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Generate impression based on findings.
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64 year old female with dysphagia and history of paraesophageal hernia s/p EGD and dilation in April 2014. Scout radiograph of the chest showed no mediastinal widening, abnormal pulmonary opacities, or pleural effusions.Double contrast evaluation of the hypopharynx and neck did not demonstrate a Zenker's diverticulum,esophageal web, or cricopharyngeal bar (series 14 and 15). Double contrast evaluation of the esophagus and gastric cardia/fundus revealed no mucosal abnormalities. However, a large sliding hiatal hernia was identified, with the proximal 2/3 of the stomach located within the thoracic cavity. This hernia measured 13.1 x 7.4 cm and contained a large paraesophageal component. Volvulus of the stomach was noted without evidence of obstruction. Duodenal diverticulum was incidentally identified, measuring 1.4 x 1.1 cm.During the exam, spontaneous gastroesophageal reflux was observed to the level of the thoracic inlet.Fluoroscopic evaluation of esophageal peristalsis demonstrated a normal primary peristaltic wave.TOTAL FLUOROSCOPY TIME: 5:44 mm:ss
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1.Large sliding hiatal hernia with paraesophageal component as described above. Volvulus of the intrathoracic stomach was identified without evidence of obstruction.2.Spontaneous GE reflux to the level of the thoracic inlet.3.Small duodenal diverticulum.
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Generate impression based on findings.
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22 years, Female. Reason: identify location of Sitzmarker History: constipation 22 Sitz markers are distributed mostly throughout the colon. Nonobstructive bowel gas pattern.
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22 Sitz markers are distributed mostly throughout the colon.
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Generate impression based on findings.
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status post ileocecectomy, evaluate NG tube NG tube in the gastric body. Bowel gas pattern consistent with a postoperative ileus. Midline skin stables. Basilar atelectasis / consolidation.
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NG tube in the gastric body.
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Generate impression based on findings.
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48 year old male with history of greater tuberosity fracture. There is flattening of the posterolateral aspect of the humeral head indicating a Hill-Sachs deformity. Anterior to this defect is a comminuted fracture of the aspect the greater tuberosity. The fracture plane measures approximately 3 cm in the oblique coronal plane as measured on the transverse images. There is mild superomedial displacement of a couple of fracture fragments, perhaps secondary to retraction from the rotor cuff, but otherwise alignment is anatomic. The lesser tuberosity and surgical neck are intact.There is focal blunting and sclerosis of the glenoid at the 3 o'clock position which may be secondary to prior trauma, but we see no discrete fracture to suggest a bony Bankart lesion. There is no evidence of intra-articular loose bodies or significant joint effusion. There is no frank atrophy of the rotator cuff muscles, but evaluation of the rotator cuff is limited on CT and would be better evaluated on MRI.
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Greater tuberosity fracture and Hill-Sachs deformity as above.
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Generate impression based on findings.
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39-year-old female with history of ORIF. Hardware components of a side plate and screw device are seen affixing an oblique fracture of the middle phalanx in anatomic alignment. There is no evidence of hardware complication. Callus formation indicates early healing.
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Orthopedic fixation of healing phalangeal fracture as above.
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Generate impression based on findings.
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38-year-old male with back pain status post fall. Eight views of the cervical spine show no fracture or other specific finding to account for the patient's pain.Three views of the thoracic spine show tiny osteophytes indicating minimal osteoarthritis without fracture or malalignment.Five views of the lumbar spine show a small hypoplastic rib at L1. Vertebral body heights are preserved without fracture, and disc spaces are within normal limits. A calcific density measuring just under 2 cm projecting over the pelvis on the right may represent a peculiar vascular calcification and/or a calcified lymph node.
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No fracture or other specific findings to account for the patient's pain.
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Generate impression based on findings.
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81 year old female with history of hip prothesis. The bones are demineralized suggesting osteopenia. Hardware components of a right hip bipolar hemiarthroplasty device are situated in near anatomic alignment without radiographic evidence of hardware complication. Again seen are fractures involving the proximal femur at the level of the lesser trochanter as well as a medially displaced lesser trochanter fracture fragment with a small amount of heterotopic ossification between it and the adjacent femur. The fracture lines are slightly less distinct indicating interval healing.
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Right hip hemiarthroplasty and healing proximal femur fractures as above.
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Generate impression based on findings.
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65 year old female with history of low back pain. Lumbar Spine: Severe degenerative disc disease affects L4-5 and L5-S1. Moderate degenerative disc disease affects L2-3. There is moderate facet joint osteoarthritis particularly at the lower lumbar spine. Vertebral body heights are well-maintained. Alignment is anatomic. There is a calcified uterine fibroid. Multiple surgical clips project over the upper abdomen. Scattered arterial calcifications are present. Ribs: We see no evidence of displaced rib fracture or masses. There are mild degenerative arthritic changes affecting the thoracic spine. Surgical clips project over the upper abdomen.
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Degenerative arthritic changes of the spine without discrete masses.
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Generate impression based on findings.
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59 years, Male. Reason: 59M s/p complete hepatectomy with DHT now advanced. Imaging for DHT placement. History: DHT placement Dobhoff tube coiled within the stomach. Nonobstructive bowel gas pattern. Multiple skin staples. IVC filter. Basilar opacity / effusions.
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Dobhoff tube coiled within the stomach.
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Generate impression based on findings.
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Reason: evaluate ILD History: cough sob fibrosis LUNGS AND PLEURA: Bilateral basal predominant linear interstitial abnormality with mild traction bronchiectasis and minimal architectural distortion. No evidence of significant nodularity, pleural effusion, ground glass opacity, or honeycombing. No significant air trapping on expiratory phase imaging.Punctate calcified granuloma on the right. Linear scarring or atelectasis in the superior aspect of the right lower lobe.MEDIASTINUM AND HILA: Scattered small subcentimeter nodes. Moderate coronary calcification.CHEST WALL: Healed rib fractures on the left.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted.
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Bilateral basal predominant linear interstitial abnormality with mild traction bronchiectasis and minimal architectural distortion. No evidence of significant nodularity, pleural effusion, ground glass opacity, or honeycombing. The findings may be seen with UIP but could also be the sequelae of chronic aspirate or remote infection.
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Generate impression based on findings.
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Infertility Scout AP film of the pelvis was normal. Opacification of the uterine cavity revealed a normally oriented uterine cavity without mucosal irregularity or filling defects in the uterine cavity. Both tubes were freely opacified. There was free spillage from the left fallopian tube and probably from the right fallopian tube.TOTAL FLUOROSCOPY TIME: 2 minutes 56 seconds
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Normal uterine cavity with patent left and probably patent right fallopian tubes.
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Generate impression based on findings.
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53-year-old male with metastatic prostate cancer. Evaluate for metastases. CHEST:LUNGS AND PLEURA: Scattered micronodules, largest of which is in the right middle lobe (series 4 , image 62) measuring 4 mm. most likely these are postinflammatory, however without old examinations for comparison, the significance of these cannot be ascertained with certainty. No larger nodules or evidence of airspace disease is seen. No pleural disease.,MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Scattered sclerotic foci seen in the thoracic vertebral bodies (posterior T3 -- sagittal image 76) (anterior T6 -- series 3, image 41). These are suspicious for metastatic foci. Nuclear medicine scintigraphy is more sensitive indicator of extent of skeletal disease.ABDOMEN: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: Enlarged prostate without other abnormality.BLADDER: Air in the bladder, presumably from prior instrumentation. No other significant abnormality is seen. significant abnormality notedLYMPH NODES: Mildly prominent but predominantly subcentimeter scattered lymph nodes are seen about the left common iliac and bilateral external iliac chains. Some of these achieve slightly larger size and a reference measurement is seen in left external iliac lymph node (1.6 x 1.4 cm). Largest right pelvic lymph node (series 3, image 154) measures 1.3 x 0.9 cm.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Scattered sclerotic foci are seen in the right pubic symphysis, right acetabulum/ischium, and in the bilateral iliac bones most consistent with metastatic disease. Nuclear medicine scintigraphy is a more accurate indicator of extent of metastatic disease.OTHER: No significant abnormality noted
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1. Scattered sclerotic foci indicative of metastatic bone disease. Nuclear medicine scintigraphy is a more accurate indicator of extent and activity of skeletal metastatic disease. 2. Mildly prominent iliac lymph nodes bilaterally, but only one lymph node larger than 1 cm diameter as referenced above. 3. Scattered pulmonary parenchymal micronodules, most often these are postinflammatory, but without prior examinations for comparison, definitive characterization is not possible.
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Generate impression based on findings.
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Male 67 years old; Reason: 67M with amyloidosis c/b ESRD on HD and intestinal involvement requiring TPN, has nausea at baseline, EGD showing residual food bezoar, ?delayed gastric emptying Visually there was persistent abnormal retention of radiotracer with no significant gastric emptying noted. Using anterior and posterior geometric means, residual gastric activity at the following postprandial intervals was calculated as follows:30 mins: 78 % of peak activity (normal >70 %)1 hour: 76.6 % of peak activity (normal 30-90 %) 2 hours: 81.6 % of peak activity (normal <60 %) 4 hours: 81.3 % of peak activity (normal <10 %)
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Findings consistent with marked gastroparesis.
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Generate impression based on findings.
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Female 70 years old; Reason: HX of celiac disease with acute abd pain History: PAin ABDOMEN:LUNG BASES: Significant emphysematous changes of the visualized lungs.Coronary valvular calcifications.LIVER, BILIARY TRACT: Subcentimeter hypodensity in the posterior right hepatic lobe is too small to adequately characterize but likely a small cyst or hemangioma. Mild intra-and extrahepatic biliary dilatation.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: Mildly calcified and tortuous abdominal aorta and its branches. Retroaortic left renal vein.BOWEL, MESENTERY: Majority of oral contrast is seen within the esophagus and stomach..BONES, SOFT TISSUES: No significant abnormality noted..OTHER: No significant abnormality noted..PELVIS:UTERUS, ADNEXA: No significant abnormality noted..BLADDER: No significant abnormality noted..LYMPH NODES: No significant abnormality noted..BOWEL, MESENTERY: No significant abnormality noted..BONES, SOFT TISSUES: Left femoral screw with associated streak artifact. Nonspecific perineal induration (3:150) at the level of the labial folds.OTHER: No significant abnormality noted..
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Mild intra-and extrahepatic biliary dilatation likely secondary to prior cholecystectomy, but correlate with surgical history. No obvious radiodense filling defects.No CT evidence of acute abdominal or pelvic pathology.Severe partially visualized emphysematous changes.
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Generate impression based on findings.
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Status post fallVIEWS: Left forearm and left and AP and lateral and left wrist AP, lateral and oblique 2/2/15 (7 view/s) There is a greenstick fracture of the distal metaphyses of the left radius. Alignment is anatomic.
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Left distal radius fracture as described.
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Generate impression based on findings.
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Ms. Phillips is a 45 year old female with a personal history of left breast lumpectomy in 2004 for LCIS. No current breast related complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. A linear marker was placed on the scar overlying the left breast. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram.
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Generate impression based on findings.
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50 year-old female with increased pain and swelling following a fall. Three views of the right hand are provided. Evaluation is limited by inability to optimally position the patient. Given this limitation, we see no fracture.
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No fracture evident.
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Generate impression based on findings.
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40 year-old female with history of lupus, shoulder pain. Evaluate for avascular necrosis. Three views of the left shoulder show a 4-mm triangular sclerotic focus along the superomedial humeral head which could conceivably represent a very small area of chronic avascular necrosis, though was also present on CT chest examinations dating back to 2002. We seen no subchondral fracture or articular surface collapse.Three views of the right shoulder appear normal without evidence of avascular necrosis or other findings to account for the patient's pain.
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1. 4-mm sclerotic focus along the left superomedial humeral head could conceivably represent a very small area of chronic avascular necrosis, though was also present on CT chest examinations dating back to 2002. If further imaging evaluation is clinically warranted, MRI may be considered.2. Normal right shoulder.
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Generate impression based on findings.
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Intermittent testicular torsion with scrotal fixation on 01/27. Pain and swelling with bleeding on left. RIGHT TESTIS: Normal in echogenicity. Measures 1.9 x 4.5 x 2.1 cm.LEFT TESTIS: Normal in echogenicity. Measures 2.5 x 4.1 x 3.3 cm.RIGHT EPIDIDYMIS: Normal in appearance.LEFT EPIDIDYMIS: Could not be visualized.OTHER: A complex fluid collection measuring approximately 4 0.5 x 4.5 x 5.2 cm is present on the left. The left skin is thickened.DOPPLER
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Large left hematocele. No evidence of torsion.
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Generate impression based on findings.
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33-year-old female with wrist pain. Three views of the right wrist show a small bony excrescence projecting from the radial styloid which is nonspecific and could represent a small exostosis or old trauma. The rest of the wrist is unremarkable and we see no soft tissue mass.Three views of the left wrist show undulating soft tissue opacity along the lateral aspect of the distal radial diaphysis of uncertain clinical significance. This could represent soft tissue swelling from recent trauma or even an anomalous muscle, however we cannot exclude the possibility of a soft tissue tumor.
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1. Small bony excrescence projecting from the radial styloid is nonspecific and could represent a small exostosis. 2. Undulating soft tissue opacity along the lateral aspect of the distal radial diaphysis is of uncertain clinical significance. This could represent soft tissue swelling from recent trauma or even an anomalous muscle, however we cannot exclude the possibility of a soft tissue tumor. This could be further evaluated with MRI as clinically warranted.
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Generate impression based on findings.
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History of metastatic breast cancer, currently with CSF leak from Ommaya; evaluate for signs of increased intracranial pressure. There are postoperative findings related to right cerebellar hemisphere mass resection. There is no evidence of acute intracranial hemorrhage. There are a few hypoattenuating foci are present in the right insula, right temporal lobe, and the right frontal subcortical white matter. An area of hypoattenuation in the left paracentral lobule corresponds to the area of restricted diffusion and T2 hyperintensity on the recent MRI. There is no midline shift or herniation. There is a right transfrontal ventriculostomy catheter that terminates near the right foramen of Monro. There is mild hypoattenuation surrounding the catheter, which may represent edema. The ventricles and basal cisterns are unchanged in size and configuration. The imaged paranasal sinuses and mastoid air cells are clear. The extracranial soft tissues are unremarkable.
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1. A few foci of hypoattenuation in the brain that correspond to signal abnormalities on the recent MRI may represent metastases. However, evaluation for intracranial metastases is limited on non-contrast CT.2. A hypoattenuating focus in the right paracentral lobule may represent an evolving subacute infarct with hemorrhagic transformation or midline shift. However, non-contrast CT is insensitive for the detection of non-hemorrhagic acute infarct.3. No evidence of hydrocephalus in the shunted ventricular system.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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Right breast cancer staging..IMAGES: Submitted for interpretation are soft copy FDG PET/CT images from the skull base to the thighs. (The nonenhanced CT images were obtained solely for purposes of completing the PET scan, are not of diagnostic quality and are thus not interpreted or used to diagnose disease independently of the PET images.) Today's CT portion grossly demonstrates an approximately 2 cm right breast mass in the subcutaneous tissues. Several enlarged right axillary lymph nodes are present. Scarlike lung opacities are seen in the right upper lobe and both apices.Today's PET examination demonstrates a markedly hypermetabolic right breast mass (SUV max = 13.4), compatible with the patient's diagnosis of breast cancer.Multiple significantly hypermetabolic right axillary lymph nodes (SUV max = 6.7) are compatible with regional lymph node metastases.No additional suspicious FDG avid lesion to indicate metastatic disease elsewhere. Linear mildly hypermetabolic focus in the posterior soft tissues/ligament between L2 and L3 spinous processes is consistent with inflammation.
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1.Markedly hypermetabolic right breast mass, compatible with breast cancer.2.Multiple hypermetabolic right axillary lymph nodes metastases.3.No FDG avid metastatic disease identified elsewhere.
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Generate impression based on findings.
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87-year-old male with weight loss, abdominal pain, failure to thrive, abnormal chest x-ray. CHEST:LUNGS AND PLEURA: Extensive underlying emphysematous changes diffusely. Total collapse of the left lower lobe with dilated common mucus filled bronchi seen diffusely. Mucous is seen filling with air patent into the left mainstem bronchus with fluid levels, indicating patency. These are changes most consistent with pneumonia and aspiration. No surrounding or intrinsic mass is seen, however this should be followed to clearing a small endoluminal masses can be missed. Elsewhere in the left lung particularly in expanded lingula, tree in bud opacities are seen indicative of bronchiolitis and inflammatory disease.No other abnormalities are seen.MEDIASTINUM AND HILA: No adenopathy. Coronary artery calcifications two a mild degree is seen. No pericardial or pleural effusions or other disease seen.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Small spleen without 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: Foley catheter. Large amount of air in bladder, which may relate to recent instrumentation but large amount of air and the unusual appearance of the air raises question of secondary process. Extensive amount of air has fingerlike projections into the wall of the bladder and superiorly with loculations that may lie within or outside of the bladder itself (see series 3, images 155 through 148 and sagittal images 71 through 76).. Mottled air bubbles are seen in what may be the bladder wall or within urine within dependent bladder (series 3, image 164). Bladder wall is markedly thickened. Explanation for these findings remains uncertain and may reflect chronic cystitis perhaps from chronic outlet obstruction with diverticular changes, complicated by the presence of intraluminal air. Uhnlikely to represent emphysematous cystitis changes as the air is not seen dissecting in the wall, but clinical correlation for infectious cystitis would be recommended..LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1. Left lower lobe consolidation with volume loss and bronchiectasis consistent with pneumonia. No obstructing mass seen, and most likely relates to aspiration. See above. 2. Bladder wall thickening with extensive air in bladder. Configuration of air extension into the wall in fingerlike projections is of uncertain etiology. this may relate to chronic numerous bladder diverticulae filling with air and unlikely to represent emphysematous cystitis, but correlation for urinary tract infection could confirm this.
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Generate impression based on findings.
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History of fracture.VIEWS: Left forearm AP and lateral and left ovaries AP, lateral and oblique 2/2/15 (5 views) Cast material obscures fine bone details. There is a transverse fracture of the distal radius and ulna with mild posterior and medial displacement.
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Left, transverse distal radial and ulna fractures as described.
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Generate impression based on findings.
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23-year-old male with neutropenia, evaluate for sinusitis Mild mucosal thickening and frothy lucencies within the frontal sinuses, minimally worse on the left. There is opacification of the frontal recesses bilaterally.Moderate mucosal thickening within the ethmoid sinuses is unchanged.Mild mucosal thickening within the sphenoid sinus, slightly worse, with mucosal thickening at the sphenoethmoidal recesses bilaterally.Severe frothy mucosal thickening of the bilateral maxillary sinuses, worse on the left, with a large right mucous retention cyst/polyp. There is mucosal thickening and occlusion of the ostiomeatal units bilaterally.No orbital extension. Mastoid air cells are clear. The imaged intracranial structures are unremarkable.
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Acute pansinusitis, slightly worse than the prior exam.
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Generate impression based on findings.
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Male 29 years old; Reason: left testicular pain, evaluate cause History: pain RIGHT TESTIS: The right testis is normal in echogenicity. The testis measures 4.7 x 2.8 x 2.5 cm.LEFT TESTIS: The left testis is normal in echogenicity. The testis measures 4.8 x 2.9 x 2.3 cm.RIGHT EPIDIDYMIS: Right epididymis is normal in appearance without increased echogenicity or hypervascularity.LEFT EPIDIDYMIS: Normal in appearance without increased echogenicity or hypervascularity.OTHER: Mild dilatation of tubular vessels in the left scrotal area which appear to mildly increase on Valsalva, consistent with a small left varicocele. Small bilateral hydroceles are present.
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1.Small left varicocele is present. 2.Small bilateral hydroceles.
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Generate impression based on findings.
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49 year old female with history of Roux-en-Y gastric bypass in 2005, now feels food getting stuck and bloating. Assess anastomosis and transit time. Scout radiograph showed a nonobstructive bowel gas pattern and IVC filter in expected position.Single contrast visualization of the esophagus showed no gross contour abnormality or obstructing mass. Contrast passed freely across the proximal anastomosis into the gastric remnant, and then across the distal anastomosis into the small bowel. No evidence of obstruction or leak was identified. The gastric remnant measured 3.6 x 3.5 x 3.5 cm, CC x AP x TR. Distal anastomosis measures approximately 1.5 cm across.Transit time to the colon was 1 hour, 15 minutes. Fluoroscopic evaluation demonstrated convergence of multiple bowel loops in a radiating pattern in the left lower quadrant, with decreased separation following compression. Findings are compatible with nonobstructive adhesions, as there were no strictures or other barriers to contrast flow. No ulcers, sinus tracts, or fistulae were identified. No evidence of fibrofatty proliferation. The terminal ileum and ileocecal valve were normal in appearance. No internal hernias or ventral hernias were evident. The ascending colon was grossly normal. No specific findings in the epigastric region or right lower quadrant corresponding to the patient's sites of pain. TOTAL FLUOROSCOPY TIME: 9:58 mm:ss
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1.Postsurgical changes s/p gastric bypass without evidence of anastomotic stricture or leak. 2.Multifocal, nonobstructive adhesions with normal small bowel transit time. 3.No evidence of active small bowel inflammation.
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Generate impression based on findings.
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Reason: Tachycardia and chest pain, eval PE History: chest pain PULMONARY ARTERIES: Minimal dependent edema and atelectasis.LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Aberrant right subclavian artery, normal anatomic variant.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Multiple foci of portal venous gas, presumably secondary to known colitis. Trace ascites. The abdomen pelvis CT will be reported separately.
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1. No evidence of PE.2. Portal venous gas which is presumably related to known colitis and can be a marker of intestinal ischemia or infarct. Please see separate A/P CT report for full details.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable.
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Generate impression based on findings.
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15-year-old female with respiratory failureVIEW: Chest AP (one view) 02/02/15, 1445 hrs ET tube tip is below thoracic inlet and above the carina. Right upper extremity PICC tip is at the superior cavoatrial junction. Right internal jugular central venous catheter is in the SVC. Spinal rods and hooks with residual thoracic dextroscoliosis is unchanged. Catheter projecting over the right hemithorax may represent a chest tube, soft tissue drain, or epidural catheter.Cardiothymic silhouette is normal. Small bilateral pleural effusions are smaller compared to the prior exam. Left lower lobe atelectasis is unchanged. Mild pulmonary edema pattern appears improved.
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Improving pulmonary edema pattern and pleural effusions. Persistent left lower lobe atelectasis.
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Generate impression based on findings.
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39-year-old female with history of knee pain. There is mild narrowing of the medial compartment and small osteophytes compatible with mild osteoarthritis. There is a moderate-sized joint effusion. Minimal osteoarthritis affects the left knee as seen on the frontal views.
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Moderate-sized joint effusion and mild osteoarthritis as above.
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Generate impression based on findings.
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Reason: assess for pna, 3 wk of cough, neutropenic fever History: neutropenic fever with cough LUNGS AND PLEURA: Redemonstration of scattered nodular ground glass and tree in bud opacities slightly increased from the prior exam. No focal areas of consolidation.No pleural effusions.MEDIASTINUM AND HILA: Central venous catheter with its tip in the RA.No hilar or mediastinal lymphadenopathy.Cardiac size is normal the pericardial effusion.CHEST WALL: No axillary lymphadenopathy.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology.
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Scattered tree in bud the and groundglass nodular opacities slightly increased from the prior exam and compatible with bronchiolitis.
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Generate impression based on findings.
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Ms. Boykin is a 57 year old female presenting for short term follow up for bilateral high probably benign breast masses. Family history of breast cancer in paternal aunt and two paternal first cousins. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Multiple bilateral benign morphology masses are stable in size and appearance when compared to prior exams. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast.
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Multiple stable benign morphology masses. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram.
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Generate impression based on findings.
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Initial staging of non-small cell lung cancer. Evaluate for extrathoracic disease. Dyspnea with chest wall pain.RADIOPHARMACEUTICAL: 11.5 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 130 mg/dL. Today's CT portion grossly demonstrates a left apical apical mass with smaller left upper lobe pulmonary nodules. Multiple enlarged mediastinal lymph nodes are seen in the left hilar, bilateral paratracheal, and subcarinal regions. Pleural-based nodular lesions are seen in the left lower lobe. Linear atelectasis or scarring is present in bilateral lower lobes. Hypodense right renal lesion is likely a cyst.Today's PET examination demonstrates large markedly hypermetabolic left apical mass (SUV max = 20.8), compatible with the history of lung cancer.Several additional left upper lobe hypermetabolic nodules (SUV max = 11.8) are suggestive of additional left upper lobe parenchymal tumor.Markedly hypermetabolic left hilar lymph node (SUV max = 9.6), consistent with lymph node metastasis.Multiple additional enlarged markedly hypermetabolic lymph node metastases (SUV max = 16.8), are seen in bilateral paratracheal, prevascular, as well as pre-and subcarinal locations.Several small but abnormally hypermetabolic pleural based lesions are seen in the left lower lobe medially and laterally (SUV max = 9.2), consistent with additional metastatic disease.No suspicious FDG avid lesion within the abdomen, pelvis, or visualized skeleton.
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1.Large hypermetabolic left apical and additional smaller hypermetabolic left upper lobe pulmonary nodules, consistent with the history of lung cancer.2.Multiple large markedly hypermetabolic left hilar and bilateral mediastinal lymph metastases.3.Hypermetabolic pleural based soft tissue density lesions in the left lower lobe indicative of additional metastatic disease.4.No FDG avid extrathoracic metastases identified.
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Generate impression based on findings.
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There are a few periventricular hypodensities without associated mass effect. The ventricles and sulci are normal in size. There are no masses, mass effect or midline shift. There is no evidence for intracranial hemorrhage or acute cerebral or cerebellar cortical infarction. There are no extraaxial fluid collections or subdural hematomas. A small air-fluid level is present in the left sphenoid sinus with scattered foci of paranasal sinus mucosal thickening in the posterior ethmoid and anterior sphenoids sinuses. The mastoid air cells are clear.
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1.Small vessel ischemic disease of indeterminate ages.2.Acute left sphenoid sinusitis.
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Generate impression based on findings.
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Female 36 years old; Reason: Pulmonary embolism, s/p abdominal surgery History: hypoxia The comparison chest radiograph performed on /2/2015 demonstrates low lung volumes with bibasilar atelectasis. The ventilation images show a small defect in the right lung base consistent with atelectasis and low lung volumes on X-ray; otherwise there is uniform distribution of activity on single-breath and wash-in images. There is no abnormal Xe-133 retention during the wash-out phase. The perfusion images show a physiologic distribution of pulmonary perfusion with matched defect in the right lung base. There is no discrete unmatched perfusion defects.
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No scintigraphic findings to suggest pulmonary embolism.
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Generate impression based on findings.
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9-week-old male with intermittent coughVIEWS: Chest AP/lateral (two views) 02/02/15 Aortic arch, cardiac apex, and stomach are left-sided. No pleural effusion or pneumothorax. No focal pulmonary opacities. Mild to moderate bronchial wall thickening is suggestive of reactive airway disease/bronchiolitis.
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Reactive airway disease/bronchiolitis pattern.
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Generate impression based on findings.
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Male, 33 years old.evaluate for retained foreign body, case over eight hours Linear opacity measuring 3 cm projecting over the right heart border noted on initial radiographs time stamped through 15:32 hours. Additional radiographs were performed after removing the overlying blue drape time stamped through 15:55 hours. There is no unexpected radiopaque foreign body on these radiographs, and it is likely that the initially seen object was external to the patient. Catheter overlies the abdomen. Gaseous distension of several bowel loops.
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No unexpected radiopaque foreign body. Findings verbally communicated to the operating room and the attending surgeon, Dr. Alverdy at 4:05 pm on 2/2/2015.
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Generate impression based on findings.
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11-month-old male, ex 27 weeker, with bronchiolitis, tachypnea, hypoxia, evaluate for underlying evidence of chronic lung diseaseVIEWS: Chest AP/lateral (two views) 02/02/15 Aortic arch, cardiac apex, and stomach are left-sided. No pleural effusion or pneumothorax. Linear atelectasis in the right lung base. Minimal retrocardiac atelectasis. Moderate bronchial wall thickening compatible with history of bronchiolitis.
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Bronchiolitis pattern with bilateral atelectasis.
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Generate impression based on findings.
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12-year-old female with elbow painVIEWS: Left elbow lateral extension and flexion (2 views) 02/02/15 No acute fracture or malalignment. No elbow joint effusion.
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Normal examination.
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Generate impression based on findings.
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Female 58 years old; Reason: breast cancer with bone metastases currently on hormone therapy. Evaluate response to therapy. History: Increase in chest wall pain. There is punctate uptake in the anterior left sixth rib which is new from prior study which correlates with sclerotic focus on comparison CT with a soft tissue component and is consistent with metastatic disease. Focal uptake in the lower lumbar spine correlates with severe degenerative changes on comparison CT.Scattered sclerotic foci on comparison CT predominantly in the axial skeleton are not seen on today's bone scan, suggestive of prior treatment of metastatic lesions.Areas of increased activity consistent with degenerative changes in the bilateral knees and bilateral acromioclavicular joints.
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New left anterior sixth rib activity is consistent with metastatic disease when correlating with CT findings.
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Generate impression based on findings.
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36 year old female with right knee pain, toe pain. Four views of the right knee show perhaps minimal medial tibiofemoral compartment narrowing and otherwise are within normal limits.Postoperative changes of left MCL reconstruction with an orthopedic screw affixing the medial aspect of the left distal femur are seen on the frontal view. Compared to prior left knee radiographs, there appears to be slight retraction of this screw by approximately 2 mm. Postoperative changes of ACL reconstruction are also noted.Four views of the right second toe show no fracture or malalignment.
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1. Minimal narrowing of the medial tibiofemoral compartment of the right knee. Postoperative changes of MCL and ACL reconstruction of the left knee with slight distal dislodging of the left MCL screw.2. No fracture or malalignment of the right second toe.
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Generate impression based on findings.
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17-year-old male with posterolateral olecranon painVIEWS: Right elbow AP/lateral/oblique (3 views) 02/02/15 No acute fracture or malalignment. No elbow joint effusion.
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Normal examination.
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Generate impression based on findings.
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Staging of melanoma left neck status post excision and left neck dissection 12/8/14.RADIOPHARMACEUTICAL: 9.8 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 103 mg/dL. Today's CT portion grossly demonstrates postsurgical changes from a left neck dissection. Scattered atherosclerotic calcifications are noted. Small bilateral hypodense renal lesions are likely cysts.Today's PET examination demonstrates multiple small mild to moderately hypermetabolic foci in the left neck (SUV max = 4.2). These are arranged in two linear configurations in the region of the left neck dissection, several adjacent to surgical clips. Given the milder uptake, locations, and configuration, these are felt to more likely represent persistent post surgical inflammation than tumor.Otherwise no suspicious FDG avid lesion is identified on whole body PET. He focus of activity in the left groin skin surface is consistent with excreted urinary activity.
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1.Multiple small foci of mild to moderate in the left neck considered most likely postsurgical inflammation, although residual tumor activity cannot be entirely excluded.2.Otherwise no suspicious FDG avid lesion.
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Generate impression based on findings.
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Asymptomatic female with dense breasts presents for whole breast ultrasound for dense breast screening. Bilateral breast implants. 3-D whole breast ultrasound was performed for both breasts and images were reviewed on an independent workstation. There is no solid or cystic mass identified. Bilateral retropectoral saline implants are seen.
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No sonographic evidence for malignancy.BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.
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Generate impression based on findings.
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Male 73 years old; Reason: hx of GIST CHEST:LUNGS AND PLEURA: Visualized lung fields stable in appearance.MEDIASTINUM AND HILA: Heterogeneous thyroid gland with unchanged hypoattenuating focus in the right thyroid lobe, measuring up to 10 mm, similar to prior study. Unchanged nonspecific soft tissue attenuation in anterior mediastinal area. Moderate calcified coronary artery disease.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Multiple hypoattenuating hepatic foci without significant change, including reference hepatic segment II focus measuring 2.5 x 2.4 cm, image 74 series 3, previously measured 2.5 x 2.4 cm. Additional scattered hypoattenuating foci seen that are too small to characterize.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Unchanged left adrenal nodularity.KIDNEYS, URETERS: Stable hypoattenuating renal lesions, too small to characterize. RETROPERITONEUM, LYMPH NODES: Aortobiiliac atherosclerotic disease.BOWEL, MESENTERY: Upper abdominal postsurgical sequela. PELVIS:PROSTATE, SEMINAL VESICLES: Status post TURP.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Small fat containing left inguinal hernia. Unchanged left iliac sclerosis. Multilevel degenerative changes of spine.
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1. Stable exam as above.
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Generate impression based on findings.
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41-year-old male with fibrous dysplasia, left humerus fracture. Evaluate healing. Three views of the left humerus again demonstrate findings compatible with fibrous dysplasia affecting the left humerus as well as the proximal radius/ulna, scapula, and ribs. Also again seen is a transverse fracture through the distal humeral metadiaphysis. A small amount of callus formation is now present indicating an attempt at healing.
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Healing pathologic fracture as described above.
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Generate impression based on findings.
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Female 37 years old Reason: Concern for pulmonary embolism in the setting of third trimester pregnant, underlying sickle cell disease with extensive clotting history History: pregnant 31w0d, sickle cell disease, O2 desaturation, tachycardia, LE pain The exam is somewhat limited secondary to suboptimal opacification of the pulmonary arteries.PULMONARY ARTERIES: No pulmonary embolism to the segmental level. Pulmonary artery is enlarged measuring up to 37 mm suggestive of pulmonary arterial hypertension. No evidence of right heart strain. LUNGS AND PLEURA: Dependent atelectasis. No pleural effusion. Scattered micronodules which are similar to prior. No suspicious masses or nodules. MEDIASTINUM AND HILA: Cardiomegaly, unchanged. No pericardial effusion. Right IJ central venous catheter with tip at the RA/SVC junction.Several prominent mediastinal lymph nodes. Mildly enlarged cardiophrenic lymph node, unchanged.CHEST WALL: Osseous changes consistent with sickle cell disease. Mildly enlarged axillary and subpectoral lymph nodes are unchanged.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Scattered intraperitoneal free air likely secondary to recent C-section. Calcified, atrophic spleen is unchanged. Incompletely imaged liver which appears enlarged.
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No pulmonary embolism to the segmental level. No airspace consolidation to suggest infection or hemorrhage.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable.
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Generate impression based on findings.
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54-year-old female with history of reverse Bennett fracture, pain. Three views of the left hand again demonstrate a fracture of the base of the fifth metacarpal with fracture fragments in near-anatomic alignment. The fracture line appears slightly less distinct compared with the prior study suggesting some interval healing. The bones appear slightly demineralized.
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Healing fifth metacarpal fracture.
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Generate impression based on findings.
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22 year-old female with history of Crohn's colitis now with abdominal pain, tachycardia, and increasing CRP. Evaluate for free air. ABDOMEN:LUNG BASES: Interval improvement in bilateral small pleural effusions. Mild bilateral basilar atelectasis.LIVER, BILIARY TRACT: Liver measures approximately 28 cm in craniocaudal dimension. Interval development of portal venous gas in the peripheral distribution. Stable mild periportal edema and marked gallbladder wall thickening likely related to periportal edema and ascites.SPLEEN: Interval development of extensive nonocclusive thrombus within the splenic vein with air. Additionally, there is focus of gas within the spleen which is new compared to previous examination (series 13, image 56). Again identified is small wedge-shaped peripheral hypoattenuation at the inferior aspect of the spleen most likely infarcts. PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant change in the mildly enlarged retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant interval change in the distribution of the colonic wall thickening with mild interval improvement in thickening of the transverse colon. Persistent thickening of the descending colon with associated inflammatory changes. Finding suggestive of persistent acute on chronic colitis. No evidence for pneumatosis.Small volume perihepatic and right paracolic gutter ascites. No loculated fluid collections or findings to suggest an abscess.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: As above.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.New nonocclusive extensive splenic vein thrombus with air, focus of air within the spleen and peripheral portal venous gas. Findings are of uncertain significance. Diagnostic consideration includes infarct in spleen causing air necrosis, and thrombophlebitis with infection, although other rare etiologies could cause this as well..2.Persistent periportal edema and marked gallbladder wall thickening likely related to the periportal edema.3.Findings suggestive of active Crohn's colitis in similar distribution compared to prior examination with slightly less edema in the transverse colon.4.Persistent ascites.5.Interval improvement in bilateral small pleural effusions.
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Generate impression based on findings.
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Restaging metastatic melanoma status post ipilimumab chemotherapy, last 9/21/14.RADIOPHARMACEUTICAL: 12.8 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 224 mg/dL. Today's CT portion grossly demonstrates right chest Port-A-Cath with tip in the SVC. Multiple subcutaneous soft tissue density nodules and stranding is noted. Left pelvic obturator lymph node has decreased in size although is still abnormally enlarged measuring approximately 2.5 cm with again central low density suggesting necrosis. Extensive atherosclerotic calcifications are present. Swelling with subcutaneous stranding in the left lower extremity is again noted although the appearance is less pronounced than previously.Today's PET examination demonstrates complete interval resolution of hypermetabolic activity previously involving the left pelvic obturator lymph node, consistent with complete metabolic response to therapy at this site.There is no definite FDG avid tumor currently. There are several small mild to moderately hypermetabolic foci in the subcutaneous tissues of the right upper arm (SUV max = 2.6) and in the anterior right pelvic subcutaneous fat (SUV max = 3.2) which are new from previous. Given their locations and milder uptake, inflammatory foci are favored although new tumor cannot be entirely excluded. A small mild to moderately hypermetabolic focus at the posterior musculature in the left popliteal region is stable to slightly improved (SUV max = 3.6 previously, = 3.0 currently) and may also be inflammatory.Otherwise no suspicious FDG avid lesion is identified.
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Complete interval resolution of previous markedly hypermetabolic tumor activity involving the left obturator lymph node without definite FDG avid tumor currently. There are several small new hypermetabolic foci in the subcutaneous fat of the right upper arm and anterior right pelvis which are considered more likely inflammatory. However, tumor progression cannot be entirely excluded at these sites and attention to these regions on follow-up exams as well as physical exam can be made.
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Generate impression based on findings.
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70 years, Male. Reason: r/o megacolon History: abd pain Dilated loops of small bowel with collapsed colon and air fluid levels consistent with small bowel obstruction. No pneumoperitoneum.Opacity in the right apex consistent with previously identified radiation fibrosis on CT chest 1/9/2015 examination. Left basilar atelectasis.
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Findings consistent with small bowel obstruction.
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Generate impression based on findings.
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43-year-old male with history of pain. Mild osteoarthritis affects the acromioclavicular joint. We see no acute fracture or dislocation.
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Mild osteoarthritis of the acromioclavicular joint without acute fracture or dislocation.
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Generate impression based on findings.
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18 year-old male with history of lower back pain. Evaluate for sacroiliitis. The margins along the inferior aspect of the SI joints are irregular and indistinct suggesting bilateral sacroiliitis. There is mild prominence along the lateral aspects of the femoral head/neck junctions suggesting mild CAM deformities.
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Findings suggestive of bilateral sacroiliitis. A contrast enhanced MRI may be considered for further evaluation.
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Generate impression based on findings.
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Ms. Pritchett is a 39 year old female who presented with a palpable mass in the right upper outer breast. On ultrasound performed earlier today, the primary lesion is identified in the right breast 10 o'clock location. Also, 3.5 cm lateral to the primary lesion, an additional questionable satellite lesion is identified. Both of these will be the targets for today's biopsy. Right ultrasound re-identified the two target lesions for biopsy. The first lesion to be targeted is a hypoechoic mass measuring 1.8 cm at the 10 o’clock position with increased vascularity, 4 cm from the nipple. The lesion was readily visible. A second lesion to be targeted is a hypoechoic mass measuring 0.6-cm at the 10 o'clock position, with increased vascularity, 6 cm from the nipple. The second lesion was readily visible.PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip and post-procedure unilateral mammogram were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure.Biopsy of primary lesion:The right breast was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a inferolateral to superomedial approach, two 12-gauge core needle (Celero) specimens were obtained of the lesion. Targeting was judged excellent. All specimens sank to the bottom of the prefilled container of 10% formalin. Specimen quality was judged excellent.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Hydromark clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Biopsy of satellite lesion:The same incision was used for targeting of the second lesion. 1% lidocaine with 1:100,000 epinephrine was used at depth. Using aseptic technique, continuous ultrasound guidance and a inferomedial to superolateral approach, three 14-gauge core needle (Achieve) specimens were obtained of the lesion. Targeting was judged excellent. All specimens sank to the bottom of the prefilled container of 10% formalin. Specimen quality was judged excellent. Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Bard wing clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Post-procedure digital right CC and ML views revealed the percutaneously placed clips to be in the expected location in the central aspects of the lesions. No evidence of hematoma or other complication.A pressure dressing was positioned over the biopsy sites and an ice pack positioned over the pressure dressings. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and left the Breast Imaging Department in stable condition.The procedure was performed by Dr. Sheth. Dr. Abe was present during the procedure at all times.
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Successful ultrasound-guided core biopsy of the right breast primary lesion and satellite lesion with clip placements. Pathology is pending at this time.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.
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Generate impression based on findings.
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Ms. Pritchett is a 39-year-old female with known head and neck cancer. Recent mammogram demonstrated suspicious findings on the right breast (which were biopsied on the same day) and an enlarged left axillary lymph node. Left axillary ultrasound re-identified the target lymph node for biopsy. It was in the inferior. Bipolar maximum dimension was 0.9 cm and marked non-hilar cortical blood flow was seen on color flow imaging. The target node was somewhat subtle.PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy of an axillary lymph node were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure. The left breast was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and inferolateral to superomedial approach, a 14-gauge core needle (Achieve) was directed into the target node and three specimens were obtained, using the open-trough technique. Samples were obtained centrally through the hypoechoic cortex and at the periphery. Targeting was judged very good. Two specimens sank to the bottom of the prefilled container of 10% formalin. Specimen quality was judged very good. Whitish tissue was noted throughout all specimens.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Hydromark clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Post-procedure digital left CC and ML views revealed the percutaneously placed clip to be in the expected location in the central aspect of the lymph node. No evidence of hematoma or other complication. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and left the Breast Imaging Department in stable condition.The procedure was performed by Dr. Sheth. Dr. Abe was present during the procedure at all times.
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Successful ultrasound guided core biopsy of an abnormal left axillary lymph node with clip placement. Pathology is pending at this time.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.
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Generate impression based on findings.
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Reason: intracranial bleed History: HA; change in vision L eye The CSF spaces are appropriate for the patient's stated age with no midline shift. Periventricular and subcortical white matter hypodensities of a moderate degree are present.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are stable. There is redemonstration silicone oil in the left eye.
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1.No evidence for acute intracranial hemorrhage mass effect or edema.2.CT is insensitive for the early detection of nonhemorrhagic cerebral infarction.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. One possibility is that this is vascular related related whereas others include vasculitis and demyelination.
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Generate impression based on findings.
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Clinical question: Evaluate for hemorrhage. Signs and symptoms: Knee anticoagulation. Nonenhanced head CT:There is no detectable acute intracranial hemorrhage as is questioned clinically.Examination demonstrate a previously known left MCA territory ischemic stroke without evidence of interval change since prior study.Additional focus of ischemic stroke in the right posterior parietal lobe remains also identical to prior exam.Ventricular system remain within normal and stable since prior exam and with maintained midline.The CSF cisterns remain widely patent.Unremarkable orbits, paranasal sinuses, mastoid air cells and calvarium.
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1.No acute intracranial hemorrhage.2.Stable ischemic strokes in the left MCA territory and right posterior parietal since prior study.
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Generate impression based on findings.
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Female 44 years old Reason: r/o stone History: r/o stone. The exam is not sensitive detecting lesions in the bowel due to lack of oral contrast and in the solid organs and vasculature due to the lack of intravenous contrast. Given those limitation, 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: Renal cysts bilaterally, unchanged. No evidence of nephrolithiasis. No hydronephrosis hydroureter.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: Left adnexal cyst likely physiologic.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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No evidence of nephrolithiasis. No findings to explain acute abdominal or epigastric pain.
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Generate impression based on findings.
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77-year-old male with tachycardia and fevers with placement of a biliary stent. Evaluate.Patient with history of pancreatic cancer. CHEST:LUNGS AND PLEURA: Mild emphysema. Scattered pulmonary micronodules are noted. A left lower lobe pulmonary nodule measures 5 mm (series 4, image 69). No pleural effusions or pneumothorax.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size is normal without pericardial effusion. Severe coronary artery calcifications are present.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Stable common bile duct stent and associated pneumobilia. Gallbladder wall thickening with extensive pericholecystic inflammatory changes and associated fluid highly suspicious for acute cholecystitis. There is extension of the gallbladder process into the liver as noted on series 3, image 142.Hypoattenuating lesion peripherally in the right hepatic lobe is nonspecific and new compared to previous examination (series 3, image 131) and may represent a metastatic focus.SPLEEN: No significant abnormality notedPANCREAS: Interval decrease in size of the pancreatic head hypoattenuating mass and hypoattenuating mass surrounding the common bile duct. No significant change in the diffuse pancreatic ductal dilatation with associated distal pancreatic atrophy.ADRENAL GLANDS: Incompletely characterized left adrenal gland nodule measuring 1.5 x 1.4 cm (series 3, image 116).KIDNEYS, URETERS: Subcentimeter left renal hypoattenuating focus is too small to characterize but statistically likely a cyst. No hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: Mild interval increase in size of the infrarenal abdominal aortic aneurysm which measures approximately 6.8 x 6.9 cm (series 3, image 147), previously measuring 6.7 x 6.7 cm. BOWEL, MESENTERY: Mild pericolonic inflammatory changes at the hepatic flexure likely from the adjacent pericholecystic inflammatory changes. No evidence of small bowel obstruction.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: As above.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.Findings highly suggestive of acute cholecystitis. Patient is status post emergent cholecystostomy tube placement.2.Mild pericolonic inflammatory changes at the hepatic flexure, likely secondary from the aforementioned acute cholecystitis.3.Persistent pneumobilia. 4.Interval decrease in the hypoattenuating mass involving the pancreatic head and surrounding the CBD.5.Mild interval increase in the infrarenal abdominal aortic aneurysm measuring up to 6.9 cm.6.5mm left lower lobe pulmonary nodule.
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Generate impression based on findings.
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Reason: R/o bleed History: 57 yo M on asa and plavix s/p fall The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
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1.No evidence for acute intracranial hemorrhage, mass effect or edema.
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Generate impression based on findings.
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Clinical question: Status post craniotomy. Signs and symptoms: Headache. Nonenhanced head CT:Examination demonstrate expected postoperative changes of a right frontal craniotomy. There is evidence of a right anterior temporal tumor resection. Residual vasogenic edema in the right temporal lobe and is associated mass effect with resultant approximate the 5-mm to the left with slight interval progression since prior exam. There's mild effacement of the right aspect of basal cistern which is new since prior study.Partially compressed right lateral ventricle and mildly prominent left lateral ventricle remains similar to prior study.Expected post operative epidural air collection under the craniotomy flap measuring maximum of 5-mm in thickness is present.
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1.Expected postoperative changes of right frontal craniotomy. 2.There is interval increased mass-effect and deviation of midline to the left of approximately 5 mm.3.Residual vasogenic edema in the right temporal lobe.4.Stable size of ventricular system and no evidence of intracranial hemorrhage
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Generate impression based on findings.
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Reason: evaluate for mass, ICH History: seizure The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a small amount of subarachnoid hyperdensity present adjacent to the right temporal lobe along its lateral surface.There is redemonstration of hypodense foci in the thalami and basal ganglia bilaterally. Periventricular and subcortical white matter hypodensities of a mild degree are present.A hyperdense focus is present in the left superior temporal gyrus measuring 15 x 7 mm axial dimensions and surrounded by a halo of hypodensity. There are smaller foci of hyperdensity one in the left centrum semiovale measuring 2 mm. One in the left temporal lobe measures 4 mm.There are subdural effusions present bilaterally left slightly more than right. On the left side the subdural effusion measures 4 mm whereas on the right side it measures approximately 3 mmAtherosclerotic calcifications are present along the distal internal carotid arteries. Atherosclerotic calcifications are present along the distal vertebral arteries.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
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1.A small amount of subarachnoid blood is present adjacent to the right temporal lobe.2.There is a new hyperdense lesion present in the left superior frontal gyrus which is suspected to represent a hemorrhagic focus. There are smaller lesions present elsewhere. Their locations are suggestive of cerebral amyloid angiopathy. Please refer to MRI from 10/31/13 for additional comments. An new MRI may help assess for interval progression and help assess the etiology.3.There are small bilateral subdural effusions present which are new since the prior exam.4.There is redemonstration of multiple lacunar infarcts in the basal ganglia and thalami.5.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.
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Generate impression based on findings.
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4-month-old male intubatedVIEW: Chest AP (one view) 02/03/15, 0548 ET tube tip is below the thoracic inlet and above the carina. NG tube terminates in the stomach.Cardiothymic silhouette is normal. Blunting of the left costophrenic sulcus. No pneumothorax. Right upper lobe atelectasis with elevation of the minor fissure. Increased aeration of the left lung with persistent left lower lobe atelectasis.
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Improvement in left lung aeration after repositioning of ET tube.
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Generate impression based on findings.
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64 years, Male. Reason: concern for ileus, known pancreatitis History: as above Nasoenteric tube has been repositioned. I suspect it is in the proximal jejunum with the tip now located to the right of the midline.Pigtail catheter in the left midabdomen unchanged.Possibly about this. No evidence of obstruction or ileus.
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No evidence of obstruction or ileus.
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Generate impression based on findings.
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7-week-old female with cough, evaluate for pneumoniaVIEWS: Chest AP/lateral (two views) 02/02/15 Aortic arch, cardiac apex and stomach are left-sided. Cardiothymic silhouette is normal. Mild peribronchial cuffing and large lung volumes is suggestive of reactive airway disease/bronchiolitis. No focal pulmonary opacities.
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Reactive airway disease/bronchiolitis pattern.
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Generate impression based on findings.
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70 years, Male. Reason: eval NG placement History: eval NG placement Right abdomen and pelvis excluded from field of view.Persistent marked dilatation of jejunum and proximal jejunal loops measuring up to 5.1 cm in diameter. This is unchanged or slightly more marked compared to the prior exam.The NG tube should be advanced advanced further. The sidehole is near the EG junction and the tip is in the distribution of the gastric fundus.
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NG tube should be advanced further because the sidehole is in the distribution of the EG junction. Persistent marked jejunal dilatation.Dr. Nayna Lodhia pager 3708 informed 8:05am.
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Generate impression based on findings.
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31 day old female with feverVIEWS: Chest AP/lateral (two views) 02/02/15, 1855 Aortic arch, cardiac apex, and stomach are left-sided. Cardiothymic silhouette is normal. No pleural effusion or pneumothorax. Mild peribronchial cuffing and slightly enlarged lung volumes are suggestive of bronchiolitis/reactive airway disease.
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Bronchiolitis/reactive airway disease pattern.
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Generate impression based on findings.
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Male 5 years old Reason: ETT and IJ location History: sepsisVIEW: Chest AP (one view) 2/3/15 at 554 hours. NG tube terminates in the stomach. ET tube tip is below the thoracic inlet. Right IJ venous access terminates at the right atrium. Cardiac silhouette size is top normal. Persistent small lung volumes and left lower lobe opacity, either atelectasis or pneumonia. Improvement in right lower lobe atelectasis.
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Interval improvement in right lower lobe atelectasis.
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Generate impression based on findings.
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3-year-old male with hemoglobin S workupVIEWS: Chest AP/lateral (two views) 02/02/15, 1817 Aortic arch, cardiac apex, and stomach are left-sided. Cardiothymic silhouette is normal. No pleural effusion or pneumothorax. Moderate bronchial wall thickening is suggestive of bronchiolitis/reactive airway disease. No focal pulmonary opacities.
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Bronchiolitis/reactive airway disease pattern.
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Generate impression based on findings.
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Male 5 years old Reason: eval IJ and ETT History: sepsisVIEW: Chest AP (one view) 2/2/15 at 1727 hrs ET tube tip is below the thoracic inlet. NG tube terminates in the stomach. Right IJ venous access tip is at the right atrium. Cardiac silhouette size is top normal. Small lung volumes and bibasilar opacities likely atelectasis or pneumonia.
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Central line, NG tube and ET tube placement as described.Multifocal opacities development.
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Generate impression based on findings.
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Male; 53 years old. Reason: For surgical plan History: distal esophageal leak LUNGS AND PLEURA: Moderate right and small left pleural effusions. Moderate right and marked left adjacent basilar atelectasis/consolidation, increased on the left since prior chest CT on 1/28/15. Right pleural pigtail catheter and two left chest tubes in place. Small left basilar pneumothorax.MEDIASTINUM AND HILA: Right PICC tip in SVC. Endotracheal tube terminates above the carina. NG tube tip in stomach. Distal portion of the Dobbhoff tube in stomach with tip not included in the field-of-view. Distal esophageal stent predominately within the proximal stomach. Stable mild free fluid adjacent to the distal esophagus. Interval resolution of minimal pneumomediastinum adjacent to the distal esophagus.Normal heart size without pericardial effusion. No visible coronary artery calcifications.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Small amount of free fluid posterior to the stomach fundus.
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1. Bilateral pleural effusions. Moderate to marked bibasilar atelectasis/consolidation, increased on the left since prior CT chest. Bilateral chest tubes in place with small left basilar pneumothorax.2. Small amount of free fluid adjacent to the distal esophagus and stomach fundus. Interval resolution of pneumomediastinum. 3. Distal esophageal stent predominately within the stomach, migrated distally since chest radiograph on 1/30/15.
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Generate impression based on findings.
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Clinical question: Status post TSH. Signs and symptoms: Status post TSH. Nonenhanced head CT:Examination demonstrate expected postoperative changes of TSH. There is no detectable intracranial hemorrhage or pneumocephalus. Ventricular system remain within normal size with maintained midline. The cerebral cortex, cortical sulci and gray -- white matter differentiation remain the feeding normal.There is revisualization of an enlarged sella containing primary fluid density and a small amount of hemorrhage and fatty material consistent with post operative changes and packing. Expected patchy opacification of the ethmoid air cells.Bilateral mastoid air cells and middle ear cavities remain well pneumatized.Images through the orbits are unremarkable.
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1.Expected post operative changes of TSH as detailed.2.Unremarkable intracranial contents and in particular without evidence of mass effect, pneumocephalus or hemorrhage.
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Generate impression based on findings.
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70 years, Male. Reason: NG tube placement History: NG tube Pelvis and portion of the right abdomen excluded from field of view.Marked diffuse small bowel dilatation. Proximal jejunal loops measuring about 4.2 cm in diameter.NG tube is in the esophagus and should be advanced. Follow-up films are then obtained at the time of this dictation. Into the joint structures are unchanged.
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NG tube in esophagus. Diffuse small bowel dilatation. Obstruction cannot be excluded.
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Generate impression based on findings.
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Reason: Evaluate for new RUE and RLE weakness and numbness Neck CTA: There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the right vertebral artery. There is aortic arch origin of the left vertebral artery. There are calcifications present at the origin of the left vertebral artery associated with a stenosis.There is heterogeneous density of the thyroid gland. Atherosclerotic calcifications are present at the carotid bifurcations.There are degenerative changes present in the cervical spine with facet hypertrophy in the upper cervical spine and the large anterior osteophytes and mean lower cervical spine are.Findings suggest centrilobular emphysema.Brain CTA: There is opacification of the distal internal carotid arteries, the distal vertebral arteries and the proximal anterior middle and posterior cerebral arteries. No aneurysms or intracranial stenosis is appreciated.There is 50% stenosis present at the origin of the left middle cerebral artery.There is mild fusiform dilation of the left middle cerebral artery inferior division to approximately 3 mm disk distal to a 50% stenosis at the proximal left inferior division of the MCA.The anterior communicating artery and the posterior communicating arteries are identified and are intact. The right A1 segment is hypoplastic. The anterior communicating artery is relatively large. There is a fetal origin of the posterior cerebral arteries bilaterally with small P1 segments. The basilar artery is relatively small. The right vertebral artery is larger than the left vertebral artery.The right posterior cerebral artery is an narrowed at the proximal right P2 segment.There is 65% stenosis at the origin of the right superior cerebellar artery. The left superior cerebellar artery originates from the left posterior cerebral artery which has a fetal origin.There is cavernous origin of the right ophthalmic artery which enters the orbit through the superior orbital fissure.CT head:There is redemonstration of encephalomalacia involving the right superior and middle temporal gyri and the right inferior parietal lobule.Periventricular and subcortical white matter hypodensities of a moderate degree are present.Punctate hypodensities are present in the basal ganglia.The visualized portions of the paranasal sinuses demonstrate some opacities in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. Atherosclerotic calcifications are present along the distal internal carotid arteries.
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1.There is 50% stenosis present at the origin of the left middle cerebral artery2.There is a 65% stenosis present at the origin of the right superior cerebellar artery.3.There is mild fusiform dilation of the left middle cerebral artery inferior division to approximately 3 mm disk distal to a 50% stenosis at the proximal left inferior division of the MCA.4.Stenosis at the origin of the left vertebral artery from the aortic arch.5.Encephalomalacia of the right temporal and parietal lobes is redemonstrated.6.Old lacunar infarcts are redemonstrated in the basal ganglia.7.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. 8.CT is insensitive for the early detection of acute nonhemorrhagic cerebral infarction.9.Findings suggest centrilobular emphysema.10.Heterogeneous appearing thyroid gland is nonspecific on CT. Please correlate with clinical symptoms
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Generate impression based on findings.
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Female, 53 years old.RFO trigger: Multiple surgical teams Suspected RFO location: possible sharps and sponges Name of suspected RFO: possibly in abdomen and pelvis Attending Surgeon name/pager: dr. Yamada pgr. 6610 Body Mass Index (BMI): 59.18 No unexpected radiopaque foreign body. Nasoenteric tube in the esophagus, consider advancement.Catheter in the midline overlying the gluteal crease per the resident on-call represents a pelvic drainage catheter.No unexpected radiopaque foreign body.
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No unexpected radiopaque foreign body. Results relayed by telephone by radiology resident on call Dr.Sujay Sheth to surgical attending Dr. Yamada on 2/2/15 at 23:00 hours.
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Generate impression based on findings.
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Ms. Miller is a 68 year old female with a personal history of left breast mastectomy in March 2013 for IDC/DCIS followed by chemoradiation therapy and implant based reconstruction. Three full field and three implant displaced views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. A retropectoral silicone implant is unchanged in size and contour. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in the right breast.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram.
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Generate impression based on findings.
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Clinical question: Pituitary hemorrhage. Signs and symptoms: Left eye blindness. Nonenhanced head CT:The examination redemonstrates a pituitary macroadenoma within the sella with resultant expansion of sella and extension into the basal cistern. The tumor demonstrate no interval change since prior exam in its size and width stable hemorrhagic changes. There is highly suspected extension of tumor into the left cavernous sinus. Unremarkable cerebral cortex, cortical sulci, ventricular system and CSF spaces otherwise and with maintain gray -- white matter differentiation.Calvarium and orbits as well as bilateral mastoid air cells and middle ear cavities are unremarkable.
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1.Hemorrhagic pituitary macroadenoma without interval change since prior exam.2.Stable and unremarkable exam otherwise.
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Generate impression based on findings.
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1-year-old female with cough and fever, evaluate for acute chestVIEWS: Chest AP/lateral (two views) 02/02/15, 1937 Cardiothymic silhouette is normal. No pleural effusion or pneumothorax. Peribronchial cuffing and large lung volumes is suggestive of reactive airway disease/bronchiolitis. No focal pulmonary opacities.
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Reactive airway disease/bronchiolitis pattern.
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Generate impression based on findings.
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Male, 61 years old.RFO trigger: Multiple surgical teams RFO trigger: R/O RFO Suspected RFO location: abdomen, pelvis Name of suspected RFO: instruments, sponges, needles Attending Surgeon name/pager: Dr Steinberg, Pgr - 7388 Body Mass Index (BMI): 26.48 No unexpected radiopaque foreign body. Multiple drainage catheters oriented vertically in the midline. Right nephro-ureterostomy catheter. Pelvic Jackson-Pratt drain. Scattered surgical clips of the pelvis. Vertical skin staple line.Additional catheter looped over the midabdomen is external to the patient discussed by radiology resident on call with the clinical team in the operating room.NG tube tip in the distribution of the gastric fundus. Side hole in the distribution of distal esophagus.Findings were discussed by radiology resident on call Dr. Sujay Sheth with the surgical attending Dr. Park by telephone on 2/2/15 at 20:30 hours.
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No unexpected radiopaque foreign body.
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Generate impression based on findings.
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The ventricles and sulci are within normal limits. There is no midline shift or mass effect. There is no intracranial hemorrhage. There are no areas of abnormal attenuation. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear.
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No acute intracranial abnormalities.
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Generate impression based on findings.
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82-year-old male with AML with abdominal pain and distention. Evaluate. Lack of IV contrast enhancement limits evaluation of solid organs and bowel.ABDOMEN:LUNG BASES: Mild interval increase in bilateral small pleural effusions with associated atelectasis/consolidation. Moderate emphysema.Severe cardiomegaly.LIVER, BILIARY TRACT: No significant interval change in the hypoattenuating focus in segment 6 consistent with a cyst. Gallbladder is moderately distended with gallbladder wall thickening, which is nonspecific in the setting of ascites. There is hypoattenuation in the region of the biliary tree which may be mild biliary ductal dilatation versus periportal edema.SPLEEN: Marked splenomegaly compatible with patient's history of AML.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Moderate atherosclerotic calcifications affect the abdominal aorta and its branches. BOWEL, MESENTERY: Ascites with mildly dilated loops of small bowel throughout the abdomen which may represent ileus from the ascites versus partial small bowel obstruction.BONES, SOFT TISSUES: Diffuse anasarca.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: As above.BONES, SOFT TISSUES: Diffuse anasarca. Degenerative changes affect the visualized spine.OTHER: No significant abnormality noted
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.1.Ascites with mildly dilated small bowel loops which may represent ileus versus partial small bowel obstruction.2.Mild interval increase in small bilateral pleural effusions with associated consolidation, which is suspicious for pneumonia.3.Moderately distended gallbladder with gallbladder wall thickening which is nonspecific in the setting of ascites. If there is clinical concern for cholecystitis, further evaluation with right upper quadrant ultrasound may be considered.
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Generate impression based on findings.
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6-week-old female with coughVIEWS: Chest AP/lateral (two views) 02/02/15 , 2005 hrs Aortic arch and cardiac apex are left-sided. Cardiothymic silhouette is normal. Minimal bronchial wall cuffing and large lung volumes may represent bronchiolitis/reactive airway disease. No focal pulmonary opacities.
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Bronchiolitis/reactive airway disease pattern.
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Generate impression based on findings.
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Female 49 years old; Reason: Lemierre's disease, concern for liver emboli History: as above ABDOMEN:LUNG BASES: Enlarged heart. Basilar atelectasis, emphysema at the lung bases.LIVER, BILIARY TRACT: Liver is normal in morphology but slightly enlarged with patent vasculature.SPLEEN: Heterogenous enhancement of the spleen.PANCREAS: Age-related atrophy.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Poor enhancement of the kidneys with atrophy and small hypodense foci. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.No liver thrombi as clinically questioned.
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Generate impression based on findings.
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The ventricles and sulci are within normal limits. There is no midline shift or mass effect. There is no intracranial hemorrhage. There are no definite areas of abnormal attenuation or pathological enhancement. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. There is redemonstration of an incidental rounded prominent fluid density structure within the pineal cistern measuring 2.0-cm transverse.The intracranial internal carotid arteries are normal in course and caliber. There is mild atherosclerotic calcification along the cavernous carotid arteries. There is a large focal outpouching off the medial paraclinoid left internal carotid artery with dense peripheral calcification, representing an aneurysm. This is inferiorly directed, with an irregular lobulated appearance. The neck measures 3 mm, while the aneurysm measures 7 x 8 mm in greatest axial dimensions, by 5 mm in greatest CC dimension. An additional more focal saccular outpouching is noted off the superior medial aspect of the larger aneurysm.There is a hypoplastic right A1 segment. The middle and anterior cerebral arteries are otherwise unremarkable. There is fetal origin of the posterior cerebral arteries bilaterally, with diminutive caliber of the vertebrobasilar system. The vertebral arteries are co-dominant. There is no evidence of flow-limiting stenosis.CTA NECK
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1. Focal irregular complex saccular aneurysm of the medial aspect of the paraclinoid left internal carotid artery which is inferiorly directed, measuring 7 x 8 x 5 mm with 3-mm neck. Prominent peripheral calcification of this aneurysm, with smaller daughter component along the superior medial aspect.2. Diminutive vertebrobasilar system due to fetal origin of the posterior cerebral arteries. This is therefore a normal variant.3. Mild atherosclerotic disease along the carotid bifurcations with mild flattening of the right carotid bulb.4. Stable appearance of likely incidental large pineal cyst.5. Enlarged left thyroid gland with heterogeneous appearance and focal lesions, including one which is partially calcified in the upper pole, somewhat to prior exam. Correlation with thyroid function tests is recommended and thyroid ultrasound may be obtained as clinically indicated.6. Right upper lobe miliary appearing micronodules, some of which are pleurally based. Dedicated CT chest may be obtained for further evaluation.Dr. Yang discussed these findings over the telephone with Dr. Ahmad Daher on 2/3/2015 8:12 AM.
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Generate impression based on findings.
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Male 35 years old Reason: eval lung fields History: sob, cp PULMONARY ARTERIES: No evidence of pulmonary embolism to the subsegmental level. Pulmonary artery is normal in caliber without evidence of right heart strain.LUNGS AND PLEURA: Minimal centrilobular and paraseptal emphysema, not significantly changed. No consolidation or pleural effusion. No pneumothorax. Stable 3 mm nonspecific nodular density in the right upper lobe (series 8, image 86). Subpleural lymph node in the right middle lobe, unchanged (series 8, image 182).MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. No mediastinal or hilar lymphadenopathy. No coronary artery calcifications in this non-gated study.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.
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No evidence of pulmonary embolism. PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable.
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Generate impression based on findings.
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Clinical question: Evaluate chronic migraines. Signs and symptoms: Migraines. Nonenhanced head CT:There is no detectable acute intracranial process. CT however these insensitive for early detection of acute non-hemorrhagic ischemic stroke.There is mild prominence of cerebral cortical sulci without interval change since prior exam. Ventricular system, CSF spaces and gray/white matter differentiation remains remain normal and stable since prior study.Unremarkable calvarium and soft tissues of the scalp.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.
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1.No detectable acute intracranial process.2.Stable exam since prior study from 2013.
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Generate impression based on findings.
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93 years, Female. Reason: r/o free air History: acute onset R abdominal pain and hypoxia Nonobstructive gas pattern. No intramural air or free air evident. Remainder or strictures unchanged from prior examinations.
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No intramural air or free air. No evidence of obstruction.
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Generate impression based on findings.
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Respiratory distress.VIEW: Chest AP (one view) 2/3/15 at 312 hours ET tube tip is low thoracic inlet. Central line terminates in the right atrium. Gastrostomy tube noted. Spica cast is present. Cardiac silhouette size is normal. Persistent bibasilar opacities from atelectasis or pneumonia.
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Persistent bibasilar opacities.
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Generate impression based on findings.
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Male 22 years old; Reason: recent stone with stent in place. now with recurrent abd pain History: recent stone with stent in place. now with recurrent abd pain ABDOMEN:LUNG BASES: Linear pattern of basilar atelectasis bilaterally.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: 12mm obstructing stone is noted in the proximal left ureter (series 3 image 58) which causes proximal mild left hydroureteronephrosis and perinephric/ureteral stranding compatible with obstructive uropathy. Thre are smaller stones within the left renal pelvis.Right kidney Is unremarkable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Large sacral decubitus ulcer with sclerotic changes in the sacrum/coccyx most compatible with chronic osteomyelitis.BONES, SOFT TISSUES: Foreign body in the right back soft tissuesOTHER: No significant abnormality noted.
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1.12 millimeter obstructing left renal calculus.
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Generate impression based on findings.
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70 year-old male with diffuse tenderness to palpation, guarding, diarrhea. Evaluate for small bowel obstruction. ABDOMEN:LUNG BASES: Trace pericardial effusion. Partially visualized moderate coronary artery calcifications.LIVER, BILIARY TRACT: Status post cholecystectomy. No focal hepatic lesions identified.SPLEEN: Small accessory splenule is noted.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right renal hypoattenuating lesion is not significantly changed compared to previous exam and consistent with a cyst. No hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: Moderate atherosclerotic calcifications affect the abdominal aorta and its branches.BOWEL, MESENTERY: Moderately dilated loops of small bowel measuring up to 4 cm with distensibility gradient between the small bowel and the colon. Findings consistent with small bowel obstruction with transition point in the distal ileum as best appreciated on coronal series 80280, images 62 through 74. No pneumatosis intestinalis or portal venous gas.Interval removal of gastrostomy tube. Small bowel-containing umbilical hernia.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: As above.BONES, SOFT TISSUES: Degenerative changes affect the visualized spine.OTHER: No significant abnormality noted
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1.Findings consistent with small bowel obstruction with transition point in the distal ileum.2.Trace pericardial effusion.
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Generate impression based on findings.
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Clinical question: Patient being refractory AML, one-day history of acute left-sided facial swelling, no fluctuance on exam, assess for possible bony abnormalities/infection. Signs and symptoms: As above. Nonenhanced maxillofacial CT:Examination demonstrate no convincing evidence of soft tissue swelling of the facial region. The subcutaneous fat and the fascial planes remain visible and unremarkable.There is near complete opacification of right maxillary sinus with out detectable associated bony changes. There is minimal interval improvement of opacification of the right maxillary sinus has prior exam. The rest of the paranasal sinuses demonstrate minimal mucosal thickening however with slight interval improvement since prior exam. There is no evidence of bony abnormality of the maxillofacial region as is questioned clinically.Images through the orbits are unremarkable and stable since prior study.Bilateral mastoid air cells and middle ear cavities remain well pneumatized.There is a well-demarcated small focus of bony expansion in the right posterior temporal similar to prior exam. This finding is nonspecific however it has a benign appearance and could represent a focus of benign fatty deposit or a small hemangioma of questionable clinical significance.
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1.Chronic pansinusitis most noticeable in the right maxillary sinus as detailed. There is mild interval improvement since prior study.2.No detectable swelling/abnormality of the soft tissues of the cheek.3.No detectable bony abnormality of maxillofacial region as is questioned clinically.4.Unremarkable orbits, paranasal sinuses and mastoid air cells.
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Generate impression based on findings.
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33-year-old male with history of fevers. Evaluate for dental infection. This is a lucency within the right first molar which represents a cavity. There is a rounded opacity projecting over the right maxillary sinus which likely represents a mucous retention cyst.
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Cavity of the right first maxillary molar. Other findings as above.
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Generate impression based on findings.
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67-year-old male with history of fall. There is an oblique fracture through the distal fibula extending to the level of the tibiotalar joint with approximately 8 mm of posterolateral displacement of the distal fracture fragment. There is also a transverse fracture of the medial malleolus with approximately 1 cm of distraction and lateral displacement in relation to the talus. There also appears to be a minimally displaced "posterior malleolar" fracture fragment.
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Trimalleolar fracture as described above.
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Generate impression based on findings.
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59-year-old female with history of new onset seizures. There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration. There is no mass effect or herniation. A retention cyst is present in the right posterior ethmoid air cells. The mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable.
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No evidence of intracranial hemorrhage or mass effect. However, non-contrast CT is insensitive for the detection of non-hemorrhagic acute infarct.
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Generate impression based on findings.
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Male 54 years old; Reason: diverticulitis History: LLQ pain; hematochezia ABDOMEN:LUNG BASES: Basilar emphysema bilaterally.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Subcentimeter cystic lesion in the pancreatic head measuring 9 x 7 mm (image 53 series 3) is unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of bowel obstruction, mesenteric inflammation or free air. No free fluid or drainable collections. Scattered colonic diverticula.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: Please see aboveBONES, SOFT TISSUES: Degenerative changes of the lumbar spine.OTHER: No significant abnormality noted.
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1.Etiology for the patient's hematochezia is not evident on the current exam.
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Generate impression based on findings.
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Female; 63 years old. Reason: chest and back pain r/o PE -- if able, try to include gallbladder History: chest pain PULMONARY ARTERIES: No acute pulmonary embolus. Normal caliber of the main pulmonary artery. No evidence of right heart strain.LUNGS AND PLEURA: Mild bibasilar subsegmental atelectasis and/or scarring. 1.9 x 0.8 cm right diaphragmatic pleural nodule (coronal image 46, series 80664). No pleural effusions.MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. No visible coronary artery calcifications. Single nonspecific prominent right cardiophrenic lymph node.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. 1.4-cm round soft tissue nodule in the left upper quadrant with density similar to the spleen, most likely a splenule (image 186, series 7). Small hypoattenuating lesion in the right lobe of the liver near the dome is incompletely characterized but likely a cyst. Gallbladder is incompletely evaluated.
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1. No acute pulmonary embolus.2. Nonspecific right diaphragmatic pleural nodule, potentially due to a solitary fibrous tumor and for which 3-6 month follow-up is recommended to ensure stability.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable.
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Generate impression based on findings.
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12 year old ex 32 week premie female with cystoperitoneal shunt placed at birth now presenting with worsening headaches and high opening pressure on LP. There is an intact right occipital approach catheter terminating within a large posterior fossa cyst that communicates with the pineal cistern and results in anteroinferior displacement of the cerebellum and anterosuperior displacement of the tentorium and cerebral hemispheres. There appears to be congenital hypoplasia of the occipital lobes. There is also vermian hypoplasia. Comparison with the prior exam is difficult due to absence of coronal and sagittal reformatted images as well as different axial angulation, however, the cyst is grossly unchanged in size. The fourth ventricle has decreased in size. The ventricles and basal cisterns are otherwise unchanged in size and configuration. There is no evidence of acute intracranial hemorrhage. There is an unchanged subcentimeter focus of fat within the pineal cistern. There is no midline shift. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable.
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1.Large shunted posterior fossa cyst is grossly unchanged in size with associated vermian and occipital lobe hypoplasia. 2.No evidence of ventriculomegaly with interval decrease in size of the 4th ventricle. 3.Unchanged midline lipoma in the pineal cistern.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is mostly fatty replaced. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSA - Screening Mammogram.
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Generate impression based on findings.
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70 years, Male. Reason: eval dobhoff History: evsl dobhoff I cannot follow the course of the Dobbhoff tube despite no obvious patient or respiratory motion.I suggest pulling the Dobbhoff tube back several inches and repeating film to make sure that the catheter is intact along its course. Discussed with Dr. Patel pager 3929.
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Although Dobbhoff tip is in the distribution of the gastric fundus I cannot follow the course of the catheter and recommend repeat evaluation.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is composed of scattered fibroglandular elements. There is a calcified in the mass anterior quadrant in the left breast, likely a fibroadenoma. There are multiple benign-appearing small masses in both breasts.No suspicious microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Mammogram works best when searching for changes. Submission of prior mammogram is, therefore, recommended for future reference. If the patient submits her old mammograms, we can compare them with the current study to establish stability.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram.
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