixed solid and cystic nodule is identified in the right mid/lower lobe.LEFT LOBE: A 4 .8 x 2.7 x 3.4 cm solid hypoechoic, vascular nodule is identified in the left thyroid lobe.ISTHMUS: A 0.8 x 0.6 by 0.8 cm hypoechoic nodule is identified in the left isthmus with questionable nonshadowing hyperechoic foci inferiorly which may represent calcifications.LYMPH NODES: No significant abnormality noted.
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Multiple thyroid nodules as detailed above with questionable calcifications within the left isthmus nodule. Successful targeted biopsy of the right lower nodule was performed.US FNA W/IMAGE GUIDANCE, US THYROID SOFT TISSUE NECK; 1/29/2015 2:43 PMCLINICAL INFORMATION AND PRE-OPERATIVE DIAGNOSIS: Female 38 years old Reason: Right 1.9 cm Nodule, please FNA this nodule. The left nodule has already been biopsiedCOMPARISON: MRI cervical spine 01/29/15.OPERATORS: Doctors Mathew and Ward; The attending physician, Dr. Mathew, was present for the critical portions of the procedure.
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Generate impression based on findings.
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78 year old female with history of right ankle fracture and left ankle pain. Right ankle: Overlying cast material limits fine osseous detail. Redemonstrated is a transverse fracture of the medial malleolus and an oblique fracture of the distal fibula. Alignment is slightly improved. There is moderate soft tissue swelling about the ankle.Left ankle: There is a transverse fracture through the tip of the fibula. There is perhaps a small tibiotalar joint effusion. There is moderate soft tissue swelling about the ankle.
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1.Moderate soft tissue swelling and a minimally displaced fracture through the tip of the left fibula.2.Interval partial reduction and casting of right ankle fractures as above.
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Generate impression based on findings.
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60 year-old male with history of psoriasis. Left hand: There is mild osteoarthritis affecting the radiocarpal, basilar and interphalangeal joints. There are no radiographic findings of psoriatic arthritis. Small rounded ossicle adjacent to the trapezium may be the sequela of chronic trauma.Right hand: There is mild osteoarthritis affecting the radiocarpal, basilar and interphalangeal joints. There are no radiographic findings of psoriatic arthritis. Left knee: Tricompartmental osteophytes and joint space narrowing worse in the lateral compartment compatible with moderate osteoarthritis. There are no radiographic findings of psoriatic arthritis.Right knee: Tricompartmental osteophytes indicate mild osteoarthritis. There are no radiographic findings of psoriatic arthritis.Pelvis: The SI joints appear normal. Mild osteoarthritis affects the hips and visualized lumbar spine.
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Degenerative changes as above without radiographic findings of psoriatic arthritis.
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Generate impression based on findings.
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Evaluate for neoplasm, history of encephalitis RIGHT TESTIS: Measures 5 x 3.5 x 2.8 cm. Parenchymal vascularity within normal limits. No evidence of acute orchitis or torsion. No focal parenchymal lesion.LEFT TESTIS: Measures 5 x 3.4 x 2.6 cm.RIGHT EPIDIDYMIS: Unremarkable.LEFT EPIDIDYMIS: Unremarkable.
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Unremarkable exam, no focal testicular lesion delineated.
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Generate impression based on findings.
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Female 34 years old Reason: 34 y/o woman with metastatic breast cancer with acute right-sided pleuritic chest pain. Evaluate for PE. History: Right sided pleuritic chest pain. PULMONARY ARTERIES: No evidence of acute pulmonary embolism. Pulmonary arteries is normal in caliber without right heart strain.LUNGS AND PLEURA: Innumerable pulmonary micronodules compatible metastatic disease. Postradiation changes in the left apex.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy. Normal heart size without pericardial effusion.CHEST WALL: Sclerotic metastasis sternum and thoracic spine. Post surgical changes in the breast.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Innumerable hepatic lesions compatible with metastatic disease.
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1. No acute pulmonary embolism.2. Multiple subcentimeter pulmonary micronodules suspicious for metastatic disease.3. Multiple hepatic metastases recently characterized on a chest/abdomen/pelvis CT, unchanged.4. Sclerotic bone metastases of the sternum and thoracic spine, unchanged.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Negative.
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Generate impression based on findings.
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Reason: right chest pain, abnormal chest X-ray History: as above PULMONARY ARTERIES: Technically adequate examination acute segmental pulmonary embolus in the right upper lobe and subsegmental embolus in many posterior basal segment of the right lower lobe.LUNGS AND PLEURA: Subpleural airspace opacities in the right lower lobe and mild ground glass opacity compatible with hemorrhagic infarcts.MEDIASTINUM AND HILA: Moderate coronary artery calcification.No evidence of right heart strain.No pericardial effusionCHEST WALL: Degenerative disease in the spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Cholelithiasis.
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Acute pulmonary embolism in the right upper and right lower lobes. The findings were discussed with Dr. Brukner at the time of reporting.PULMONARY EMBOLISM: PE: Positive.Chronicity: Acute.Multiplicity: Multiple.Most Proximal: Segmental.RV Strain: Negative.
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Generate impression based on findings.
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44-year-old male with history of chronic fourth digit ulceration. Evaluate for osteomyelitis. Exam is limited due to patient positioning. The fingers are held in flexion. There are no radiographic findings of acute osteomyelitis. There are chronic changes at the fifth MCP joint. There is fusion of the proximal interphalangeal joint of the index finger. There is a soft tissue defect about the middle finger. IV tubing overlies the wrist.
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Limited exam. There are no radiographic findings of acute osteomyelitis. Other findings as above.
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Generate impression based on findings.
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Female, 62 years old, status post fall, struck head. Head:Sequelae of left frontal tumor resection are demonstrated including evidence of craniotomy, with a region of cystic encephalomalacia involving the left frontal lobe containing coarse probably dystrophic calcification. The appearance of these findings has not significantly changed.No evidence of intracranial hemorrhage or any new abnormal fluid collection is seen. No parenchymal edema or mass effect is detected. Diffuse ill-defined periventricular T2 hyperintensity is unchanged and nonspecific, possibly related to a combination of small vessel ischemic disease and treatment effect. The ventricles are stable in size and morphology including ex vacuo dilatation of the left lateral ventricle.Apart from changes related to craniotomy, the osseous structures of the skull are intact. No fractures are detected. Swelling, hematoma formation and perhaps a small laceration affect the right periorbital soft tissues. Evidence of chronic inflammation is again seen involving the left maxillary sinus with sinus involution and thickening of the walls.C spine:Alignment is anatomic. Vertebral body morphology is within normal limits. No fracture or dislocation is suspected.Mild multilevel cervical spondylosis is seen but without evidence for significant spinal canal stenosis. Mild foraminal narrowing is suspected on the right at C4-5, and bilaterally at C5-6.A nonspecific 9 mm hypoattenuating focus is evident in the right thyroid lobe. A punctate focus of calcification is unchanged along the midline nasopharyngeal mucosa and may be reflective of prior inflammation.
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1. Redemonstration of sequelae related to craniotomy and tumor resection, but no evidence of any acute intracranial abnormality.2. Right periorbital soft tissue injury without evidence of fracture.3. No cervical spine fracture or dislocation.
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Generate impression based on findings.
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Trauma.VIEWS: Chest AP (one view), cervical spine AP and lateral (two views), pelvis AP (one view), 1/29/2015 , 16:25 The aortic arch, cardiac apex and stomach are left-sided. Cardiac silhouette is normal. No focal lung opacity, pleural effusion or pneumothorax is seen. Vertebral body heights and disk spaces are normal. No fracture is seen. No prevertebral soft tissue swelling is identified.The femoral heads are directed into the acetabula. No pelvic fracture is seen.
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Normal chest, cervical spine and pelvis.
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