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Generate impression based on findings.
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Male 8 years old Reason: evaluate stool burden, other acute abdominal process History: 8 y/o M with abd pain and vomiting.VIEW: Abdomen AP (one view) 1/31/2015 There is a moderate amount of stool in the distal transverse, descending, sigmoid colons and rectum. No dilated loop of bowel, pneumoperitoneum, or pneumatosis intestinalis.
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Moderate amount of stool burden in the distal colon and rectum.
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Generate impression based on findings.
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Female 1 day old Reason: Ex 37 week twin, respiratory distress History: INITIAL XR - increasing respiratory distress; increasing O2 requirementVIEW: Chest and abdomen AP (two views) 1/30/15 Aortic arch, cardiac apex and stomach are left-sided. Cardiac silhouette is normal in size and shape. Diffuse lung haziness. No focal lung opacities. No effusions or pneumothorax.Disorganized, likely age related and nonspecific abdominal gas pattern. No evidence of obstruction, free air, pneumatosis intestinalis or portal venous gas.
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Bilateral diffuse lung haziness consistent with TTN versus RDS.Disorganized, likely age related and nonspecific abdominal gas pattern.
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Generate impression based on findings.
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Male 16 years old Reason: evaluate ett and for effusions or atelectasis History: Intubated, status-post cardiac arrest due to respiratory disorder.VIEW: Chest AP (one view) 1/31/15 at 536 hours. NG tube terminates at the stomach but proximal side ports are above GE. junction. ET tube tip is below the thoracic inlet. Cardiac silhouette size is normal. No focal lung opacities, effusions or pneumothorax.
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Misplaced NG tube as described.Interval resolution of left upper pneumothorax.
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Generate impression based on findings.
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Female 17 years old Reason: left pleural effusion, chest tube placement; re eval lung fields History: chest tube dependent.VIEW: Chest AP (one view) 1/31/15 at 612 hours. Left-sided chest tube unchanged. Cardiac silhouette size is normal. Persistent left lower lobe opacity likely atelectasis or pneumonia and subsegmental atelectasis of the right lung base. No effusions or pneumothorax.
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No change in lung aeration.
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Generate impression based on findings.
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Male 9 years old Reason: assess ETT placement History: intubatedVIEW: Chest AP (one view) 1/31/15 at 5 o'clock hours. Central lines and ET tube unchanged. Cardiac silhouette size is normal. Worsening in bibasilar opacities likely atelectasis. No effusions or pneumothorax.
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Worsening in bibasilar atelectasis.
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Generate impression based on findings.
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Female 11 years old Reason: assess ETT placement History: intubated, status asthmaticusVIEW: Chest AP (one view) 1/31/15 at 543 hours. Skeletal deformities, NG tube and ET tube are again noted. Cardiac silhouette is not clearly visualized. Bibasilar opacities on some segmental atelectasis of the right upper lobe unchanged.
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Persistent multifocal opacities as described.
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Generate impression based on findings.
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Female 7 years old Reason: assess ETT placement, interval improvement in ARDS History: ARDS, pancreatitis.VIEW: Chest AP (one view) 1/31/15 at 550 hours. ET tube tip is below thoracic inlet. Neurostimulator and NG tube as well as gastrostomy tube unchanged. Cardiac silhouette size is normal. Right upper lobe atelectasis development with interval improvement in bilateral pleural effusion.
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Interval improvement in bilateral pleural effusions and development of right upper lobe atelectasis.
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Generate impression based on findings.
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Male 53 years old Reason: r/o dissection History: uncontrolled HTN The study had to be repeated due to technical malfunction. CHEST:LUNGS AND PLEURA: Mild biapical and bibasal atelectasis/scarring.MEDIASTINUM AND HILA: Mild coronary artery calcification. CHEST WALL: No significant abnormality notedCT ANGIOGRAM:The ascending aorta measures 4.3 x 4.3 cm. The descending aorta measures 2.6 to 2.4 cm. There is a 3-vessel aortic arch. There is no intra-mural hematoma or pericardial effusion.UPPER ABDOMEN: Limited images through the upper abdomen demonstrate no significant abnormality. In particular the origins of the celiac artery and superior mesenteric artery are grossly patent without significant stenosis.
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1. Ascending thoracic aorta dilatation at 4.3 cm. No evidence of aortic dissection.
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Generate impression based on findings.
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Images are somewhat limited by patient motion. There is a focus of diffusion restriction within the right dorsal medulla, consistent with an acute infarct. There is corresponding rounded T2/FLAIR hyperintensity with minimal apparent expansion suggesting edema.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 mild-moderate chronic small vessel ischemic changes. Additional patchy abnormal signal is seen within the pons, also likely related to chronic small vessel ischemic changes. No extra-axial fluid collection is identified, although there is again noted to be slight asymmetric prominence of the left great than right frontal subarachnoid space which may relate to focal volume loss. This remains unchanged. There is prominent susceptibility along the basal ganglia in a bilateral knee pain there is mineralization.Distal right vertebral artery flow void is not visualized. Normal flow-voids are demonstrated in the remainder of the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Spondylotic changes are present along the visualized upper cervical spine.
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1. Right dorsal medulla acute infarct. Nonvisualization of the distal right vertebral artery flow void correlating with CTA findings.2. Mild-moderate underlying chronic small vessel ischemic changes.
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Generate impression based on findings.
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23 are old male with head injury, evaluate for intracranial hemorrhage. There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration. There is no mass effect or herniation. The imaged paranasal sinuses and mastoid air cells are clear. There is a chronic-appearing defect of the right lamina papyracea. A small anterior right frontal subgaleal hematoma, measuring up to 5 mm, with overlying mild soft tissue swelling. There is no underlying calvarial fracture.
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No evidence of intracranial hemorrhage. There is a small right frontal subgaleal hematoma, without underlying calvarial fracture.
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Generate impression based on findings.
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Images are limited by likely pulsation artifact especially on the sagittal images. Sagittal STIR images are essentially nondiagnostic. There is focal concavity of the right superior superior endplate of L1 and to a lesser degree the right superior endplate of L2, which may relate to Schmorl's nodes. There is mild to moderate vertebral body height loss anteriorly of L5, corresponding with the CT appearance. There is bandlike T1 hypointensity with enhancement along the superior endplate of L5. STIR images suggest low signal in this location although evaluation is limited due to the artifact, with heterogeneous T2 appearance.Mild enhancement is suggested within the mildly expanded L4-5 disk. There is also mild ventral epidural enhancement diffusely at the lower L4 level, with flattening of the ventral thecal sac. Within the central spinal canal, there is subtle leptomeningeal enhancement along the cauda equina nerve roots, extending from mid L4 to upper L5 levels. There is effacement of the normal CSF signal on the axial T2 weighted images at this level. Of note, there is mild developmental narrowing of the distal lumbar spinal canal due to short pedicles and prominent dorsal epidural fat. There is nonenhancing bilateral facet effusions at L4-L5, with severe bilateral facet arthropathy and likely reactive enhancement within paraspinal soft tissues. Overall, there is at least moderate central spinal stenosis and minimal left as well as mild to moderate right foraminal narrowing. Although there is no significant retropulsion of fracture fragments, there is a mild disk bulge with slight left foraminal prominence.The lumbar spine is in normal alignment, with a normal lumbar lordosis. The vertebral body and disk heights are otherwise well-maintained. The distal spinal cord and conus are within normal limits with the conus terminating at the lower limits of normal at L2-L3 level.At L5-S1, there is a small central annular fissure along the mild disk bulge. There is mild bilateral facet arthropathy and ligamentum flavum thickening. There is moderate central spinal canal stenosis.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the remainder of the lumbar spine. There is multilevel facet arthropathy.There is a partially visualized lobulated structure within the pelvis which likely represents the uterus with numerous fibroids, with one lesion measuring at least up to 4.2-cm.
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1. Mild-moderate likely subacute compression deformity of L5 along the superior endplate with mild enhancement in the L4-L5 disk which may be reactive. No significant retropulsion of fracture fragments although mild disk bulge noted at this level with left foraminal prominence. With underlying developmental narrowing of the spinal canal at this level, as well as superimposed spondylotic changes, there is overall moderate central spinal canal stenosis and mild to moderate right foraminal narrowing.2. Mild ventral epidural enhancement noted spanning the L4 level as well as mid L4 to upper L5 cauda equina nerve root enhancement, likely representing reactive changes to previous trauma, resulting in decompression deformity and central spinal canal stenosis. Prominent bilateral likely degenerative facet effusions incidentally noted, without enhancement although with surrounding enhancing likely reactive paraspinal soft tissues, and therefore infection is felt to be unlikely.3. Partially visualized lobulated uterus likely relating to multiple fibroids.
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Generate impression based on findings.
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45 old male with c-spine tenderness after falling out of bed this morning. There is an obliquely oriented fracture through the spinous process of C2 extending into the inferior aspect of the lamina with mild displacement. There is questionable anterior wedging of the T1 vertebral body seen on the lateral view, but no other fracture is evident.
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C2 posterior arch fracture and other findings as described above. We recommend a CT scan of the cervical spine for further evaluation. These findings were discussed with Mallory Geschke (PA, Pager 7942).
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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 or pathological enhancement. There is no extraaxial fluid collection. Small retention cysts in the bilateral maxillary sinuses. The mastoid air cells are clear.The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is a hypoplastic right P1 segment, with a fetal-type supply of the right posterior cerebral artery, which is a normal variant. There is no evidence of flow-limiting stenosis or aneurysm.
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There is no evidence of intracranial flow-limiting stenosis or aneurysm.
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Generate impression based on findings.
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NONCONTRAST: There is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. CTA HEAD: The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. There is minimal developmental diminutive appearance of the post-PICA right V4 segment. The vertebral arteries, basilar artery, and posterior cerebral arteries are otherwise normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm. There is no pathological parenchymal enhancement.CTA NECK: There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber. Both vertebral artery origins are patent. There is no evidence of flow-limiting stenosis or occlusion.There are nonspecific prominent bilateral level 1 and level 2 lymph nodes. There is straightening of the cervical spine with mild spondylotic changes. The osseous structures are within normal limits. The lung apices show no discrete mass.
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1.No acute intracranial hemorrhage, mass effect or midline shift. 2.No flow-limiting steno-occlusive lesions in the head or neck. No intracranial aneurysm.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.
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Generate impression based on findings.
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Female 52 years old Reason: r/o acute abnormalities, r/o PE History: shortness of breath PULMONARY ARTERIES: No evidence of pulmonary embolism. 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 is normal without pericardial effusion. No visualized coronary arterial calcifications in this non-gated study. No mediastinal or hilar lymphadenopathy.CHEST WALL: Mild degenerative change of the thoracic spine with anterolisthesis and leftward shift of what appears to be L2 vertebral body.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Bilateral Bochdalek hernias. No significant abnormality.
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No evidence of pulmonary embolism. No acute cardiopulmonary abnormalities to explain patient's shortness of breath.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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44-year-old female with progressive posterior headache and syncope. There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration. There is no mass effect or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable.
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No evidence of intracranial abnormality.
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Generate impression based on findings.
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Axial T2 star images are somewhat degraded by artifact. The cervical spine is in normal alignment, with trace reversal of the normal cervical lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal.At C2-C3, there is minimal left facet arthropathy and uncovertebral hypertrophy. There is mild left foraminal narrowing.At C3-C4, there is minimal bilateral uncovertebral hypertrophy. There is moderate bilateral foraminal narrowing.At C4-C5, there is a tiny central disk protrusion indenting the ventral thecal sac. There is minimal left uncovertebral hypertrophy with mild-moderate left foraminal narrowing.At C5-C6, there is minimal left facet arthropathy and contributing to moderate left foraminal narrowing.At C6-C7 and C7-T1, there is no significant disk pathology or stenosis.
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No evidence of cord compression. Mild to moderate scattered spondylotic changes as detailed above. Specifically at the C5-C6 level, there is moderate left foraminal narrowing.
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Generate impression based on findings.
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Elevated lipase and abdominal pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Stable bilobar hepatic cysts.SPLEEN: No significant abnormality notedPANCREAS: Subtle increased prominence of pancreatic head and uncinate process with mild peripancreatic soft tissue infiltration in this area. No ductal dilatation. No significant peripancreatic fluid collection. No significant necrosis at this time. Patent regional vasculatureADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable left renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Prominent endometrial cavity for age.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Subtle prominence of pancreatic head and uncinate process associated with mild peripancreatic infiltration in this area consistent with uncomplicated pancreatitis.Prominent endometrial cavity for age; GYN consult suggested.
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Generate impression based on findings.
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22-year-old male status post reduction of fifth metacarpal fracture. Splint material obscures underlying osseous detail. Again seen is a fifth metacarpal fracture, the angulation of which has been reduced slightly, now with approximately 30 to 40 degrees volar angulation of the distal fragment.
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5th metacarpal fracture as above.
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Generate impression based on findings.
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22-year-old male with pain and decreased range of motion There is a comminuted, predominantly transverse fracture of the fifth metacarpal neck with approximately 40 degrees volar and radial angulation of the distal fracture fragment. Overlying soft tissue swelling is noted.
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Boxer's fracture as described above.
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Generate impression based on findings.
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57 year-old female with persistent tachycardia; has CT A/P findings of significant tumor burden; concern for PE History: as above The exam is limited secondary to suboptimal opacification of the pulmonary arteries.PULMONARY ARTERIES: Limited exam with no evidence of saddle pulmonary embolism. Pulmonary artery is normal in caliber without evidence of right heart strain. LUNGS AND PLEURA: There is a right lower lobe spiculated mass that measures 2.8 x 1.9 cm (series 11, image 75) with adjacent reticular pattern and peribronchial and septal thickening. These findings are most consistent with primary lung carcinoma with peribronchial lymphangitic spread. Right lung fissures are also thickened and nodular. Moderate right pleural effusion with overlying atelectasis.No conclusive suspicious lesions in the left lung.MEDIASTINUM AND HILA: Bilateral mild lymphadenopathy of the mediastinum and right hilum. Moderately enlarged right internal mammary chain lymph nodes and small cardiophrenic lymph nodes. Normal heart size with small pericardial effusion. No visualized coronary arterial calcifications in this non-gated study.Nonspecific asymmetric eccentric thickening of the distal esophagus.CHEST WALL: Numerous sclerotic lesions of the thoracic spine consistent with bone metastasis.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Innumerable hepatic lesions with hepatomegaly consistent with metastatic disease better characterized on CT abdomen from 1/28/2015. No biliary ductal dilatation.Innumerable splenic lesions also identified and unchanged from previous study.Moderate hiatal hernia.
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1. Limited exam with no evidence of saddle pulmonary embolism however PE beyond the level of the main pulmonary arteries cannot be excluded.2. Right lower lobe spiculated mass with peribronchial lymphangitic process and hepatic and skeletal lesions consistent with primary lung cancer with widespread metastasis.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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Feeding tube placement Distal end of feeding tube within first portion of duodenum. Mild ileus pattern unchanged.
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Distal end of feeding tube within first portion of duodenum. Mild ileus pattern unchanged.
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Generate impression based on findings.
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Feeding tube placement Distal end of the feeding tube within gastric antrum. No bowel obstruction.
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Distal end of feeding tube within gastric antrum. No bowel obstruction.
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Generate impression based on findings.
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Nausea and vomiting Residual contrast within the colon. No bowel obstruction.
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Residual contrast within the colon. No bowel obstruction.
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Generate impression based on findings.
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NG tube placement Distal end of the NG tube within gastric antrum. Multiple dilated loops of centrally located small bowel suggestive for small bowel obstruction.
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Distal end of the NG tube within gastric antrum. Multiple dilated loops of centrally located small bowel suggestive for small bowel obstruction.
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Generate impression based on findings.
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Rule out RFO.; increased BMI No unexpected radiopaque foreign body
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No unexpected radiopaque foreign body. Dr.Eggener informed of results 1/30/2015; 9:05pm
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Generate impression based on findings.
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There is evidence of prior bilateral uncinectomy and right-sided ethmoidectomy.Frontal sinus: There has been interval improvement of mucosal thickening in the right frontal sinus. The left frontal sinus remains near-completely opacified.Anterior/Posterior ethmoids: Mild interval improvement of opacification of the ethmoid air cells; although there is persistent moderate mucosal thickening.Maxillary sinuses: Mild interval improvement of maxillary sinus air/fluid levels, with persistent mucosal thickening, right greater than left. Sphenoid sinus: Near-complete opacification of the sphenoid sinuses, not significantly changed. There is persistent opacification of the sphenoethmoidal recesses. There is partial opacification of the bilateral mastoid air cells, unchanged. There is fluid present in the left middle ear, which is new when compared to prior. There is mild S-shaped nasal septal deviation. There is a stable appearance of severe thinning/focal dehiscence involving the cribriform plate and fovea ethmoidalis on the left. The lamina papyracea are intact. The imaged intracranial structures are grossly unremarkable.
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1. Moderate/severe pan-sinus disease, which is mildly improved from recent CT of the sinuses dated 1/19/15.2. New fluid within the left middle ear cavity is nonspecific, but please correlate for acute otitis media.3. There is a stable appearance of focal dehiscence in the cribriform plate and fovea ethmoidalis on the left, which may be developmental in nature or related to chronic infection/inflammation.
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Generate impression based on findings.
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Abdominal pain; history metastatic tanker carcinoma No bowel obstruction or free air
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No bowel obstruction or free air
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Generate impression based on findings.
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Esophageal SCC presenting with cough assess for pneumonia and interval progression of cancer. Motion artifact degrades image quality.CHEST:LUNGS AND PLEURA: Small pleural effusions with associated atelectasis. Patchy areas of groundglass opacity as well as signs of bronchiolitis, suggestive of aspiration bronchiolitis and pneumonitis, but no specific signs of pneumonia. Focal opacity in the right middle lobe at site of prior chest tube tract consistent with scar. No pneumothorax.MEDIASTINUM AND HILA: Dilated, fluid-filled neoesophagus. Subcarinal lymph node conglomerate measures 12-mm (4/51). High right tracheoesophageal lymph node enlargement measuring 9-mm in short axis (4/20) previously obscured by pleural fluid and streak artifact in this area. Small left hilar lymph nodes (4/55). Small pericardial fluid collection. Normal heart size. Moderate coronary artery calcifications.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: . Hepatic ascites. SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Linear areas of hypoattenuation in the right kidney new from previous and though not specific could reflect small infarcts as they extend to the cortex.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Thickening of the left medial diaphragmatic crus, probably unchanged. Left renal vein is dilated, poorly visualized on the current exam due to artifact however there is narrowing of the left renal artery as it passes between the aorta and superior mesenteric artery, suspicious for a Nutcracker syndrome. BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Small bowel in the upper abdomen to the left of midline appears dilated. There appears to be a transition point (coronal image 50, sagittal image 72, axial series image 125) with collapse of bowel distal to this level. It is unclear if this is due to an adhesion or bowel wall thickening. Mesenteric fat stranding and ascites noted. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1. Exam limited due to motion and image noise. Development of upper abdominal ascites with dilated proximal bowel and collapse of distal small bowel in the left upper quadrant with apparent transition point as annotated on the images. As no oral contrast was utilized is unclear if this is from an extrinsic compression due to adhesion or from bowel wall thickening. A dedicated abdominal CT utilizing IV and oral contrast is recommended for further evaluation.2. Mild bronchiolitis and pneumonitis probably related to aspiration, but no signs of pneumonia.3. New mild intrathoracic lymphadenopathy, nonspecific.4. Linear hypoattenuation in the right kidney incompletely assessed although small infarcts are within the differential diagnosis. Additionally, there is narrowing of the left renal artery by the SMA suspicious for Nutcracker syndrome.Clinical service notified of final interpretation at time of final dictation.
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Generate impression based on findings.
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Feeding tube placement Distal end of feeding tube within distended stomach; no bowel obstruction.
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Distal end of feeding tube within distended stomach; no bowel obstruction
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Generate impression based on findings.
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Feeding tube placement Distal end of feeding tube within distended stomach. No bowel obstruction.
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Distal end of feeding tube within distended stomach. No bowel obstruction.
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Generate impression based on findings.
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NG tube placement Distal end of NG tube within stomach. No bowel obstruction
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Distal end of NG tube within stomach. No bowel obstruction
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Generate impression based on findings.
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Shock No bowel obstruction
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No bowel obstruction.
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Generate impression based on findings.
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NG tube placement Distal end of the NG tube within the gastric remnant with distal side port within distal esophagus. Dilated Roux limb again noted.
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Distal end of the NG tube within the gastric remnant with distal side port within distal esophagus. Dilated Roux limb again noted.
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Generate impression based on findings.
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Feeding tube placement Distal end of feeding tube within stomach. Distal end of the NG tube also within stomach; the distal side-port projects above the diaphragm; however it is unclear whether or not it is within the distal esophagus or within a hiatal hernia/intrathoracic stomach.
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Distal end of feeding tube within stomach. Distal end of the NG tube also within stomach; the distal side-port projects above the diaphragm; however it is unclear whether or not it is within the distal esophagus or within a hiatal hernia/intrathoracic stomach.
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Generate impression based on findings.
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Abdominal pain No bowel obstruction. Extensive stool throughout colon
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No bowel obstruction. Extensive stool throughout colon.
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Generate impression based on findings.
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Feeding tube placement Distal end of the feeding tube projects within the expected region of a right lower lobe bronchus
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Distal end of the feeding tube projects within the expected region of a right lower lobe bronchus; Dr. Goodenow notified of results 1/31/2015; 10:20am.
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Generate impression based on findings.
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Post stroke; NG tube placement Distal end of NG tube within stomach. No bowel obstruction
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Distal end of NG tube in stomach. No bowel obstruction
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Generate impression based on findings.
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History of subdural hematoma and right meningioma. The right cerebral convexity subdural fluid collection has resolved. There is an unchanged mildly hyperattenuating extra-axial right temporal convexity mass that measures up to approximately 10 mm in width. There is no evidence of acute intracranial hemorrhage. There is mild nonspecific patchy cerebral white matter, which may represent small vessel ischemic disease. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. There are carotid siphon and vertebral artery calcifications. The imaged paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable.
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1. The right cerebral convexity subdural fluid collection has resolved and there is no evidence of acute intracranial hemorrhage.2. A right temporal convexity mass is compatible with a meningioma, but it is better delineated on the prior MRI.
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Generate impression based on findings.
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NJ-tube placement Distal end of the NJ tube projects within the left lower quadrant unchanged from prior, probably within mid jejunum. Interval placement of distal esophageal Wallstent. No bowel obstruction.
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Distal end of the NJ tube projects within the left lower quadrant unchanged from prior, probably within mid jejunum. Interval placement of distal esophageal Wallstent. No bowel obstruction.
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Generate impression based on findings.
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Down syndrome and choanal atresia. The images are degraded by patient motion artifact. There is near complete bony stenosis of the right posterior choana with an approximately 1 mm soft tissue gap. There is opacification of the right nasal cavity as well as the right maxillary and ethmoid sinuses. The left nasal cavity and posterior choana are patent. The orbits and imaged intracranial structures are grossly unremarkable. There is opacification of the bilateral middle ears and mastoid air cells. The inner ear structures otherwise appear grossly unremarkable. There appears to be mild midface hypoplasia with approximately 4 mm of underjet.
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1. Right choanal atresia with a predominantly osseous component and an approximately 1 mm wide membraneous component, as well as associated retained sinonasal secretions.2. Nonspecific bilateral tympanomastoid opacification, which may represent otomastoiditis. 3. Apparent midface hypoplasia, which may be related to Down syndrome.
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Generate impression based on findings.
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37 female with history of liver transplant, altered mental status after plasma exchange. There is no evidence of intracranial hemorrhage. The ventricles and sulci are prominent, consistent with mild-moderate age-related volume loss. No extra-axial collections are identified. There is no mass effect or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable.
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No evidence of intracranial hemorrhage or mass effect. However, non-contrast CT is insensitive for the detection of non-hemorrhagic acute infarct.
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Generate impression based on findings.
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GJ tube placement Distal end of GJ tube projects over left mid abdomen; most probably within proximal jejunum. No bowel obstruction.
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Distal end of GJ tube projects over left mid abdomen; most probably within proximal jejunum. No bowel obstruction.
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Generate impression based on findings.
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Abdominal pain No bowel obstruction.
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No bowel obstruction.
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Generate impression based on findings.
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Nasopharyngeal mass on endoscopy; asymmetric lingual tonsil hypertrophy; globus sensation and choking for many years. Maxillofacial: There is mild diffuse prominence of the adenoids. There appear to be secretions within the left lateral nasopharyngeal recess. Otherwise, no discrete mass is discernible. The paranasal sinuses are clear. The nasal cavity is also clear. There is no significant nasal septal deviation. The lamina papyracea and ethmoid roofs are intact. The carotid grooves and optic canals are covered by bone. The nasopharynx, facial soft tissues, orbits, and imaged intracranial structures appear to be unremarkable. The mastoid air cells and middle ear cavities are clear. Neck: The palatine and lingual tonsils are unremarkable. There is no evidence of significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. The major cervical vessels are patent. There is multilevel degenerative spondylosis. The airways are patent. The imaged intracranial structures are unremarkable. There are emphysematous changes in the imaged portions of the lungs.
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1. Diffuse nonspecific prominence of the adenoids. Although no discrete mass is discernible on CT, MRI of the nasopharynx may be useful for further evaluation.2. No evidence of sinusitis or mastoiditis.3. No evidence of significant lymphadenopathy in the neck.
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Generate impression based on findings.
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SIRS and constipation No bowel obstruction. Unremarkable colon without evidence for dilatation or wall thickening/edema
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No bowel obstruction. Unremarkable colon without evidence for dilatation or wall thickening/edema
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Generate impression based on findings.
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Female 6 months old Reason: PNA? History: CoughVIEWS: Chest AP/lateral (two views) 1/31/15 Aortic arch, cardiac apex and stomach are left-sided. Cardiac silhouette is normal in size and shape. Peribronchial thickening O. lung volumes and subsegmental atelectases of the left normal . No effusions or pneumothorax.
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Bronchiolitis pattern with subsegmental atelectasis of the left lower lobe
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Generate impression based on findings.
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22-year-old male with right knee pain and swelling, no injury. Four views of the right knee are provided. I see no fracture, malalignment, or large joint effusion. I see no specific findings to account for the patient's pain.A small bony excrescence projecting from the medial aspect of the distal left femoral metaphysis may represent a exostosis/osteochondroma.
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I see no specific findings to account for patient's pain. If further imaging evaluation is clinically warranted, MRI may be considered.
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Generate impression based on findings.
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Esophageal cancer status post esophagectomy with acute desaturation and arrhythmia requiring reintubation. PULMONARY ARTERIES: Technically excellent quality contrast infusion. No evidence of pulmonary embolus. No signs of right heart strain.LUNGS AND PLEURA: Small left pleural effusion. Diffuse interstitial and air space opacities in a so-called crazy paving pattern with areas of lobular distribution groundglass and consolidation with additional areas of lobular sparing. Trace (8mm) pneumothorax in the right anterior costophrenic sulcus. Right chest tube entering the chest wall laterally terminates postero-medial be at the level of the carina.MEDIASTINUM AND HILA: Pneumomediastinum in the anterior compartment.The proximal and mid neoesophagus is unopacified but appears slightly thickened, nonspecific in the immediate postoperative setting. An enteric tube terminates in the distal neoesophagus. Endotracheal tube terminates at the level of the clavicular heads. Right jugular catheter terminates in the SVC. Right tracheoesophageal lymph node measures 18-mm (5/70), previously 10-mm. New right hilar lymph node measures 26 mm, not present previously (5/116).Mild pericardial thickening, but no pericardial fluid. Unchanged cardiomegaly. No visible coronary artery calcifications on this non-gated study.CHEST WALL: Spit fistula left neck incompletely assessed as it is unopacified due to phase of contrast. Subcutaneous emphysema, right greater than left which may be related to chest tube placement.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Trace pneumoperitoneum
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No evidence of acute PE. Severe interstitial and airspace opacities consistent with acute interstitial pneumonia/ARDS; drug reaction cannot be excluded. Pneumomediastinum. Small right pneumothorax. Trace pneumoperitoneum.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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Metastatic rectal carcinoma CHEST:LUNGS AND PLEURA: Interval increase in size of several of the previously noted bilateral pulmonary metastatic nodules. Reference right lower lobe nodule best seen on image 64 of series 6 now measures 3.6 x 2.5 cm; this is in comparison to 2.9 x 2.5 cm on 10/11/2014.Small pleural effusions again noted.MEDIASTINUM AND HILA: Slight interval increase in size of reference right hilar metastatic focus best seen on image 51 of series 4 measuring 2.5 x 1.6 cm; this is in comparison to 2.1 x 1.4 cm on 10/11/2014.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. Stable subcentimeter low attenuation focus within segment 4A of the left of the liver.SPLEEN: No significant abnormality noted.PANCREAS: Stable uncinate process lipomaADRENAL GLANDS: Stable right adrenal adenomaKIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable ileostomy.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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Interval increase in size of several of the previously noted pulmonary metastatic nodules. Slight interval increase in size of reference right hilar metastatic focus.
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Generate impression based on findings.
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Female 34 years old Reason: rule out cholecystitis History: pain n/v LIVER: The liver measures 17.3 cm in length. There is no focal liver lesion. The main portal vein is patent and demonstrates normal directional flow with peak velocity is 0.2 m/sec. GALLBLADDER, BILIARY TRACT: Cholelithiasis. The gallbladder is collapsed, limiting assessment of the gallbladder wall. There is no pericholecystic fluid. There is no intra-or extrahepatic biliary duct dilatation. The patient was sonographic Murphy sign negative. PANCREAS: No significant abnormalities noted.KIDNEYS: The right kidney measures 10.3 cm. The left kidney measures 11.0 cm. There is no hydronephrosis.OTHER: The spleen measures 10.1 cm.
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Cholelithiasis, without definite evidence of acute cholecystitis.
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Generate impression based on findings.
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Pain and point tenderness in anterior midfoot. Rule out fracture. History of fracture in foot. Three views of the left ankle again show a sideplate and screws affixing the distal fibula. I see no fracture line. Two screws also affix the medial malleolus. I see no fracture line.Three views of the left foot are provided. I see no acute fracture. Mild osteoarthritis affects the first metatarsophalangeal joint.
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Fixation of the distal fibula and medial malleolus without acute fracture evident.
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Generate impression based on findings.
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65-year-old male with history of headaches, dizziness, and photophobia. 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 within normal limits for age. No extra-axial collections are identified. There are scattered areas of hypoattenuation in the periventricular and subcortical white matter, which are nonspecific, but favored to represent age-indeterminant small vessel ischemic changes.There is mucosal thickening of the bilateral ethmoid air cells, frontal, sphenoid and maxillary sinuses, with retention cysts and frothy material in the left maxillary sinus. The left ostiomeatal complex is partially opacified. The left mastoid air cells are underpneumatized and partially fluid-filled. There are significant secretions in the naso- and oropharynx. An NG tube is noted. A superficial soft tissue nodule just under the skin and lateral to the right zygomatic arch, measures 8 x 13 mm. The skull and scalp soft tissues are unremarkable.
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1. No evidence of intracranial hemorrhage or mass effect. The innumerable foci of diffusion restriction seen on MR brain from the same date are not appreciated on CT.2. Moderate pan-sinus disease.3. Superficial right soft tissue nodule is nonspecific, but may represent a benign sebaceous cyst; please correlate with physical exam.
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Generate impression based on findings.
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Male 63 years old Reason: rule out pe History: palpitations, dvt The exam is limited secondary to suboptimal pulmonary opacification and motion artifact. Due to the patient's borderline GFR, the emergency department decided against repeating the examination.PULMONARY ARTERIES: No evidence of pulmonary embolism in the main pulmonary arteries. Pulmonary artery caliber is normal without right heart strain.LUNGS AND PLEURA: Low lung volumes. No consolidation, pleural effusion, or pneumothorax. No suspicious masses or nodules.MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. Atherosclerotic calcifications of the aorta and branches with mild coronary artery calcifications. No hilar or mediastinal adenopathyCHEST WALL: Diffuse idiopathic skeletal hyperostosis of the thoracic spine. Fusion hardware is noted in the cervical spine.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 large central pulmonary embolism.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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T4aN3M1 squamous cell carcinoma of the base of the tongue with lung metastases. There is no significant change in size of the ill-defined right tongue base lesion, which measures up to approximately 20 mm. However, there is interval increase in size and heterogeneity of the adjacent left lingual tonsil, There is no significant interval change in bilateral cervical lymphadenopathy. For example, a right level 2 lymph node measures 12 mm, previously 12 mm and a left level 2 lymph node measures 11 mm in short axis, previously 11 mm. The thyroid and major salivary glands are unchanged. The left internal jugular vein is absent. There is mild right and moderate left atherosclerotic plaque at the carotid bifurcations. The osseous structures are unchanged. The airways are patent. There is moderate mucosal thickening within the left mastoid air cells. The imaged intracranial structures are unremarkable. There is an unchanged right apical subpleural lesion.
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1. Although the right tongue base lesion does not appear to be significantly changed, there is interval increase in size of the left lingual tonsil, which is nonspecific, but tumor progression cannot be excluded.2. No significant interval change in the treated bilateral cervical lymphadenopathy. 3. Unchanged right apical subpleural metastatic lesion.
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Generate impression based on findings.
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Severe acute hypoxia. Acute respiratory failure. LUNGS AND PLEURA: Large pleural effusions occupying approximately two thirds of the thorax with adjacent compressive atelectasis. Motion artifact degrades image quality of the aerated lung parenchyma, however no acute abnormalities are appreciated. The suggestion of mild septal thickening in the extreme lung apices is observed suggesting minimal edema though the remainder of the areas lungs are clear.MEDIASTINUM AND HILA: ETT terminates above the carina. Nasogastric tube can be followed to the stomach. Debris in the right mainstem bronchus and airways of the right lower lobe.Heterogeneous multinodular thyroid gland, nonspecific in appearance by CT. Calcified mediastinal and hilar lymph nodes. The right main pulmonary artery appears large however this finding is unchanged. Mild coronary artery calcifications. Calcifications of the aortic valve leaflets. Normal heart size. No pericardial fluid. Subcarinal lymphadenopathy, 22-mm (5/44), previously 24-mm.CHEST WALL: Thoracic kyphosis. Lipoma in the right posterior lateral chest wall. Skin thickening and subcutaneous fat stranding consistent with anasarca bilaterally, right greater than left. The soft tissues of the right breast in particular appear edematous. Numerous small lymph nodes in the chest wall bilaterally are not significantly changed.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Limited scanning range. Upper abdominal ascites is new from the previous study, though volume appears moderate to large. Partially visualized cystic lesion upper pole right kidney was present previously.
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Number one. Large bilateral pleural fluid collections with associated compressive atelectasis; and bilateral lower lobe and lateral segment of right middle lobe are collapsed. Anasarca and ascites.
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Generate impression based on findings.
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Productive cough, fevers and chills. HIV with a CD4 count of 122. LUNGS AND PLEURA: Motion artifact degrades image quality. Mild centrilobular and paraseptal emphysema.Diffuse bronchiolitis pattern throughout the lungs, lower zone predominant. Within the right lower lobe, peribronchial distribution airspace opacities are compatible with pneumonia. Mild diffuse bronchial wall thickening. No pneumothorax or pleural fluid.MEDIASTINUM AND HILA: Mild diffuse mediastinal and hilar lymphadenopathy, right greater than left. Moderate coronary artery calcifications. Normal heart size. No pericardial fluid. Main pulmonary artery enlarged measuring at least 30-mm in transverse dimension, suggestive of pulmonary hypertension.CHEST WALL: Numerous small lymph nodes throughout the chest wall.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Limited scanning range. Hepatosplenomegaly. Granuloma in the spleen. Cholelithiasis without signs of cholecystitis. Small lymph nodes in the upper abdomen.
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Diffuse bronchiolitis with bronchopneumonia in the right lower lobe. In an immunocompromised patient this could be of bacterial, atypical mycobacterial, fungal or viral etiology but given the presence of a splenic granuloma and the patient's low CD4 count, endobronchial spread of tuberculosis should be ruled out. Diffuse lymphadenopathy may be related to HIV, the slight asymmetry is consistent with expected pattern in a right lower lobe pneumonia. Hepatosplenomegaly. Signs of pulmonary hypertension.
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Generate impression based on findings.
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There is mild motion artifact degrading image quality. There is an hyperattenuating parenchymal hematoma centered in the left thalamus/posterior limb of the left internal capsule extending superiorly into the left corona radiata measuring 18 x 16 mm in oblique axial dimensions (axial image 16), and up to 31 mm in oblique CC dimensions (coronal image 41). There is regional mass effect causing partial effacement of the left lateral ventricle. There is no midline shift or herniation.There is asymmetrically prominent CSF density extra-axial fluid attenuation abutting the undersurface of the right tentorium extending towards the midline measuring up to 6 mm in thickness on sagittal image 30. There is focal low-density in the caudate heads bilaterally, consistent with likely chronic lacunar infarcts. There is also minimal patchy periventricular abnormal low density, consistent with small less ischemic changes of indeterminate age. The imaged paranasal sinuses and mastoid air cells are clear. There is anterior dislocation of the bilateral mandibular condyles which are entirely anterior to the mandibular fossae of the temporal bone. The skull and extracranial soft tissues are grossly unremarkable.
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1.Acute parenchymal hematoma centered in the left thalamus/internal capsule extending superiorly into the left corona radiata with local mass effect causing partial effacement of left lateral ventricle. No midline shift.2.Underlying mild age indeterminate small vessel ischemic changes with probable chronic bilateral lacunar infarcts in the caudates.3.6-mm thick asymmetric fluid attenuating extra-axial right infratentorial collection probably representing a subdural hygroma.4.Complete dislocation of the bilateral mandibular condyles which are located anterior to the mandibular fossae of the temporal bone.Findings were discussed by Dr. Pranay Uppuluri with Dr. Hock from the ED at 11:35 AM today over the telephone.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.
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Generate impression based on findings.
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Immunocompromised patient with history of heart transplant and prostate cancer. Malaise and fatigue, diarrhea. LUNGS AND PLEURA: No signs of pneumonia. Extensive dependent atelectasis in the posterior lung fields. The patient's known right upper lobe nodule has increased in size, measuring 18 x 22 mm, previously 12 x 16 mm. The surface area abutting the right minor fissure has also increased. On the coronal sequence, the nodule measures 11-mm in thickness, previously 10-mm. The on the sagittal sequence the nodule measures 11 mm CC by 15-mm AP, previously 8 and 9-mm respectively.MEDIASTINUM AND HILA: 16 x 24 mm low-attenuation nodule in the anterior mediastinum, previously 14 x 20 mm, slightly larger. Postoperative findings consistent with history of cardiac transplant. No pericardial fluid. No conclusive coronary artery calcifications on this non-cardiac gated study. The proximal thoracic esophagus is mildly dilated.CHEST WALL: Small left low cervical lymph nodes present previously however fat stranding in this area appears increased, incompletely assessed. Small right tracheoesophageal lymph node (5/7) appears minimally larger. Sternotomy hardware.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Limited scanning range. Hypoattenuating lesions in the kidneys bilaterally measure the density of simple fluid and are most likely cysts however are incompletely included in knee scanning range and incompletely assessed.
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Interval increase in size of right upper lobe pulmonary nodule suspicious for primary pulmonary neoplasm. Recommend correlation with PET scan. Finding and recommendation discussed with the admitting clinical service at the time of dictation.
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Generate impression based on findings.
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Male 26 years old Reason: eval for infection, h/o fungal pneumonia History: ALL, pretransplant LUNGS AND PLEURA: Interval development of right lower lobe cavity at site of prior bronchiectasis with internal filling defect consistent with mycetoma formation, measuring 14 x 22 mm (series 4, image 63). Persistent diffuse bilateral bronchiolitis pattern which is nonspecific and could be secondary to infection. Unchanged focal bronchiectasis in the right lung. Interval resolution of small right pleural effusion.MEDIASTINUM AND HILA: Left subclavian catheter with tip in the left brachiocephalic vein, unchanged.No visualized coronary arterial calcifications in this non-gated study.Scattered, small mediastinal lymph nodes, grossly unchanged.Persistent small pericardial effusion, mildly decreased from previous.Debris is noted in the mid esophagus.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Hepatosplenomegaly, similar to prior.
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Interval development of right lower lobe cavity containing a filling defect most consistent with mycetoma as above.Nonspecific diffuse bronchiolitis pattern, which could be inflammatory or secondary to infection. Resolution of small right pleural effusion.
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Generate impression based on findings.
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There are postoperative changes related to sinonasal debridement with marked improvement in the degree of opacification of the frontal ethmoid sinuses with moderate opacification of a few scattered ethmoid air cells on the left and mild mucosal thickening still present in the right. There is significant improvement in mucosal thickening of the sphenoid sinus. There is redemonstration of a left sphenoidotomy, as well as bilateral antrostomies. There is also significant improvement in opacification of the bilateral maxillary sinuses with moderate right and mild left maxillary sinus mucosal thickening still present. There is improvement in aeration of the left nasal cavity with mild aerated secretions still present in the right nasal cavity. There have also been bilateral middle turbinectomies.The right sphenoethmoidal recess is now patent and no longer opacified. There is a minimal rightward nasal septal bowing. There is persistent minimal scattered bilateral mastoid air cell opacification. The imaged intracranial structures and orbits are within normal limits.
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Significant interval improvement with scattered mild/moderate areas of persistent mucosal thickening in paranasal sinuses as described above. No air-fluid level to suggest acute sinusitis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.
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Generate impression based on findings.
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Pain along lateral joint line. Evaluate for osteophytes, osteoarthritis. Moderate to severe osteoarthritis affects the knee, particularly the patellofemoral joint, with tricompartmental osteophytes. There is also a moderate-sized joint effusion. There also appears to be meniscal chondrocalcinosis.
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Osteoarthritis and joint effusion as above.
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Generate impression based on findings.
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Postoperative changes are again seen from T11 laminectomy, including along the epidural space at this level although without focal fluid collection or hematoma. There is a nodule of enhancement within the central spinal canal spanning the T11 level which measures 0.8-cm transverse by 0.6-cm AP by 1.2 cm CC. This is grossly in similar location to the preoperative area of nodular enhancement, which measured 0.6 x 1.0 x 1.2-cm, respectively. Sagittal postcontrast images do demonstrate a small focal area of non-enhancement along the dorsal cranial aspect of the nodule as seen on 1801/9. Previously noted additional ill-defined enhancement extending cranially to span the T10 level no longer appreciated, although there is minimal dorsal linear enhancement along the surface of the cord. The abnormality is felt at least in part to be epidural in location especially given the intraoperative findings correlating to previous imaging abnormality. This is perhaps most conspicuous on the sagittal T2-weighted/STIR images where there is indentation of the dorsal cord by the nodule and consequently ventral cord convexity. However, an intramedullary component of enhancement is also possible, given appearance on axial T1 post contrast and T2-weighted images. Additional areas of patchy enhancement are seen within the paraspinal soft tissues relating to the recent surgery.On T2 weighted images, there is redemonstration of extensive abnormal T2 hyperintensity within the cord extending from the T8-T9 level down to the T12-L1 level. This has decreased in cranial extent from the postoperative exam, where it was noted to be up to the T7-T8 level. There is no significant cord expansion. Preoperative imaging demonstrated abnormal cord T2 hyperintensity essentially throughout the entire thoracic cord.The thoracic spine is in normal alignment, with a normal thoracic kyphosis. The vertebral body heights are well maintained. There is minimal midthoracic disk narrowing. No worrisome focal marrow signal abnormality is appreciated. At T11-T12, there is perhaps moderate spinal stenosis relating to dorsal postoperative changes with slight flattening of the dorsal lateral aspects of the thecal sac. There are prominent facet hypertrophic changes with moderate left foraminal narrowing. There is also prominent ligamentum flavum thickening at this level.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the remainder of the thoracic spine.Linear opacities are present in the right lower lobe, which may relate to atelectasis.LUMBAR SPINE
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1. No significant interval change in postoperative changes centered at the T11 level. Compared to preoperative imaging, persistent focal enhancing nodule which reportedly is epidural in location although difficult to delineate on MR images, best seen on sagittal T2 weighted images. Resultant persistent mass effect upon the dorsal aspect of the cord. Findings may in part represent postoperative changes and dural reaction, although the possibility of residual mass cannot be entirely excluded. In addition, axial images appear to suggest that the enhancement extends intramedullary in location, as also noted on pre-operative imaging. Previously more ill-defined enhancement extending cranially along the cord has resolved. Future follow-up is recommended to exclude concern for an intramedullary mass. At least moderate central spinal stenosis at this level, with minimal preservation of ventral CSF space.2. Decreased cranial extent of diffuse cord T2 hyperintensity, now at T8-T9 level, with much reduced in cranial extent from the preoperative exam. This may relate to changes from reported transverse myelitis, edema, or possibly syringohydromyelia.3. Extensive postoperative changes in lumbar spine without high-grade stenosis.
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Generate impression based on findings.
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Metastatic lung cancer to the right neck with vocal cord paralysis, status post Radiesse paste injection into right vocal cord. There is interval decrease in size of an ill-defined conglomerate of right level 4 lymph nodes, which measures up to 12 x 16 mm, previously 14 x 20 mm. However, there is no significant interval change in the necrotic right paratracheal lymph node, which measures up to 15 x 24 mm, previously 15 x 24 mm. Likewise, there is no significant interval change in size of an irregular left upper mediastinal lymph node, now measuring up to approximately 25 mm. There are findings related to right vocal cord augmentation. A portion of the calcium hydroxyapatite paste extends to the level of the hypopharynx, which is unchanged. The right jugular vein is unchanged and occluded distal to this point. The right common and internal carotid arteries are patent. The thyroid and major salivary glands are unremarkable. The airways are patent. The imaged intracranial structures are unremarkable. There is a small mucosal retention cyst within the left maxillary sinus. There is unchanged cervical spondyloarthropathy. There is a right upper lobe lung mass.
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1.Interval decrease in size of an ill-defined conglomerate of right level 4 lymph nodes, but other cervical and upper mediastinal lymphadenopathy are not significantly changed.2.Partially-imaged right lung mass. Please refer to the separate chest CT report for additional details.
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Generate impression based on findings.
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AML, fever of unknown origin, and pre SCT work-up. The paranasal sinuses are clear. The nasal cavity is also clear. There is mild nasal septal deviation towards the right. The lamina papyracea and ethmoid roofs are intact. The carotid grooves and optic canals are covered by bone. The nasopharynx, facial soft tissues, and orbits appear to be unremarkable. There are partially-imaged postoperative findings in the right occipital region. There is prominence of the partially-imaged ventricular system, which appears to be unchanged.
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No evidence of sinusitis.
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Generate impression based on findings.
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History of rhinorrhea, decreased sense of smell and taste. Assess for chronic sinusitis. There is minimal scattered ethmoid sinus mucosal thickening. The other paranasal sinuses are clear. There are minimal secretions within the nasal cavity. There is no significant nasal septal deviation. The lamina papyracea are intact bilaterally. The floor of the anterior cranial fossa and cribriform plate region are unremarkable. The nasal septum is midline. The orbits and the posterior nasopharynx appear unremarkable.
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Minimal scattered ethmoid sinus mucosal thickening. The other paranasal sinuses are clear.
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Generate impression based on findings.
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LVAD on coumadin with MAPs in the 130s and prior hemorrhagic CVA. There are postoperative findings related to right frontal craniotomy. There is no evidence of intracranial hemorrhage or mass. There is extensive hypoattenuation in the right frontal lobe, which is appears slight more hypoattenuating than on the prior exam. There is unchanged hypoattenuation in the left cerebellar hemisphere. The ventricles are essentially unchanged in size and configuration. There is no midline shift or herniation. There is partial opacification of the right maxillary sinus. The imaged mastoid air cells are clear. The skull and scalp soft tissues are unremarkable.
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1. No evidence of acute intracranial hemorrhage with evolution of the prior right frontal hemorrhage and postoperative alterations.2. Chronic left cerebellar hemisphere infarct.
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Generate impression based on findings.
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Palpable lymph node as well as possible lesion on the PET from 2012. History of a left thyroid colloid nodule and hypophosphatemic rickets. There is no evidence of significant cervical lymphadenopathy based on size criteria. There is a left thyroid nodule that measures up to 10 mm. The major salivary glands are unremarkable. There is an aberrant right subclavian artery. The major cervical vessels are patent. There appears to be diffuse osteopenia. The airways are patent. The imaged orbits are unremarkable. There is a partially-empty sella. There is mild mucosal thickening within the maxillary sinuses. There is a partially-imaged cavitary lesion or bronchiectasis in the left lower lobe.
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1. No evidence of significant cervical lymphadenopathy based on size criteria. 2. A left thyroid nodule that measures up to 10 mm likely corresponds to the previously biopsied colloid nodule.3. Partially-imaged cavity lesion or bronchiectasis in the left lower lobe. Please refer to the separate chest CT report for additional details.4. Nonspecific partially-empty sella. 5. Apparent diffuse osteopenia may be related to hypophosphatemic rickets.
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Generate impression based on findings.
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Metastatic medullary thyroid carcinoma. Neck: There are postoperative findings related to thyroidectomy and neck dissection. There thyroidectomy bed appears unchanged. However, there has been continued interval increase in size of lower neck and partially-imaged mediastinum. For example, a left lower neck mass now measures 20 x 16 mm, previously 16 x 20 mm. The partially-imaged upper mediastinal lymph nodes also appear to have increased in size. In addition, there are multiple nodules in the partially-imaged lungs. The airways are patent. The salivary glands are unremarkable. There is mass effect upon the proximal left common carotid artery from the adjacent mass lesions. Much of the right internal jugular vein is inapparent, which is unchanged. The osseous structures are unchanged. There is streaky hyperattenuation in the bilateral facial subcutaneous tissues, which likely represents cosmetic filler.Head: There is no evidence of intracranial mass or abnormal enhancement. The grey-white matter differentiation appears to be intact. The ventricles are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable.
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1. Continued tumor progression in the lower neck and upper mediastinal lymph nodes.2. Metastases within the partially-imaged lungs. Please refer to the separate chest CT report for additional details.3. No evidence of intracranial metastases.
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Generate impression based on findings.
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Significant interval increase in the size of the intraparenchymal hematoma centered in the left thalamus/internal capsule, now measuring 56 x 39 mm in the axial dimension (series 4, image 18), previously 18 x 16 mm, and up to 49 mm in oblique CC dimension (coronal image 50), previously 31 mm. There is resultant 8 mm rightward midline shift and near-complete effacement of the left lateral ventricle. There is increased downward mass effect on the midbrain and left temporal horn, as well as partial effacement of the suprasellar and quadrigeminal cisterns. There is intraventricular extension of hemorrhage, with blood in the body of the left lateral ventricle, near the foramen of Monro, as well as layering in the bilateral occipital horns. The remainder of the ventricular system appears larger when compared to recent prior, concerning for developing communicating and non-communicating hydrocephalus. There is new bilateral sulcal effacement, left greater than right.There is unchanged CSF-density asymmetric extra-axial fluid abutting the undersurface of the right tentorium extending towards the midline. Bilateral caudate hypodensities likely represent chronic infarcts. Patchy periventricular hypodensities are consistent with age-indeterminant small vessel ischemic disease. The imaged paranasal sinuses and mastoid air cells are clear. Bilateral mandibular condyles are no longer dislocated. The skull and extracranial soft tissues are grossly unremarkable.
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1.Significant interval increase in the acute parenchymal hematoma centered in the left thalamus/internal capsule, with new intraventricular extension, rightward midline shift, near-complete effacement of the left lateral ventricle, and partial effacement of the basilar cisterns. 2.Mild prominence of the ventricular system when compared to recent prior is concerning for developing communicating and non-communicating hydrocephalus.3.Unchanged appearance of mild age-indeterminate small vessel ischemic changes and chronic bilateral caudate lacunar infarcts.4. Stable thin CSF-density right extra-axial infratentorial collection may represent a subdural hygroma. Findings were conveyed to the ED physician, Dr. Mansour, by the RROC on 1/31/15 at 12pm.
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Generate impression based on findings.
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Progression of intracranial stenosis? New pulsatile tinnitus. There is paucity of flow-related enhancement throughout the intracranial right internal carotid artery, with reconstitution at the circle of Willis. There is also lack of flow-related enhancement throughout the bilateral intracranial vertebral arteries, with collateral flow derived from a prominent anterior spinal artery. In addition, there is high-grade narrowing of the mid basilar artery, which appears to be new since 2005. There is a wide-neck outpouching along the inferolateral aspect of the left cavernous carotid artery that measures up to approximately 5 mm. There is also irregularity along the left carotid siphon, which may be related to the presence of vascular calcifications. The bilateral anterior, middle, and posterior cerebral arteries are grossly patent. There is encephalomalacia in the right parieto-occipital region.
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1. Occlusions of the right internal carotid artery and bilateral vertebral arteries appear to be unchanged since 2005, but a high-grade stenosis of the basilar artery appears to be new or markedly progressed since 2005.2. A wide-neck outpouching along the inferolateral aspect of the left cavernous carotid artery that measures up to approximately 5 mm likely represents an aneurysm. 3. Chronic right parieto-occipital region infarct.
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Generate impression based on findings.
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There are postoperative findings related to right neck dissection with no recurrent mass or significant cervical lymphadenopathy. There is effacement of the right carotid space fat planes within the suprahyoid neck, without change and likely post-treatment related. The thyroid and major salivary glands are unremarkable. The major cervical vessels are patent. The osseous structures are unchanged with right-sided facet hypertrophy from C2-3 through C6-7 levels. The airways are patent. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear. There is a left chest wall MediPort catheter again seen.
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Posttreatment findings are without locoregional tumor recurrence or significant cervical lymphadenopathy.
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Generate impression based on findings.
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T3N2c/N3 right-sided hypopharyngeal mass treated with chemotherapy. There is residual asymmetric effacement of the left piriform sinus associated with diffuse swelling in the hypopharyngeal region. However, the assessment is limited by the lack of intravenous contrast. There is no definite evidence significant cervical lymphadenopathy based on size criteria, although the assessment is also limited by the lack of intravenous contrast. The thyroid and major salivary glands are unremarkable. There is a right internal jugular venous catheter. The osseous structures are unremarkable. The airways are patent. The imaged orbits and intracranial structures are grossly unremarkable. There is mild left maxillary sinus mucosal thickening. There are multiple nodules within the partially-imaged lungs. There is also pulmonary emphysema and a left apical calcified granuloma.
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1. Residual asymmetric effacement of the left piriform sinus associated with swelling in the hypopharyngeal region, which likely represents the treated tumor, although the assessment is limited by the lack of intravenous contrast. Therefore, endoscopy may be useful for further evaluation.2. No evidence of significant lymphadenopathy in the neck, although the assessment is limited by the lack of intravenous contrast. 3. Multiple nodules within the partially-imaged lungs are compatible with metastases. Please refer to the separate chest CT report for additional details.
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Generate impression based on findings.
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Recurrent left parotid gland adenoid cystic carcinoma status post total parotidectomy and radiation therapy at another hospital in 2005 and completed palliative chemotherapy on August 22, 2014. There are postoperative findings related to left neck dissection, including parotid and submandibular gland resection, with flap reconstruction. There is persistent ill-defined soft tissue in treatment bed. However, there is persistent ill-defined soft tissue in the left parotidectomy bed and interval increase in hyperattenuating nodularity in the fat planes of the left posterior triangle of the neck. There is also interval decreased swelling of the left aryepiglottic fold, but otherwise increased edema within the rest of the supraglottic region. The left tongue demonstrates fatty attenuation, which is compatible denervation atrophy. There is chronic thrombosis of the right internal jugular vein. There is no significant lymphadenopathy in the right neck. There is persistent opacification of left mastoid air cells. There are degenerative changes of the cervical spine, most prominent at the C6-7 level, resulting in narrowing of the bilateral neural foramina. The imaged intracranial structures are grossly unremarkable. There is a subcentimeter nodule in the partially imaged left lung.
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1. Post-treatment findings in the neck with persistent nonspecific ill-defined soft tissue in the region of the left parotidectomy bed.2. No significant lymphadenopathy in the neck.3. Chronic thrombosis of the right internal jugular vein. 4. A subcentimeter left lung nodule is compatible metastatic disease. Please refer to the separate chest CT report for additional details.
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Generate impression based on findings.
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Concern for brain metastases. Right sided tremors/visual disturbance. There is a new mass in the left frontal lobe that measures up to 18 mm with surrounding mild vasogenic edema, adjacent to an area of encephalomalacia. There is also a new mass within the right cerebellar hemisphere that measures up to 20 mm with surrounding mild vasogenic edema. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable.
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New mass lesions within the left frontal lobe and right cerebellar hemisphere are compatible with metastases.Discussed with Dr. Nabhan at 8:30 AM on 1/2/15.
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Generate impression based on findings.
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History of antiphospholipid syndrome and previous PEs. Hypoxia. PULMONARY ARTERIES: Suboptimal contrast opacification and severe motion artifact both from patient respiration and tachycardia limit evaluation. Chronic thrombus in branches of the right descending pulmonary artery and left lower lobe pulmonary artery are less well visualized on the current examination but appear similar. No filling defects are identified within the main pulmonary arteries. The presence of emboli beyond the lobar level cannot be excluded by this study.LUNGS AND PLEURA: Mosaic attenuation of the lung parenchyma consistent with chronic thromboembolic disease. Basilar scarring bilaterally. No new focal opacities. No pleural fluid or signs of pulmonary edema.MEDIASTINUM AND HILA: Cardiomegaly unchanged. Increase in volume of pericardial fluid, now moderate. Straightening of the intraventricular septum consistent with right heart strain. Coronary artery calcifications again noted.CHEST WALL: Prominent axillary lymph nodes not significantly changed. Within the lateral aspect of the left breast, a new solid soft tissue lesion measuring approximately 4.1-cm in AP dimension is incompletely visualized. This is of unclear etiology and may be correlated with mammography and physical examination. Numerous fluid-filled cystic lesions in the left breast could reflect dilated ducts, nonspecific.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. Unchanged cyst-like lesion in the upper pole the left kidney, incompletely characterized. Splenulus and small lymph nodes unchanged.
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1. Limited examination with no acute pulmonary embolus to the lobar level. 2. Chronic pulmonary emboli bilaterally with signs of right heart strain, unchanged. Signs of chronic thromboembolic disease, but no acute pulmonary abnormality. 3. Enlargement of pericardial fluid collection, now moderate. 4. Left breast mass, nonspecific; neoplasm cannot be excluded. Correlate with mammography and physical exam. Cardiology intern covering pager 1230?4279 Dawen Zhang notified via text page at 1.51 p.m. and via telephone at 1:55 p.m. on 1/31/2015.PULMONARY EMBOLISM: PE: Positive.Chronicity: Chronic.Multiplicity: Multiple.Most Proximal: Lobar.RV Strain: Positive.
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Generate impression based on findings.
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59-year-old male with history of rectal cancer and new altered mental status. There is no evidence of intracranial hemorrhage. The ventricles and sulci are prominent, consistent with mild age-related volume loss. There is no mass effect or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. An NG tube is noted.
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No evidence of intracranial hemorrhage or mass effect.
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Generate impression based on findings.
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Head and neck cancer and CRT. CHEST:LUNGS AND PLEURA: Minimal scarring in the right middle lobe unchanged. No suspicious pulmonary nodules.MEDIASTINUM AND HILA: Left subclavian catheter tip in the SVC. Very faint coronary artery calcifications and a distal branch of the left anterior descending coronary artery. Normal heart size. No pericardial fluid or lymphadenopathy.CHEST WALL: Right-sided gynecomastia unchanged. Mild spinal osteophyte formation.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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No signs of metastatic disease. Right -sided gynecomastia, please refer to prior mammography report for management recommendations. Very mild coronary artery calcification.
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Generate impression based on findings.
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66-year-old male status post PEA arrest, plan to restart anticoagulation, evaluate for intracranial hemorrhage. 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 moderate age-related volume loss. No extra-axial collections are identified.There are scattered areas of hypoattenuation in the periventricular and subcortical white matter, which are nonspecific, but favored to represent age-indeterminant small vessel ischemic changes. Low density in the right lateral frontal subcortical white matter likely relates to more focal age-indeterminate small vessel ischemic changes. Punctate hyperdensities in the bilateral basal ganglia is compatible with senescent mineralization. There is atherosclerotic calcification of the bilateral distal internal carotid arteries, left greater than right.The paranasal sinuses and mastoid air cells are clear. There is moderate leftward deviation of the nasal septum. The skull and scalp soft tissues are unremarkable.
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No evidence of intracranial hemorrhage. Minimal age-indeterminate small vessel ischemic changes.
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Generate impression based on findings.
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History of head face and neck neoplasm (ACC), solitary pulmonary nodule, RT follow-up. CHEST:LUNGS AND PLEURA: Surgical clips caudal to the right hilum with associated bronchiectasis and architectural distortion.Pleural thickening and nodularity on the left not significantly changed. Atelectasis at the left lung base. Trace loculated fluid in the deep left costophrenic angle. No parenchymal-based pulmonary nodules.MEDIASTINUM AND HILA: Left paramediastinal pleural metastases occur in the expected distribution of the left phrenic nerve course. Some of the pleural metastases along the left mediastinum extend into the mediastinal and epicardial fat, similar to previous, but there is no pericardial fluid. Loss of epicardial fat plane focally along the cranial aspect of the left ventricle (5/53). Severe coronary artery calcifications.Small lymph nodes seen adjacent to the right hilar clips appears unchanged (5/52).CHEST WALL: Osseous nonunion of anterolateral right fourth rib pathologic fracture unchanged. Adjacent soft tissue density (5/52) caudal to the level of the fracture is similar to previous (5/52). Tumor extends into the para-aortic and subpleural fat of the left lower and medial thorax.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Left adrenal gland nodule and a right adrenal gland mass are unchanged, previously reported as benign on PET.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Elevation of the left hemidiaphragm consistent with phrenic nerve paralysis, likely due to mediastinal pleural metastases along the left anterior mediastinum.OTHER: No significant abnormality noted.
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Stable exam. No new sites of disease.
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Generate impression based on findings.
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Back pain. Evaluate status post fusion, tumor resection There is a posterior stabilization device with screws entering the L1-L5 vertebrae. I see no hardware complications. Amorphous bone graft material is seen along the lateral aspects of the lumbar spine. Skin staples and foci of gas density in the posterior soft tissues reflect recent surgery. Embolization coils and spinal vascular opacification reflect a recent interventional procedure. Absence of the left pedicles of L3 and L4 reflect destruction by tumor as seen on prior imaging studies. There is atherosclerotic calcification of the distal aorta and common iliac arteries.
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Postoperative changes of lumbar spine fusion and other findings as above.
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Generate impression based on findings.
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72-year-old male with speech disturbance, evaluate for CVA. 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. The paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable.
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No evidence of intracranial hemorrhage or mass effect. Please note CT is insensitive for the detection of acute non-hemorrhagic infarcts, and MRI should be considered if there is continued clinical suspicion.
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Generate impression based on findings.
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85 year-old female status post fall. 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 are scattered areas of hypoattenuation in the periventricular and subcortical white matter, which are nonspecific, but favored to represent chronic small vessel ischemic changes.The paranasal sinuses and mastoid air cells are clear. Multiple calvarial osteomas are similar when compared to previous CT. The scalp soft tissues are unremarkable.
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1. No evidence of intracranial hemorrhage or calvarial fracture. 2. Stable chronic small vessel ischemic disease.
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Generate impression based on findings.
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There is an oblique fracture at the base of the C2 spinous process, with slight distraction of the fracture fragments. There is mild adjacent soft tissue swelling including decreased fat planes and mild edematous appearance of the paraspinal muscles. The vertebral column alignment is within normal limits. There is a normal relationship of the dens with the arch of C1. There is no significant spinal canal stenosis. The visualized intracranial structures appear normal. There is scarring at the left lung apex. A partially calcified left level IV lymph node may represent post-treatment effects of a previously metastatic lymph node, as it was previously pathologic appearing on CT neck and was larger in size. The thyroid is diminutive in appearance when compared to CT of the neck dated 11/13/13, and also may be post-treatment related. There is atherosclerotic calcification of the bilateral carotid bifurcations.
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1. There is an oblique, slightly distracted fracture through the base of the C2 spinous process, with mild adjacent soft tissue swelling.2. A partially-calcified left level IV lymph node may represent post-treatment effects of a previously pathologic lymph node related to patient's known esophageal cancer.
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Generate impression based on findings.
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71-year-old female with intermittent blurry vision. 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 to moderate age-related volume loss. No extra-axial collections are identified. There are scattered areas of hypoattenuation in the periventricular and subcortical white matter, which are nonspecific, but favored to represent chronic small vessel ischemic changes.There is mucosal thickening along the floor of the right maxillary sinus. The mastoid air cells are clear. The skull and is unremarkable. Soft tissue nodularity in the posterior scalp is unchanged from prior exam, likely representing scarring.
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No evidence of intracranial hemorrhage or mass effect. Please note CT is insensitive for the detection of acute non-hemorrhagic infarcts, and MRI should be considered if there is continued clinical suspicion.
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Generate impression based on findings.
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Reason: eval for CVA History: increasing difficulty walking, loss of memory and new incontinence. 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 moderate age-related volume loss, most pronounced in the frontotemporoparietal region. No extra-axial collections are identified. Evaluation of acute ischemia is limited secondary to extensive patchy and confluent areas of hypoattenuation in the periventricular and subcortical white matter, which are nonspecific, but favored to represent age-indeterminant small vessel ischemic changes.A small retention cyst is present in the lateral left maxillary sinus. The right maxillary sinus appears asymmetrically smaller than the left, which is likely developmental. The mastoid air cells are clear. The skull and scalp soft tissues are unremarkable.
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No evidence of intracranial hemorrhage or mass effect. Please note CT is insensitive for the detection of acute non-hemorrhagic infarcts, and MRI should be considered if there is continued clinical suspicion.
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Generate impression based on findings.
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There is no acute intracranial hemorrhage. The area of prior infarct at the left pontomedullary junction is not conspicuous on this exam. There are mild patchy foci of hypoattenuation in the periventricular white matter. The ventricles and sulci are within normal limits. There is no midline shift or mass effect. There is no extraaxial fluid collection. The mastoids and middle ears are grossly clear. There is mild mucosal thickening in the right maxillary sinus. There are bilateral lens implants.CTA HEAD
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1. High-grade steno-occlusive disease of the distal cervical and intracranial portions of the left vertebral artery.2. Severe stenosis at the right carotid bifurcation and moderate stenosis at the left carotid bifurcation.3. No evidence of acute intracranial hemorrhage, but mild patchy white matter may represent small vessel ischemic disease. However, non-contrast CT is insensitive for the detection of non-hemorrhagic acute infarct.4. Increased in size of an irregular left upper lobe lung opacity since 2011. Although nonspecific, this may represent a neoplasm and follow-up with a dedicated chest CT is recommended.5. A right thyroid nodule that measures up to 10 mm is nonspecific. A thyroid ultrasound may be useful for further evaluation.Findings sent to Darwin Eton, MD via Epic In Basket message at 17:30 on 12/29/2014.
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Generate impression based on findings.
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The lumbar spine is in normal alignment, with a normal lumbar lordosis. There is mild disk narrowing at L4-L5. The vertebral body and disk heights are otherwise well-maintained. There is mild disk desiccation at L2-L3 through L4-L5. No worrisome focal marrow signal abnormality is appreciated. There is mildly heterogeneous signal throughout the visualized marrow which is nonspecific. The distal spinal cord and conus are within normal limits with the conus terminating at the upper L2 level.At L4-5, there is a trace disk bulge which abdomen to the. There is mild central spinal stenosis. There are prominent bilateral facet effusions as well as facet arthropathy and ligamentum flavum thickening. There is mild-moderate right and mild left foraminal narrowing.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the remainder of the lumbar spine. There is multilevel facet arthropathy and ligamentum flavum thickening.There is a tiny T2 hyperintense lesion which is nonspecific off the posterior interpolar right kidney.
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Very minimal spondylotic changes most on its L4-L5 where there is mild central spinal canal stenosis and mild and moderate right and mild left foraminal narrowing.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.
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Generate impression based on findings.
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Images are limited by patient motion. The cervical spine is in normal alignment, with a normal cervical lordosis. There is minimal disk narrowing at C5-C6. The vertebral body and disk heights are otherwise well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no pathological enhancement.Motion limitation limits evaluation, although there is suggestion of mild scattered spondylotic changes, most conspicuous at C5-C6 where there is a left paracentral disk protrusion which indents the ventral thecal sac and perhaps mild central spinal canal stenosis. There is also trace ligamentum flavum thickening.There is redemonstration of thick walled cavitary mass with consolidation in the right lung apex with associated right lung volume loss and retraction. THORACIC SPINE
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1. No MR evidence of metastatic disease or infection within the cervical or thoracic spine, although evaluation is limited secondary to extensive motion artifact.2. Very minimal cervical spondylotic changes essentially at C5-C6 without significant foraminal narrowing. Mild central spinal canal stenosis.3. Incompletely evaluated abnormalities within the right hemithorax. Please see the recent CT chest for further details.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.
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Generate impression based on findings.
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There is no evidence of acute intracranial hemorrhage, mass, or cerebral edema. There is minimal thickening of the interhemispheric falx inferiorly (series 2 image 6) likely representing the crista galli. There is prominence of the extra-axial spaces anteriorly and the ventricles. There is no midline shift or herniation. The imaged mastoid air cells and middle ear cavities are opacified. The skull and extracranial soft tissues are unremarkable.
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1.No acute intracranial hemorrhage or mass effect. 2.Prominence of extra-axial spaces and the ventricles which is most commonly secondary to benign extra-axial hydrocephalus of infancy which should resolve by two years of age. If clinically indicated, follow-up imaging can be obtained.3.Opacification of the mastoids and middle ear cavities. Please correlate clinically.
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Generate impression based on findings.
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Left arm weakness, confusion, and slurred speech. There is no evidence of intracranial hemorrhage or mass. There is encephalomalacia in the left inferior frontal gyrus with mild ex vacuo dilatation of the left lateral ventricle. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable.
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1. No evidence of intracranial hemorrhage, mass, or cerebral edema.2. Chronic left inferior frontal gyrus infarct. Otherwise, non-contrast CT is insensitive for the detection of non-hemorrhagic acute infarct.
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Generate impression based on findings.
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MAX/FACIAL: No acute facial bone fracture is identified. The temporomandibular joints are intact. No orbital fracture is identified. The globes are intact. There is no evidence of intraorbital hematoma or stranding. There is soft tissue swelling and infiltration of the subcutaneous fat overlying the right zygomatic arch, consistent with acute inflammation. Mild mucosal thickening of the frontal sinus, anterior ethmoid cells, and maxillary sinuses. The mastoid air cells are clear. There is extensive periapical and periradicular lucency surrounding the left mandibular molars, which was not included in the previous exam field of view. CERVICAL SPINE: There is redemonstration of slight straightening of the cervical spine. However, there is no acute malalignment and there is no fracture of the cervical spin or prevertebral soft tissue swelling. There is a normal relationship of the dens with the arch of C1. There is a stable appearance of mild degenerative disease. The previously described multilevel disk bulges are not partially-obscured by artifact and not well-appreciated on this exam. There is endplate osteophytic spurring anteriorly and annular calcification. There is no significant spinal canal stenosis. The visualized lung apices appear normal.
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1. There is soft tissue stranding overlying the right zygomatic arch, without underlying fracture, consistent with stated history of assault.2. Mild degenerative disease of the spine, not significantly changed since recent exam. No fracture is identified in the cervical spine. 3. Periapical and periradicular lucency surrounding the left mandibular molars is suggestive of periodontal/endodontal disease, and correlation with dental exam is recommended.
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Generate impression based on findings.
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The ventricles and sulci are slit-like, with increased effacement of the fourth ventricle. There is more extensive cortical hypoattenuation especially near the vertex and along the occipital lobes, with further decreased gray-white differentiation. The deep gray nuclei are no longer delineated. The basal cisterns are effaced.There is no midline shift or mass effect. There is no intracranial hemorrhage. There is no extraaxial fluid collection. There is mild frontal and ethmoidal mucosal thickening.
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Expected evolution of global anoxic brain injury, with worsened diffuse cerebral edema. Stable slit like ventricles supratentorially, with worsened effacement of the fourth ventricle likely relating to downward herniation of supratentorial structures. Near complete effacement of cisterns. No acute intracranial hemorrhage
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Generate impression based on findings.
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Evaluation is limited due to lack of contrast and previous postoperative changes. The lumbar spine is in normal alignment, with a normal lumbar lordosis. There is mild progressive disk height loss at L2-L3. The vertebral body and disk heights are otherwise stable. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the upper L2 level. Incidental note is again made of T1 hyperintensity likely associated with the filum terminale from approximately L3 through the sacrum.At L1-L2, there is no significant disk pathology or stenosis.At L2-L3, there is a previous left-sided laminectomy. There is slight progression of the diffuse disk bulge with possible central annular fissure. There is at least moderate central spinal canal stenosis at this level with bunching of the cauda equina nerve roots. There is mild bilateral facet arthropathy and ligamentum flavum thickening. There is moderate left and mild-moderate right right foraminal narrowing.At L3-L4, additional postoperative changes are suggested with increased dorsal outpouching deformity of the thecal sac and overall mild to moderate central spinal canal stenosis. There remains a trace disk bulge with mild bilateral facet arthropathy and ligamentum flavum thickening. The left foramen is opacified by abnormal signal which may relate to postoperative changes and/or persistent severe stenosis. There is mild right foraminal narrowing.At L4-L5, there is a stable trace disk bulge with slight right sided prominence. There is moderate bilateral foraminal narrowing.At L5-S1, there is no significant disk pathology or stenosis.
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1. Expected evolution of postoperative changes with progressive spondylotic changes at L2-L3 where there is a slightly increased diffuse bulge with central prominence and likely annular fissure, although evaluation of postoperative is is difficult due to lack of contrast. Resultant moderate central spinal canal and left foraminal stenosis at this level.2. Additional mild-moderate central spinal canal stenosis remaining at L3-L4. Left foramen not well assessed although normal fat is not visualized within the foramen which may relate to underlying postoperative changes and/or stenosis.3. Incidental fatty filum, which can be seen associated with tethered cord. Please correlate clinically.
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Generate impression based on findings.
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There are multifocal, minimally displaced, bilateral nasal bone fractures, partially comminuted on the left, with associated superficial swelling about the nasal region, left greater than right. The temporomandibular joints are intact. No orbital fracture is identified. The globes are intact. There is no evidence of intraorbital hematoma or stranding. There is scattered mucosal thickening of the paranasal sinuses, most pronounced in the right maxillary sinus. There is layering high-density fluid in the posterior nasopharynx which may represent blood products. The mastoid air cells are clear.
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There are multifocal, minimally displaced, bilateral nasal bone fractures, partially comminuted on the left, with associated superficial swelling about the left greater than right nasal region.
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Generate impression based on findings.
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23-year-old female with remote history of ependymoma resection, recent AMS, found to have left subdural hematoma; evaluate for stability. Stable appearance of trace left frontoparietal extra-axial fluid collection, which is slightly higher density than CSF, indicative of a non-acute hematoma. There is minimal mass effect on the regional gyri and sulci, without significant midline shift or herniation. The ventricles are unchanged with persistent dilatation of the fourth ventricle. There is moderate to severe global volume loss. Unchanged appearance of remote suboccipital craniotomy. There is minimal mucosal thickening of the paranasal sinuses. There is moderate leftward deviation of the nasal septum.
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1. Stable appearance of trace left frontoparietal non-acute subdural hematoma, with minimal localized mass-effect and no midline shift. 2. Unchanged diffuse global volume loss as well as post-operative findings related to prior suboccipital craniotomy, including persistent ex vacuo dilatation of the fourth ventricle.
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Generate impression based on findings.
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Female 21 years old Reason: rule out appendicitis History: RLQ pain Limited contrast most of the small bowel is not opacified limiting sensitivity for bowel.ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Intrinsically normal. Small amount of perihepatic ascites.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. Bright focus in the fluid-filled duodenum Series III image 68 probably represents ingested matter or oral contrast. Possible but unlikely that this represents a blushing lesion.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: 3 x 2 cm right adnexal cyst series 2 image 109 with abnormally bright enhancing wall and a small vessel tracking ventrally from the cyst to the right lower quadrant where there is a small cluster of vessels and an arterial-density blush of contrast is seen on series 3 image 109 correlating to coronal image 48. Significance is uncertain. Could represent a hemorrhagic cyst.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Slightly more than physiologic fluid in the dependent portions of pelvis and tracking into the right lower quadrant.No evidence of bowel wall thickening or dilatation. The appendix is not visualized and is presumably normal. No intramural air or free air.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Findings as above favor pain related to this right adnexal cyst, hyper-enhancing wall and associated small amount of ascites and arterial blush in the right lower quadrant. Correlate with GYN pelvic ultrasound and Doppler findings in the right adnexa and right lower quadrant.
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Generate impression based on findings.
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Male 95 years old; Reason: Evaluate obstruction History: 95 yo M with ?R inguinal hernia, p/w constipation and vomiting ABDOMEN:LUNGS BASES: Increasing bilateral pleural effusions and small to moderate on the right small on the left with associated basilar atelectasis superimposed on chronic fibrotic changes.Possibly some new atelectasis or consolidation left lower lobe, correlate aspiration and infection.Left AV valve calcification. Enlarged left atrium. NG tube.LIVER, BILIARY TRACT: Multiple hepatic hypodense lesions likely cysts, unchanged.Unchanged blush in segment 7 appearance of venous shunting in the right hepatic and portal veins.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic left kidney unchanged.RETROPERITONEUM, LYMPH NODES: Heavy atherosclerotic disease common no evidence of aneurysm. No pathologic size nodes.BOWEL, MESENTERY: NG tube coiled in gastric body. Marked dilatation of the entire small bowel consistent with mechanical obstruction. Etiology is seen in the pelvis, see below. No intramural air or free air. No evidence of ascites in the upper abdomen however see pelvis.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: Marked dilatation of small bowel without small bowel seen in a right inguinal hernia with associated ascites in the hernia sac and pelvis and mild hyperemia of the small bowel loop within the right inguinal hernia consistent with high-grade mechanical obstruction. The patient is at risk for perforation although currently there is no intramural air or free air seen.BONES, SOFT TISSUES: Mild generalized anasarca. Chronic postop changes right femur and surgical hardware, unchanged.Mild compression fracture L2 unchanged.OTHER: Heavy atherosclerotic disease iliac vasculature.
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1.High grade mechanical obstruction secondary to right inguinal hernia with associated pelvic ascites and fluid in the hernia sac and hyperemia of the small bowel loop within the hernia sac suggesting ischemia. Patient is at risk for perforation, although no perforation is currently seen.2.New or increased small bilateral pleural effusions, and possible left lobe consolidation. To aspiration or infection.3.Other chronic findings as above, including intrapelvic portal to hepatic venous shunt.
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Generate impression based on findings.
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Exam is limited due to multiple factors leading to suboptimal opacification of the vasculature, which may in part be technical but could also relate to the patient's cardiac status.The entire right internal jugular vein does not opacify with contrast. Previously seen right internal jugular vein Permacath has been removed. There is a thrombus in the mid to lower aspect of the right internal jugular vein with extensive infiltration of the surrounding fat planes. There is thickening of the regional soft tissues on the right side of the neck measuring overall 55 x 49 mm on series 6 image 40 which has progressed from prior exam accounting for differences in patient positioning. There is no soft tissue air or drainable fluid collection. There is mild mass effect causing slight medial deviation of the right common carotid artery. The area of soft tissue thickening extends superiorly to the level of C2 and inferiorly to the supraclavicular fossa.The remaining major cervical vessels are patent. The airways are patent. The thyroid gland is unremarkable. The parotids and submandibular glands show diffuse small foci of hypo- and hyperattenuation, which may represent nodularity as can be seen with inflammatory etiologies such as Sjogren's; please correlate clinically.There is a small central disk protrusion and C4-5, disk osteophyte complex at C5-6 with left uncovertebral hypertrophy causing moderate left neural foraminal stenosis. There is extensive dental disease with numerous dental caries and periapical lucencies. There are severe emphysematous changes in the imaged lung apices. There are prominent in right subpectoral lymph nodes partly imaged measuring up to 13 mm in short axis on series 6 image 61, nonspecific. There are bilateral axillary lymph nodes which are enlarged seen on the prior CT chest.
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Complete right internal jugular vein thrombosis with progressive extensive surrounding likely phlegmonous change extending superiorly from C2 level to the subclavicular fossa. No drainable fluid collection or abscess.
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Generate impression based on findings.
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62 year-old female with NSCLC status post CRT and right upper lobe wedge resection on 12/12/2014 presents with fatigue/decreased P.O. intake LUNGS AND PLEURA: Postsurgical changes of an right upper lobe wedge resection is again seen. Septal thickening and architectural distortion in the remaining right upper lobe as well as the superior segment of the right lower lobe is again noted, most likely due to postradiation and postsurgical changes. There is unchanged pleural based subsegmental atelectasis along the fissures and chest wall also likely due to postradiation/postsurgical changes. There is increased fluid within the hydropneumothorax measuring up to 20 Hounsfield units. There is atelectasis surrounding the hydropneumothorax. Airways are patent. Unchanged small right pleural effusion.Moderate emphysematous changes are seen, right greater than left. Reference right lower lobe pulmonary nodule is unchanged measuring 5 mm (series 4, image 35). Additional micronodules are unchanged.MEDIASTINUM AND HILA: Left-sided chest port with tip at the superior cavoatrial junction. The heart size is normal. No pericardial effusion. No significant mediastinal or hilar lymphadenopathy.CHEST WALL: Stable degenerative changes to the thoracic spine. New, nondisplaced fracture of the right ninth rib without evidence of metastatic involvement. There is associated stranding of the subcutaneous tissue similar to the prior exam.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Borderline enlarged cluster of gastrohepatic lymph nodes measuring up to 1 cm (series 3, image 76).
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1.Increased fluid within the right upper lobe hydropneumothorax. Superimposed infection cannot be entirely excluded.2.New, nondisplaced right ninth rib fracture.3.Unchanged 5-mm right lower lobe nodule.
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