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Generate impression based on findings.
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Male 61 years old Reason: 61M with new diagnosis of metastatic neuroendocrine tumor of unclear origin with peritoneal carcinomatosis and hepatic mets, imaging for staging. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Diffusely dilated esophagus 1.9-cm is seen on coronal image 32 in contrast filled. Correlate rule out motility abnormality and reflux.Small nonpathologic sized mediastinal nodes.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Extensive tumor involvement throughout the liver with confluent mass involving the central portion of the liver, confluent with the caudate lobe and porta hepatis, with marked mass-effect and compression of hepatic and portal venous hepatic veins and arterial vasculature. There is also compression effect on the biliary tree with mild to moderate intrahepatic biliary dilatation distal to the central tumor in the peripheral portions of the right and left lobes.The tumor in the left lobe bulges the capsule and compresses the extrahepatic portal vein. The tumor abuts and probably invades adjacent pancreatic proximal body and neck and encases the extrahepatic portal venous confluence circumferentially.Four baseline index lesion measurement purposes, a small lesion in the posterior segment right lobe is measured on series 3 image 98, 2 x 1.8 cm.A second index lesion in the lateral segment of left lobe is measured on series 3 image 93, 3.5 x 2.1 cm.Lesion along the posterior capsule of the right lobe on series 3 image 84 represents an extrahepatic peritoneal implant.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Hypodensities consistent with cysts.RETROPERITONEUM, LYMPH NODES: Small shotty retroperitoneal nodes. Confluent the porta hepatis compresses the intrahepatic and intrahepatic inferior vena cava. Invasion of the inferior vena cava cannot be excluded.BOWEL, MESENTERY: Peritoneal implants as seen on the surface of the liver. For example series 3 image 122, 109BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: TURP defect.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Several soft tissue densities are seen in the distribution of the omentum or mesentery in the right lower quadrant, consistent with carcinomatosis. The more medial lesion, as measured on series 3 image 164, is 2.7 x 1.9 cm.No evidence of bowel wall thickening or dilatation. No evidence of ascites.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Multifocal hepatic metastases with compression of hepatic vasculature and biliary tree. Tumor extends to compress the structures in the porta hepatis and possibly extends into the pancreas. Compression of intra-and infrahepatic inferior vena cava.Carcinomatosis as detailed above.Esophageal dilatation and possible reflux.
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Generate impression based on findings.
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There is artifact the skull base due to beam hardening which limits evaluation. Given this limitation, there is no evidence of intracranial hemorrhage, mass, or cerebral edema. There is periventricular and subcortical white matter hypoattenuation consistent with known chronic microvascular ischemic changes which are better depicted on the prior MRI.The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There are minimal atherosclerotic calcifications in the cavernous carotid and V4 segment vertebral arteries. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. There is a partial empty sella sella incidentally noted.
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No acute intracranial hemorrhage, or mass effect. CT is insensitive for detection of early nonhemorrhagic stroke.
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Generate impression based on findings.
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Female 74 years old Reason: sepsis neutropenia abdominal pain History: abdominal pain. The exam is not sensitive detecting lesions in the solid organs of vasculature to the lack of intravenous contrast and in the bowel due to the lack of oral contrast. Given those limitations, the following observations are made:CHEST:LUNGS AND PLEURA: Basilar atelectasis. No lung nodules.MEDIASTINUM AND HILA: Central line catheter tip at SVC - RA junction. Atherosclerotic calcifications, particularly at the aortic root.CHEST WALL: Central line enters via a right jugular approach.Wedge collapsed midthoracic vertebral body unchanged from chest CT of 7/5/14.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: 2.4 x 2 cm left adrenal nodule 25 HU in density, nonspecific.Right adrenal gland is normal.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: There is an eccentric aneurysm along the left aspect of the mid abdominal aorta measuring about 1.7 cm in diameter, measured on coronal image 46. There is a paucity of calcification in the aneurysm as compared to the rest of the aorta. For this reason I recommend follow-up to evaluate for stability.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Calcified uterine lesion consistent with fibroid.BLADDER: No Foley catheter in place but there is air in the urinary bladder, presumably from prior recent instrumentation. Correlate clinically.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Arthroplasty right hip.OTHER: No significant abnormality noted.
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Limited by lack of oral and intravenous contrast. No findings to explain acute abdominal pain.Eccentric aortic aneurysm. Prior exams please compare to show stability if not, follow-up should be obtained.Air in urinary bladder presumably instrumentation, correlate clinically.Left adrenal nodule does not criteria for adenoma and is thus non-specific.Wedge collapsed midthoracic vertebral body.
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Generate impression based on findings.
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65-year-old male with AMS, intubated with multiple cortical strokes LUNGS AND PLEURA: Bibasilar dependent atelectasis. Within the left upper lobe, there is architectural distortion, volume loss, and emphysematous changes with interstitial thickening may be secondary to postsurgical changes or postradiation changes. No focal opacities to suggest infection. Ground glass nodule in the right middle lobe (series 5, image 61) measuring 4 mm. Additional bilateral micronodules are noted measuring up to 3 mm.MEDIASTINUM AND HILA: There is a 1.6 x 1.6 cm hypodense nodule within the left thyroid gland. Additional hypodense nodules within the thyroid gland are seen. Prominent right paratracheal lymph nodes not enlarged by CT size criteria. Tortuous aorta. Moderate atherosclerotic calcifications affect the aorta and its branch vessels. There is moderate to severe coronary artery calcifications.ET tube tip is in place. Nasogastric tube tip is in the gastric antrum. There is debris within the upper esophagus. Median sternotomy wires are noted.CHEST WALL: No axillary, cardiophrenic, or retrocrural lymphadenopathy. The first and second have been surgically resected with expected protrusion of chest wall fat into the left hemithorax. Mild degenerative changes affect the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Cholecystectomy clips are seen.
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1.Status post resection of the first and second left rib with adjacent postsurgical and/or postradiation changes to the left upper lobe.2.No focal pulmonary opacities suspicious for infection or infarct. Bibasilar atelectasis.3.Thyroid nodules as described above.
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Generate impression based on findings.
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There is no evidence of intracranial hemorrhage, mass, or cerebral edema. There is a small rounded lucency in the right subinsular region and series 5 image 12 probably volume averaging artifact from a prominent regional sulcus or possibly a dilated perivascular space. 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.
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No acute intracranial hemorrhage or mass-effect.
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Generate impression based on findings.
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Male 75 years old; Reason: eval of ?diverticulitis History: abd pain, blood in stool, elevated lactate. The exam is not sensitive for detecting lesions in the solid organs or vasculature due to the lack of intravenous contrast. Given those limitations, the following observations are made:ABDOMEN:LUNGS BASES: Bibasilar atelectasis or fibrosis. Also see chest CT report of 2/19/13.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Circumferential wall thickening involving the splenic flexure and proximal descending colon with paucity of hautral markings. The colonic wall measures about 5 mm in thickness as seen on series 3 image 61. There is no fat stranding or fluid around the colon however correlate for colitis. No intramural air or free air.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: Diverticulosis in the sigmoid colon. Mild fat stranding in the region is chronic and unchanged dating back to 2008.BONES, SOFT TISSUES: Prominent Schmorl's node superior endplate L4.OTHER: Atherosclerotic disease, no evidence of aneurysm.
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Limited by the lack of intravenous contrast believe there is a process causing thickening of long segment of distal transverse and proximal descending colon. Correlate for acute or chronic colitis. No evidence of diverticulitis. No intramural or free air.Stable bilateral renal cysts.Sigmoid diverticulosis.Atherosclerotic disease.
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Generate impression based on findings.
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Female 7 years old Reason: abd erythema, tenderness, and warmth, concerning for acute process History: concern for acute processVIEW: Abdomen AP (one view) 2/1/15 at 457 hours NG tube terminates in the stomach. Right hip dislocation and lateral uncovering of the left hip and bilateral coxa valga deformity noted. Gastrostomy tube is in place. Left lower lobe atelectasis. Soft tissue edema. Interval removal of left femoral venous access.Scattered, featureless and minimally distended bowel loops with central distribution. No evidence of free air.
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Soft tissue edema and minimally distended, nonspecific bowel loops as described.
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Generate impression based on findings.
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There is no evidence of intracranial hemorrhage. There are new moderate areas of hypoattenuation in the right parietal lobe, and in the left insula extending superiorly into the left corona radiata via the left putamen representing age indeterminate, probably subacute strokes; these are unchanged. There is minimal questioned ex vacuo dilatation of the left frontal horn suggesting element of chronicity underlying the subacute component in the left-sided infarct.No acute intracranial hemorrhage or mass effect. The ventricles and basal cisterns are otherwise 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.
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1. No acute intracranial hemorrhage.2. Findings, in conjunction with provided clinical history, suggest subacute infarcts in the left MCA territory and the right parietal lobe. In the left MCA territory, there may be a an underlying chronic infarct as well. However, CT is insensitive for detection of early nonhemorrhagic stroke.Findings were communicated with the Dr. Naoum Issa by Dr. Pranay Uppuluri over the telephone at 10:40 AM today.
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Generate impression based on findings.
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Female 7 years old Reason: ET tube in place? History: intubated sedated , history of pancreatitis.VIEW: Chest AP (one view) 2/1/15 at 357 hours. Neurostimulator, NG tube and gastrostomy unchanged. ET tube tip is below the thoracic inlet. Cardiac silhouette size is normal. Left lower lobe opacity and left-sided pleural effusion noted. Interval improvement in right upper lobe atelectasis.
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Interval improvement in right upper lobe atelectasis and worsening left lower lobe opacity and left-sided pleural effusion.
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Generate impression based on findings.
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Axial images are limited due to poor signal to noise especially along the mid to lower cervical spine which may in part relate to dental amalgam susceptibility artifact. There may also be mild motion artifact.The cervical spine is in normal alignment, with a normal cervical lordosis. There is mild-moderate disk narrowing at C5-C6 and C6-C7, with diffuse cervical disk desiccation. 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.At C2-C3, there is no significant disk pathology or stenosis.At C3-C4, there is a very tiny central disk protrusion which indents the ventral thecal sac. There is mild to just calcinosis.At C4-C5, there is minimal bilateral facet arthropathy and left uncovertebral hypertrophy, resulting in mild left foraminal narrowing. There is mild central spinal canal stenosis.At C5-C6, there is a trace posterior osteophyte disk complex with prominent bilateral uncovertebral hypertrophy and facet arthropathy. There is overall moderate central spinal canal stenosis as well as moderate bilateral foraminal narrowing. There is slight flattening of the cord contour, as well as mild ligamentum flavum thickening.At C6-C7, there is a mild diffuse posterior osteophyte disk complex along with left greater than right facet arthropathy and uncovertebral hypertrophy. There is moderate central spine canal stenosis as well as moderate bilateral foraminal narrowing.At C7-T1, there is no significant disk pathology or stenosis.Incidental note is made of a slightly asymmetrically low-lying right cerebellar tonsil, which extends 4-5 mm below the level the foramen magnum. It has a normal rounded configuration.
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Somewhat technically limited exam secondary to artifact especially along the mid to lower cervical spine. Within these limitations, overall mild-moderate scattered spondylotic changes as detailed above, without to moderate central spine canal stenosis at C6-C7 at C5-C6, as well as moderate bilateral foraminal narrowing at these levels.
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Generate impression based on findings.
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46 years, Male. Reason: eval for ileus History: nausea Diffusely dilated small and large bowel without transition zone. No intramural air or free air given limitation of supine view. Likely post operative ileus. Vertical staple line. Spinal hardware.Atelectasis or fibrosis left lower lobe.
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Postoperative ileus.
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Generate impression based on findings.
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There is a stable left basal ganglia/thalamic hyperattenuating hematoma measuring 58 x 44 mm on series 5 image 15 with surrounding vasogenic edema and mass effect. There is persistent 8mm midline shift to the right. The regional sulci and left lateral ventricle remain nearly effaced. There is mild intraventricular hemorrhage layering in the occipital horns of the lateral ventricles, and small amount of hemorrhage in the left lateral ventricle body and near the foramen of Monro region. There are mildly progressive small foci of scattered subarachnoid hemorrhage in the right sylvian fissure, and frontal lobe sulci. There is persistent downward mass effect on the midbrain, as well as partial effacement of the suprasellar and quadrigeminal plate cisterns. The ventricular caliber remains prominent but unchanged from the most recent exam. Prominence of the right extra-axial CSF attenuation superior to the right cerebellar hemisphere is once again seen and unchanged. There are tiny remote bilateral caudate infarcts.
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1. Stable large intraparenchymal hematoma in the left basal ganglia/thalamic region with unchanged mild intraventricular hemorrhage, mass effect, midline shift and prominent ventricular caliber.2. Mildly progressive small focus of subarachnoid hemorrhage in the right cerebral hemisphere.
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Generate impression based on findings.
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40 years, Female. Reason: sbo vs severe constipation History: N?V. Normal bowel gas pattern. No evidence of obstruction. Average stool burden in colon.Osseous and soft tissue structures are unremarkable.Single-lead ICD chest. Sternotomy wire and plate.
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No evidence for obstruction. Average stool burden in colon.
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Generate impression based on findings.
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Right chest wall pain No acute or subacute rib abnormality observed, particular attention was placed in the area of the patient placed markers. Underlying chest is clear. Moderate degenerative changes of the right shoulder are partially observed. Suspected partial scoliosis and cholecystectomy clips.
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No acute rib abnormality
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Generate impression based on findings.
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Male 16 years old Reason: pna, atelectasis History: new tachypneaVIEW: Chest AP (one view) 1/31/15 at 1052 hrs Central lines unchanged. Interval NG tube removal. Cardiac silhouette size is normal. Right lower lobe opacity, likely atelectasis or pneumonia. Interval resolution of left lower lobe atelectasis.
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Right lower lobe opacity, likely atelectasis or pneumonia
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Generate impression based on findings.
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50 year-old female with pain and swelling of right clavicle LUNGS AND PLEURA: There is a large left upper lobe nodule measuring 1.5 x 2.0 cm (series 7, image 19), similar to the prior exam. There are numerous additional nodules in bilateral lungs consistent with history of metastases. No pneumothorax.MEDIASTINUM AND HILA: The heart size is normal. No pericardial effusion. There are enlarged mediastinal and right hilar lymph nodes measuring up to 1.5 cm in short axis (series 5, image 29).CHEST WALL: There is an expansile, lytic lesion in the right clavicular head with surrounding inflammatory changes compatible with a metastatic lesion. This lesion abuts but does not appear to invade the adjacent mediastinal structures. Left posterior T6 lytic rib lesion is unchanged.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Probable splenule is partially visualized.
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1.Expansile, lytic lesion in the right clavicular head with surrounding inflammatory changes is compatible with a metastatic lesion.2.Innumerable pulmonary nodules and lymphadenopathy consistent with metastatic lesions of patient's known RCC.3.Left posterior T6 lytic rib lesion is unchanged.
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Generate impression based on findings.
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55 years, Male. Reason: Assess pain pump History: bacteremia with implanted hardware. Diffusely dilated small bowel particularly in the right abdomen. Mildly dilated colon but no discrete transition zone. Average stool burden. No intramural air or free air evident.Spinal hardware. Spinal implanted hardware and catheter intact along its visualize course.
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Generalized ileus.
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Generate impression based on findings.
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NONCONTRAST: There is a stable left basal ganglia/thalamic hyperattenuating hematoma measuring 58 x 44 mm on series 5 image 15 with surrounding vasogenic edema and mass effect. There is persistent 8mm midline shift to the right. The regional sulci and left lateral ventricle remain nearly effaced. There is mild intraventricular hemorrhage layering in the occipital horns of the lateral ventricles, and small amount of hemorrhage in the left lateral ventricle body and near the foramen of Monro region. There are trace foci of scattered subarachnoid hemorrhage in the right sylvian fissure, and frontal lobe sulci. There is persistent downward mass effect on the midbrain, as well as partial effacement of the suprasellar and carotid foraminal plate cisterns. The cerebellar tonsils remain above the foramen magnum.The ventricular caliber remains prominent but unchanged from the most recent exam. Prominence of the right extra-axial CSF attenuation superior to the right cerebellar hemisphere is once again seen and unchanged. There are tiny remote bilateral caudate infarcts.CTA: There are moderate bilateral cavernous carotid atherosclerotic calcifications without flow-limiting stenosis. Both A1 segments are present. The left vertebral artery is smaller than the right. Both vertebral arteries join to form the basilar artery. The posterior communicating arteries are not visualized. The anterior communicating artery is seen. There is minimal luminal irregularity without flow limiting stenosis in the bilateral M1 segments prior to branching, as well as the bilateral P1 and P2 segments which may be secondary to intracranial atherosclerosis. There is a duplicated left superior cerebellar artery. There is no definite aneurysm or vascular malformation.
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1.Mild intracranial atherosclerosis without flow-limiting stenosis, or vascular malformation. However, evaluation after resolution of hematoma would be advised for follow-up. 2.Stable large intraparenchymal hematoma in the left basal ganglia/thalamic region with unchanged mild intraventricular hemorrhage, mass effect, midline shift and prominent ventricular caliber. New small scattered foci of subarachnoid hemorrhage in the right cerebral hemisphere, which may relate to recirculation of CSF and blood products.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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Post operative changes are seen from previous anterior cervical fusion of C6 and C7, with resultant susceptibly artifact from the instrumentation limiting evaluation of surrounding structures. Axial images are somewhat limited by patient motion an unusual angulation of the gradient echo images.The cervical spine is in normal alignment, with slight straightening of the normal cervical lordosis. There is mild disk narrowing at C4-C5. 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.At C2-C3, there is no significant disk pathology or stenosis.At C3-C4, there is a trace disk bulge which indents the ventral thecal sac. There is mild central spinal canal stenosis. Prominent left facet arthropathy contributing to mild-moderate bilateral foraminal narrowing.At C4-C5, there is a mild posterior osteophyte disk complex diffusely with right paracentral prominence, as well as left greater than right facet arthropathy and uncovertebral hypertrophy. There is moderate central spinal stenosis with slight ventral cord deformity. There is moderate-severe right mild to moderate left foraminal narrowing, best demonstrated on axial T2* images.At C5-C6, there is a left paracentral prominent posterior osteophyte disk complex which flattens the left ventral thecal sac. There is bilateral uncovertebral hypertrophy with proximal mild left foraminal narrowing. There is also bilateral facet arthropathy. There is mild central spinal canal stenosis.At C6-C7, there is no significant disk pathology at this level of previous fusion. There is no significant stenosis.At C7-T1, there is no significant disk pathology or stenosis.
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Postoperative changes relating to previous C6-C7 fusion, with mild-moderate spondylotic changes as detailed above with findings most probably C4-C5 where there is moderate spinal canal stenosis as well as moderate-severe right and mild to moderate left foraminal narrowing.
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Generate impression based on findings.
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Left wrist reduction Cast material obscures detail, however the comminuted intra-articular distal radial fracture appears to improved in overall orientation, the dorsally angulated fragment currently is minimally impacted and angled in a more routine position.
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Improved alignment of the distal radial interarticular fracture, see detail provided
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Generate impression based on findings.
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56 years, Male. Reason: s/p g tube reinsertion, please shoot high History: see above Percutaneous G-tube overlies gastric body.Normal bowel gas pattern. Osseous and soft tissue structures are otherwise unremarkable.
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G-tube projects over gastric body.
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Generate impression based on findings.
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Male 17 years old Reason: Nasal bone fracture? History: fallVIEWS: Nasal bones AP and right and left lateral 1/31/15 (3 views) Minimally displaced nasal bone fractures. Visualized paranasal sinuses are normally aerated.
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Minimally displaced nasal bone fractures.
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Generate impression based on findings.
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37 years, Male. Reason: concern for obstruction, ileus. History: abdominal pain, constipation, distention Minimally prominent loops of small bowel in the right upper quadrant. Normal gas distribution in colon. Less than average stool burden. No intramural air or free air.Osseous and soft tissue structures and lung bases are normal.
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Mild ileus right upper quadrant.
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Generate impression based on findings.
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Wrist and elbow pain Elbow: Limited evaluation without evidence of radiographic abnormality, consider 4 views if suspicion remains highWrist: A comminuted intra-articular distal radial fracture is observed with moderate dorsal angulation of the distal largest fragments and associated impaction. Soft tissue swelling. Subsequent images interpreted
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Distal radial fracture
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Generate impression based on findings.
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Male 5 years old Reason: Evaluate Lung Fields History: Suspected SepsisVIEW: Chest AP (one view) 1/31/15 at 1443 hrs. Lower extremity central line tip is at the RA/SVC junction. Cardiac silhouette size is normal. Small lung volumes with no focal opacities, effusions or pneumothorax.
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No focal lung opacities. Persistent small lung volumes.
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Generate impression based on findings.
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Patient fell. Pain Elbow: Large effusion is observed with deformity of the radial head concerning for a minimally impacted neck fracture.. Minimal osteophytes and degenerative changes. Serial imaging will help confirmWrist: No acute radiographic abnormality. Diffuse demineralization and mild scattered degenerative changes largely involving the radiocarpal joint
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Questionable radial transverse neck fracture with possible mild impaction. Mild degenerative changes of the wrist
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Generate impression based on findings.
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70 years, Male. Reason: eval for ileus History: abd pain. Respiratory motion. Pelvis excluded from field of view.Dobbhoff tube overlies the gastric fundus. Nonobstructive bowel gas pattern.Opacities lung bases please refer to chest x-ray.
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Dobbhoff tube overlies gastric fundus.
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Generate impression based on findings.
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Pain and swelling, for two weeks. Pain worsening recently Diffuse marked swelling greater overlying the medial malleolus without underlying acute osseous abnormality. Ankle mortise remains intact and symmetric. If there is concern for ligamentous injury, stress views may be indicated
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Diffuse soft tissue swelling greater medially without underlying acute osseous abnormality
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Generate impression based on findings.
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Second and third digit pain with fourth digit nail bed injury check for fracture Soft tissue swelling largely observed involving the second digit without underlying osseous abnormality. The absence of osseous abnormality includes all digits. There is however a small soft tissue defect overlying the tuft on the ulnar margin of the fourth digit which may correlate with the related history and laceration.No radiopaque foreign bodies
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Minimal second digit swelling and soft tissue laceration suspected involving the fourth digit. No osseous abnormality
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Generate impression based on findings.
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There is no evidence of intracranial hemorrhage, mass, or cerebral edema. There is periventricular and subcortical white matter hypoattenuation, likely representing age indeterminate microvascular ischemic changes. The ventricles and basal cisterns are prominent consistent with diffuse volume loss. There is no midline shift or herniation. There are extensive bilateral basilar, V4 vertebral artery segment, cavernous carotid and superior right cervical internal carotid artery atherosclerotic calcifications. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable.
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1.No acute intracranial hemorrhage or mass-effect. CT is insensitive for detection of early nonhemorrhagic stroke.2.Moderate age indeterminate microvascular ischemic changes and diffuse volume loss.3.Extensive atherosclerosis.
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Generate impression based on findings.
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Respiratory insufficiency.VIEW: Chest AP (one view) 2/1/15 at 333 hours. ET tube tip is below the thoracic inlet. A gastrostomy tube again noted. Cardiac silhouette size is normal. Persistent right upper and left lower lobe opacities as well as bronchial wall thickening. Interval improvement in left upper lobe atelectasis.
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Interval improvement in left upper lobe atelectasis with persistent bronchial wall thickening and multifocal opacities.
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Generate impression based on findings.
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43-year-old male with persistent tachycardia PULMONARY ARTERIES: Limited examination by suboptimal contrast opacification and streak artifacts. Within these limitations, there are a few filling defects that are concerning for pulmonary embolism although these may represent flow artifacts. For example, there is a right upper lobe pulmonary artery filling defect (series 11, image 92) and a left lower lobe pulmonary artery filling defect (series 11, image 160). LUNGS AND PLEURA: No pleural effusion. No pneumothorax. Scattered micronodules bilaterally, the largest measuring 5 mm (series 12, image 24) in the left upper lobe.MEDIASTINUM AND HILA: Hypodense nodule within the left thyroid lobe measuring 1.1 x 1.2 cm (series 11, image one). The heart size is normal. There is no evidence of RV strain. No pericardial effusion. No significant mediastinal or hilar lymphadenopathy. CHEST WALL: No axillary, cardiophrenic, or retrocrural lymphadenopathy is evident.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Hepatic steatosis.
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1.Limited examination due to suboptimal contrast opacification of the pulmonary arteries and streak artifacts. Within these limitations, there are questionable filling defects bilaterally that may represent flow artifacts. Repeat imaging may be considered for confirmation if necessary.2.Scattered micronodules bilaterally, the largest measuring 5 mm. Recent guidelines by the Fleischner society (Radiology 2005: 237:395-400) suggest that patients with low risk for lung cancer and nodules greater than 4 mm and less than or equal to 6 mm in diameter should have follow up in 12 months. In patients with a higher risk, such as smokers, follow-up is recommended in 6 months. Patients with a known malignancy are at increased risk for metastasis and should receive a three month follow-up.Findings relayed to pager 3651 on 2/1/15 at 1006. PULMONARY EMBOLISM: PE: Indeterminate.Chronicity: Indeterminate.Multiplicity: Multiple.Most Proximal: Segmental.RV Strain: Negative.
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Generate impression based on findings.
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Please evaluate hematoma involving right thigh, sudden drop in hemoglobin Mild to moderate diffuse swelling largely observed in the subcutaneous medial soft tissues throughout the groin and extending down towards the knee. No distinct focal fluid collection or hematoma is observed and only a small trace amount of fluid is observed adjacent to the gracilis (<5-6 cc). Small knee effusion is also observed and of fluid density.Bone windowing demonstrates scattered bone island in the anterior acetabulum at without additional acute or subacute abnormality. Early mild demineralization with superimposed moderate to near severe osteoarthritic changes most pronounced involving the symphysis and right hip. Right hip changes include near bone-on-bone narrowing, sclerosis and osteophytes
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Scattered edema and diffuse swelling more pronounced over the inner thigh and groin yet without a discreet focal fluid collection to suggest a measurable hematoma.
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Generate impression based on findings.
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95 years, Male. Reason: Eval for obstruction, constipation History: 95 yo M with ?R inguinal hernia here with constipation and vomiting. Markedly dilated loops of small bowel in left lower quadrant concerning for high grade mechanical small bowel obstruction. No intramural air or free air.Postsurgical changes right femur. Atherosclerotic calcifications. Surgical clip right lower quadrant. Dextroscoliosis and mild degenerative changes. Osteoporosis.
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Findings of high-grade mechanical small bowel obstruction. These findings were communicated by me via stat consult at 5:12 a.m. Follow-up CT is been obtained prior to the time of this dictation.
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Generate impression based on findings.
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Respiratory insufficiency.VIEW: Chest AP (one view) 1/31/15 at 1825 hrs. Interval intubation of the right bronchus intermedius with complete atelectasis of the left lung and right upper lobe. Cardiac silhouette is non-sizable.
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Right bronchus intermedius intubation with complete collapse of the left lung and right upper lobe
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Generate impression based on findings.
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Male 7 years old Reason: lac by glass History: lacVIEWS: Left hand AP, lateral and oblique 1/31/15 (3 views) High density structure only visualized in AP view at the thenar eminence may represent hematoma or laceration. No evidence of radiopaque foreign bodies no fracture or malalignment.
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No fracture or radiopaque foreign bodies.
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Generate impression based on findings.
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Female 2 years old Reason: abdominal pathology History: bowel dilation noted on cxrVIEW: Abdomen AP (one view) 1/31/15 at 2229 hrs. Right middle lobe opacity and bronchial wall thickening noted.Disorganized, slightly distended and nonspecific abdominal gas pattern. No evidence of obstruction, free air, pneumatosis intestinalis or portal venous gas.
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Disorganized, slightly distended and nonspecific abdominal gas pattern.
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Generate impression based on findings.
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56 years, Male. Reason: s/p g-tube reinsertion History: same Percutaneous G-tube overlies distribution gastric body. Contrast seen in nondilated jejunum and stomach presumably related to G-tube insertion.Lung bases are normal.Osseous and soft tissue structures otherwise unremarkable
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G-tube tip overlies gastric body.
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Generate impression based on findings.
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Female 2 years old Reason: lung pathology History: cough/wheeze, not responding to albuterol and O2VIEW: Chest AP (one view) 1/31/15 Aortic arch, cardiac apex and stomach are left-sided. Cardiac silhouette is normal in size and shape. Peribronchial thickening and right middle lobe opacity likely atelectasis or pneumonia . No effusions or pneumothorax.
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Peribronchial thickening and right middle lobe opacity, likely atelectasis or pneumonia
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Generate impression based on findings.
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Fever and pain, check ORIF Tibial plateau fixation with bilateral sideplates and numerous screws appears unchanged. Specifically no evidence of interval hardware complications. Underlying comminuted reconstructed bilateral tibial plateaus appears also similar with minimal interval increased healing and less well defined fracture planes. Overall deformity and positioning is similar. The effusion is smaller and currently minimal however there is increased diffuse overall swelling with minimal stranding in the subcutaneous tissues. Although not specific, this can be associated with an evolving process. Serial imaging and/or axial imaging may be indicated if suspicion remains high
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Essentially stable proximal tibial reconstruction with mild changes of interval healing. No definite discrete findings to suggest underlying osteomyelitis, however swelling and effusion present are nonspecific.
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Generate impression based on findings.
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Male 20 months old Reason: Finger pain History: 5th digit traumaVIEWS: Left hand AP and lateral 1/31/15 (two views) Fifth finger soft tissue swelling with no fracture or malalignment.
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Soft tissue swelling of the fifth finger with no fracture or malalignment.
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Generate impression based on findings.
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Male 5 years old Reason: s/p L DRF reduction History: see aboveVIEWS: 2/1/15 at 248 hours. (Two views) Cast material obscures fine bone details. Improvement in alignment of the left distal radial fracture.
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Improvement in alignment of the distal fracture of the left radius after casting.
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Generate impression based on findings.
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Male 5 years old Reason: wrist History: traumaVIEWS: Left wrist AP, lateral and oblique 1/31/15 (3 views) There is a dorsally displaced and impacted fracture of the distal left radius with soft tissue swelling and joint effusion.
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Distal left radial fracture as described.
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Generate impression based on findings.
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Female 39 years old Reason: Evaluate for intrarenal hematoma or mass History: hematuria RIGHT KIDNEY: 10.6 cm in length. No hydronephrosis or hydroureter. No evidence of perinephric hematoma. Specifically the hematoma seen on the CT scan of 2/2011 is not visible. Normal blood flow on limited color Doppler imaging.LEFT KIDNEY: 10.1 cm in length. No hydronephrosis or hydroureter. No evidence of perinephric hematoma. Normal blood flow on limited color Doppler imaging.URINARY BLADDER: : No significant abnormality noted.OTHER: No significant abnormalities noted.
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Normal exam. No evidence of mass or hematoma. If hematuria persists, recommend dedicated renal CT or MR for evaluation.
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Generate impression based on findings.
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Left ankle injury.VIEWS: Left ankle AP, lateral and oblique 1/31/15 (3 views) Joint effusion and soft tissue swelling with no fracture or malalignment.
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Joint effusion and soft tissue swelling. No fracture.
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Generate impression based on findings.
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Male 44 years old Reason: right upper quadrant pain History: right upper quadrant pain. Limited by bandages around the cholecystostomy tube.LIVER: 16.2 cm in length. No evidence of perihepatic fluid collections. No definite focal lesions.GALLBLADDER, BILIARY TRACT: Echogenic material consistent with sludge or hematoma in a partially collapsed gallbladder with a percutaneous cholecystostomy tube in place. No measurable fluid in the region of the gallbladder fossa. Gallbladder wall thickening probably due to collapse.PANCREAS: Poorly visualized.RIGHT KIDNEY: Grossly normal, 10.2 cm in length.OTHER: Left kidney 11 cm in length.Spleen 8.5 cm in length.Small right pleural effusion.No evidence of ascites.
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Echogenic material in the gallbladder may represent sludge and/or hematoma cholecystostomy tube. Limited visualization to the bandages.
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Generate impression based on findings.
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There is no interval development of grade 1 anterolisthesis of L4 on L5 measuring 3 mm, degenerative in etiology. The lumbar spine is otherwise in normal alignment, with slight exaggeration of the normal lumbar lordosis. There is mild disk narrowing at L4-L5 as well as disk desiccation. The vertebral body and disk heights are otherwise well-maintained. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are grossly within normal limits on sagittal images with the conus terminating at the L1-L2 level.At L3-L4, there is a persistent right foraminal disk protrusion superimposed upon a trace disk bulge. There has been progression of bilateral facet arthropathy and ligamentum flavum thickening. There is impingement on the exiting right L3 nerve root which appears somewhat thickened and indistinct on the axial T1-weighted images which may indicate inflammation. There is mild to moderate right foraminal narrowing.At L4-L5, there is now uncovering of the disk with severe bilateral facet arthropathy and ligamentum flavum thickening. There is slight decreased transverse dimension of the central spinal canal although without significant stenosis.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the remainder of the lumbar spine. Additional prominent bilateral facet arthropathy is noted L5-S1.There is a tiny T2 hyperintense lesion within the upper pole of the left kidney which is nonspecific but most likely representing a small cyst. The bladder is distended.
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1. Progression of spondylotic changes at L3-L4 where a right foraminal disk protrusion impinges upon the exiting right L3 nerve root with mild-moderate right foraminal narrowing.2. Interval development of degenerative grade 1 anterolisthesis of L4 on L5 with uncovering of the disk although without significant stenosis.
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Generate impression based on findings.
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Female 22 years old Reason: Fevers of unknown origin. Had edema in previous GB examination. Even though could be due to ascites, we would like to evaluate for cholecystitis in the setting of recurrent fevers. History: Fevers of unknown origin. LIVER: Enlarged 20 2 cm in length. Echogenic consistent with fatty infiltration. No definite focal lesions.Normal portal venous flow, peak velocity .2 m/secGALLBLADDER, BILIARY TRACT: Previously seen submucosal edema in the gallbladder on the prior CT scan has resolved. No evidence of gallstones on ultrasound or comparison to prior CT. Sonographic Murphy's sign was absent.No intra-or extrahepatic biliary dilatation. CBD .2 cm in diameter. PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Morphologically normal 11.2 cm in length.OTHER: Left morphologically normal 1 cm in length.Splenomegaly 14.0 cm in length.No evidence of ascites
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Hepato-splenomegaly. Mild fatty liver. No findings to explain recurrent fever.Previously seen submucosal edema in the gallbladder on the prior CT scan is resolved.
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Generate impression based on findings.
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Status post fall.VIEWS: Right tibia-fibula AP and lateral. Right foot and ankle AP, lateral and oblique 2/1/15 (8 views) There is an oblique, comminuted and minimally posteriorly displaced fracture of the distal metadiaphyses of the right fibula. Soft tissue swelling also noted as well as ankle joint effusion.
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Comminuted fracture of the distal metadiaphyses of the right fibula with joint effusion and soft tissue stranding as described.
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Generate impression based on findings.
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Male 7 years old Reason: FB esophagus History: Swallowed quarterVIEWS: Chest AP/lateral (two views) 2/1/15 Aortic arch, cardiac apex and stomach are left-sided. Cardiac silhouette is normal in size and shape. No focal lung opacities. No effusions or pneumothorax.Radiopaque round metallic object is lodged at the esophagus in the thoracic inlet.
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Foreign body ingestion as described.
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Generate impression based on findings.
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Female 23 years old Reason: RUQ ultrasound History: RUQ pain Limited by difficulty suspending respiration.LIVER: 15.9 cm in length. No focal lesions. Mildly coarse echotexture.Flow in the portal vein is hepatopedal .2 m/secGALLBLADDER, BILIARY TRACT: Cholelithiasis. No evidence of tenderness to compression. No pericholecystic fluid. No intrahepatic or extrahepatic biliary dilatation. Common bile duct .2 cm in diameter.PANCREAS: Partially secured by bowel gas. Visualized portions normal.RIGHT KIDNEY: Morphologically normal, 12.5 cm in length.OTHER: Left morphologically normal, 11.9 cm in length.Spleen 10.2 cm in length.No evidence of ascites.
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Cholelithiasis, no evidence of cholecystitis.
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Generate impression based on findings.
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72 years, Female. Reason: Dobbhoff placement History: same Dobbhoff tube tip projects in the distribution of distal gastric body. Overlying LVAD and other catheters and tubes unchanged.Nonobstructive bowel gas pattern.
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Dobbhoff tip projects over the distal gastric body.
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Generate impression based on findings.
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Female 23 years old Reason: rule out mass vs obstruction History: SEVERE RUQ and epigastric pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality noted. Cholelithiasis was seen on ultrasound is not evident by CT and there is no pericholecystic fluid. No significant biliary dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No bowel wall thickening or dilatation. No free or loculated intraperitoneal fluid.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: 3.8 x 2.9 right adnexal cyst and left adnexal 3.7 x 3.2 cm cyst, presumably functional.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Small amount of intraperitoneal fluid presumably physiologic.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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No findings to explain patient's symptoms of right upper quadrant and epigastric pain. Adnexal cysts presumably functional.
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Generate impression based on findings.
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Facial traumaVIEWS: Nasal bones AP and right and left lateral 1/30/15 (3 view/s) There is no evidence of fracture, malalignment or soft tissue swelling
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No fracture.
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Generate impression based on findings.
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Sickle cell disease with knee pain for 5 months.VIEWS: Right knee AP, lateral and oblique 1/30/15 (3 view/s) There is no evidence of fracture, malalignment, joint effusion or soft tissue swelling.
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Normal examination.
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Generate impression based on findings.
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Female 15 years old Reason: s/p R ankle reduction VIEWS: Right ankle AP lateral and oblique 1/2/15 at 851 hours (3 views) Cast material obscures fine bone details. Comminuted fracture of the right fibula is unchanged in alignment.
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Status post casting as described.
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Generate impression based on findings.
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The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There are areas of T2 hyperintensity within the posterior centrum semiovale bilaterally, in a near symmetric pattern. Centrally, these areas demonstrate dropout of signal on FLAIR, with retained marginal FLAIR hyperintensity. Additional smaller linear foci of nonspecific T2/FLAIR hyperintensity are noted in the bifrontal deep white matter. There are no areas of pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. Incidental note is made of slight caudal extension of the cerebellar tonsils below the level the foramen magnum, measuring approximate 6 mm. The right cerebellar tonsil is slightly lower than the left. There is a very minimally gentle pointed appearance of the tonsils. There is moderate crowding of structures noted at this level. The remainder of the midline structures and craniocervical junction are within normal limits. SPINE
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1. Minimal areas of probable cystic encephalomalacia within the centrum semiovale bilaterally likely related to previous insult of unknown etiology. A few additional nonenhancing nonspecific scattered linear foci of T2/FLAIR hyperintensity in the frontal lobe white matter.2. Findings suggestive of a borderline to mild Chiari one malformation. Please correlate clinically.3. Minimal spondylotic changes at C5-C6. Otherwise, unremarkable contrast enhanced MR appearance of the spine.
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Generate impression based on findings.
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Male 4 years old Reason: Fx? History: fall from bed, L elbow painVIEWS: Left elbow AP, lateral and oblique 2/1/15 (3 views) Cortical interruption along the lateral aspect of the metaphysis of the left humerus with anterior fat-pad this placement.
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Left humerus nondisplaced fracture with joint effusion.
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Generate impression based on findings.
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Female 45 years old Reason: r/o appendicitis History: lower abdominal pain and persistent retching ABDOMEN:LUNG BASES: Extensive airspace disease right lung base. There is also bronchiectasis and suggestion of bronchial impaction. tree-and-bud opacities consistent with bronchiolitis. Rule out aspiration pneumonia.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Upper normal pancreatic duct, unchanged. No parenchymal lesions.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: Right adnexal cysts presumably functional, but none are large.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality noted. Normal appendix. No fat stranding. No free or loculated fluid.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Lung findings as above consistent with infection and bronchial impaction. Rule out aspiration.No evidence of appendicitis.
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Generate impression based on findings.
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Female 7 years old Reason: concern for abd concern (abscess?) History: r/o abd abscess or necrotizing cellulitis ABDOMEN:LUNG BASES: Bibasilar opacities and pleural effusions noted. ET tube and NG tube noted.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality noted.PANCREAS: Slightly enlarged pancreas with no evidence of necrosis or a pancreatic fluid accumulation. No pancreatic pseudocyst.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Significant abdominal soft tissue right ear map with no evidence of subcutaneous emphysema or fluid collections.OTHER: Minor amount of ascites.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Please refer to abdominal paragraphBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Enlarged pancreas and soft tissue edema as well as ascites.
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Generate impression based on findings.
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Female 87 years old Reason: Rule out pelvic mass History: Vaginal bleed, pelvic pain The exam is not sensitive for detecting lesions in the solid organs are vasculature due to the lack of intravenous contrast. Given those limitations, the following observations are made:ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Mild left hydroureter without discrete obstruction site. Correlate clinically as to need for further evaluation to rule out lesion at left UVJ.RETROPERITONEUM, LYMPH NODES: Diffuse atherosclerotic disease aorta and branch vessels. No evidence of aneurysm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Osteoporosis and degenerative changes.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: Atrophic or surgically absent.BLADDER: Bladder is mildly distended with some minimal hazy mesenteric fat stranding in the region. This is of uncertain significance. Correlate for infection. There is also mild left hydroureter.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Osteoporosis and degenerative changes.OTHER: Atherosclerotic disease common no evidence of aneurysm.I
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Exam complicated by contrast extravasation as detailed in technique paragraph. Exam limitation due to lack of intravenous contrast.Unexplained dilatation of the left ureter. Some mild fat stranding around urinary bladder. Correlate for UTI and for partially obstructing urothelial lesion.
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Generate impression based on findings.
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Female 2 days old Reason: cooling, eval esophageal probe placement History: therapeutic coolingVIEW: Chest and abdomen AP (two views) 2/1/15 at 945 hours. Interval ET tube removal. Esophageal temperature probe and NG tube terminates in the stomach. UVC tip is at the right atrium. Cardiac silhouette size is normal. No focal lung opacities, effusions or pneumothorax.Disorganized, nonspecific abdominal gas pattern. No evidence of obstruction, free air, pneumatosis intestinalis or portal venous gas.
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Misplaced esophageal temperature probe.No focal lung opacities after ET tube removal.Disorganized, nonspecific abdominal gas pattern.
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Generate impression based on findings.
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Male 8 years old Reason: 8 yo with chronic constipation s/p bowel clean out - assess for stool burden History: chronic constipationVIEW: Abdomen AP (one view) 1/31/15 at 1531 hrs. Normal abdominal gas pattern with minimal fecal accumulation. No obstruction or free air.
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No obstruction or free air.
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Generate impression based on findings.
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Female 12 years old Reason: Shunt breaks/fractures, malfunction? History: HA x 5 weeks. OSH report of shunt fractureVIEWS: Shunt series: Skull AP/lateral (two views), chest AP/lateral (two views), abdomen AP/lateral (two views) 1/31/15 Intracranial portion of the VP shunt looks normal. There is a fracture of the catheter at the limit of the neck.Cardiac silhouette size is normal. No focal opacities, effusions or pneumothorax. Normal abdomen the gas pattern.
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Fracture of the catheter at the level of the soft tissues of the right sided of the neck. Findings were communicated to and acknowledged by Dr. BARRILE, ASHLEY pager number 4687 on 2/1/15 at 1016 hrs.
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Generate impression based on findings.
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NONCONTRAST: There is no evidence of intracranial hemorrhage. There are new moderate areas of hypoattenuation in the right parietal lobe, and in the left insula extending superiorly into the left corona radiata via the left putamen representing age indeterminate, probably subacute strokes; these are unchanged. There is minimal ex vacuo dilatation of the left lateral ventricle suggesting element of chronicity superimposed on subacute component in the left-sided infarct. No acute intracranial hemorrhage or mass effect. The ventricles and basal cisterns are otherwise 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 left internal carotid artery is entirely occluded from the origin to the level of the ophthalmic segment which minimally fills retrograde. There is abrupt occlusion of the left M1 segment near its origin with a tiny stump opacifying with contrast at the origin. Few left MCA branches are noted to fill, however there is asymmetric paucity of vessels in the left MCA territory as compared to the right. Both A1, anterior communicating, and left posterior communicating arteries are patent. The right posterior communicating artery is not seen and may be hypoplastic. The right vertebral artery is developmentally hypoplastic. Both vertebral arteries join to form the basilar artery. There is no intracranial aneurysm.CTA NECK: The great vessel origins are intact. The left internal carotid artery is entirely occluded from the origin to the level of the ophthalmic segment which minimally fills retrograde from collateral supply. There is minimal luminal irregularity without significant stenosis at the origin of the right carotid bulb. The vertebral arteries are widely patent. The right vertebral artery is nondominant. The thyroid gland is unremarkable. The lung apices show interlobular septal thickening and hazy attenuation of the lung parenchyma which may be related to pulmonary edema. There are minimal degenerative changes in the cervical spine.
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1.Abrupt occlusion of the left M1 segment near the origin with a tiny stump, and asymmetric paucity of vessels in the left MCA territory as compared to the right.2.Occlusion of the left internal carotid artery from the origin to the level of the left ophthalmic segment where there is minimal retrograde filling.3.Unchanged appearance of bilateral probable subacute infarcts as described above.4.No acute intracranial hemorrhage.Findings were discussed with neurology resident Dr. Naoum Issa over the telephone at 10:45 a.m. today.
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Generate impression based on findings.
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Status post fracture.VIEWS: Right ankle AP, lateral crosstable and oblique 2/1/15 at 952 hours (3 views) Cast material obscures fine bone details. Oblique/comminuted fracture of the distal fibula with minimal posterior displacement is unchanged in alignment.
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Fibular fracture unchanged in alignment.
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Generate impression based on findings.
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Female 37 years old Reason: Rule out appendicitis History: Abdominal pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: Possible noncalcified uterine lesion 5 x 4.3 cm series 2 image 121. Although no calcification, statistically likely fibroid.Adnexal cysts, likely functional.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Short segment wall thickening in a collapsed segment of terminal ileum. Please see series 2 image 90 and coronal image 76/127. There is no significant proximal dilatation. Small lymph nodes in the mesentery of the right lower quadrant. Correlate history of signs of inflammatory bowel disease.No evidence of appendicitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Short segment thickening neoterminal ileum correlate for any signs of symptoms of inflammatory bowel disease.Noncalcified rounded, uterine mass lower uterine segment. Correlate clinically. (This addition to Stat consults was discussed with Dr. Cannon pager 6112, by ROC at 12 noon.)
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Generate impression based on findings.
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Images slightly limited by patient body habitus. There is trace degenerative grade 1 anterolisthesis of L4 on L5. The lumbar spine is otherwise in normal alignment, with exaggeration of the normal lumbar lordosis. The vertebral body heights are well-maintained. There is mild scattered disk narrowing, most prominent at L4-L5. There is diffuse disk desiccation. No worrisome focal marrow signal abnormality is appreciated, although there are extensive endplate degenerative marrow changes at L5-S1 especially on the left. The distal spinal cord and conus are within normal limits with the conus terminating at the L1-L2 level. There is mild developmental narrowing of the mid to distal lumbar spinal canal due to short pedicles and slight prominence of dorsal epidural fat.At L1-L2, there is no significant disk pathology or stenosis.At L2-L3, there is mild developmental narrowing of the central spinal canal. There is right greater the left facet arthropathy and ligamentum flavum thickening.At L3-L4, there is a mild disk bulge with superimposed shallow left foraminal/far lateral disk protrusion. There is prominent bilateral facet arthropathy and ligamentum flavum thickening. Overall, there is mild to moderate central spinal canal stenosis and encroachment upon the lateral recesses. There is minimal bilateral foraminal narrowing.At L4-L5, there is uncovering of the disk with superimposed disk bulge with rightward prominence. There is moderate bilateral facet arthropathy and ligamentum flavum thickening. There is significant narrowing of both lateral recesses, with moderate to severe central spinal stenosis and bunching of the cauda equina nerve roots. There is moderate to severe right and mild-moderate left foraminal narrowing.At L5-S1, there is a large left paracentral/foraminal disk protrusion which has significant mass effect upon the thecal sac. The descending left sacral nerve roots are significantly displaced posteriorly. There is effacement of the superior aspect of the left lateral recess. There is mild bilateral facet arthropathy and ligamentum flavum thickening. There is moderate to severe left foraminal narrowing with abutment of the exiting left L5 nerve root. There is moderate central spinal canal stenosis on the left.
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1. Overall, moderate spondylotic changes most significant at L4-L5 and L5-S1 as detailed above, with moderate to severe central spinal canal stenosis at L4-L5, significant narrowing of both lateral recesses, as well as moderate-severe right foraminal narrowing at this level. Additional large left paracentral/foraminal disk protrusion at L5-S1 with moderate to severe left foraminal narrowing, moderate left-sided central spine canal stenosis, and posterior displacement of descending left sacral nerve roots.2. Minimal degenerative grade 1 anterolisthesis of L4 on L5.
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Generate impression based on findings.
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Male 2 days old Reason: are the lungs clear is there a left anterior pneumothorax History: respiratory distress, left pneumothoraxVIEW: Chest AP (one view) 2/1/15 at 444 hours. NG tube terminates in the stomach. Cardiac silhouette size is normal. Small , lineal left-sided medial pneumothorax with no effusions. Right upper lobe subsegmental atelectasis on a background of diffuse haziness.
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Small left-sided medial pneumothorax, left upper lobe subsegmental atelectasis on the bottom of diffuse haziness.
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Generate impression based on findings.
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Female 42 years old Reason: evaluate for periumbilical mass; patient has cyclic appearance of a mass and bleeding from umbilicus History: Pain and bleeding ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small ringlike lesion in the umbilicus. This is nonspecific. Given history I can't rule out a focus of endometriosis, however note that there are no findings on the peritoneal side of the abdomen. The bowel is normal. No ascites or peritoneal implants are seen.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: No significant abnormality noted. Small functional cysts.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No evidence of ascites or peritoneal implants to suggest endometriosis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Nonspecific small soft tissue density with central hypoattenuation within the umbilicus. No intraperitoneal abnormalities.
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Generate impression based on findings.
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Male 2 days old Reason: are the lung fields clear History: no lines - increasing respiratory distress; increasing O2 requirementVIEW: Chest and abdomen AP (two views) 1/31/15 at 2101 hrs. Proximal side-port of NG tube is above GE junction. The aortic arch, cardiac apex and stomach are left-sided. Cardiac silhouette size is normal. It may be a small left anterior pneumothorax on a background of diffuse lung haziness. No focal opacities or effusions.Normal, age related abdominal gas pattern. No evidence of obstruction or free air.
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Possible small left-sided pneumothorax on a background of diffuse lung haziness.
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Generate impression based on findings.
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Male 4 months old Reason: where is the PICC History: Respiratory distress. Stenosis of the larynx.VIEW: Chest AP (one view) 1/31/15 at 2235 hrs Left neck central line terminates at the confluence of both innominate veins. ET tube tip is at the carina. Cardiac silhouette size is normal. Persistent complete right lung collapse due to possible mucous plugging. Development of streaky subsegmental atelectasis of the left upper lobe and lingula. The global paucity like atelectasis noted as well.
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Multifocal opacities as described. Possible mucous plugging of the right main bronchus.Central line positioning as described
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Generate impression based on findings.
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Male 77 years old Reason: esophageal cancer on chemotherapy please assess response and compare to previous imaging History: esophageal cancer. CHEST: Some blurring due to the respiratory motion.LUNGS AND PLEURA: Index nodule left lobe series 4 image 50, 5 mm diameter. Previously 4 mm. Nodules in the right lower lobe unchanged. No new nodules. No effusions.MEDIASTINUM AND HILA: Markedly dilated esophagus unchanged. Stent in distal esophagus. And air are seen within the stent.Left thyroid lobe replaced by mass or masses, unchanged. Small nodule seen in the right lobe of the thyroid, unchanged.Scattered mediastinal lymph nodes. Reference history mediastinal lymph nodes dorsal to the esophagus at the level of the carina, series 2 image 35, 1 x 0.9 cm. Previously 1.1 x 0.7 cm.Index lymph node in the left neck lateral to the thyroid is seen on series 2 image 9 measures 1.9 x 1.1 cm. Previously 1.9 x 1 cm.Port-A-Cath tip SVC RA junction.Heavy atherosclerotic calcification coronary arteries.CHEST WALL: Port-A-Cath right chest wall.Expansile mass right lower rib consistent with metastatic focus series 3 image 104, 3.7 x 2.4 cm. Previously 2.7 x 1.6 cm.ABDOMEN: Some blurring due to respiratory motion in the upper abdomen.LIVER, BILIARY TRACT: Gallstone. No biliary dilatation. Peripheral somewhat wedge-shaped hepatic blush in the posterior segment of the right lobe unchanged probably hemangioma with more typical pattern seen on the 7/24/14 CT.SPLEEN: No significant abnormality notedPANCREAS: Atrophic. Minimal calcifications uncinate process, unchangedADRENAL GLAN. DS: No significant abnormality notedKIDNEYS, URETERS: Right renal cysts unchangedRETROPERITONEUM, LYMPH NODES: Gastrohepatic ligament lymph node series 2 image 82 1.5 x 1.1 cm. Previously 2.2 x 1.1 cm.BOWEL, MESENTERY: Esophagogastric stent unchanged in position. Percutaneous gastrostomy catheter still in place. No evidence of bowel wall thickening or dilatation.Large duodenal diverticulum descending duodenum.Nodular omentum consistent with carcinomatosis (e.g., Se 3 Im 117). No measurable discrete solid mass.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No evidence of ascites. Nodularity omentum right lower quadrant consistent with carcinomatosis. No evidence of ascites.Colonic diverticulosis.BONES, SOFT TISSUES: Degenerative changes.OTHER: Vasectomy clips
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Progression of disease with new evidence of carcinomatosis. Index lung nodules and lymph nodes as measured.Other findings unchanged including thyroid nodules, gallstone, dilated esophagus with patent stent in place.
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Generate impression based on findings.
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Female 14 years old Reason: assess lung felids History: EncephalopathyVIEW: Chest AP (one view) 2/1/15 at 344 hours. ET tube tip is above the carina. NG tube terminates in the stomach. Cardiac silhouette size is normal. Right lower lobe opacity, likely atelectasis development.
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Interval development of right lower lobe opacity, likely atelectasis.
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Generate impression based on findings.
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Female 17 years old Reason: left pleural effusion, chest tube; re eval lung fields History: chest tube dependentVIEW: Chest AP (one view) 2/1/15 at 414 hours. Left-sided chest tube again noted. Cardiac silhouette size is normal. Left retrocardiac opacity unchanged. Interval improvement in right lung base subsegmental atelectases with worsening in right-sided pleural effusion.
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Interval worsening in right-sided pleural effusion.
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Generate impression based on findings.
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Male 0 days old Reason: are the lung fields clear History: INITIAL XR - increasing respiratory distress; increasing O2 requirementVIEW: Chest and abdomen AP (two views) 2/1/15 NG tube terminates in the stomach. UVC tip is at the right atrium. UAC terminates at T7. Aortic arch, cardiac apex and stomach are left-sided. Cardiac silhouette is normal in size and shape. Diffuse left haziness consistent with TTN versus RDS. No focal lung opacities. No effusions or pneumothorax.Normal abdominal gas pattern. No obstruction or free air. No pneumatosis intestinalis.
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NG tube and umbilical lines positioning as described.Bilateral diffuse lung haziness consistent with TTN versus RDS.
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Generate impression based on findings.
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Female 11 years old Reason: intubated, plan to extubate today History: Respiratory distress.VIEW: Chest AP (one view) 2/1/15 at 428 hours. ET tube tip is at the carina. Cardiac silhouette is non-sizable. Chronic atelectasis of both lung bases are again noted. No new focal opacities, effusions or pneumothorax. Multiple skeletal deformities again noted.
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Persistent bibasilar atelectasis.
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Generate impression based on findings.
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Female 6 years old Reason: eval stool burden History: incontinence and diarrhea.VIEW: Abdomen AP (one view) 2/1/15 Normal abdominal gas pattern. No evidence of obstruction, free air or significant stool burden.
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Normal examination.
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Generate impression based on findings.
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Exam is somewhat limited due to patient motion. The lumbar spine is in normal alignment, with a normal lumbar lordosis. There is mild disk narrowing L4-L5 and moderate disk narrowing L5-S1. There is also disk desiccation at these levels, as well as at L3-L4 and along the visualized lower thoracic spine. The vertebral body and disk heights are otherwise well-maintained. There is diffuse abnormal low T1 signal throughout the visualized marrow likely into patient's known diffuse osseous metastatic disease. There is a more focal areas of hyperintensity in the anterior L3 vertebral body which corresponds to an area of sclerosis on CT, likely representing a metastasis. Additional focal areas of abnormal STIR hyperintensity is seen scattered about the lumbar vertebrae. The distal spinal cord and conus are within normal limits with the conus terminating at the upper L2 level. There is developmental narrowing of the mid to distal lumbar spinal canal due to short pedicles and prominence of dorsal epidural fat.At L3-L4, there is a minimal left distal foraminal annular fissure. There is mild developmental narrowing of the central spinal canal.At L4-L5, there is a mild disk bulge. There is mild bilateral facet arthropathy and ligamentum flavum thickening. Overall, there is mild to moderate central spinal canal stenosis and mild bilateral foraminal narrowing.At L5-S1, there is a mild diffuse posterior osteophyte disk complex with right greater than left facet arthropathy. Along with the underlying developmental narrowing, there is overall moderate spinal stenosis along with moderate-severe right and mild to moderate left foraminal narrowing. There is a slight peripheral location of the cauda equina nerve roots spanning the L5 level.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the remainder of the lumbar spine. There is partial visualization of the bladder, with abnormal soft tissue nodularity noted posteriorly in the midline and to the right. This likely corresponds to the patient's known area of metastasis.
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1. Diffuse abnormal marrow signal consistent with patient's known history of metastatic disease, with a few focal areas of abnormal signal suggesting more focal metastases. No evidence of compression deformity.2. Significant mid-to distal lumbar spinal canal developmental narrowing with superimposed lower lumbar spondylotic changes. This results in moderate central spinal stenosis at L4-L5 and L5-S1, with additional moderate-severe right foraminal narrowing at L5-S1 due to a prominent disk osteophyte.3. Partially visualized bladder nodularity, likely related to patient's known area of metastasis.
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Generate impression based on findings.
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Male 54 years old Reason: pt with met melanoma s/p 4 cycles of Ipi please asses response to therapy and compare to previous imaging History: met melanoma. CHEST:LUNGS AND PLEURA: Micronodule right upper lobe pleural-based, unchanged. No suspicious lesions.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Stable micronodule. No evidence metastatic disease.
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Generate impression based on findings.
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There is no evidence of intracranial hemorrhage, mass, or cerebral edema. There is an old left temporal and parietal lobe infarct with encephalomalacia in the left MCA territory, unchanged with mild expected location of the left lateral ventricle. There is persistent hypoattenuation probably representing mild chronic ischemia within the pons, unchanged. Minimal nonspecific periventricular and subcortical white matter hypoattenuation is felt to be unchanged. The ventricles and basal cisterns are prominent consistent with age-related volume loss. 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.
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No acute intracranial hemorrhage or mass effect. Chronic left temporoparietal infarct with encephalomalacia, with other mild chronic small vessel ischemic changes. CT is insensitive for detection of early nonhemorrhagic stroke.
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Generate impression based on findings.
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Male 64 years old Reason: history of testicular cancer s/p adjuvant chemotherapy, assess for recurrence. CHEST:LUNGS AND PLEURA: Calcific granulomata right upper lobe, unchangedMEDIASTINUM AND HILA: Calcified azygos node.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Punctate hypodensity lateral segment left lobe too small to characterize likely cyst, unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Punctate hypodensities left lower pole too small to characterize likely cyst, unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Granulomatous disease right lung. No evidence of metastatic disease.
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Generate impression based on findings.
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Male 64 years old; Reason: 64 yo males s/p APR with colostomy and left nephrectomy about 2 months ago for rectal cancer and renal cell carcinoma. Pt with continued abdominal pain and episode of rectal bleeding. Evaluate for tumor recurrence History: Abdominal Pain ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: There is one simple cyst in the liver and one small nonspecific hypodensity, both of which are stable. No new lesions.Cholelithiasis, no evidence of biliary dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post left nephrectomy.Right kidney is normal.RETROPERITONEUM, LYMPH NODES: Previously seen index precaval node is no longer present may have been resected.There is a new index retrocaval node which is slightly larger seen on series 3 image 50 measuring 1.2 x 0.9 cm. On the 10/16 exam it measured 0.8 x 0.8 cm on series 3 image 58.Note is made of a duplicated infrarenal inferior vena cava. Atherosclerosis, no evidence of aneurysm.BOWEL, MESENTERY: Left hemicolectomy with colostomy seen in left abdomen. No evidence of dilated bowel in the upper abdomen. No free or loculated intraperitoneal fluid.BONES, SOFT TISSUES: Colostomy left anterior abdominal wall.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: APR and left hemicolectomy. Extensive fluid in the presacral space consistent with postoperative change.Oral contrast the small bowel it is not reached the right colon. There is dilated small bowel in the pelvis (up to 3.8c cm, coronal images 56) and in the rectal fossa with a transition zone seen in the left lower quadrant, series 2 image 83, concerning for adhesions with early or incomplete small bowel obstruction.No evidence of ascites or carcinomatosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.Postsurgical changes right rectal fossa and pre-sacral space.2.Early or incomplete small bowel obstruction probably due to adhesions in the pelvis. Correlate for obstructive symptoms. 3.New index retrocaval lymph node provided slightly increased in size compared to the prior exam.Findings discussed by ROC Dr. Erick Blaschke with Dr. Cannon, pager 6112, 12:12pm.
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Generate impression based on findings.
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The thoracic spine is in normal alignment, with slight straightening of the normal thoracic kyphosis. 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. There is no pathological enhancement.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine. There are small bilateral nerve root sleeve cysts at C7-T1 bilaterally, and less prominently scattered along the upper thoracic foramina.Counting survey images demonstrate mild cervical spondylotic changes with probable developmental narrowing. There is mild opacity dependently within the lungs, likely related to atelectasis.LUMBAR SPINE
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1. No MR evidence of metastatic disease to the thoracic or lumbar spine.2. Minimal lower lumbar spondylotic changes with up to moderate right and mild to moderate left foraminal narrowing at L5-S1.
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Generate impression based on findings.
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Please note that the exam was converted to a protocol for facial soft tissues rather than specifically for evaluation for encephalocele. 3-D T2 weighted images and other thinner section high-resolution imaging through the area of interest is therefore not available.Within the limitations, there is extensive pansinus opacification with residual areas of aeration in the maxillary sinuses centrally and minimally along the medial right sphenoid sinus. There are also foci of probable low signal air scattered in the posterior ethmoid air cells bilaterally. The ostiomeatal unit is completely ossified on the right and perhaps near completely opacified on the left. There are lobulated areas of STIR hyperintensity with enhancement within the maxillary sinuses as well as opacifying portions of the nasal cavity which may represent focal polyps. There are also areas of intrinsic T1 hyperintensity noted within the maxillary sinuses bilaterally and left sphenoid sinus, likely representing inspissated secretions.The area of questioned previous dehiscence along the left ethmoid roof is not optimally evaluated on this exam due to relatively thick section imaging. It is suggested on series 7 image 16 correlating with the area bony defect, with relative decreased T2 hypointense cortical signal. There is also corresponding attenuation of T1 hypointense signal in this location, although this is much more subtle. This is located just anterior to the level of the anterior margin of the crista galli. At this location as well as adjacent levels along the ethmoid roof, there is no definite evidence of a focal encephalocele or meningocele. The inferior frontal lobes appear symmetric along the floor of the anterior cranial fossa. There is no adjacent dural thickening and enhancement.
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1. Suboptimal exam secondary to incorrect protocol with absence of thinner section imaging through the area of concern. However, area of focal thinning/absence of medial left ethmoid roof just anterior to the crista galli suggested with no definite MR evidence of encephalocele or meningocele. No adjacent dural abnormalities, with symmetric appearance of anterior/inferior frontal lobes Additional dedicated thinner section ethmoid roof imaging for further encephalocele evaluation could be obtained as clinically indicated, at no additional charge.2. Extensive pansinus opacification with areas of lobulated enhancement noted in the nasal cavities and sinuses, which be related to polyposis.
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Generate impression based on findings.
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There are unchanged posttreatment findings without evidence of recurrent mass or significant cervical lymphadenopathy. There are unchanged reference left level Ia and Ib lymph nodes measuring 6 mm, and 4 mm respectively. The left submandibular gland is absent. The thyroid and the remaining major salivary glands are unremarkable. There is air in the right parotid duct which has likely refluxed secondary to "puffed cheek" maneuver during CT scanning. There is a stent in the left internal carotid artery with limited evaluation. There is significant narrowing of the right internal carotid artery with calcified and noncalcified plaque without significant change. The airways are patent. There is uncovertebral hypertrophy and facet arthropathy at C3-4 and C4-5 leading to predominantly right-sided neural foraminal stenoses. There are areas of disk space narrowing at C3-4 and C4-5 without significant change. There is minimal retrolisthesis of C3 on C4 and C4 on C5 without change. The imaged intracranial structures are unremarkable. There are bilateral maxillary sinus polyps versus mucous retention cysts. There is moderate left mastoid air cell opacification as noted before. There is a persistent linear opacity in the left lung apex and pleural based soft tissue nodular opacities, partly imaged. Please refer to dedicated accompanying CT chest report for further details.
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1.No locoregional tumor recurrence or pathologic cervical enlargement.2.Significant narrowing of the right internal carotid artery with calcified and noncalcified plaque, similar to prior study.3.Left upper pleural nodularity, incompletely evaluated. Please refer to dedicated accompanying CT chest report for further details.
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Generate impression based on findings.
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Male 70 years old; Reason: hematuria, evidence of renal disease? tumor? History: hematuria. ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Two small hypointense nonenhancing lesions in the liver consistent with cysts.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: 2.4 x 1.8 cm right adrenal nodule series 6 image 40 measures near water density contrast consistent with an adenoma.KIDNEYS, URETERS: IV contrast scans show no evidence of nephrolithiasis. Postcontrast scans show no focal lesions and no evidence of hydronephrosis, hydroureter or perinephric fat stranding or fluid.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Surgical clips subcutaneous tissues left lateral abdominal and pelvic wall, series 6 image 69 -- 87. Correlate with surgical historyOTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: Status post prostatectomy and lymph node dissection.BLADDER: No significant abnormality noted.LYMPH NODES: Resection clips. Small nonpathologic sized nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Nonspecific punctate sclerotic focus lateral aspect L1 vertebral body.OTHER: Penile prosthesis noted.
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1.No findings to explain hematuria.2.Postsurgical changes.3.Right adrenal nodule consistent with adenoma.4.Solitary, small, nonspecific sclerotic focus L1 vertebral body.
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Generate impression based on findings.
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Female 46 years old Reason: 46-year-old female with rectal pain and drainage with sensation of an abscess forming. Rule out rectal abscess History: anal pain, drainage and recurrent abscess formation ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Total colectomy. No evidence of ascites or carcinomatosis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: No significant abnormality noted. Essure coils noted in distribution of both tubes.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Colectomy and J-pouch. No bowel wall thickening or dilatation. Minimal soft tissue density in tract is seen in the perianal area greater on the right than on the left, smaller than on the prior exam. Tract is best seen on series 5 image 153 measuring 1.6-cm in length and 0.9-cm in thickness.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Decrease in size of perianal collection in tract right greater than left. No evidence of abscess.Expected postsurgical changes.
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Generate impression based on findings.
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There has been a mixed response to interval therapy with new lesions, as well as both increased size and decreased size of previous lesions in the neck. There has been interval increased size of a now 28 x 24 mm mass on series 7 image 34 (previously measuring 17 x 11 mm) in the left level 2 chain with mass effect medially displacing the carotid and internal jugular vessels, with effaced fat plane between the mass and the sternocleidomastoid posteriorly. There is a new peripherally enhancing centered centrally necrotic lymph node measuring 8 x 4 mm in the left level IIb chain on series 7 image 32. There are few other smaller scattered nonenlarged lymph nodes as well which appear to be mildly prominent and/or new.The right parotid gland lesion seen previously is much smaller measuring 4 x 3 mm today (series 7 image 26) compared to 11 x 13 mm previously. The left level IIb lymph node has a peripheral rim of enhancement with mild central hypoattenuation measuring 10 x 7 mm on series 7 image 28, previously measuring 13 x 13 mm.The left submandibular gland is absent. There is a hyper enhancing prominent left sublingual gland which appears to have hypertrophied, possibly due to absence of the left submandibular gland, or possibly posttreatment change. This appears similar to prior exam.There are postoperative findings related to near complete right maxillary resection with distorted regional anatomy including the right inferior orbital wall and more rounded right inferior rectus muscle anatomy with downward sagging of the orbital contents. The right-sided ethmoid air cell complex and turbinates were included in the resection. There is nonspecific soft tissue along the residual lateral wall of the right maxillary sinus which is unchanged. The residual right maxillary sinus wall remains unchanged. There is nonspecific soft tissue along the surgical bed in the expected location of the pterygopalatine fossa, but this appears similar and is likely postoperative.The appearance of the vessels in the neck are unchanged with marked narrowing of the left internal jugular vein at the level of the larger left level II mass described above. The left cervical vessels are displaced anteriorly. The airways are patent. The osseous structures are unchanged.
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1. Mixed response to interval therapy with new pathologic appearing lymph nodes, as well as interval increased and decreased size of previous pathologic lymph nodes in the neck as described above.2. Postoperative changes involving the right maxillary sinus, without definite recurrent mass.
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Generate impression based on findings.
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Male 60 years old; Reason: 60M s/p open ureteral reimplant now with concern for evisceration History: evisceration Exam is not sensitive for detecting lesions in the solid organs of vasculature due to the lack of IV contrast and in the GI tract into the lack of oral contrast. Given nodes limitation the following observations are made:ABDOMEN:LUNGS BASES: New bibasilar effusions and extensive consolidation or atelectasis. Multifocal patchy airspace disease right middle lobe. Correlate to rule out aspiration or pneumonia.LIVER, BILIARY TRACT: Cholecystectomy clips.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left nephroureterostomy catheter.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification distal aorta. No evidence of aneurysm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes lumbar spine. Surgical hardware.Surgical changes anterior abdominal wall. Staple line. Small bubbles of gas. Small incisional hernia containing omentum and non-obstructive small bowel loop.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: Surgically absent.BLADDER: Status post cystectomy. Foley catheter in the diversion loop.LYMPH NODES: Lymph node dissection. Small nonpathologic sized nodes.BOWEL, MESENTERY: Fluid collection along left pelvic sidewall coronal image 70 measuring 7 x 4.3cm. may represent postsurgical lymphocele, seroma, urinoma or hematoma.J-P drain pelvis. Fat stranding and minuscule amount of free fluid.BONES, SOFT TISSUES: Staple line. Small bubbles of gas. Small incisional hernia containing omentum and nonobstructive small bowel loop.Minimal anasarca.OTHER: No significant abnormality noted.
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1.Small nonobstructive incisional hernia. Expected postsurgical changes.2.Air space disease right middle lobe and both lower lobes. Rule out pneumonia. 3.Fluid collection left pelvic sidewall as described above.
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Generate impression based on findings.
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41 years, Male. Reason: ? ileus History: Distension, no flatus or BM POD#6 Generalized ileus. No obvious intramural air or free air. Vertical and transverse staple lines. Suture lines right lower quadrant.No visible stool.
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Mild generalized ileus.
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Generate impression based on findings.
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72 years, Female. Reason: Dobbhoff placement History: same Dobbhoff tube as been advanced. The tip is overlies the pyloric area.Remainder of the visualized structures are unchanged.
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Dobbhoff tube advanced with tip now overlying the pyloric area.
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Generate impression based on findings.
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64 years, Male. Reason: 64 yo m with abdominal distension, eval for ileus History: as above Dialysis catheter overlies pelvis. Right-sided iliac catheter tip in the distribution of right common iliac vasculature.Multiple dilated loops of small bowel without a discrete transition zone most consistent with a generalized ileus. Given limitations supine view no obvious intramural or free air. Moderate stool burdened primarily in the rectum.Lung bases clear. Catheters noted. Cardiomegaly.
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Generalized ileus.
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Generate impression based on findings.
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46-year-old female with right hip pain, evaluate for FAI MEASUREMENTS: CAM location : Right femoral head-neck junction.Alpha angle : Approximately 69 degreesCoronal center-edge angle : 20 degreesSagittal center-edge angle : 58 degreesFemoral neck-shaft angle : 136 degreesAcetabular version (1 o’clock) : 19 degreesAcetabular version (2 o’clock) : 20 degreesAcetabular version (3 o’clock) : 21 degreesFemoral version angle (+anteverted, -retroverted) : +12 degreesMcKibbin index : 33 degrees AIIS width : 14.2 mmDistal base of AIIS to acetabular rim : 5.3 mm
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1. Findings consistent with again CAM deformity and femoral acetabular impingement including subchondral cysts and prominence of the femoral head-neck junction.2. Measurements provided above.
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Generate impression based on findings.
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26 year-old female with right hip pain, assess for FAI MEASUREMENTS: CAM location : Minimal CAM deformity at the femoral head neck junction. Alpha angle : 61 degreesCoronal center-edge angle : 39 degreesSagittal center-edge angle : 69 degreesFemoral neck-shaft angle : 130 degreesAcetabular version (1 o’clock) : 3 degreesAcetabular version (2 o’clock) : 4 degreesAcetabular version (3 o’clock) : 15 degreesFemoral version angle (+anteverted, -retroverted) : 23 degreesMcKibbin index : 38 degreesAIIS width : 8 mmDistal base of AIIS to acetabular rim : 1.7 mm
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Minimal CAM deformity with acetabular and femoral version measurements, as described above.
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Generate impression based on findings.
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left thalamic and basal ganglia ICH follow up. Left basal ganglia and thalamic ICH with mass effects and IVH, no change since prior study.Midline shift to the right side was measured about 9mm and the maximum size of the ICH is about 46mm x 59mm. No significant interval change of minimal acute SAH on the right hemisphere since prior scan.No evidence of new hemorrhagic or ischemic lesion on this scan.The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear.
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No change of IVH, left basal ganglia and thalamic ICH with mass effects with midline shift toward right side since prior scan.No change of right hemispheric SAH since prior scan.
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Generate impression based on findings.
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44-year-old male with history of thymic cancer with new right upper quadrant and right lower quadrant abdominal pain, jaundice, and left lung mass on admission chest radiograph. Evaluate for liver and lung metastatic disease. CHEST:LUNGS AND PLEURA: Multiple bilateral pulmonary nodules and masses, significantly greater on the left compared to the right. Reference left lower lobe mass measures 5.8 x 4.8 cm (series 5, image 41). There are additional multiple large pleural based masses on the left. No pleural effusions or pneumothorax.Previously noted right lower lobe consolidation has resolved.MEDIASTINUM AND HILA: The superior and anterior mediastinum is replaced with heterogeneous soft tissue measuring approximately 6.7 x 4.1 cm (series 3, image 27) with likely calcifications; findings most likely recurrent versus residual tumor.Left hilar lymph node measures 1.9 x 1.8 cm (series 3, image 40).CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: The liver measures approximately 30 cm in the cranial caudal dimension. Multiple masses ranging from millimeters to 9 cm that nearly replace the entire liver parenchyma. Reference right hepatic lobe lesion measures 9.1 x 8.9 cm. No biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: The right adrenal gland is not identified due to mass effect from aforementioned hepatomegaly. Subcentimeter nodularity of the left adrenal gland noted.KIDNEYS, URETERS: Hypoattenuating focus in the left kidney with Hounsfield units of 58 and measuring approximately 2.7 x 2.2 cm (series 3, image 91). RETROPERITONEUM, LYMPH NODES: Mildly enlarged retroperitoneal lymph nodes.BOWEL, MESENTERY: Small amount of abdominal and pelvic ascites.BONES, SOFT TISSUES: Mixed lytic sclerotic foci within the left iliac wing (series 3, images 143 through 159) with evidence of cortical erosion, highly concerning for metastatic disease.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Small amount of abdominal and pelvic ascites.BONES, SOFT TISSUES: As above.OTHER: No significant abnormality noted
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1.Findings consistent with diffuse hepatic metastatic disease without biliary obstruction.2.Findings consistent with pulmonary metastatic disease.3.Soft tissue attenuation in the anterior mediastinum highly suspicious for disease recurrence.4.Hypoattenuating focus in left kidney. Differential considerations include high-density cyst versus metastatic disease.5.Left iliac wing with cortical erosion highly concerning for metastatic disease.6.Small amount of abdominal and pelvic ascites.
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Generate impression based on findings.
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Reason: Eval for position of chest tube and pneumothorax History: s/p MVA with persistent pneumothorax LUNGS AND PLEURA: Moderate to large left pneumothorax. Left chest tube appears to perforate the left upper lobe with tip in the medial apex. Small amount of loculated left pleural fluid.10 x 11 mm right upper lobe pulmonary nodule with central calcification. A couple additional pulmonary nodules in the right upper lobe. Right basilar scarring/atelectasis.MEDIASTINUM AND HILA: Coarse calcification in the right thyroid gland. Calcified right hilar lymph nodes. No significant mediastinal or hilar lymphadenopathy. Heart size is normal with no pericardial effusion. No visible coronary artery calcifications.CHEST WALL: Small amount of left chest wall subcutaneous emphysema.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted.
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1.Moderate to large left pneumothorax. Left chest tube appears to perforate the left upper lobe with tip in the apex. 2.Small loculated left pleural effusion.3.A few right upper lobe pulmonary nodules. The largest 11 mm nodule is partially calcified consistent with a granuloma.
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Generate impression based on findings.
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57-year-old male with prostate cancer, known brain metastases; presenting with worsening headache and vomiting. Hypodensity in the right temporal lobe, consistent with known metastatic lesion and surrounding edema, which appears to have mildly increased in size, now measuring 34 x 35 mm, previously 28 x 31 mm. Mild interval increase in the degree of regional mass effect and sulcal effacement. There is no significant midline shift. There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable.
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Redemonstration of right temporal lobe hypoattenuating metastatic lesion, with mild interval increase in the degree of associated edema, which may be in part related to posttreatment effect. There is mild regional mass-effect, but no significant midline shift, evidence of herniation, hydrocephalus, or acute hemorrhage.
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Generate impression based on findings.
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Chest pain.VIEWS: Chest PA/lateral (two views) 2/2/15 at 049 hours. Cardiac silhouette size is normal. No focal lung opacities, effusions or pneumothorax. Visualized osseous structures are normal.
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Normal examination.
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