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Generate impression based on findings.
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Dental streak artifact again limits evaluation of the oral cavity. Within this limitation, there is no definite residual discrete enhancing tissue along the left base of tongue in area of previous mass. There is at most minimal asymmetric ill-defined enhancement along the cranial aspect of the previous mass, as seen on 8044 8/27-29, measuring approximately 10 mm CC.PHARYNX/LARYNX: The nasopharynx, oropharynx, hypopharynx, and larynx are unremarkable. The upper trachea and esophagus are unremarkable. There is no new abnormal soft tissue mass or pathological enhancement.GLANDS: The postcontrast appearance of the salivary glands is unremarkable. The thyroid gland is unremarkable. ORAL CAVITY: The oral tongue and floor of mouth are unremarkable, within the limitations of this exam as there is artifact from dental amalgam.CERVICAL SOFT TISSUES: There are no pathologically enlarged cervical lymph nodes.OTHER: There is mild-moderate calcified plaque at the carotid bifurcations. There are multilevel cervical spondylotic changes. There are a few scattered dental caries. There is a right-sided Port-A-Cath. There are scattered biapical blebs. There are sternotomy sutures partially visualized. There is mild mucosal thickening in the right maxillary sinus.
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1. Further decrease size of enhancing left base of tongue tumor with only minimal ill-defined enhancement remaining along the cranial aspect of the mass. Exam is again limited due to extensive streak artifact from dental amalgam.2. No cervical lymphadenopathy.
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Generate impression based on findings.
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Study slightly limited due to patient motion. No evidence of acute intracranial hemorrhage. There is encephalomalacia in the left temporal and parietal lobes from prior MCA territory infarct, unchanged. Hypoattenuation within the pons is unchanged and likely related to chronic ischemia. Ventricles and sulci are prominent, suggestive of mild to moderate age-related volume loss. No hydrocephalus. Mild ex vacuo dilatation of left lateral ventricle is unchanged. Periventricular and subcortical hypoattenuation is nonspecific but may be related to age indeterminate mild small vessel ischemic disease. There is no midline shift or mass effect. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear.
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1.No acute intracranial hemorrhage or mass effect. Please note CT is insensitive for detection of acute nonhemorrhagic infarcts, and MRI should be considered if there is continued clinical suspicion.2.Left temporo-parietal encephalomalacia related to remote MCA territory infarct.
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Generate impression based on findings.
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cT3N0 squamous cell carcinoma of the supraglottic larynx status post 7/7 cycles of FHx. There has been interval decrease in size of the supraglottic squamous cell carcinoma without evidence of measurable tumor. There is no evidence of significant cervical lymphadenopathy based on size criteria. Thin linear hyperattenuation near the midline in the strap muscles may represent undescended thyroid tissue. The thyroid and major salivary glands are unchanged. There is a retropharyngeal course of the bilateral internal carotid arteries. The major cervical vessels are patent. There is a right internal jugular venous catheter. There are several unchanged subcentimeter sclerotic foci within the jaws, which may represent enostoses or a sequela of a chronic inflammatory process, for example. There are cystic lesions in the bilateral cheeks that likely represent epidermal inclusion cysts. The lesions in the right cheek now display surrounding inflammatory changes. The imaged intracranial structures and orbits are unremarkable. The imaged portions of the lungs are clear.
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1. Interval decrease in size of the supraglottic squamous cell carcinoma without evidence of measurable tumor.2. Probable inclusions cysts in the bilateral cheeks, in which the right-sided lesions now display signs of inflammation or infection.
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Generate impression based on findings.
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53 year-old woman with a history of right mastectomy in 2006 for inflammatory breast carcinoma. She is status post chemo- and radiation therapy. She has also an undergone left breast reduction surgery. No current breast complaints. 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, unchanged in pattern and distribution. Stable focal asymmetry/architectural distortion in the left breast 6 o'clock position consistent with history of breast reduction surgery scar. No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in left breast.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains unremarkable, right unilateral diagnostic mammogram is recommended annually. Results and recommendations were discussed with the patient. In view of history of breast cancer and dense breast, breast MRI may be useful for screening. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.
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Generate impression based on findings.
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Female 74 years old Reason: RUQ, sepsis, source unknown History: RUQ, sepsis, source unknown Very limited study due to patient body habitus and skin dressings.LIVER: Liver measures 16.2 cm in length and demonstrates markedly heterogeneous and coarsened echotexture suggestive of chronic liver disease. The portal vein is patent and demonstrates normal directional flow.GALLBLADDER, BILIARY TRACT: Unremarkable appearance of the gallbladder. No biliary dilatation.PANCREAS: Not visualized.RIGHT KIDNEY: The left kidney measures 10.4 cm. The right kidney measures 11.4 cm. There is no hydronephrosis.OTHER: The spleen measures 9.7 cm. Abdominal ascites. Right pleural effusion.
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1. Very limited study. Heterogeneously coarse hepatic echotexture suggestive of chronic liver disease. 2. Abdominal ascites. 3. Right pleural effusion.
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Generate impression based on findings.
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Male 65 years old Reason: evaluation of known renal nodule for status change, (left) History: Known nodule, no symptoms RIGHT KIDNEY: The right kidney measures 9.6 cm. The renal cortex is diffusely hyperechoic. Multiple anechoic lesions seen throughout the kidney are suggestive of simple cysts. LEFT KIDNEY: The left kidney measures 10.2 cm. The renal cortex is diffusely hyperechoic. Multiple anechoic lesions seen throughout the kidney are suggestive of simple cysts. There is a 0.5-cm shadowing echogenic focus within the left lower pole consistent with renal calculus although this was not definitively identified on recent CT.OTHER: No significant abnormalities noted.
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The renal cortex is hyperechoic bilaterally consistent with medical renal disease. Multiple anechoic lesions identified throughout both kidneys consistent with renal cysts. Continued follow-up is recommended in the absence of postcontrast imaging of these lesions as recommended on prior noncontrast CT.
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Generate impression based on findings.
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Dysphagia. High-risk of esophageal / other cancer initial treatment strategy. Recent CT with nonspecific foci.RADIOPHARMACEUTICAL: 9.2 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 87 mg/dL. Today's CT portion grossly demonstrates small bilateral pleural effusions. There is a trace pericardial effusion. Mild to moderate atherosclerotic coronary arterial calcifications are present.Today's PET examination demonstrates no suspicious FDG avid lesion to indicate tumor activity currently.
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No suspicious FDG avid lesion to indicate tumor activity currently in the neck, chest, abdomen, or pelvis.
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Generate impression based on findings.
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Hypertension, tachycardia and elevated urine metanephrines. Rule out pheochromocytoma. ABDOMEN:LUNG BASES: Left pleural effusion indwelling chest tube. Small right pleural effusion with overlying compressive atelectasis. Moderate atelectasis at the left lung base. Esophageal stent appears patent and extends into the stomach. The cephalad aspect of the stent is not included in the scanning field. Fluid is noted in the posterior mediastinum adjacent to the stent an incompletely imaged in its cephalad aspect; correlate with chest CT as clinically indicated.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No evidence of adrenal masses. The left adrenal gland is slightly nodular but there is no definite evidence of a pheochromocytoma. Shotty retroperitoneal lymph nodes are noted.KIDNEYS, URETERS: Hypodense nodules in both kidneys. The larger ones appear to represent cysts. The smaller ones are too small to characterize. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted. Specifically, no evidence of a organ of Zuckerkandl lesion.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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No findings to explain clinical symptoms; no evidence of pheochromocytoma. Status post esophageal stenting with fluid in the posterior mediastinum which could be better evaluated on a dedicated chest CT. Left pleural effusion with indwelling chest tube.
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Generate impression based on findings.
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Female 47 years old Reason: r/o path nodules History: asymptomatic now. Hx of TB in childhood. Incidental pul nodules (3) seen on esophagram;non smoker LUNGS AND PLEURA: Right upper lobe well circumscribed parenchymal nodule measuring 14 x 15 mm. There are scattered calcified micronodules likely intrapulmonary lymph nodes or postinfectious in etiology. Inferior two nodules seen on esophagram are likely secondary to extrapleural artifact.No pleural effusion.MEDIASTINUM AND HILA: Calcified right hilar lymph node likely post infectious in etiology.. Nonspecific mildly enlarged lower paratracheal lymph node. Normal heart size without pericardial effusion. Mild coronary arterial coruscations. CHEST WALL: Mild degenerative changes of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Dilated stomach with enteric contents. Oral contrast is noted in the colon, presumably from esophagram on 1/23/2014. Calcified peripancreatic lymph node.
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Right upper lobe well circumscribed nodule is likely benign and likely secondary to prior granulomatous infection.Inferior two nodules seen on esophagram are likely secondary to extrapleural artifact.
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Generate impression based on findings.
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Reason: Follicular Lymphoma History: 67Yrs male with a history significant for melanoma (locally advanced), thyroid cancer, and recently-diagnosed follicular lymphomaRADIOPHARMACEUTICAL: 12.2 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 120 mg/dL. Today's CT portion grossly demonstrates postsurgical changes of a left parietal craniotomy with adjacent porencephaly and ex vacuo dilatation of the left lateral ventricle. Posttreatment changes in the neck. Medium sized right and small left pleural effusions. Small to medium-sized pericardial effusion. Extensive atherosclerotic coronary arterial calcifications. Cholecystectomy clips. Large matted confluent mesenteric lymphadenopathy. Subcutaneous stranding in the lower trunk and lower extremities compatible with anasarca.Today's PET examination demonstrates a small mildly hypermetabolic nodule (SUV max= 4.4) within the anterior subcutaneous soft tissues of the thyroid bed, new from previous, could represent an inflammatory nodule or progression of tumor (such as lymphoma or thyroid given patient's history).Moderately hypermetabolic prevascular lymph node (SUV max= 6.2) has not significantly changed and could represent stable inflammatory or tumor activity.Large confluent hypermetabolic mesenteric lymph nodes have mildly decreased in size and metabolic activity, but it remains significantly hypermetabolic (SUV max= 10.5, previously 16.7 when normalized to account for mean background SUV).No additional suspicious foci.
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1.Hypermetabolic confluent mesenteric lymph nodes have improved mildly, but still remain significantly metabolically active and compatible with current persistent tumor activity.2.New hypermetabolic small subcutaneous nodule in the anterior thyroid bed and stable hypermetabolic small prevascular lymph node could represent additional tumor activity (lymphoma or other primary including thyroid cancer given patient's history) or inflammatory activity.
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Generate impression based on findings.
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Parotid cancer with liver mets status post chemo. CHEST:LUNGS AND PLEURA: No significant change in appearance of the left lung with extensive chronic tissue necrosis and bronchiectasis. The intracavitary mycetoma in the left upper lobe has moved in position and is now dependent measuring 20 mm, previously 17 mm (5/46). There is a probable new small partially calcified mycetoma at the apex (5/20).Bronchiectasis and mucous plugging in the right upper lobe, some of the presumed mucous plugs have cleared however mosaic attenuation of the parenchyma appears more pronounced suggesting progressive air trapping. Fibrosis in the right lower lobe adjacent to a fat-containing posterior diaphragmatic crus hernia.MEDIASTINUM AND HILA: Leftward mediastinal shift. Prominent subcarinal lymph node on the left upper normal in size, 10 mm, previously 9 mm, not significantly changed (3/40). Assessment for coronary calcification is difficult due to architectural distortion.. Normal heart size. Unchanged trace volume of pericardial fluid. Right chest port tip in the right atrium.CHEST WALL: Osteopenia limits sensitivity for detection of metastatic disease. Right chest port. Chest port tip at the SVC/RA junction. Unchanged rib focal cortical sclerosis posteriorly in the right (4/53), possibly a bone island. Right chest port. Left internal mammary chain lymph node measures 7 mm, previously 6-mm (3/42). Other small lymph nodes in the left internal mammary chain may be subjectively slightly larger. Subcentimeter left subpectoral lymph nodes unchanged.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Hepatic metastases difficult to visualize due to phase of contrast. Caudate lobe lesion measures 10 mm, previously 12-mm (3/81). Cholelithiasis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Nonspecific subcentimeter cyst-like lesions.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the aorta and its branches. A porta hepatis lymph node is slightly larger (9-mm compared to 7 mm previously, 3/86, non-index lesion).BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Gastrostomy tube retention device within the the stomach. The stomach is under distended and cannot be accurately assessed.BONES, SOFT TISSUES: Elevation of the left hemidiaphragm. Lucent areas in the lumbar spine (L2-L4), sacrum and visualized pelvis unchanged and most likely represent to osteoporosis.Soft tissue thickening along the G-tube tract appears worse and may indicate infection or inflammation, correlate with physical exam.OTHER: No significant abnormality noted.
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1. Progressive soft tissue thickening surrounding the G-tube tract suspicious for infection or inflammation, correlate for pain or signs of infection in this area.2. Although not significantly changed, some of the lymph nodes in the mediastinum, left internal mammary chain and porta hepatis appear minimally larger.3. Hepatic metastases not well visualized due to phase of contrast; the caudate lobe lesion measures smaller.4. Left upper lobe mycetoma appears slightly increased in size. Development of air trapping in the right lung may indicate worsening small airways obstruction.
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Generate impression based on findings.
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Eight-year-old male with abdominal distention/constipationVIEWS: Abdomen AP (one views) 01/30/15 Gastrostomy tube is in place. Small amount of stool is seen throughout the rectum and descending colon. Diffuse gas distended loops of small and large bowel are seen. No air fluid levels are seen. No pneumoperitoneum, pneumatosis intestinalis, or portal venous gas. The lung bases are within normal limits.
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Nonspecific bowel gas pattern. No specific evidence for obstruction.
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Generate impression based on findings.
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Images are slightly limited by patient motion. The lumbar spine is in normal alignment, with a normal lumbar lordosis. There is mild narrowing with forming Schmorl's node at L1-L2, with interval distal degeneration. There is also mild narrowing of the L5-S1 disk although this is stable and may be developmental. The vertebral body and disk heights are otherwise well-maintained. No worrisome focal marrow signal abnormality is appreciated.The distal spinal cord and conus are within normal limits with the conus terminating at the L1-L2 level, similar to prior. From L2-L3 through lower L3, there is minimal linear intrinsic T1 hyperintensity along the dorsal aspect of the thecal sac. In addition, there is trace linear intrinsic T1 hyperintensity extending from the mid L5 level down to the distal end of the thecal sac. This likely represents a thin fatty filum which has been cut during tethered cord repair, previously noted to be continuous thin fat signal. Postoperative changes are suggested at the L3-L4 level in the subcutaneous soft tissues. Prone images demonstrate definite significant ventral motion of the distal cord and conus as well as cauda equina nerve roots within the distal thecal sac.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the lumbar spine.
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1. Interval postoperative changes from tethered cord release with retracted ends of fatty filum, with stable level of conus termination at L1-L2. Appropriate ventral motion of the distal cord and conus as well as cauda equina nerve roots on prone imaging.2. Interval degeneration of L1-L2 disk with probable impending Schmorl's node, although without significant central spinal canal or foraminal stenosis. Please correlate clinically for possible source of patient's current back pain.
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Generate impression based on findings.
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Reason: pt with history of prostate Ca, now with new onset bone pain , elevated alk phos, r/o progressive disease/ bone mets History: bone pain, fatigue, increased alk phos Innumerable widespread confluent increased radiotracer uptake involving the axial and proximal appendicular skeleton as well as diffusely decreased soft tissue uptake compatible with a metastatic superscan, new compared to prior.
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Innumerable widespread confluent osseous metastases, new from previous.
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Generate impression based on findings.
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Female 44 years old Reason: pt w/ RUQ pain, r/o biliary cause of pain History: RUQ pain LIVER: Liver measures 17.5 cm in length. No focal parenchymal abnormality. Portal vein is patent and demonstrates normal directional flow.GALLBLADDER, BILIARY TRACT: No evidence of gallstones, gallbladder wall thickening or pericholecystic fluid. There is a 0.4-cm non-shadowing, non-mobile focus adherent to the gallbladder wall with an appearance suggestive of a gallbladder polyp.PANCREAS: Unremarkable where visualized.KIDNEYS: The right kidney measures 10.3 cm. The left kidney measures 10.0 cm. There is no hydronephrosis.OTHER: The spleen measures 8.2 cm.
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0.4-cm echogenic focus adherent to the gallbladder wall which is suggestive of a gallbladder polyp. No specific cause for patient's right upper quadrant pain is identified.
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Generate impression based on findings.
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Male 50 years old; Reason: concern for cteph History: rv failure The comparison chest radiograph performed on 1/29/2015 demonstrates cardiomegaly with no focal pulmonary opacities or pleural fluid. The ventilation images show a uniform distribution of activity on single-breath and wash-in images. There is abnormal Xe-133 retention in the left apex and right midlung during the wash-out phase. The perfusion images show a physiologic distribution of pulmonary perfusion without significant perfusion defect.
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Very low probability for pulmonary embolism.
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Generate impression based on findings.
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Non-small cell lung CA status post CRT. CHEST:LUNGS AND PLEURA: Small left pleural fluid collection, partially loculated in the upper thorax, not significantly changed in volume. Small volume of pleural fluid on the right is new.Progressive post therapeutic changes in the lungs bilaterally consistent with evolving radiation pneumonitis and radiation fibrosis. Scarlike opacity in the costophrenic angles bilaterally is symmetric in appearance and may relate to aspirate or RT. Scattered areas of atelectasis related to endobronchial debris are nonspecific.Cavitary lesion in the left upper lobe not easily measurable however there a solid nodular focus measuring 13 x 15 mm (3/35) in transaxial dimensions and 9-mm in thickness (coronal image 67), not conclusively present previously. This is a nonspecific finding and could reflect treated tumor or progressive radiation fibrosis however should be monitored.MEDIASTINUM AND HILA: Unchanged small mediastinal lymph nodes. Unable to distinguish left hilar lymphatic tissue from radiation pneumonitis. Right inferior interlobar lymphatic tissue measures 7 mm, previously 6-mm, not significantly changed (non- index lesion, 3/45). Calcifications at the aortic root. No visible coronary artery calcifications. Small pericardial fluid collection at the base of the heart has increased in volume.CHEST WALL: Unchanged subcentimeter low cervical lymph nodes on the left. Compression fracture of T2 unchanged.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Probable cyst right hepatic lobe unchanged.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Subcentimeter left adrenal gland nodule in the medial limb (3/88) does not meet the criteria for an adenoma but appears unchanged over multiple prior studies.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Subtle thickening of the left diaphragmatic crus (3/86, coronal image 48 ) unchanged.OTHER: No significant abnormality noted.
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Progressive post therapeutic changes in the lungs bilaterally. Nonspecific solid nodular focus within in the radiation field of the left upper lobe should be monitored on subsequent studies; if of clinical concern this area can be further characterized by PET scan. Increased in small volume of pericardial and pleural fluid probably related to RT. Diaphragmatic lesion on the left appears stable.
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Generate impression based on findings.
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87 year-old female with confusion, rule out fracture A lucency along the medial aspect of the lateral tibial plateau indicates a nondisplaced tibial plateau fracture. Low lying patella and poor visualization of the extensor mechanism suggests injury to the extensor mechanism. Large joint effusion. Diffuse osteopenia is noted. Moderate osteoarthritis affects the knee.
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1. Lucency along the lateral tibial plateau, consistent with a nondisplaced tibial plateau fracture, for which further evaluation with cross-sectional imaging should be considered if clinically warranted. 2. Low-lying patella and poor visualization of the quadriceps tendon suggestive of injury to the extensor mechanism. 3. Large joint effusion.
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Generate impression based on findings.
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54-year-old male with history of left hip pain. Hardware components of a left hemi hip arthroplasty are situated in near-anatomic alignment without radiographic evidence of hardware complication. There is interval development of heterotopic bone within the adjacent soft tissues. Mild osteoarthritis affects the pubic symphysis.
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Left hip arthroplasty as above.
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Generate impression based on findings.
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55-year-old male with history of foot ulcerations, erythema evaluate for gas There is mild soft tissue swelling about the foot without gas or discrete ulceration visualized. No erosions or bone destruction. Alignment is within normal limits. Small plantar calcaneal spur and unchanged cortical defect along the mid diaphysis of the second metatarsal. Scattered degenerative changes affect the first MTP and midfoot, similar to the prior exam.
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Mild soft tissue swelling without gas or specific radiographic features of osteomyelitis.
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Generate impression based on findings.
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Female 56 years old; Reason: 56F with h/o melanoma in 1989 now presenting with left axillary LN concerning for recurrent disease. History: disease staging CHEST:LUNGS AND PLEURA: Anteriorly located pleural based 7 mm right upper lobe lung nodule, image 42 series 4, with associated calcification suggested, may reflect prior granulomatous disease. MEDIASTINUM AND HILA: Multiple left axilla surgical clips seen. Enlarged left axillary and subpectoral adenopathy with some lymph nodes demonstrating central hypoattenuation likely reflecting necrosis. Reference lymph node measuring 1.9 x 1.8 cm, image 27 series 4.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter bilobar hypoattenuating liver lesions seen, too small to characterize. Lobulated hypoattenuating lesion seen in inferior pole of spleen, measuring 1.8 x 1.3 cm, may be a mildly complex splenic cyst or a hemangioma but not well assessed on this nondedicated dedicated exam. Additional smaller hypoattenuating lesion seen more superiorly, too small to characterize, image 102 series 4. Comparison to prior imaging if available to document stability of lesions would be helpful. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Mild left adrenal thickening.KIDNEYS, URETERS: Symmetric renal parenchymal enhancement.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Multilevel degenerative changes of spine, right femoral head subchondral cyst formation.
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1. Enlarged left axillary and subpectoral lymphadenopathy, suspicious for recurrent/metastatic disease.2. Additional indeterminant splenic and hepatic lesions as above.
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Generate impression based on findings.
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41-year-old female with history of ORIF of pelvis in 2000. A plate and screw device is identified coursing horizontally along the posterior aspect of the sacrum and SI joints. There is a second plate and screw device coursing obliquely along the left posterior aspect of the sacrum. A third plate and screw device affixes the left superior pubic ramus. Deformity of the left superior pubic ramus is secondary to trauma. Additionally, there is a single screw traversing the left sacroiliac joint. There is a fractured screw overlying the left SI joint, otherwise there is no evidence of hardware complication. There is an IUD in an enlarged uterus. The visualized abdominal structures are unremarkable.
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1.Postsurgical changes of the pelvic fracture fixation as above.2.Enlarged uterus for which dedicated imaging may be obtained if clinically warranted.
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Generate impression based on findings.
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Call back from screening mammogram for increasing calcifications in the right breast. An ML view and two spot magnification views of the right breast were performed digitally and reviewed with the aid of R2 CAD, 9.3. There are loosely clustered punctate calcifications with a few stable coarse calcifications in the right retroareolar region. Morphology of these calcifications appears benign.
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Benign appearing calcifications in the right retroareolar region. Follow up in 6 months with right unilateral diagnostic mammogram is recommended. Results and recommendations were discussed with the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months).
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Generate impression based on findings.
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Male 77 years old Reason: h/o transformed CLL, and biliary stenting History: RUQ pain, elevated Alk phos and ALT LIVER: The liver measures 17.0 cm in length. Hepatic echogenicity is mildly increased. No focal liver lesion is identified. Biliary stent in situ with satisfactory decompression of the biliary system. The main portal vein is patent and demonstrates normal directional flow. Focal prominence of the hepatic contour medially within the right hepatic lobe with similar echogenicity to the hepatic parenchyma may represent insinuation of the liver.GALLBLADDER, BILIARY TRACT: The gallbladder is poorly distended. Within this limitation it appears unremarkable.PANCREAS: The pancreas is unremarkable where visualized.KIDNEYS: The left kidney measures 10.6 cm. The right kidney measures 10.7 cm. There is no hydronephrosis.OTHER: The spleen measures 11.3 cm. No ascites.
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Biliary stent in situ with satisfactory decompression of the biliary system. No specific cause for patient's right upper quadrant pain is identified.
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Generate impression based on findings.
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37 year old female with strong family history of breast cancer (sister diagnosed with breast cancer at age 38). Three standard views of both breasts 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 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 annually. 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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Male 28 years old Reason: eval for cholelithiasis History: intermittent RUQ pain LIVER: The liver measures 16.8 cm in length. Unremarkable appearance of the hepatic parenchyma. The main portal vein is patent and demonstrates normal directional flow.GALLBLADDER, BILIARY TRACT: Unremarkable appearance of the gallbladder without gallstones, gallbladder wall thickening or pericholecystic fluid.PANCREAS: Unremarkable where visualized.KIDNEYS: The right kidney measures 12.7 cm. The left kidney measures 12.2 cm. There is no hydronephrosis.OTHER: The spleen measures 9.8 cm.
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No evidence of cholelithiasis. No specific cause for patient's right upper quadrant pain is identified.
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Generate impression based on findings.
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Reason: h/o HNC and CRT, compare to previous measurements History: none CHEST:LUNGS AND PLEURA: Scattered punctate micronodules and right middle lobe scarring, unchanged.There is no evidence of pulmonary or pleural metastases.Mild central lobular emphysema is upper lobe predominant.MEDIASTINUM AND HILA: Severe coronary artery calcifications are present, the heart and pericardium otherwise unremarkable.There is no mediastinal or hilar lymphadenopathy.The thoracic aorta is moderate to severely calcified.A right jugular catheter terminates at the RA level.CHEST WALL: No significant abnormality noted, except for a stable left sixth rib expansile lesion suggestive of fibrous dysplasia. ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Very small hepatic cyst like hypodensity, likely benign.SPLEEN: Previously noted splenic hypoattenuation region no longer visible. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Extensive aortoiliac calcifications.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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No evidence of metastases, or other significant abnormality.
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Generate impression based on findings.
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40 year-old female with history of right hip pain. Moderate osteoarthritis affects the hips, SI joints, and pubic symphysis. No evidence of acute abnormality.
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Degenerative changes of the hips, SI joints and pubic symphysis as above.
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Generate impression based on findings.
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26 year-old female with left hip pain, assess for FAI MEASUREMENTS: CAM location : Minimal CAM deformity at the femoral head neck junction. Alpha angle : 61 degreesCoronal center-edge angle : 39 degreesSagittal center-edge angle : 69 degreesFemoral neck-shaft angle : 130 degreesAcetabular version (1 o’clock) : 3 degreesAcetabular version (2 o’clock) : 4 degreesAcetabular version (3 o’clock) : 15 degreesFemoral version angle (+anteverted, -retroverted) : 23 degreesMcKibbin index : 38 degreesAIIS width : 8 mmDistal base of AIIS to acetabular rim : 1.7 cm
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Minimal CAM deformity with acetabular and femoral version measurements as described above.
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Generate impression based on findings.
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History of right mastectomy in 2006 for invasive lobular carcinoma. Status post autologous right reconstruction. Family history of breast cancer in her mother and a paternal aunt. No current breast complaints. 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, unchanged in pattern and distribution. No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in left breast.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains unremarkable, left unilateral diagnostic mammogram is recommended annually. Results and recommendations 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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55 year old who is called back from the screening study. An ML view and two spot magnification views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. There are diffuse punctate calcifications in both breasts, predominantly distributing in upper outer quadrant. There are no clustered calcifications or other suspicious morphology. They appear to be benign developing calcifications.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendations 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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Male 53 years old Reason: rlo hydronephrosis History: Increasing Cr RIGHT KIDNEY: The right kidney measures 11.5 cm. Right upper pole cyst. There is no hydronephrosis.LEFT KIDNEY: The left kidney measures 11.6 cm. Subcentimeter left mid pole cyst. There is no hydronephrosis.URINARY BLADDER: The bladder is decompressed.OTHER: No significant abnormalities noted.
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No hydronephrosis.
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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. There are no areas of abnormal attenuation. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear.
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No acute intracranial abnormality.
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Generate impression based on findings.
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Primary pulmonary hypertension, concern for amiodarone toxicity, low FEV1. LUNGS AND PLEURA: Scattered calcified and noncalcified micronodules nonspecific and too small to accurately characterize.No pleural fluid or pneumothorax. Mild dependent atelectasis resolves upon prone positioning of the patient.Mosaic attenuation of the lung parenchyma, accentuated on the expiration sequence, consistent with small airways disease.No areas of consolidation are appreciated. Mild scarring at the lung bases, but no specific signs of pulmonary fibrosis or bronchiectasis.Subtle approximately 1 cm focus of groundglass opacity in the anterior left upper lobe, series 4 image 105, coronal image 55, difficult to characterize due to streak artifact through the area.MEDIASTINUM AND HILA: Severe cardiomegaly with marked enlargement of the left atrium and left ventricle. Left subclavian ICD/pacemaker is present with leads in the right atrial appendage, right ventricle anteriorly, coronary sinus and pulmonary outflow tract. No pericardial fluid. No visible coronary artery calcifications on this non-cardiac gated study. The main pulmonary artery is difficult to accurately measure on this unenhanced exam but measures at least 32 mm in transverse dimension, consistent with pulmonary hypertension.Hiatal hernia. No visible lymphadenopathy.Segmental level and airways are attenuated, presumably related to compression from adjacent enlarged pulmonary arteries.CHEST WALL: Left chest wall pacemaker generator.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Limited scanning range. 18 millimeter cystlike hypoattenuating lesion in the left hepatic lobe incompletely characterized. Similar 9 mm lesion at the hepatic dome.
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1. No conclusive radiographic evidence of pulmonary fibrosis or septal thickening to suggest Amiodarone pulmonary toxicity.2. Single area of ground glass opacity in the anterior left upper lobe could potentially represent focal acute interstitial pneumonitis related to pulmonary toxicity but is too subtle to accurately characterize, suggest conservative imaging follow up if the patient remains symptomatic.3. Mosaic attenuation of the lung parenchyma in a pattern suggesting small airways disease. In addition, the proximal segmental airways are focally narrowed by adjacent enlarged central pulmonary vasculature.4. Severe enlargement of the left cardiac chambers. One of the ICD weld is positioned in the pulmonary outflow tract just below the level of the pulmonic valve.5. Pulmonary micronodules are too small to characterize but probably benign. These may be followed by CT in one year if the patient is in a high risk category.6. Signs of pulmonary hypertension.
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Generate impression based on findings.
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The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. The cerebellar tonsils remain somewhat low lying especially on the left although with normal configuration. There is stable left parieto-occipital plagiocephaly. There is mild mucosal thickening in the maxillary sinuses. There is persistent trace fluid in the mastoids.NECK
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1. Continued stable post treatment changes relating to previous left parotid space rhabdomyosarcoma.2. Persistently enlarged right level 2a lymph node which is nonspecific and statistically most likely reactive in etiology.3. Unremarkable contrast enhanced MRI brain, except for minimally low lying cerebellar tonsils not meeting imaging criteria for Chiari one malformation at this time.
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Generate impression based on findings.
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Ankle painVIEWS: Right foot AP, lateral and oblique 1/30/15 (3 views) There is no evidence of fracture, malalignment, joint effusion or soft tissue swelling.
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Normal examination.
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Generate impression based on findings.
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9-year-old male with history of rhabdomyosarcoma, now greater than 12 months off therapy LUNGS AND PLEURA: Postoperative changes to the left upper lobe are again seen. Bibasilar, left greater than right, atelectasis. Scattered bilateral micronodules are stable compared to the prior examination. No new pulmonary nodules or masses. No pleural effusions.MEDIASTINUM AND HILA: The heart size is normal. No pericardial effusion. No significant hilar or mediastinal lymphadenopathy.CHEST WALL: No axillary, retrocrural, or cardiophrenic lymphadenopathy.UPPER ABDOMEN: Imaged portions of the liver, spleen, pancreas, and kidneys appear within normal limits.
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1.Bibasilar opacities likely represent atelectasis. Follow-up to ensure resolution should be considered.2.No specific evidence of recurrent or metastatic disease in the thorax. Stable bilateral pulmonary micronodules and postoperative changes in the left upper lobe.
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Generate impression based on findings.
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52-year-old female with history of right shoulder pain. Four suture anchors are noted within the humeral head. There is widening of the acromioclavicular interval compatible with acromioplasty. There is no evidence of acute fracture. Alignment is anatomic.
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Postsurgical changes as above without acute abnormality.
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Generate impression based on findings.
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Male 56 years old Reason: previous kidney stone- left side History: chronic right flank pain RIGHT KIDNEY: The right kidney measures 11.4 cm. There is no hydronephrosis.LEFT KIDNEY: The left kidney measures 11.2 cm. There is no hydronephrosis. There is a 2.9-cm anechoic lesion at the mid pole of the left kidney suggestive of a simple cyst. Adjacent to this there is a 0.6-cm shadowing echogenic focus consistent with non obstructing calculus identified on recent CT.URINARY BLADDER: The prostate gland is enlarged. The bladder is poorly distended.OTHER: No significant abnormalities noted.
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0.6-cm left renal calculus as identified on recent CT. No right renal calculi. No hydronephrosis.
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Generate impression based on findings.
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19-year-old female with history of thumb injury. There is mild soft tissue swelling about the thumb and thenar eminence, but we see no fracture.
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Soft tissue swelling without acute fracture.
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Generate impression based on findings.
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68-year-old female with an inflammatory arthritis, RA versus gout Right hand: Mild diffuse osteopenia. No erosions or other specific evidence of inflammatory arthritis. There is narrowing of the distal radial ulnar joint and scattered interphalangeal joints. A small ossicle adjacent to the ulnar styloid likely represents old trauma.Left hand: Mild diffuse osteopenia. There are no erosions or other specific evidence of inflammatory arthritis. A small ossicle adjacent to the ulnar styloid likely represents old trauma. Narrowing of scattered interphalangeal joints and the basilar joint consistent with osteoarthritis.Right foot: No erosions or other specific evidence of inflammatory arthritis. Moderate degenerative changes affect the first MTP joint and midfoot. Mild pes planus deformity.Left foot: Mild pes planus deformity and moderate degenerative arthritic changes affecting the midfoot and first MTP joint. No specific radiographic features of inflammatory arthritis.
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Diffuse osteopenia and arthritic changes as described above without specific radiographic features inflammatory arthritis.
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Generate impression based on findings.
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88-year-old female with pain, evaluate for fracture Limited exam demonstrating a trimalleolar fracture and tibiotalar joint dislocation. There is posterior dislocation of the distal fracture fragments. The talus is fractured as well but not well-visualized on this limited exam. Diffuse soft tissue swelling.
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Limited exam demonstrating ankle fracture dislocation as described above. Further evaluation with CT is recommended if clinically warranted.
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Generate impression based on findings.
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69-year-old female with radiculopathy There is moderate degenerative disk disease at L5/S1, progressed from the prior exam. Lumbar alignment and vertebral body heights are maintained. Facet joint osteoarthritis affects the lower lumbar spine. Mild osteoarthritis affects the SI joints.
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Degenerative arthritic changes as described above, progressed from the prior exam.
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Generate impression based on findings.
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39 year-old female with right knee pain Moderate medial joint space narrowing and small tibiofemoral osteophytes, progressed from the prior exam. A bipartite patella is again noted bilaterally, a normal anatomic variant. Moderate osteoarthritis also appears to affect the left knee as seen on the frontal views.
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Moderate osteoarthritis, progressed from the prior exam.
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Generate impression based on findings.
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COPD Sjogren's with mild bronchiectasis in 2006 now with clinical worsening and oxygen requirement. LUNGS AND PLEURA: No cysts, fluid or pneumothorax. Mild emphysema.Slight progression of airway thickening film with development of mild bronchiectasis in the anterior right upper lobe (4/42). Mild short segment bronchiectasis left lower lobe (4/71). Caliber of the airways elsewhere is not significantly changed.Interval development of water/fluid-density peribronchovascular nodules in the left upper lobe (4/28-26) and right lower lobe (4/76), measuring up to 13 x 10 mm. Scarring in the right middle lobe is new.Evidence of tracheobronchomalacia, with collapse of the trachea and bronchial airways on the expiration sequence.MEDIASTINUM AND HILA: Severe coronary artery calcifications. Normal heart size. Mild pericardial fluid or thickening anteriorly. Small distal paraesophageal lymph nodes bilaterally unchanged (3/78). Main pulmonary artery 26 mm, within normal limits in caliber. Mild atherosclerotic calcification of the aorta.CHEST WALL: Degenerative changes of the spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Limited scanning range. Nonspecific subcentimeter hypoattenuating lesions in the liver too small to characterize but statistically most likely represent cysts.
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1. Mild worsening of bronchiectasis, with development of mucoid plugging and peribronchovascular nodules suspicious for focal lymphoid hyperplasia versus LIP or lymphoma.2. Collapse of the airways consistent with severe tracheobronchomalacia.3. Severe coronary artery calcifications.4. No lymphadenopathy or cysts.
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Generate impression based on findings.
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Female 38 years old Reason: r/o acute abnormalities History: shortness of breath, tachycardia, hx of ca, hx of PE The exam is limited secondary to lack of optimal opacification of the pulmonary artery.PULMONARY ARTERIES: No acute pulmonary embolism to the segmental level. Pulmonary artery is normal in caliber. No evidence of right heart strain.LUNGS AND PLEURA: Moderate right and small left pleural effusions. Left hemithorax volume loss with pleural thickening and severe thickening of the inter and intralobular septa, highly suspicious for lymphangitic tumor spread. Thickening of the bronchovascular bundles and narrowing of the arterial and bronchial structures on the left side also suggests tumor as the etiology. Scattered subcentimeter nodules and groundglass opacities in the right lung are nonspecific.MEDIASTINUM AND HILA: Heart size is normal with a small pericardial effusion. Right chest wall port with tip in the RA. Persistent pericardial cyst in the right cardiophrenic angle. Distal esophagus is dilated and fluid-filled with an air-fluid level. High left paratracheal lymphadenopathy. Right hilar lymphadenopathy. Thickening of the bronchovascular bundles with several small mediastinal lymph nodes.CHEST WALL: Post surgical changes from prior breast reconstruction. No evidence of bone metastasis. Low cervical lymphadenopathy on the left. Supraclavicular lymphadenopathy on the left.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. The fluid in the upper abdomen. Hepatic metastases with right lobe biliary drain incompletely included within the scanning range. Gastric stent in place.
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1. Limited exam with no acute pulmonary embolism to the segmental level however the left pulmonary arteries are attenuated by presumed tumor.2. Pleural and lymphangitic tumor in the left hemithorax.3. Bilateral pleural effusions, right greater than left. 4. Lymphadenopathy and hepatic metastases.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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Male 57 years old Reason: 57 yo M with etoh cirrhosis s/p OLT x 2 with recent CT demonstrating stenosis of the hepatic artery conduit, arterioportal fistula in the left hepatic lobe and stenosis of the suprahepatic IVC, at the anastomosis needing further evaluation History: s/p OLT x 2 with recent CT findings as above PORTAL VENOUS: The main portal vein is patent and demonstrates normal directional flow with peak systolic velocity is 0.4 m/sec.HEPATIC ARTERIES: The main hepatic artery is identified at the porta hepatis, somewhat distal to the area of concerning stenosis on CT abdomen. The waveform demonstrates mild turbulence and dampening of the upstroke. The peak systolic flow 0.6 m/sec. The resistive index is 0.4.SPLENIC ARTERY: The splenic artery peak systolic velocity is measured 0.8 m/sec. The resistive index is 0.5.OTHER: No significant abnormality noted.
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The main hepatic artery at the porta hepatis, distal to the area of concerning stenosis on CT, demonstrates mild turbulence of the waveform with dampening of the upstroke. The peak systolic flow is measured at 0.6 m/sec and there is a reduced resistive index of 0.4 which can be seen in the setting of hepatic artery stenosis.
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Generate impression based on findings.
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Female 57 years old; Reason: Patient with h/o T1N2b (per chart right tonsillar cancer) treated with surgery and radiation. Now with right tongue pain, groin pain, wt loss please evaluate. RADIOPHARMACEUTICAL: 14.4 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 103 mg/dL. Today's CT portion grossly demonstrates postsurgical changes in the right neck. There are cholecystectomy clips.Today's PET examination demonstrates number small but markedly hypermetabolic lymph nodes in the left jugular chain extending from the level of the left mandibular angle to the left supraclavicular region with an SUV max of 5.4, highly suspicious for recurrent tumor.There is increased metabolic activity in the left pharyngeal region at the level of the fossa of Rosenmueller with an SUV max of 8.3 which could reflect asymmetric benign inflammatory activity, although additional tumor activity in this region cannot be excluded.There is no suspicious FDG avid lesion identified in the right neck, chest, abdomen, and pelvis.
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1.Multiple small but significantly hypermetabolic lymph nodes in the left neck are consistent with recurrent tumor activity. There is also asymmetric left pharyngeal activity which could reflect additional left neck tumor activity or benign uptake.2. No FDG avid tumor is identified in the right neck, chest, abdomen, or pelvis.
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Generate impression based on findings.
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Reason: 61M with newly diagnosed metastatic neuroendocrine tumor of unknown primary, p/w abdominal pain, mets to liver and omentum History: 61M with newly diagnosed metastatic neuroendocrine tumor of unknown primary, p/w abdominal pain, mets to liver and omentumRADIOPHARMACEUTICAL: 9 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 79 mg/dL. Today's CT portion grossly demonstrates multiple abdominal and pelvic soft tissue implants, more notably in the pelvis. Anterior bladder wall thickening.Today's PET examination demonstrates widespread confluent markedly hypermetabolic liver metastases (SUV max=25.4).Numerous mesenteric tumor implants in the abdomen and pelvis compatible with carcinomatosis. For reference, the largest left upper quadrant focus measures SUV max of 11.5.No FDG avid tumor in the neck or chest.
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1.Extensive markedly hypermetabolic abdominopelvic carcinomatosis and hepatic metastases.2.No FDG avid tumor in the neck or chest.
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Generate impression based on findings.
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Images are slightly limited by patient motion. The ventricles and sulci are within normal limits for age. The basal cisterns remain patent. There is no midline shift or mass effect. There are scattered punctate foci as well as confluent areas of T2/FLAIR hyperintensity, consistent with mild chronic small vessel ischemic changes. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is mild patchy opacification of bilateral ethmoid air cells. Degenerative changes are noted in the visualized upper cervical spine, with mildly heterogeneous marrow which is nonspecific.MRA HEAD
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1. No acute infarct. Mild chronic small vessel ischemic changes.2. Unremarkable MRA of the head.3. Mild irregularity of the right carotid bulb with mild narrowing of the distal left common carotid artery due to eccentric plaque. Mild narrowing of the left vertebral artery origin.
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Generate impression based on findings.
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15-year-old female with stomach pain, flank pain, blood in urine BLADDER Wall Thickness: Findings consistent with bladder reconstruction. Contents: Multiple folds are again noted in the bladder wall consistent with neurogenic bladder. There is a moderate amount of debris within the bladder, increased since the prior exam. There are also calcified stones within the bladder. Distal Ureter -- SFU Grade** Right: 0 Left: 0 Ureteral Jets Right: Not observed Left: Not observedKIDNEYS Cortical Echogenicity: Increased. Medullary Echogenicity: Normal Pelvicaliceal System -- SFU Grade* Right: 0 Left: 0 Length*** Right: 9.0 cm Left: 8.1 cm Mean for age: 10 cm Range for age: 9 - 11.5 cmADDITIONAL OBSERVATIONS: None.
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Neurogenic bladder containing bladder calculi and increased debris since the prior exam. Increased renal cortical echogenicity suggestive of medical renal disease. No hydronephrosis or renal stones.*SFU grading system: Grade 0: No hydronephrosis. Grade 1: The renal pelvis is visualized. Grade 2: A few but not all of the calices are identified in addition to the renal pelvis. Grade 3: Virtually all the calices are seen. Grade 4: Grade 3 and parenchymal thinning. **SFU grading system retrovesical ureter: Grade 0: No ureteral dilatation. Grade 1: Ureter less than 7 mm. Grade 2: Ureter is 7-10 mm. Grade 3: Ureter is over 10 mm. Fernbach SK, Maizels M, Conway JJ. Ultrasound Grading of Hydronephrosis: Introduction to the System used by the Society for Fetal Urology. Pediatric Radiology (1993) 23: 478-480.***Rosenbaum DM, Korngold E, Teele RL. Sonographic Assessment of Renal Length in Normal Children. AJR Am J. Roentgenol (1984) 142:467-469
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Generate impression based on findings.
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63-year-old male with history of pain. Left foot: Moderate osteoarthritis affects the first MTP joint. There is a plantar heel spur and a mild pes planus deformity. There are no radiographic findings of inflammatory arthritis.Right foot: Moderate osteoarthritis affects the first MTP joint. There is a plantar heel spur and a mild pes planus deformity. There are no radiographic findings of inflammatory arthritis.Left hand: There is juxta-articular osteoporosis at the MCP joints. Chronic osseous erosions are noted at the bases of the fourth and fifth proximal phalanges appearing similar to prior. There is mild MCP joint space narrowing. A positive ulnar variance is noted.Right hand: There is juxta-articular osteoporosis at the MCP joints. Questionable erosions at the first to third metacarpal heads and the bases of the fourth and fifth proximal phalanges appears similar to prior. There is mild MCP joint space narrowing.
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1.Degenerative changes at the feet as above.2.Chronic changes of rheumatoid arthritis without new erosions.
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Generate impression based on findings.
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58-year-old female with back and neck pain, history of DISH Right foot and ankle: The bones are diffusely demineralized. There is extensive intertarsal fusion involving the midfoot. Marked ossification extends along the Achilles tendon and plantar soft tissues likely related to the patient's history of DISH. Moderate degenerative arthritic changes affect the first metatarsal joint.Left foot and ankle: There is extensive intertarsal fusion and ossification extending along the Achilles tendon and plantar soft tissues likely related to the patient's history of DISH. The bones are diffusely demineralized. Moderate degenerative arthritic changes affect the first metatarsal joint.Pelvis: Moderate osteoarthritis affects both hips. Diffuse osteopenia.Spine survey: Diffuse osteopenia and flowing anterior vertebral body osteophytes consistent with the history of DISH. Mild thoracic kyphosis and age indeterminate vertebral body compression deformities at T6, T8, and T9.
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Flowing anterior vertebral body osteophytes consistent with DISH and marked fusion and bone formation involving the feet and ankles as well as additional findings as described above.
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Generate impression based on findings.
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20-year-old male with history of pain. There is no evidence of acute fracture or malalignment. The soft tissues are unremarkable.
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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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Abdominal pain. Unspecified disease the pericardium. Moderate aortic regurgitation. Evaluate for aortic dissection. CHEST:LUNGS AND PLEURA: Minimal basilar atelectasis. No masses.MEDIASTINUM AND HILA: No evidence of aortic dissection as clinically queried. The ascending aorta measures 3.6 cm in diameter and the descending thoracic aorta measures 2.6 cm in diameter (image 60; series 10). Moderate pericardial effusion.CHEST WALL: Subcentimeter axillary lymph nodes.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted. Cholelithiasis.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. Shotty retroperitoneal lymph nodes BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Tiny ventral hernia containing fat as noted previously.
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No evidence of aortic dissection. Cholelithiasis without evidence of cholecystitis. Ventral fat containing hernia as described unchanged in appearance since prior examination. Moderate pericardial effusion.
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Generate impression based on findings.
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Three T1 weighted images are limited by motion artifact. The ventricles and sulci are prominent, as is a moderate global volume loss, greater than expected for the patient's stated age. The basal cisterns remain patent. There is no midline shift or mass effect. There are few nonspecific foci of T2/FLAIR hyperintensity within the periventricular, subcortical and deep white matter. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. There is likely a hypoplastic right A1 segment. The midline structures and craniocervical junction are within normal limits. There is a prominent mucosal retention cyst or polyp in the left maxillary sinus. There is trace fluid in a few right mastoid air cells.
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A few foci of nonspecific T2/FLAIR hyperintensity within the bilateral cerebral white matter. Otherwise, unremarkable noncontrast MRI of brain.
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Generate impression based on findings.
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Postoperative changes are again seen from previous left parietal craniotomy. There is a stable overall appearance of the additional metastatic lesion to the left high occipital calvarium which is T2/FLAIR hyperintense but with hypointense margins. It measures 1.0 x 1.9 cm, unchanged.The ventricles and sulci are prominent, consistent with moderate age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with stable mild chronic small vessel ischemic changes. There is a focal small area of encephalomalacia in the right lateral frontal lobe. There is no diffusion abnormality. No extra-axial fluid collection is identified. There is characteristic of a thickening in the ethmoid sinuses.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.
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1. No acute abnormality. Stable mild chronic small vessel ischemic changes and right frontal encephalomalacia.2. No definite intracranial metastases identified although evaluation limited due to lack of contrast.3. Stable left occipital calvarial metastasis and postoperative changes from previous left parietal craniotomy.
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Generate impression based on findings.
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Abdominal pain. Unspecified disease the pericardium. Moderate aortic regurgitation. Evaluate for aortic dissection. CHEST:LUNGS AND PLEURA: Minimal basilar atelectasis. No masses.MEDIASTINUM AND HILA: No evidence of aortic dissection as clinically queried. The ascending aorta measures 3.6 cm in diameter and the descending thoracic aorta measures 2.6 cm in diameter (image 60; series 10). Moderate pericardial effusion.CHEST WALL: Subcentimeter axillary lymph nodes.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted. Cholelithiasis.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. Shotty retroperitoneal lymph nodes BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Tiny ventral hernia containing fat as noted previously.
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No evidence of aortic dissection. Cholelithiasis without evidence of cholecystitis. Ventral fat containing hernia as described unchanged in appearance since prior examination. Moderate pericardial effusion.
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Generate impression based on findings.
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There is an expected evolution of the previously identified bilateral supratentorial and infratentorial subdural blood products, with relative current dependent location of the hemorrhage. There is significant decreased amount of focal clot along the left paramedian frontal lobe, as well as decreased thickness of subdural blood products along the falx superiorly. There is persistent prominence of the subarachnoid space anteriorly as well as mild prominence of the ventricles, likely relating to benign enlargement of subarachnoid spaces of infancy. The underlying iso- to minimally hyperdense subdural collections are decreased in conspicuity, likely related to redistribution and expected evolution. Convexity of the anterior fontanelle appears similar.Patchy opacities are noted diffusely in the paranasal sinuses. A small amount of fluid is present in the mastoid air cells bilaterally.
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Interval expected evolution and redistribution of scattered bilateral supratentorial and infratentorial subdural blood products. No new acute intracranial hemorrhage.
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Generate impression based on findings.
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60 year-old male with left knee pain Moderate osteoarthritis affects the knee with joint space narrowing and tricompartmental osteophytes. Chondrocalcinosis is also noted. Similar findings affect the contralateral knee as seen on the frontal views.
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Moderate osteoarthritis and chondrocalcinosis.
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Generate impression based on findings.
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35-year-old male, rule out foreign body A small metallic foreign body is noted within the distal aspect of the tuft. The underlying osseous structures appear unremarkable.
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Metallic foreign body with unremarkable underlying osseous structures.
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Generate impression based on findings.
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83-year-old female status post left knee arthroplasty revision Hardware components of a total left knee arthroplasty revision are situated in gross anatomic alignment. The proximal aspect of the femoral component is not visualized on this exam. Diffuse soft tissue swelling and foci of gas are consistent with recent surgery.
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TKA revision as above.
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Generate impression based on findings.
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Pain in left shoulder An impacted comminuted fracture through the left humeral head with associated minimal free fragment created by the tuberosity. Superimposed severe osteoarthritic changes largely involving the glenohumeral articulation. Large effusion.
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Impacted comminuted fracture of the humeral head
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Generate impression based on findings.
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Knee pain. Tibial plateau fracture. CT evaluation demonstrates the comminuted tibial fracture with a complex set of fracture planes extending through the tibial spines (both medial and lateral) and extending into the medial plateau. Minimal impaction is observed it fragments essentially remain in place and aligned.Moderate soft tissue swelling and some effusion representing a hemarthrosis with fluid fluid layering. Atherosclerotic disease.Of particular note is a mildly aneurysmal appearing femoral vein at the level of the lower distal femoral diaphysis (image 74 series 80460). Dedicated vascular imaging may be indicated if of concern and further characterization is required.
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Comminuted proximal tibial fracture with extension through the tibial spines and medial tibial plateau. See detail provided above
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Generate impression based on findings.
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Ankle fracture. Check alignment Gross realignment of the complex comminuted trimalleolar fracture with only minimal displacement of fracture components. Gross symmetry of the mortise observed yet detail limited due to extensive overlying cast material
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Gross realignment of the trimalleolar fracture
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Generate impression based on findings.
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Female 56 years old; Reason: eval for obstruction, s/p gastric bypass here w/ nausea and vomiting History: n/v ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Two subcentimeter hypoattenuating liver lesions are too small characterize.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: Status post recent ante-colic anastomosis Roux-en-Y procedure. There is distention of jejunum proximal to the jejunojejunostomy anastomosis with a degree of hold up of enteric contrast although it is seen to pass into the more distal small bowel. Distended loops measure up to 3.7 cm. The appearance is consistent with partial high grade bowel obstruction. There is no pneumatosis or pneumoperitoneum. 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: Diverticular disease without evidence of diverticulitis.BONES, SOFT TISSUES: There is a 2.1 by 1.9-cm fluid containing ventral abdominal wall hernia. OTHER: No significant abnormality noted.
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1.Status post gastric bypass with high grade partial bowel obstruction at the jejunojejunal anastomosis.
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Generate impression based on findings.
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Female 30 years old; Reason: R/o appendicitis, ovarian pathology History: 30 yo F p/w with RLQ pain ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The appendix is identified in the right lower quadrant and is unremarkable.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Hyperattenuating foci within the right ovary, likely relating to physiologic hemorrhage. There is no significant ovarian enlargement or surrounding inflammatory changes.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: Trace pelvic free fluid.
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1.No evidence of appendicitis. 2.Hemorrhagic right ovarian cysts, likely physiologic.
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Generate impression based on findings.
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Female 62 years old; Reason: eval stone History: R flank pain, hematuria The absence of intravenous and oral contrast limits evaluation of the solid organs and of the bowels. Given these limitations, the following observations were made:ABDOMEN:LUNG BASES: Mild bibasal atelectasis.LIVER, BILIARY TRACT: Cholelithiasis. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: 5.9 x 5.6 cm hypoattenuating lesion in the right kidney consistent with renal cyst. No renal stones. No hydronephrosis. RETROPERITONEUM, LYMPH NODES: Moderate arteriosclerosis of the abdominal aorta and branch vessels.BOWEL, MESENTERY: The appendix is identified in the right lower quadrant and is unremarkable.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: The uterus is atrophic or absent.BLADDER: No significant abnormality noted.LYMPH NODES: Prominent left external iliac chain lymph nodes demonstrate normal morphology with central fatty hilum.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Scoliosis with mild associated degenerative changes.OTHER: No significant abnormality noted.
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1.No renal stones. 2.Cholelithiasis without CT evidence of cholecystitis.
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Generate impression based on findings.
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Status-post distal femoral replacement The distal femur has been resected and reconstructed with a long stem total knee endoprosthesis device. Alignment is near-anatomic. Skin staples, a drain, and foci of gas density in the soft tissues reflect recent surgery.
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Distal femoral reconstruction as described above.
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Generate impression based on findings.
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Male 37 years old; Reason: appendicitis History: RLQ pain and vomiting ABDOMEN:LUNG BASES: Minimal bibasal atelectasis. Marked abnormal thickening of the intraventricular septum, better evaluated on recent cardiac MRI.LIVER, BILIARY TRACT: Subcentimeter hypoattenuating lesion in the right hepatic lobe is too small characterize.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: New wedge-shaped areas of non-enhancement involving the upper and midpole of the right kidney, without perinephric stranding with an appearance suggestive of multiple infarcts. Subcentimeter hypoattenuating lesions within the left kidney are too small to characterize but likely represent cysts. No evidence of left renal infarction. Unremarkable appearance of the bilateral renal arteries on this portal venous phase study.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The appendix is identified in the right upper quadrant and is unremarkable. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.New wedge-shaped areas of non-enhancement involving the upper and mid pole of the right kidney suggestive of infarction. Favor embolic origin given the multifocality.2.No evidence of appendicitis.3.Severe hypertrophy of the intraventricular septum better evaluated on recent MRI.
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Generate impression based on findings.
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Heel wound. Rule out "osteo". There is a soft tissue defect along the posterior aspect of the heel presumably representing the known wound. Overall, the bones appear demineralized, suggesting osteopenia/osteoporosis, but I see no focal osteolysis to confirm osteomyelitis. Moderate to severe osteoarthritis affects the first metatarsophalangeal joint. There is poorly defined bandlike sclerosis traversing the proximal diaphysis of the fifth metatarsal with adjacent periosteal reaction suggestive of a healing fracture (perhaps a stress fracture). Mild deformity of the fourth metatarsal head and neck is of uncertain etiology, but of doubtful current clinical significance. Arterial calcifications are noted in the soft tissues.
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1.Heel wound without radiographic evidence of underlying osteomyelitis. If there is strong clinical concern for osteomyelitis, MRI may be considered.2.Findings suggestive of a healing (stress) fracture of the fifth metatarsal.
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Generate impression based on findings.
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Status post right femoral component fracture Two views of the right hip show components of a total hip arthroplasty device with a fracture through the neck of the femoral component resulting in varus angulation. The acetabular component appears intact. Small foci of heterotopic ossification are noted adjacent to the greater trochanter.AP view of the pelvis reveals the aforementioned fractured right total hip arthroplasty device, as well as a left total hip arthroplasty device with components in near anatomic alignment, although the distal extent of the prosthesis is not included on the field of view of this study. Mild osteoarthritis affects the right sacroiliac joint. Severe degenerative disk disease affects the lower lumbar spine.
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Right total hip arthroplasty device with fractured femoral component as described above.
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Generate impression based on findings.
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Female 69 years old; Reason: obstruction History: vomiting The absence of intravenous and oral contrast limits evaluation of the solid organs and of the bowels. Given these limitations, the following observations were made:ABDOMEN:LUNG BASES: Mild left basal atelectasis.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: Fat attenuation lesions identified in the upper pole and lower pole of the right kidney, the largest of which measures 2.4 cm in maximum dimension. The appearance is suggestive of angiomyolipomas. There is 1.7-cm exophytic lesion arising from the midpole of the left kidney which does not meet criteria for a cyst. The differential diagnosis would include a fat poor angiomyolipoma, however the noncontrast CT appearance is nonspecific.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Wide necked ventral abdominal wall hernia containing fat and nonobstructed bowel loops. The appendix is identified in the right lower quadrant and is unremarkable. No evidence of bowel obstruction.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. No evidence of bowel obstruction.2. Fat-containing lesions in the right kidney are suggestive of angiomyolipomas. 3. Indeterminate left renal lesion. Renal protocol CT/MRI would be helpful for further characterization.
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Generate impression based on findings.
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Hand weakness. Evaluate for acromioclavicular separation or glenohumeral fracture. The bones appear slightly demineralized. I see no fracture or malalignment. Mild osteoarthritis affects the acromioclavicular joint.
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Mild acromioclavicular joint osteoarthritis without fracture or malalignment.
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Generate impression based on findings.
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Knee injury. Pain. I see no fracture or malalignment. Tiny osteophytes suggest minimal osteoarthritis, essentially within normal limits for age. I see no large joint effusion.
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Minimal osteoarthritis, essentially within normal limits for age. I see no fracture or malalignment.
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Generate impression based on findings.
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Motion artifact somewhat limits sensitivity. There are foci of restricted diffusion bilaterally in the centrum semiovale, the posterior body of the corpus callosum, the subinsular white matter on the left, and the deep white matter of the bilateral frontal lobes, compatible with small acute infarctions. There is scattered increased T2 signal corresponding to some of the areas of restricted diffusion. Other areas of patchy T2/FLAIR hyperintensity in the periventricular white matter are consistent with chronic small vessel ischemic disease. Foci of T2 hyperintensity are also noted in the anterior right insula, the right basal ganglia, and the central pons, without corresponding restricted diffusion, consistent with chronic lacunar infarctions. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.
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1. Multiple small acute infarcts in the bifrontal white matter and the corpus callosum body.2. Moderate underlying chronic small vessel ischemic disease and evidence of chronic lacunar infarctions.
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Generate impression based on findings.
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77-year-old female with known OA, persistent fungemia and left knee pain, concern for septic joint Right knee: There is relatively poor visualization of the soft tissues due to technical factors. Given these limitations, we see no erosions or radiographic features of septic arthritis. Moderate osteoarthritis affects the knee. A small lobulated focus of calcification within the distal femur likely represents an enchondroma. Left knee: There is relatively poor visualization of the soft tissues due to technical factors. There is a large joint effusion and we cannot exclude septic arthritis. No erosions are evident. Severe osteoarthritis affects the knee.
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Large left knee joint effusion which is nonspecific, but we cannot exclude septic arthritis. Severe osteoarthritis without erosions.
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Generate impression based on findings.
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41-year-old male with pain, rule out fracture Ankle: Mild soft tissue swelling is present along the lateral aspect of the ankle. There is a minimally displaced fracture of the lateral process of the talus. No additional fracture is evident.Foot: A small ossicle adjacent to the medial aspect of the second metatarsal head may reflect old trauma, but we see no acute fracture or dislocation.
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Minimally displaced fracture of the lateral process of the talus.
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Generate impression based on findings.
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40 year-old female with calf hematoma There is reticulation of the subcutaneous fat consistent with edema that becomes confluent along the posterolateral aspect of the lower leg. We see no discrete fluid collection or hematoma. Mild edema extends between the gastrocnemius and soleus muscles, but we see no discrete intra- or intermuscular fluid collection. Scattered arterial calcifications are present in the soft tissues. No knee joint effusion. The tibia and fibula are unremarkable.
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Moderate soft tissue edema as described above without evidence of hematoma.
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Generate impression based on findings.
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68-year-old female status post fall on right hip Right hip: There is a complete fracture through the femoral neck with approximately 1 cm superolateral and slight anterior displacement of the distal fracture fragment relative to the femoral head.Left hip: We see no fracture or malalignment.Pelvis: The aforementioned right femoral neck fracture is again visualized. The bones are slightly demineralized. Degenerative arthritic changes affect the lower lumbar spine.
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Right femoral neck fracture.
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Generate impression based on findings.
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20 year-old female with point tenderness along third metacarpal, hit through door There is slight irregularity of the articular surface of the base of the proximal phalanx of the middle finger seen only on the oblique view, of uncertain clinical significance. While this may reflect old trauma, we cannot entirely exclude a nondisplaced fracture of the articular surface. No additional fracture or malalignment is evident.
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Mild irregularity of the articular surface of the base of the proximal phalanx of the middle finger of uncertain clinical significance. While this may represent old trauma, we cannot entirely exclude the possibility of a nondisplaced fracture of the articular surface. If further evaluation is clinically warranted, follow-up radiographs or CT scan would be recommended.
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Generate impression based on findings.
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43-year-old female with pain and swelling, twisted knee Tricompartmental osteophytes indicate mild to moderate osteoarthritis. A moderate joint effusion is present. No fracture is evident.
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Osteoarthritis and moderate-sized joint effusion without fracture evident. If there is clinical concern for internal derangement, MRI is recommended.
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Generate impression based on findings.
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Female 14 years old Reason: r/o fracture History: ran over by truck.VIEWS: Right tibia/fibula AP and lateral (two views) 1/30/2015, 1904 Mild soft tissue swelling of the anterior right mid tibial diaphysis noted. However, there is no underlying fracture or dislocation. There is subtle widening of the anterior proximal tibial physis without adjacent soft tissue swelling or edema. An incidental nonspecific smooth small rounded density in the soft tissue lateral to the distal fibula is noted and is of indeterminate clinical significance. Correlation with physical exam is recommended.
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Mild soft tissue swelling overlying the anterior mid tibial diaphysis without underlying fracture or dislocation.
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Generate impression based on findings.
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62-year-old female with history of NSCLC, vertebral body, tenderness, rule out fracture or bony pathology Evaluation of portions of the spine is limited due to extensive stool in the bowel. There is slight rightward curvature of the lumbar spine. Severe multilevel degenerative disk disease is present throughout the lumbar spine. There is also multilevel facet joint osteoarthritis, particularly affecting the lower lumbar spine. No focal lesions are noted to indicate metastatic disease to the bone. No fracture is evident.
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Severe multilevel degenerative disk disease.
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Generate impression based on findings.
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Female 25 years old; Reason: 25F s/p lap chole on 1/27 now with leukocytosis and tachycardia; assess for biloma/hepatic abscess, etc History: tachycardia, leukocytosis The absence of intravenous and oral contrast limits evaluation of the solid organs and of the bowels. Given these limitations, the following observations were made:ABDOMEN:LUNG BASES: Bibasilar atelectasis. Superimposed infection is not excluded.LIVER, BILIARY TRACT: Status post recent cholecystectomy with surgical clips in the gallbladder fossa. 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: Mild postsurgical ileus. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Foci of free air throughout the abdomen and pelvis consistent with recent surgery. Moderate fluid throughout the abdomen with early loculation and inflammatory changes throughout the mesentery.The volume is somewhat more than would be expected for postsurgical changes however the appearance is not specific for abscess/biloma. PELVIS:UTERUS, ADNEXA: IUD in the uterusBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Pelvic fluid with early loculation.
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1. Postsurgical changes related to recent cholecystectomy. Moderate fluid with early loculation and inflammatory changes throughout the abdomen, somewhat more than would be expected. This appearance may be post inflammatory without infection however continued follow up is recommended. Biloma is felt less likely.2. Mild postoperative ileus.
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Generate impression based on findings.
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Female 50 years old Reason: Rule out PE History: Chest pain Exam is limited secondary to motion artifact, especially in the lung bases. PULMONARY ARTERIES: No evidence of acute pulmonary embolism to the segmental level. Pulmonary artery is normal in caliber without right heart strain.LUNGS AND PLEURA: No consolidation, pneumothorax, or pleural effusion.MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. No evidence of coronary arterial calcifications. No mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.
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Limited exam with no pulmonary embolism to the segmental level. No cardiopulmonary findings to account for the patient's chest pain.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable.
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Generate impression based on findings.
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Female 14 years old Reason: r/o fracture History: ran over by truckVIEWS: Right foot AP, oblique, and lateral (3 views) and right ankle AP, oblique, and lateral (3 views), 1/30/2015 A 2 x 5 mm density adjacent to the lateral aspect of the fibular epiphysis is compatible with an acute fracture. There are multiple areas of soft tissue swelling.
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Distal fibular epiphyseal fracture with overlying soft tissue swelling.
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Generate impression based on findings.
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Female 1 day old Reason: assess ETT and line placement History: 1 day old ex-36 weekerVIEW: Abdomen and chest AP (two views) 1/31/15 at 130 hours. ET tube tip is above the carina. Esophageal temperature probe and NG tube terminates at the stomach. UVC tip is at the SVC/08 atrium junction. Cardiac silhouette size is normal. Bilateral diffuse lung haziness and mild lung vascular engorgement. No focal opacities, effusions or pneumothorax.Disorganized, slightly distended and nonspecific abdominal gas pattern. No evidence of obstruction, free air, pneumatosis intestinalis or portal venous gas.
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Interval placement of ET tube, central line and esophageal temperature probe and repositioning of NG tube.Diffuse lung haziness and lung vascular engorgement.Disorganized, slightly distended and nonspecific abdominal gas pattern.
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Generate impression based on findings.
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Male 13 years old Reason: injured r ring finger playing water polo History: bruising notedVIEWS: Right hand PA, oblique, and lateral (3 views) 1/30/2014 Soft tissue swelling of the PIP joint of the fourth finger is noted. There is a small avulsion fracture and along the medial inferior corner of the fourth middle phalanx. The distal and proximal phalanges are unremarkable. The remainder of the carpal bones are unremarkable.
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Small avulsion fracture of the fourth middle phalanx with overlying soft tissue swelling.
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Generate impression based on findings.
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Male 40 days old Reason: Ex preemie, line displacement, follow-up History: Respiratory distressVIEW: Chest AP (one view) 1/30/15 at 1744 hrs. Tracheostomy tube terminates below thoracic inlet. Misplaced NG tube noted. Interval retraction of left upper extremity PICC, tip is at the proximal subclavian vein. Cardiac silhouette size is top normal. Increasing in diffuse lung haziness. No effusions or pneumothorax.
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Misplaced central line and NG tube.Increasing in diffuse lung haziness, PDA is a consideration.
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Generate impression based on findings.
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Female 45 years old Reason: renal stones, malignancy History: low back pain, chronic urinary incontinence, cachectic CHEST:LUNGS AND PLEURA: Bilateral pleural effusions, moderate on the right, small on the left, with compressive atelectasis. Additional small airspace opacities in the left lower lobe raising the possibility of superimposed infection.MEDIASTINUM AND HILA: No significant coronary artery calcification. Mildly prominent pretracheal lymph nodes.CHEST WALL: Mild nonspecific prominence of the right paravertebral soft tissues.ABDOMEN:LIVER, BILIARY TRACT: There is a 2.0 x 2.0 cm enhancing lesion in the posterior right hepatic lobe a second 1.2 x 0.8 cm enhancing lesion anteriorly within the right hepatic lobe. Both are stable compared to prior study, favor benign etiology. Subcentimeter low-attenuation lesions in the liver are too small characterize but likely represent cysts. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No evidence of renal stones. No filling defect identified within the collecting system. Hypoattenuating subcentimeter right renal lesion is too small to characterize but likely represents a cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Hypoattenuating lesions within the uterus suggestive of fibroids.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There has been interval resolution of previously described perirectal abscesses.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1. No evidence of renal stones or malignancy.2. Bilateral pleural effusions with atelectasis. Small left lower lobe air space opacities raising the possibility of superimposed infection.3. Enhancing liver lesions are unchanged compared to prior study, favor benign etiology.
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Generate impression based on findings.
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Female 15 years old Reason: Hematoma History: left arm weakness There is no evidence of hyperdense material extravasation or muscular hematoma. No evidence of joint effusion, fracture or malalignment
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No CT findings to explain patient's symptoms.
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Generate impression based on findings.
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Male 64 years old Reason: r/o PE History: tachycardia and left sided CP; d dimer 2.28 PULMONARY ARTERIES: Technically adequate study without evidence of pulmonary embolism. The pulmonary artery caliber is normal without evidence of right heart strain. LUNGS AND PLEURA: No consolidation, pleural effusion, or pneumothorax. No suspicious nodules or masses.MEDIASTINUM AND HILA: Heart size at the upper limit of normal without pericardial effusion. Extensive atherosclerotic calcifications of the aorta and its branches is present with severe coronary arterial calcifications. The left common carotid artery is heavily calcified and stenotic appearing. Very small, shallow penetrating atherosclerotic ulcer in the descending portion of the arch medially. The mitral annulus is also calcified.The origin of the SMA is calcified and dilated up to 15 mm.The ostium of the right renal artery is calcified and small in caliber, although this could be an accessory artery as the entire right renal vasculature is incompletely imaged.CHEST WALL: Moderate degenerative changes of the thoracic spine, unchangedUPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Small hiatal hernia and hepatic steatosis, unchanged
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1. No evidence of pulmonary embolism. 2. No acute pulmonary findings to account for patient's chest pain.3. Left common carotid artery is heavily calcified and stenotic appearing. Consider additional imaging to assess the extent of stenosis.4. Severe coronary artery calcifications, incompletely assessed on this non-gated study.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable.
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Generate impression based on findings.
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The ventricles and sulci are within normal limits for age. There is no midline shift or mass effect. There is no intracranial hemorrhage. There are scattered punctate and confluent areas of abnormal low density in the periventricular and subcortical white matter, consistent with stable mild chronic small vessel ischemic changes. A known area of acute infarct in the right dorsal medulla demonstrated on subsequent MRI is not well appreciated on this CT exam. There are no areas of pathological enhancement. There is no extraaxial fluid collection, although the extra-axial space along the left greater frontal lobes is somewhat focally prominent although unchanged. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. Calcification within the basal ganglia and dentate nuclei bilaterally is unchanged and may be age-related. There is mild calcified plaque along the cavernous and supraclinoid internal carotid arteries bilaterally. There is mild-moderate irregularity and narrowing of the distal cavernous and paraclinoid segments of the left internal artery. The intracranial internal carotid arteries are otherwise normal in course and caliber. There is a hypoplastic right A1 segment. The middle and anterior cerebral arteries are otherwise unremarkable.There is mild irregularity of the basilar artery. There is also mild irregularity and narrowing of the mid left V4 segment. The post PICA right V4 segment is not contrast opacified, although the very distal small right V4 segment demonstrates minimal contrast opacification which may be due to retrograde flow. Right AICA and PICA are identified. There is a fetal type origin of the left posterior cerebral artery, with mild focal irregularity and narrowing of the mid left P2 segment. There is also moderate irregularity and narrowing of the proximal left P2 segment. The vertebral arteries, basilar artery, and posterior cerebral arteries are otherwise normal in course and caliber. The left vertebral artery is dominant.There is no aneurysm.CTA NECK
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1. Lack of contrast opacification of the posterior post-PICA right V4 segment except for a small segment of the very distal non-dominant right V4 segment which likely is related to retrograde flow. Findings are consistent with focal occlusion.2. Mild to moderate scattered intracranial arterial irregularities and narrowings, most conspicuous involving the P2 segments bilaterally, as well as the left V4 and the basilar artery.3. No significant findings on the CT of the neck.4. Stable CT head appearance with mild chronic small vessel ischemic changes.
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Generate impression based on findings.
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74 year old female with recent fall, now presenting with confusion. No intracranial hemorrhage is identified. No intracranial mass, evidence of mass-effect or significant midline shift is present. The gray-white differentiation is maintained. The ventricles and sulci are prominent, consistent with mild age-related volume loss. No extra-axial collections are identified. There is mucosal thickening and layering fluid in the right sphenoid sinus, with internal high density fluid which likely represents inspissated secretions. A mucus retention cyst is present in the floor of the right maxillary sinus. The mastoid air cells are clear. The skull and scalp soft tissues are unremarkable.
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No evidence of intracranial hemorrhage.
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Generate impression based on findings.
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Female 5 years old Reason: evaluate stool burden, acute intraabdominal process History: abdominal painVIEW: Abdomen AP (one view) 1/30/2014 There is a moderate amount of stool in the proximal ascending colon. No dilated loop of bowel, pneumoperitoneum, or pneumatosis intestinalis is seen. No evidence of bowel obstruction.
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Moderate amount of stool in the proximal ascending colon.
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Generate impression based on findings.
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Female 4 months old Reason: r/o pneumonia History: fever, tachypnea, hypoxiaVIEW: Chest AP (one view) 1/31/2014 0327 Interval increase in right upper lobe atelectasis with minimal rightward mediastinal shift, which may appear exaggerated due to patient rotation on the radiograph. Interval decrease in right middle and lower lobe volumes. No focal airspace opacity. No effusions or pneumothorax.
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Interval increase in right upper lobe atelectasis. Underlying infection cannot be ruled out.
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Generate impression based on findings.
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Evaluation is limited secondary to lack of IV contrast. The right eye appears proptotic. There is mild enlargement and a slightly heterogeneous appearance of the right inferior rectus muscle, with somewhat ill-defined margins and surrounding fat stranding, which is suggestive of acute myositis/postseptal orbital cellulitis. There is questionable mild inflammatory changes lateral to the right lacrimal gland. No focal retro-orbital mass/abscess is identified.Patient is status post enucleation of the left globe, which has been replaced by a spherical high-density foreign body. Ill-defined, nodular soft tissue density is present in the posterior and lateral portions of the left orbit, which causes mild mass effect on the left optic nerve, and may be postsurgical in nature given relative lack of associated inflammatory findings. There is relative asymmetric prominence of the left extraocular muscles, which may be secondary to postsurgical muscle retraction. There is a chronic-appearing defect of the right lamina papyracea, with extraconal fat projecting into the right superior ethmoid air cells. There is pansinus mucosal thickening, most significant in the maxillary sinuses where there is maxillary sinus wall thickening consistent with chronic sinusitis. Additionally, there are air-fluid levels in the left sphenoid, left frontal sinus, and bilateral maxillary sinuses, including complete opacification of the bilateral ostiomeatal units, concerning for acute sinusitis. Although there is significant opacification of the bilateral ethmoid air cells, there does not appear to be direct extension of inflammation into the medial right orbit. The right globe is proptotic.There is multifocal thinning of the nasal septum. There is moderate septal deviation to the right with a rightward projecting bone spur that contacts the right middle turbinate. There is bony irregularity of the anterior nasal bone as well as the nasal turbinates, most significantly the right middle turbinate. The left mastoid air cells are mildly under-pneumatized. Debris is present in the right external auditory canal.
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1. Focal inflammation of the right inferior rectus is concerning for acute myositis/postseptal orbital cellulitis. The resultant mild mass effect is likely contributing to right proptosis. 2. Questionable additional inflammation in the right orbit lateral to the lacrimal gland.3. Chronic appearing bilateral maxillary sinusitis, with superimposed scattered other paranasal sinus opacification with air-fluid levels, for which clinical correlation for acute sinusitis is recommended.4. Chronic right lamina papyracea fracture.5. Ill-defined soft tissue density and prominent extraocular muscles in the left orbit are likely postsurgical in nature; comparison to prior studies is recommended if available.6. Multifocal thinning of the nasal septum and bony irregularity of the nasal turbinates. Findings conveyed to Dr. Aelaf Worku, MD by Dr. Purakal, via telephone on 1/31/15 at 12:10pm.
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Generate impression based on findings.
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Female 35 days old Reason: Cardio-Pulmonary Assessment History: Status Post-Op Cardiac SurgeryVIEW: Chest AP (one view) 1/30/15 at 2122 hrs. ET tube tip is below thoracic inlet. Right IJ venous access terminates at the right atrium. Epicardial pacer leads, multiple mediastinal clips, bilateral chest tubes and pericardial drain has been placed. Right atrial line tip is at the RA/IVC junction. NG tube terminates in the stomach.Cardiac silhouette size is enlarged but improved. Interval decreasing in lung vascular engorgement. Bi-basilar opacities are likely subsegmental atelectases. No effusions or pneumothorax.
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Multiple postsurgical changes as described.
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Generate impression based on findings.
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Female 1 day old Reason: assess ETT and line placement History: 1 day old ex-36 weekerVIEW: Abdomen and chest AP (two views) 1/31/15 at 132 hours ET tube tip is below the thoracic inlet. NG tube and esophageal temperature probe terminates at the stomach. UVC tip is at the hepatic vein. UAC terminates at T10.Cardiac silhouette size is normal. Right upper lobe atelectasis development. No effusions or pneumothorax.Disorganized, slightly distended and nonspecific abdominal gas pattern. No evidence of obstruction, free air, pneumatosis intestinalis or portal venous gas.
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Interval placement of umbilical lines, ET tube, NG tube and esophageal temperature probe.Right upper lobe atelectasis development.Disorganized, slightly distended and nonspecific abdominal gas pattern.
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