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Generate impression based on findings.
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54-year-old female with wrist pain, tenderness on distal radial styloid. Assess for bony abnormality. There is mild soft tissue swelling along the radial aspect of the wrist. We see no evidence of fracture or malalignment. Tiny osteophytes project from the trapezium and scaphoid, indicating minimal osteoarthritis.
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Soft tissue swelling and minimal osteoarthritis.
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Generate impression based on findings.
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10-month-old female with hip clickVIEW: Pelvis AP (one view) 02/03/15 The femoral heads are not ossified. Ossification of femoral heads at 7 months is in the 95% percentile. The metaphyses are well positioned with respect to the acetabula. Acetabular configuration is normal. No acute fracture or malalignment is evident.
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Delayed skeletal maturation. No evidence of developmental hip dysplasia.
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Generate impression based on findings.
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Post treatment changes from prior left partial mandibulectomy, right neck dissection, and left buccal mucosal tumor resection and regional radiation therapy are again seen. The mandible and instrumentation appear to be intact. There is further decreased left cheek subcutaneous fat stranding and skin thickening. The fat along the left masseter muscle remains ill-defined and partially based. The fat in the left mandibular foramen is not well visualized, but unchanged.PHARYNX/LARYNX: The nasopharynx, oropharynx, hypopharynx, and larynx are unremarkable. The upper trachea and esophagus are unremarkable. There is no abnormal soft tissue mass or pathological enhancement.GLANDS: The left some of the gland is surgically absent. The left parotid and right submandibular gland appear some atrophic. The thyroid gland is diminutive in size. ORAL CAVITY: The oral tongue and floor of mouth are unremarkable, within the limitations of this exam as there is artifact from the mandibular instrumentation.There are multiple dental caries. On thin section axial and coronal images, there is suggestion of increasing rind of mildly enhancing soft tissue along the left maxillary alveolar process along presumed ADA number number 13 and 14, with intervening extensive dental carie best seen on 80469/54. The rind of soft tissue is best seen on 80468/18-21 This concerning for an area of infection/phlegmon. Images are slightly limited by streak artifact, and angled images do not include this area within the field of view. There is an impacted right mandibular molar. There is a periradicular and periapical lucency along the residual left mandibular molar. CERVICAL SOFT TISSUES: There are no pathologically enlarged cervical lymph nodes.OTHER: The right internal jugular vein is again not visualized. There are persistent multilevel cervical spondylotic changes. There are multiple spiculated upper lung nodules at the lung apices, slightly decreased in prominence on the right. There continues to be moderate opacification of the maxillary sinuses with right-sided central fluid. There is a moderate scattered opacification of the ethmoid air cells. There is a partially visualized right sided Port-A-Cath.
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1. Stable postoperative and posttreatment changes within the neck with further improved appearance of left cheek soft tissues in area of previous cellulitis. No definite evidence of local regional tumor recurrence.2. Redemonstration of multiple dental caries with now increasing rind of soft tissue along the left posterior maxillary alveolar process along the molars with a previously seen large dental carie between presumed ADA number 13 and 14. Correlation with direct inspection is recommended for possible gingival infection/phlegmon.3. Redemonstration of multiple spiculated upper lung nodules, decreased in the right lung apex.
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Generate impression based on findings.
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Intoeing.VIEW: Pelvis AP (one view) 02/03/15 Femoral head ossification centers are symmetric and well directed into normally formed acetabula. No fracture is present.
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Normal examination.
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Generate impression based on findings.
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Pain Three views of the right hip again show severe osteoarthritis of the hip joint with flattening of the superior articular surface of the femoral head that appears similar to that seen on the prior study accounting for slight technical differences.The AP view of the pelvis shows the aforementioned severe right hip osteoarthritis. There is also deformity of the right superior pubic ramus that presumably reflects an old healed fracture. Overall, the bones are demineralized, suggesting osteopenia/osteoporosis. Relatively mild osteoarthritis affects the left hip. Degenerative arthritic changes affect the lower lumbar spine.
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Severe right hip osteoarthritis as above.
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Generate impression based on findings.
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Status post urethroplasty Scout film reveals the course of the suprapubic catheter.Cystografin was administered by gravity via the suprapubic catheter. The patient began to urinate involuntarily at a volume of 300 mL.There is a small contrast filled collection along the left anterolateral wall of the prostatic and possibly membranous urethra compatible with a contained leak, which measures 1.5 x 0.5 cm. There is additional mucosal contour irregularity along the dorsal wall in this region. The bulbous and penile urethra are unremarkable.
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Contained leak involving the left anterolateral wall of the prostatic and possibly membranous urethra.
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Generate impression based on findings.
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Status post right total knee arthroplasty Components of a right total knee arthroplasty device are situated in near anatomic alignment without radiographic evidence of hardware complication. Skin staples and foci of gas density in the anterior soft tissues reflect recent surgery.
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Postoperative changes of total knee arthroplasty as above.
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Generate impression based on findings.
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Status post left total knee arthroplasty Components of a left total knee arthroplasty device are situated in near-anatomic alignment without radiographic evidence of hardware complication. Skin staples, a drain, and foci of gas density in the soft tissues reflect recent surgery.
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Postoperative changes of total knee arthroplasty as above.
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Generate impression based on findings.
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Hip pain in runner. Rule out stress fracture. I see no stress fracture or other specific findings to account for the patient's hip pain, although there is perhaps mild degenerative arthritis of the visualized left sacroiliac joint.
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Possible mild left sacroiliac joint osteoarthritis, but no stress fracture or other specific findings to account for the patient's left hip pain. If further imaging evaluation is clinically warranted, MRI of the left hip may be considered.
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Generate impression based on findings.
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Female 57 years old; Reason: eval fluid collection, infectious process, obstruction History: abd pain, n/v, leukocytosis, s/p diverting ostomy ABDOMEN:LUNG BASES: Left hilar adenopathy. Soft tissue nodule in the lingula measures 1.5 x 1.1 cm (image 6/series 4). Multiple pulmonary nodules in the lung bases. Trace left pleural effusion.LIVER, BILIARY TRACT: Multiple hypodense hepatic lesions have progressed compatible with metastatic disease. Hepatic and portal veins are patent.The percutaneous biliary drain terminates within the duodenum.SPLEEN: No significant abnormality noted.PANCREAS: Atrophy of the pancreas. There is mild pancreatic ductal dilatation involving the head and neck. Cystic lesion in the pancreatic tail.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Reference left periaortic soft tissue has decreased in size measuring 1.2 x 1.2 cm (image 81/series 3) previously, 2.3 x 1.8 cm.There is confluent soft tissue encasing the upper portion of the inferior vena cava and aorta.BOWEL, MESENTERY: Postsurgical changes in the bowel with a right abdominal ostomy. There is mild wall thickening of the small bowel loops in the pelvis.A necrotic appearing mass adjacent to the cecum measures 4.5 x 3.0 cm (image 81/series 3) previously, 2.6 x 2.4 cm.Nodularity of the peritoneum suggests metastatic peritoneal carcinomatosis.Thrombosis of the superior mesenteric vein.BONES, SOFT TISSUES: Postsurgical changes in the intra-abdominal wall.OTHER: Increasing abdominal ascites.PELVIS:UTERUS, ADNEXA: Enlarged uterus.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: Pelvic ascites.
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1.Progression of the hepatic metastases. 2.Increase in the necrotic mass adjacent to the cecum.3.Increasing ascites. Consider aspiration for evaluation of infection.4.Bowel wall thickening of unclear etiology.
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Generate impression based on findings.
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Bilateral high probability benign focal asymmetries. Possible isoechoic fibroadenoma or fat lobule in the medial superior left breast. Bilateral diagnostic mammogram in 6 months was recommended. No new breast complaints. Three standard views of both breasts and bilateral spot compression views were performed digitally with additional spot compression views and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Asymmetry in the superior right breast partially disperses with spot compression imaging and is unchanged. Asymmetry in the superior left breast partially disperses with spot compression imaging and is also unchanged. The 12 mm mass in the medial superior left breast posteriorly is stable. No suspicious microcalcifications or areas of architectural distortion in either breast.
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Stable focal asymmetries bilaterally. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended in 6 months. Results and recommendation were discussed with the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months).
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Generate impression based on findings.
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Male, 54 years old, history of T1N1 oral tongue SCC, completed FHX CRT 1/4/2008, s/p recurrence with multiple lung mets and a L chest wall mass in 5/14, started on carbo/docetaxel on 5/16/14, s/p 2 cycles, and now enrolled in the MK3475 (IRB 130311) clinical study. Head:No mass effect, focal edema or suspicious enhancement is seen to suggest brain parenchymal metastatic disease. The bones of the calvarium and skull base are intact. A small fluid level is present in the left maxillary sinus.Neck:Anatomic asymmetry of the oral tongue with some volume loss of the posterior aspect is unchanged and may be related to prior treatment. No tongue or mucosal masses are identified.No pathologic adenopathy is detected in the neck by size criteria. A mildly prominent, 11 x 10 mm left axillary lymph node shows no significant interval change from the immediate prior exam, but it has increased slightly from older exams.The right submandibular gland is absent. The remaining salivary glands and thyroid are free of focal lesions. The cervical vessels enhance normally.A nodule is identified within the right upper lobe as well as scattered pleural based lesions in the left upper lung which are better assessed on the accompanying chest CT.No considering osseous lesions are detected.
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1. No evidence of recurrent primary tumor or pathologic adenopathy in the neck.2. Left axillary adenopathy is unchanged relative to the immediate prior examination, but does show some slow increase relative to older exams.3. Multiple lung lesions are better assessed on dedicated chest imaging.4. No evidence of intracranial metastases.
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Generate impression based on findings.
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Male 67 years old; Reason: metastatic prostate cancer, evaluation of disease after 12 month of investigational therapy. Patient notes history of multiple falls as well as temporomandibular joint arthritis. Please complete PCWG form There is new increased activity in the posterolateral aspect of the right 10th rib with an appearance typical of fracture and correlates with findings on CT. Activity throughout the thoracic and lumbar spine correlates with degenerative and postsurgical changes on CT. Bilateral photopenic defects of the hips correlates with bilateral hip prosthesis. Increased uptake in the right temporomandibular joint is similar to prior study consistent with arthritis. No abnormal osseous foci are identified to indicate metastatic disease.
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1. No evidence of osseous metastases.2. New right 10th rib fracture.
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Generate impression based on findings.
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Male 54 years old; Reason: h/o met base of tongue cancer, compare to previous, measurements pls CHEST:LUNGS AND PLEURA: Posterior pleural-based mass in left hemithorax without significant change in size, measuring 4.2 x 2.4 cm on image 27 series 4, interval progression of internal cavitation seen. Left basilar extensive pleural thickening and subpleural atelectasis again visualized, likely due in part to postradiation pneumonitis. Mild interval increase in amount of left basilar pleural fluid. Mild interval increase in size of right upper lobe lung nodule, measuring 1.3 x 1.2 cm, image 26 series 4, previously measured 1 x 1 cm.MEDIASTINUM AND HILA: Stable to mildly increased prominence of multiple mediastinal lymph nodes, measuring up to 1 cm.CHEST WALL: Increase in size of left lower chest wall mass/fluid collection, measuring 5.9 x 3 cm, image 90 series 3, previously measured 5.8 x 2.3 cm, adjacent soft tissue nodularity present. Associated erosive/sclerotic changes of adjacent ribs noted, particularly at level of left seventh costochondral junction, extending to region of sixth left costochondral junction. Old left anterior sixth rib fracture.ABDOMEN:LIVER, BILIARY TRACT: Stable hepatic segment 5 cyst.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Symmetric renal parenchymal enhancement.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small hiatal hernia. Large stool burden, no bowel obstruction. Fecalized small bowel seen without evidence of bowel dilatation, may reflect an incompetent ileocecal valve. Air and fluid containing appendix measuring upper limits of normal at 6 mm, no surrounding inflammation. No ascites. PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: New from earlier study is 1.6 cm lytic lesion involving T6 vertebral body, extends to level of T6/7 intervertebral disk space, suspicious for new metastatic disease. Stable subcentimeter sclerotic focus in right ilium and subcentimeter lucent focus in left ilium, image 159 series 3.
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1. Interval increase in size of right upper lobe lung nodule and left lower chest wall mass, suspicious for metastatic disease, additional pulmonary findings as above.2. New T6 vertebral body lytic lesion, compatible with osseous metastatic disease.
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Generate impression based on findings.
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Leukocytosis status post Hartmann procedure for perforated diverticulitis ABDOMEN:LUNG BASES: Interval decrease in small bilateral pleural effusions.LIVER, BILIARY TRACT: Stable subcentimeter segment 7 right lobe hypo-attenuating focus; favor benign etiology. Stable cholelithiasis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable right renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mildly dilated proximal small bowel loops again noted. Collapsed distal ileal loops observed.BONES, SOFT TISSUES: Unremarkable end colostomy. Midline wound dehiscence unchanged.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Uterus absent or atrophicBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: New loculated fluid collection within the left pelvis adjacent to the Hartman pouch staple line best seen on image 114 of series 3 measuring 2.5 x 3.4 cm.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Loculated fluid collection within the left pelvis adjacent to the Hartman pouch staple line; an abscess cannot be excluded.Persistent dilated proximal small bowel loops associated with collapsed distal ileum. While may represent a slowly resolving ileus, an early partial small bowel obstruction should also be considered.
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Generate impression based on findings.
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Two year-old female with right foot injury, not weight-bearing, no point tenderness.VIEWS: Right ankle AP/lateral/oblique (3 views) 02/03/15 No acute fracture or malalignment is evident. No significant soft tissue swelling. A joint effusion is not present.
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Normal examination.
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Generate impression based on findings.
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62-year-old with history of fibrocystic breast disease. History of benign left breast biopsy. Three standard views of both breasts and a right spot view were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. The x-shaped biopsy clip in the left breast as well as adjacent calcifications are not significantly changed. Bilateral areas of focal asymmetry elsewhere do not appear significantly changed. This includes an asymmetry which largely disperses on spot compression in the right 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: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.
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Generate impression based on findings.
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Male 45 years old; Reason: anal cancer, 2013 s/p chemoRT History: none CHEST:LUNGS AND PLEURA: Calcified granulomata adjacent to left major fissure and right apex.. The pleural spaces are clear.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedOTHER: 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: Tiny retroperitoneal nodes.BOWEL, MESENTERY: Please see belowBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No pelvic adenopathy.BOWEL, MESENTERY: Mild rectal thickening which is improved since prior. Mild infiltration of the surrounding fat.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.Stable exam without evidence for metastatic disease.
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Generate impression based on findings.
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Reason: assess for cause of increased lightheadness and ataxia with 4 falls in a week History: ataxia and increased falls 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.A hypodense focus is present in the left caudate nucleus measuring 5 mm in size which is unchanged since the prior examThe visualized portions of the paranasal sinuses demonstrate minor opacities in the left maxillary sinus and left ethmoid air cells. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin. Incidental note is made of hyperostosis frontalis interna. Atherosclerotic calcifications are present along the distal internal carotid arteries. Atherosclerotic calcifications are present along the distal vertebral arteries. There is medial deviation of the medial wall of the left orbit which is stable compared to the prior exam.
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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 acute cerebral infarction.3.Old lacunar infarct is present in the left caudate nucleus.4.Examination is stable compared to the prior exam.
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Generate impression based on findings.
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Reason: r/o ICH History: HA, hx of CVA 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.Periventricular and subcortical white matter hypodensities of a mild degree are present. These are unchanged from prior exam.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. The eyeball lenses are thin.
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1.No evidence for acute intracranial hemorrhage mass effect or edema.2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. These are unchanged since prior exam.3.CT is insensitive for the early detection of acute nonhemorrhagic cerebral infarction.
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Generate impression based on findings.
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Reason: 20F with persistent tachycardia to 140-150s, assess for PE History: 20F with persistent tachycardia to 140-150s, assess for PE PULMONARY ARTERIES: Technically adequate examination with no sign of pulmonary embolism.LUNGS AND PLEURA: Marked elevation of the left hemidiaphragm, unchanged, with overlying subsegmental atelectasis. Small subpleural scars and micronodules, probably not significantly changed.MEDIASTINUM AND HILA: No significant lymphadenopathy.Normal heart size with no evidence of right heart strain or pericardial effusion.No visible coronary artery calcification.CHEST WALL: Enlarged axillary lymph nodes bilaterally of uncertain significance, partially visualized on the previous scan.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Limit evaluation with partial visualization of the kidneys. Moderate left hydronephrosis with calcifications.
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1. No pulmonary emboli.2. Marked elevation of the left hemidiaphragm with left basilar subsegmental atelectasis, unchanged from previous. 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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37-year-old with history of right breast cancer status post mastectomy presents for unilateral follow-up. Three standard views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in the left breast.
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No mammographic evidence of malignancy. The patient is considering prophylactic left mastectomy. If that does not occur, and as long as the patient's physical examination remains normal, left unilateral diagnostic mammogram is recommended annually. Surveillance MRI should also be strongly considered. 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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There is minimal residual increased density within the asymmetrically thinned subcutaneous fat along the right lateral cheek. No discrete mass or fluid collection is identified. There is persistent nonspecific hypodense material within the posterior inferior right maxillary sinus with erosion of the maxillary sinus floor and the maxillary alveolar ridge with fistulous connection to the oral cavity, which is not as well aerated as on the prior exam. There may also be a trace air-fluid level now within the right maxillary sinus. The right orbital floor remains slightly irregular and ill-defined in appearance.PHARYNX/LARYNX: The nasopharynx, oropharynx, hypopharynx, and larynx are unremarkable. The upper trachea and esophagus are unremarkable. There is no abnormal soft tissue mass or pathological enhancement.GLANDS: The left cerebellar gland is surgically absent. Enhancement of the right as well as both parotid glands which are all diminutive in size, likely post treatment related. There are tiny hypodensities within the thyroid gland which are nonspecific.ORAL CAVITY: The oral tongue and floor of mouth are unremarkable.CERVICAL SOFT TISSUES: There are no pathologically enlarged cervical lymph nodes.OTHER: There is prominent calcified and noncalcified atherosclerotic plaque along the aortic arch and the origin of the great vessels. There is also atherosclerotic calcification of the bilateral carotid bifurcations and cavernous/clinoid portions of the internal carotid arteries. The right internal jugular vein is not again not visualized. There is further improved aeration of the mastoid air cells/middle ears. There are mild-moderate multilevel cervical spondylotic changes with moderate to severe foraminal narrowing at several levels. There is a partially visualized right-sided Port-A-Cath coursing into the superior vena cava. There is mild mucosal thickening in the left maxillary sinus along with minimal patchy mucosal thickening in the visualized ethmoid air cells.Incidental note is made of an apparent teardrop-shaped area of air density in the left axillary soft tissues which is only partially visualized, measuring at least 2.3 x 2.3 cm in greatest axial dimensions on 80570/88. Correlating with previous imaging, this appears to represents external air trapped in the axilla due to arm positioning for this portion of the exam. concurrent CT chest images do not demonstrate any air density in this location, relating to change in arm position. There are several oval soft tissue density structures within the left axilla which measure up to 1.4 cm in greatest short axis dimension. However correlating with previous postcontrast CT neck images as well as concurrent CT chest images, this appears to represent focal discontiguous dilatation of venous structures in the axilla rather than lymphadenopathy.
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1. Stable rind of nonenhancing tissue which is nonspecific within the right maxillary sinus especially along the floor of the sinus which is eroded. Stable fistulous connection between the right maxillary sinus and oral cavity.2. No cervical lymphadenopathy.
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Generate impression based on findings.
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Reason: h/o hnc and crt, compare to previous measurements History: none CHEST:LUNGS AND PLEURA: Subpleural area of atelectasis/consolidation posteriorly in the superior segment right lower lobe with debris identified within the segmental bronchus.Mild bronchial/bronchiolar wall thickening.Right basilar scarring/discoid atelectasis increased from the prior exam with demonstration of Tremont opacities at the right lung base.Scattered calcified and noncalcified micronodules without new suspicious pulmonary nodules or masses.The pleural effusions.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Cardiac size is normal.Moderate coronary artery calcification.Interval reduction in the focal anterior pericardial effusion.CHEST WALL: Right chest port with its catheter tip in the SVC.Marked degenerative changes throughout the thoracic spine.No evidence of axillary lymphadenopathy.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Stable left adrenal nodule measuring 2.6 cm x 2.7 cm.KIDNEYS, URETERS: Redemonstration of right renal pelvic calculus unchanged in without incident subsequent caliectasis.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Marked atherosclerotic disease of the aorta and its branches with stable infrarenal aortic aneurysm.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.G-tube in placeBONES, SOFT TISSUES: Severe degenerative changes and changes of degenerative disk disease throughout the lumbar spine.OTHER: No significant abnormality noted.
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1.No evidence of metastatic disease.2.New subpleural area of atelectasis/consolidation in the superior segment of the right lower lobe most likely related to aspiration.3.Increasing right basilar subsegmental atelectasis and tree in bud nodules most likely related to aspiration.
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Generate impression based on findings.
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Male 58 years old; Reason: Pancreatic neuroendocrine tumor on chemotherapy, evaluate for interval change CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: 1.2 x 0.7 cm reference cardiophrenic lymph node with additional smaller nodes also seen. Small calcified left hilar lymph nodes again seen, compatible with prior granulomatous disease.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Large heterogeneously enhancing dominant right hepatic metastasis without significant change in size accounting for differences in technique, measuring 17.9 x 14.6 cm, image 48 series 9, previously measured 18.3 by 14.3 cm. Additional hepatic segment 3 metastatic lesions also visualized, larger of the two demonstrating interval increase in size, measures 4.1 x 2.7 cm lesion on image 59 series 9, previously measured 3.1 x 2.2 cm. Second focus is unchanged, measuring 1.7 x 1.5 cm on image 53 series 9. Bilateral biliary stents, stable mild intrahepatic biliary duct dilatation. Displaced right hepatic vein. Main and left portal veins patent and proximal right portal vein markedly narrowed with distal segments not visualized secondary to tumor involvement, appearance unchanged from prior study. Splenic vein near level of pancreatic tail mass markedly narrowed and near occluded, image 100 series 10, similar in appearance to prior study.SPLEEN: No significant abnormality noted.PANCREAS: Heterogeneously enhancing solid/cystic pancreatic tail mass again seen, stable to mildly decreased in size after accounting for differences in technique, measuring 5.7 x 2.1 cm, image 50 series 9, previously measured 5.9 x 2.9 cm.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Nonobstructing 2 mm left intrarenal calculus. Bilateral renal cysts. Additional hypoattenuating left renal lesions seen that are too small to characterize. RETROPERITONEUM, LYMPH NODES: Unchanged enlarged celiac lymph nodes, measuring up to 1.2 cm in maximum short axis dimension. Subcentimeter retroperitoneal lymph nodes also seen. BOWEL, MESENTERY: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Intraprostatic calcifications.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Visualized osseous structures stable in appearance.
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1. Stable to mild decrease in size of solid/cystic pancreatic lesion, likely primary neuroendocrine tumor.2. Interval increase in size of hepatic segment 3 metastatic lesion as above with additional hepatic segment 3 and dominant right hepatic mass without significant change.
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Generate impression based on findings.
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Pain. Injury.VIEWS: Left shoulder internal/external rotation (two views) 02/03/15 The humeral head is well directed to the glenoid fossa. No fracture is identified. The bones are normal in appearance.
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Normal examination.
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Generate impression based on findings.
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Female 58 years old; Reason: evaluate for metastasis. History: uterine leiomyosarcoma CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Multiple stable bilobar hypoattenuating liver lesions.SPLEEN: 1.3 cm splenule.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Visualized osseous structures stable in appearance. Unchanged 2.2 x 1 cm soft tissue focus adjacent to left external iliac vein, image 183 series 3, may be postoperative in etiology but nonspecific.
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1. Stable exam as above without definite local tumor recurrence or metastatic disease.
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Generate impression based on findings.
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Pain and swelling. Rule out fracture.VIEWS: Left ankle AP/lateral/oblique (3 views), left foot AP/lateral/oblique (3 views) 02/03/15 Moderate soft tissue swelling over the lateral ankle is noted. A spiral/oblique fracture of the distal fibula is present. Minimal displacement is present. A tibial fracture is not seen.The bones of the foot are normal in appearance. Soft tissue swelling extends over the lateral foot and on to the dorsum.
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Fibular fracture.
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Generate impression based on findings.
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T3N2b pyriform sinus squamous cell carcinoma of the larynx, s/p CRT. There are post-treatment changes in the neck with mild residual supraglottic and hypopharyngeal mucosal edema asymmetrically greater on the right. There is no discrete mass lesion to suggest tumor recurrence. There is no significant cervical lymphadenopathy. For reference, right level Ib lymph node measures 6 mm in the short axis and unchanged. Left upper paratracheal nodule measures 5 mm and is also unchanged. Atrophic submandibular glands are unchanged. The thyroid gland is also atrophic and unchanged. There is a right subclavian central venous catheter. Major cervical vessels are patent. The airway is patent. There is mild degenerative spondylosis of the cervical spine. There are bilateral maxillary sinus retention cysts. There is extensive pleural thickening in the lung lung apex, as well as surgical clips. Please see separate report for findings in the chest.
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1. No evidence of locoregional tumor recurrence or significant cervical lymphadenopathy.2. Please refer to the separate chest CT report for additional details.
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Generate impression based on findings.
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Male 77 years old; Reason: metastatic prostate cancer on therapy with rising therapy History: metastatic prostate cancer CHEST:LUNGS AND PLEURA: Few scattered pulmonary micronodules.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. No mediastinal lymphadenopathy.CHEST WALL: Gynecomastia.OTHER: ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. Cholelithiasis. No biliary ductal dilatation. No suspicious hepatic lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal nodule measures 2.6 cm previously, 3.0 cm.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Soft tissue in the pelvic mesentery measures 1.7 x 1.5 cm (image 156/series 4) previously, 1.7 x 1.5 cm.BONES, SOFT TISSUES: Stable sclerotic lesion in the left femoral neck.OTHER: No significant abnormality noted
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1.Stable exam with no significant change in the soft tissue in the pelvic mesentery or left femoral neck lesion.2.Correlate with recent bone scan as it is more sensitive to detect new bone metastases.
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Generate impression based on findings.
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The ventricles and sulci are progressively prominent as compared to the prior CT, consistent with further global volume loss. The extra-axial space does appear somewhat more prominent anteriorly with some areas of traversing vessels, which may indicate a component of benign enlargement of subarachnoid spaces of infancy. There is new focal hyperdensity which likely is subdural in location along the anterior aspect of the left frontal lobe, measuring 5 mm in greatest thickness.Gray-white differentiation remains poorly defined, with an irregular appearance of the cortical contour. There is relative hyperdensity of the pre- and postcentral gyri. The previous foci of hyperdensity in the left occipital lobe are much less conspicuous, consistent with expected evolution of a small parenchymal hematoma. The cerebellum remains preserved.There is no midline shift or mass effect. There is a partially visualized nasogastric tube. There is moderate opacification of the left mastoid air cells and left middle ear.
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1. Interval development of focal extra-axial hyperdensity along the anterior aspect of the paramedian left frontal lobe measuring 5 mm in greatest thickness, consistent with blood products which are likely subdural in location.2. Progressive global volume loss with probable superimposed benign enlargement of subarachnoid spaces of infancy.3. Interval expected evolution of focal small left occipital parenchymal hematomas.Dr. Yang discussed these findings over the telephone with Dr. Nicole Johnson on 2/3/2015 1:30 PM.
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Generate impression based on findings.
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Female, 40 years old, with history of inflammatory myofibroblastic tumor, ALK+, on AP26113, evaluate for treatment response. Evidence of left anterior chest wall resection is again seen involving at least the first through third ribs and most of the clavicle. The pectoralis muscles have been resected. A soft tissue flap reconstruction with mesh has been performed.No evidence of local disease recurrence is seen within the operative bed, but please note that the surgical field is only partly visualized on this study.Elsewhere in the neck, no pathologic adenopathy is detected. No mucosal based lesions are seen. The salivary glands and thyroid are free of lesions. The cervical vessels enhance normally with the exception of the right IJ vein which is of small caliber similar to prior.The visualized lung apices are unremarkable. No concerning osseous lesions are detected.
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Stable postoperative findings in the left anterior chest without evidence to suggest locally recurrent disease or nodal metastases. Please note that the surgical field is only partly visualized on this study, and reference should be made to the accompanying chest CT for a more complete assessment.
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Generate impression based on findings.
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Metastatic colon carcinoma CHEST:LUNGS AND PLEURA: There has been little significant interval change in the overall appearance or size of the previously noted bilateral pulmonary metastatic nodules. The referenced left lower lobe nodule best seen on image 65 of series 4 measures 1.2 x 1.2 cm.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Bilobar hepatic metastases again noted. The reference segment 8 lesion best seen on image 58 of series 3 has not significantly changed measuring 1.5 x 1.5 cm. The referenced segment 5 right lobe lesion best seen on image 90 of series 3 has remained stable measuring 0.8 x 0.7 cm.Segment 4a left lobe lesion best seen on image 68 of series 3 measuring 1.5 x 0.9 cm.; in retrospect, this lesion was present on 9/15/2004 but was significantly less conspicuous, measuring 0.4 x 0.5 cm.Enhancing peripheral segment 3 lesion stable; favor benign etiology.Fatty infiltration of the liver.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: 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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Segment 4a left lobe liver lesion as described. In retrospect, this lesion was present on the prior study but was significantly less conspicuous and smaller.Other bilobar hepatic metastases and bilateral pulmonary metastatic nodules relatively stable.
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Generate impression based on findings.
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Female; 62 years old. Reason: HCC rule out mets History: HCC LUNGS AND PLEURA: Scattered nonspecific pulmonary micronodules. No suspicious pulmonary nodules or masses. Minimal biapical scarring. No pleural effusions.MEDIASTINUM AND HILA: Prominent mediastinal lymph nodes are seen, but there is no definite mediastinal lymphadenopathy by CT size criteria. No definite hilar lymphadenopathy, though evaluation is limited without intravenous contrast. 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. Cirrhotic liver morphology. Known large right hepatic mass is poorly visualized without IV contrast. Splenomegaly.
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Scattered nonspecific pulmonary micronodules. No definite metastatic disease in the chest.
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Generate impression based on findings.
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39 year old with history of left breast cancer status post mastectomy. Three standard views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in the right breast. A few scattered benign calcifications are again noted.Benign appearing lymph nodes are projected over the right axilla.
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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. Screening MRI can also be considered based on the patient's breast density and young age at cancer diagnosis. 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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Pain and swelling. Fracture? I see no fracture or malalignment. I see no specific findings to account for the patient's pain.
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No fracture evident. If there is strong clinical concern for fracture, repeat radiographs may be obtained in 7 to 14 days; alternatively, CT or MRI may be considered.
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Generate impression based on findings.
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Patient fell directly onto bent knee while pushing car on ice yesterday. Pain with movement and walking. Small osteophytes indicate mild osteoarthritis. I see no fracture or malalignment.
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Mild osteoarthritis without fracture evident.
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Generate impression based on findings.
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Knee pain 4 views of the left knee are provided. Round/tubular lucencies in the proximal tibial metaphysis likely reflect prior orthopedic intervention. I see no hardware on the current study. Small osteophytes indicate mild osteoarthritis. I see no joint effusion. Alignment is within normal limits.The right knee appears normal for age as seen on the frontal views.
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Mild osteoarthritis and finding suggesting prior orthopedic intervention of the left tibia.
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Generate impression based on findings.
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Female; 66 years old. Reason: Pt is a 65 y/o female with h/o aggressive RCC, evaluate for recurrence History: h/o RCC, s/p nephrectomy, evaluate for recurrence LUNGS AND PLEURA: Stable minimal scarring in the lung bases and medial right middle lobe.Stable 9 mm nodule in the left lower lobe with dense central calcification, unchanged since 4/2013 (series 4/70).Stable additional scattered pulmonary micronodules, some of which are calcified and likely represent granulomata. No suspicious pulmonary nodules or masses. No pleural effusions.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.Normal heart size without pericardial effusion.No visible coronary artery calcifications.CHEST WALL: Mild degenerative arthritic changes of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Stable punctate pancreatic calcifications likely represent prior pancreatitis. Small hypoattenuating lesions in the liver are unchanged and likely due to cysts. Status post left nephrectomy.
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Stable scattered lung nodules without evidence of metastatic disease.
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Generate impression based on findings.
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Right shoulder pain putting arm behind back and raising Mild osteoarthritis affects the glenohumeral joint. There is calcification between the humeral head and the acromion process that likely represents calcific tendinopathy of the rotator cuff (posterior supraspinatus and infraspinatus). A small focus of mineralization is also seen along the dorsal aspect of the acromioclavicular joint which may represent calcification of the capsule or a small ossicle.
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Osteoarthritis and findings suggesting calcific tendinopathy of the rotator cuff as described above.
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Generate impression based on findings.
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25 year old with palpable mass in the left breast. Targeted ultrasound was performed for the patient's area of concern in the left breast near 12 o'clock. At this site, a mixed hyperechoic and hypoechoic area was seen. A question of a few punctate calcifications was present, and this was the cause for the follow-up mammogram below.MAMMOGRAM
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Findings at the site of palpable concern are suggestive of a hamartoma or focal dense parenchyma. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually at age 40. Until that time, clinical follow-up is recommended, especially given the palpable area of concern. If physical exam findings are suspicious despite benign imaging, then further intervention including surgical consultation may be warranted. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed.
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Generate impression based on findings.
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Pain. Fracture evaluation. Again seen is an oblique fracture through the proximal diaphysis of the third metacarpal with fracture fragments in near anatomic alignment. The fracture appears similar to that seen on the prior study accounting for slight positional differences. The previously seen fracture through the base of the fourth metacarpal is not clearly evident on this study, likely due to slight differences in patient positioning. Also again noted is an oblique intra-articular fracture of the distal radius predominantly involving the radial styloid, which also appears similar to that seen on the prior study accounting for slight technical differences. There is soft tissue swelling dorsal to the metacarpal heads.
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Distal radius and metacarpal fracture(s) as described above.
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Generate impression based on findings.
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68-year-old female with history of injury to tailbone with pain. Please evaluate for fracture. The bones appear demineralized, but I see no fracture. Moderate-severe degenerative disk disease affects L5/S1.
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Degenerative disk disease; I see no fracture.
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Generate impression based on findings.
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Female; 61 years old. Reason: Hx head, neck, face CA S/P CRT compare with prior scans, measurements please CHEST:LUNGS AND PLEURA: Postoperative changes from left upper lobectomy.Mild emphysema.Previously described focal nodular and airspace opacities in the right upper lobe have resolved, consistent with aspiration and infection.Mild subsegmental atelectasis in the medial right middle lobe, increased since prior study.Scattered punctate pulmonary micronodules are stable and presumably postinflammatory.No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Scattered subcentimeter mediastinal lymph nodes are unchanged. No mediastinal or hilar lymphadenopathy.Port catheter with its tip in the SVC.Severe coronary artery calcification.CHEST WALL: Port in the right anterior chest wall.Stable presumed epidermal inclusion cyst in the right axilla.Postoperative changes from left thoracotomy.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Mild focal fat deposition in the right lobe of the liver near the falciform ligament. No suspicious hepatic lesions. Mild central intrahepatic biliary ductal dilation with dilation the common bile duct measuring up to 11 mm, which could be within normal variation in this patient status post cholecystectomy. Minimal pneumobilia, which may be due to patent ampulla.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cysts. Additional bilateral subcentimeter hypoattenuating lesions are too small to characterize but likely represent benign cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1. No evidence of metastatic disease in the chest and abdomen.2. Increased subsegmental atelectasis in the medial right middle lobe.
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Generate impression based on findings.
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Female 40 years old; Reason: mets IMT, ALK+, on AP26113, pls c/w previous study and evaluate tx response. History: IMT CHEST:LUNGS AND PLEURA: No dominant lung lesion. Stable calcified mass at the right lung base.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. No mediastinal lymphadenopathy.CHEST WALL: Postsurgical changes from a left thoracoplasty and clavicle resection.ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. Tiny hypodense foci are unchanged. Right hepatic lobe cyst is unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Post surgical changes from mobilization of the right rectus muscle.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: Hypodense and sclerotic foci in the right ilium are unchanged.OTHER: No significant abnormality noted.
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1.Stable exam without evident metastatic disease.
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Generate impression based on findings.
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Back pain. Osteoarthritis? Severe degenerative disk disease affects L4/5 and L5/S1. This appears similar to that seen on the prior study. Moderate facet joint osteoarthritis affects the lower lumbar levels. Alignment is within normal limits. Vertebral body heights are preserved.
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Degenerative disk disease and facet joint osteoarthritis affecting the lower lumbar spine.
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Generate impression based on findings.
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13-year-old male with left breast mass. A targeted bilateral ultrasound was performed. There is no solid or cystic mass identified. At the palpable area of concern identified by the patient in the left outer chest wall, only pectoralis muscle elements are seen. Similar but slightly less prominent muscular elements are seen on the contralateral side. No gynecomastia or breast mass is seen on either side.
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No sonographic evidence for malignancy. Findings at the site of palpable concern have the sonographic appearance of muscle tissue. Clinical correlation is recommended. The patient states that he did a large amount of pectoralis exercise some months ago and had more pain on the side of current concern. BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed.
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Generate impression based on findings.
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46 year old female status post cystectomy neobladder on 1/23/2015 with persistent abdominal pain. Concern for obstruction. Evaluate.Per chart review, patient with history of anterior pelvic exenteration with en bloc radical cystectomy, total abdominal hysterectomy with bilateral salpingo-oophorectomy, and bilateral standard template pelvic lymph node dissection. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant interval change in the subcentimeter well-defined hypoattenuating foci in segment 8 and 6. No new hepatic lesions. No intra-or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal subcentimeter hypodensities are too small to characterize and stable. Interval placement of bilateral nephroureteral stents with gaseous foci within the collecting systems bilaterally as well as adjacent to the right mid ureter (series 3, image 62); findings are most likely post procedural in etiology.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of small bowel dilatation to suggest obstruction. No findings to suggest colitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Hysterectomy and bilateral oophorectomy. Interval resection of left adnexal fat-containing bilobed mass.BLADDER: Interval cystectomy with neobladder formation. LYMPH NODES: Surgical clips within the pelvis compatible with bilateral pelvic lymph node dissection.BOWEL, MESENTERY: Mild pelvic ascites as well as mesenteric haziness, most likely postsurgical in etiology. There is a right pelvic sidewall soft tissue attenuation measuring 4.3 x 2.8 cm (series 3, image 97) which is likely post-surgical in etiology and may represent an evolving hematoma. There is a surgical drain in the left lower quadrant. No drainable loculated or rim enhancing fluid collections.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.No findings to suggest small bowel obstruction as clinically questioned. 2.Postoperative changes of cystectomy and neobladder formation with right pelvic sidewall soft tissue attenuation which may represent an evolving hematoma.3.Interval placement of bilateral nephroureteral stents with air within the collecting system, which is most likely post procedural in etiology.4.Postsurgical changes of hysterectomy and bilateral oophorectomy.
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Generate impression based on findings.
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Frontal sinus: Left frontal sinus is underdeveloped. The right frontal sinus and frontoethmoidal recesses are clear.Anterior ethmoids: The anterior ethmoid air cells are clear.Maxillary sinuses: There is trace mucosal thickening in the maxillary sinuses. The ostiomeatal units are clear.Posterior ethmoids: The posterior ethmoid air cells are clear.Sphenoid sinus: The sphenoid sinus and left sphenoethmoidal recess are clear. There is mild narrowing of the right sphenoethmoidal recess.There is no significant nasal septal deviation. The nasal turbinate morphology is within normal limits. There is trace debris within the left inferior and middle meatus. Minimal focal opacity is noted laterally adjacent to the head of the left middle turbinate which is nonspecific.The lamina papyracea are intact. The roof of the ethmoids is relatively symmetric.
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Very minimal scattered sinus inflammatory changes. Patent bilateral ostiomeatal units. No CT evidence of chronic sinusitis
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Generate impression based on findings.
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43-year-old male with fever, headache, and blurry vision; evaluate for mass or or bleed. Remote history of CVA in 2001. No intracranial hemorrhage is identified. No intracranial mass, evidence of mass-effect or significant midline shift is present. The gray-white differentiation is maintained. The ventricles and sulci are prominent, consistent with mild age-related volume loss. No extra-axial collections are identified. A focal hypoattenuating lesion is present in the anterior limb of the left internal capsule, consistent with prior lacunar infarct, less likely prominent perivascular space.Bilateral maxillary sinus air-fluid levels is suggestive of acute sinusitis. The mastoid air cells are clear. The skull and scalp soft tissues are unremarkable.
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1. No evidence of intracranial hemorrhage.2. Chronic lacunar infarction versus less likely prominent perivascular space in the anterior limb of the left internal capsule.3. Acute bilateral maxillary sinusitis suggested. Please correlate clinically.
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Generate impression based on findings.
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Enhancing heterogeneous well circumscribed lesion in the subcortical white matter of the left frontal lobe is unchanged in size and appearance measuring 15 x 15 mm (801/19), previously 16 x 14 mm. This lesion is associated with susceptibility and patchy enhancement which is similar to the prior exam.There is a faint focus of T2 hyperintensity within the right corona radiata which is unchanged in extent. Minimal enhancement within this lesion is not significantly changed (1101/109).Numerous foci of T2 hyperintensity without enhancement within the bilateral globus pallidi are stable. Bony defect in the right occipital calvarium with enhancement is unchanged measuring 14 x 12 mm (1101/103), previously 11 x 11 mm.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.
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1.Well-circumscribed enhancing left frontal lobe mass is stable. 2.Subtle right corona radiata T2 hyperintensity and enhancement is also unchanged.3.Multiple T2 hyperintensities within the bilateral basal ganglia are stable, suggestive of FASI related to NF1.
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Generate impression based on findings.
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GIST CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Interval decrease in size of reference right segment 6 liver mass as seen on image 124 series 3 measuring 6.9 x 8.6 cm; this is comparison to 10.2 x 11 cm on 11/9/2014.Other numerous bilobar low attenuation foci stable.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Interval decrease in size of reference mesenteric mass best seen on image 4 143 of series 3 measuring 8.6 x 4.9 cm; this is in comparison to 9 x 7.1 cm on 11/9/2014.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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Interval decrease in size of hepatic and mesenteric metastatic reference lesions.
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Generate impression based on findings.
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Polymyositis. Scleroderma. Rule out multiple myeloma. SKULL: Two views of the skull show a subcentimeter poorly defined lucency overlying the parietal region on the lateral view that may simply represent a venous lake, with a myelomatous deposit considered less likely.CERVICAL SPINE: Two views of the cervical spine are provided. The bones appear slightly demineralized, but I see no discrete myelomatous lesions. Mild degenerative arthritic changes affect the cervical spine..THORACIC SPINE: The bones appear slightly demineralized, but I see no discrete myelomatous lesions. LUMBAR SPINE: Evaluation of the lumbar spine is slightly limited by contrast in the overlying colon. The bones appear demineralized, but I see no discrete myelomatous lesions. Moderate degenerative disk disease affects L5/S1.RIBS: Portions of the lower ribs are obscured by contrast in the overlying colon. Given this limitation, I see no myelomatous lesions.PELVIS: Portions of the pelvis are obscured by contrast in the overlying colon. Given this limitation, I see no myelomatous lesions. Mild osteoarthritis affects the hips.UPPER EXTREMITY: Two views of the right humerus are provided. The bones appear slightly demineralized, but I see no discrete myelomatous lesions.Two views of the left humerus are provided. The bones appear slightly demineralized, but I see no discrete myelomatous lesions. An AP view of each forearm is provided. I see no discrete myelomatous lesions.LOWER EXTREMITY: Two views of the right femur are provided. I see no discrete myelomatous lesions.Two views of the left femur are provided. I see no discrete myelomatous lesions.AP views of the right and left tibia/fibula are provided. I see no discrete myelomatous lesions.
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A small poorly defined lucency in the skull may simply represent a venous lake. I see no definite myelomatous lesions.
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Generate impression based on findings.
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38 years with abdominal distension, evaluate gas pattern and stool burden Moderate colonic stool burden. Nonobstructive bowel gas pattern. Scattered surgical clips. Essure device in the pelvis.
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Moderate colonic stool burden without evidence of bowel obstruction.
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Generate impression based on findings.
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There is an oval slightly lobulated T2/FLAIR hyperintense structure along the posterior aspect of the mesial right temporal lobe, abutting the right cerebral peduncle with mild localized mass-effect and flattening. This measures 2.1 x 1.2 cm in greatest axial dimensions on 701/14, by 1.9 cm CC. The structure is also mildly T1 hyperintense with respect to CSF. There is associated deformity of the adjacent right hippocampus. Adjacent vasculature courses along the margins, including the right posterior cerebral artery and the right superior cerebellar artery. The right PCOM is slightly deviated medially. The lesion extends down to the level of the superior margin of Meckel's cave without definite involvement. Coronal 3-D T1 weighted images suggest that the lesion may possibly be intra-axial and partially exophytic versus extra-axial. There is no associated diffusion restriction or susceptibility. The right post-chiasmatic optic tract is elevated by the structure. There appears be a somewhat ill defined margin between the lesion and the right amygdala, better appreciated on the coronal T2 and STIR images. There is additional little asymmetric T2/FLAIR hyperintensity within the cortex of the mesial right temporal lobe lengthening along the hippocampus.The ventricles and sulci are within normal limits, with the right lateral ventricle remaining slightly larger than the left. The basal cisterns remain patent. There is no midline shift. There is no diffusion abnormality. No extra-axial fluid is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.
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1. Minimally lobulated T2/FLAIR hyperintense structure along the mesial right temporal lobe with prominent localized mass-effect including deformity of the right hippocampus. Structure could be extra-axial although possibility of an intra-axial partially exophytic origination cannot be entirely excluded. Further evaluation postcontrast images is recommended. Differential diagnosis includes a primary brain neoplasm if intra-axial, versus epidermoid if extraaxial although more typically these restrict on diffusion, or other nonneoplastic cyst. 2. Subtle asymmetric T2 such there hyperintensity within the mesial right temporal lobe cortex with questioned mild gyral expansion, which may relate to recent seizure activity. Please correlate with EEG.
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Generate impression based on findings.
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Reason: restaging EGJ cancer with supraclavicular node involvement after 2 months chemotherapy History: none Within the suprahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated. Within the infrahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated.Within the visceral space the thyroid gland appears intact.The airway appears patent.The visualized intracranial structures which include the posterior fossa are intact. The visualized portions of the orbits are intact. The paranasal sinuses are clear. The mastoid air cells are clear. The eyeball lenses are thin.The parotid and the submandibular glands appear intact.The visualized lung apices appear clear.The carotid and vertebral vasculature visualized on this exam appears intact. Atherosclerotic calcifications are present at the carotid bifurcations.The cervical vertebral bodies in general are intact with no evidence for canal stenosis. There are endplate uncovertebral osteophytes present at multiple levels with neural foramen encroachment along the lower cervical spine.
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1.No evidence for neck lymphadenopathy on the basis of CT size criteria for lymphadenopathy
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Generate impression based on findings.
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77 y/o male with fecal incontinence; check for fecal impaction or obstruction Nonobstructive bowel gas pattern. Moderate colonic stool burden. Retained contrast in the bladder. Degenerative arthritic changes affect the lower lumbar spine and hips.
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Moderate colonic stool burden without evidence of bowel obstruction.
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Generate impression based on findings.
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Female 32 years old; Reason: Right arm lymphedemaRADIOPHARMACEUTICAL: The right foot was prepared in a sterile manner. A total of 0.5 mCi Tc-99m filtered sulfur colloid was injected subcutaneously by Dr. Chang. Following injection, intraoperative probe localization was performed. No images were acquired.
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Successful right foot injection for intraoperative identification of sentinel lymph node.
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Generate impression based on findings.
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Ms. Bockover is a 69-year-old female with personal history of right breast lumpectomy in 2012 for IDC (triple negative). She now presents with a palpable mass in the right cervical neck which was found to be multiple enlarged necrotic supraclavicular and lower cervical lymph nodes on ultrasound exam. She presents today for biopsy of one of these lymph nodes. Right ultrasound re-identified the target lymph node for biopsy. It was in the right supraclavicular area. Bipolar maximum dimension was 1.8 x 1.5 cm and marked non-hilar cortical blood flow was seen on color flow imaging. The target node was readily visible.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 right supraclavicular area 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 lateral to medial approach, a 14-gauge core needle (Achieve) was directed into the target node and three specimens were obtained, using the open-trough technique. Targeting was judged excellent. All specimens sank to the bottom of the prefilled container of 10% formalin. Specimen quality was judged excellent. Whitish tissue was noted throughout all specimens.Specimens were sent to Pathology with an accompanying history sheet. Pressure was held over the biopsy site until all bleeding subsided. No evidence of hematoma or other complication on post procedure ultrasound. The skin incision was closed with a Steri-Strip. A pressure dressing was positioned over the biopsy site and an ice pack positioned over the pressure dressing. 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 right supraclavicular 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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Male 77 years old; Reason: metastatic prostate cancer on therapy with rising PSA There is a left focus continues to decrease consistent with old healed metastasis. Faint focus of activity seen along the lateral aspect of the left seventh rib is stable, may represent healed metastasis or a benign process. No new suspicious osseous lesions to suggest progression of metastatic disease.Bilateral gynecomastia is identified.
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Stable exam with no evidence of progression of osseous metastatic disease.
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Generate impression based on findings.
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History of assault with right mandible fracture January 30 from outside hospital. Pain. There is a mildly displaced fracture through the posterior aspect of the right mandibular body/right mandibular angle, as well as a nondisplaced fracture through the left mandibular body. The patient is edentulous. Temporomandibular joint alignment appears normal.
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Mandibular fractures as above.
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Generate impression based on findings.
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Male 50 years old; Reason: History testicular cancer, s/p chemo and pelvic LN dissection, assess for recurrence History: none CHEST:LUNGS AND PLEURA: Few scattered pulmonary micronodules, some of which are calcified. Subcentimeter ground-glass nodule in the right lung base seen on image 84/series 4.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Probable left small renal cortical cyst. No hydronephrosis in either kidney.RETROPERITONEUM, LYMPH NODES: Small amount of soft tissue and IVC likely representing a node measures 1.3 x 0.6 cm (image 161/series 3). There are small aortocaval lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Postsurgical changes in the anterior abdominal wall and right inguinal canal.OTHER: No significant abnormality noted
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1.Small retroperitoneal lymph nodes. No specific evidence for metastatic disease.
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Generate impression based on findings.
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Female 61 years old; Reason: History of metastatic breast cancer on treatment. Compare to prior imaging, evaluate for response and extent of disease. There are stable areas of slight decrease in decrease activity along the left femur consistent with prior bone metastasis and orthopedic procedure. No new abnormal osseous foci are identified to indicate metastatic disease.
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Stable exam with no evidence of progression of osseous metastatic disease.
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Generate impression based on findings.
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Two year-old female with right foot injury, partial weight-bearingVIEWS: Right foot AP/oblique/lateral (3 views) 02/03/15 No acute fracture or malalignment is evident. No joint effusion. No significant soft tissue swelling.
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Normal examination.
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Generate impression based on findings.
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There is asymmetric mild effacement of the anterior horn of the right lateral ventricle, but no definite mass is identified. The right lateral ventricle in general is smaller than the left, likely a normal variant. There is no midline shift. There is no intracranial hemorrhage, within the limitations of only postcontrast imaging. There are no areas of abnormal attenuation or pathological enhancement. The ventricles and sulci are prominent, consistent with mild age-related volume loss. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear.
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Mild asymmetric effacement of the right frontal horn, which may be secondary to normal variant coarctation. However, the possibility of a mass lesion is not excluded. Further evaluation with MRI brain is recommended for confirmation.
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Generate impression based on findings.
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Renal cell carcinoma CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable contour deformity consistent with partial right nephrectomy without worrisome mass.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Stable negative examination. No evidence for acute, inflammatory, or metastatic process.
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Generate impression based on findings.
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72-year-old male with esophageal carcinoma and chemotherapy. Evaluate. CHEST:LUNGS AND PLEURA: Scattered pulmonary micronodules, some of which are calcified, most likely secondary to prior granulomatous disease. No suspicious pulmonary nodules or masses. No pleural effusions or pneumothorax.MEDIASTINUM AND HILA: Subcentimeter left supraclavicular lymph node, which was noted to be FDG avid on the outside PET exam.Nonspecific subcentimeter mediastinal lymph nodes and subcentimeter right hilar lymphoid tissue (series 3, image 47). Heart is normal in size without pericardial effusion. Severe coronary artery calcifications.Mild to moderate distal esophageal wall thickening measuring up to 1.2 cm (series 3, image 69) with narrowing of the esophageal lumen, most likely patient's known esophageal cancer.CHEST WALL: Right-sided chest port with catheter tip in the SVC/right atrial junction. No axillary lymphadenopathy.ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesions. No intra-or extrahepatic biliary ductal dilatation.SPLEEN: Splenic granulomata.PANCREAS: No significant abnormality notedADRENAL GLANDS: Adrenal glands are symmetric in size and morphology.KIDNEYS, URETERS: No hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: Mild to moderate atherosclerotic calcifications affect the abdominal aorta and its branches. Enlarged gastrohepatic lymph node measures 1.5 x 1.3 cm (series 3, image 87), previously measuring 2.6 x 2.2 cm (series 202, image 126).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.Distal esophageal wall thickening as above most likely consistent with patient's known esophageal carcinoma. 2.Enlarged gastrohepatic lymph node as above highly suspicious for metastatic disease.3.Significant interval regression in size of the left supraclavicular and retroperitoneal lymphadenopathy.
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Generate impression based on findings.
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44-year-old female with history of swelling and pain. There is a comminuted fracture of the distal fibular diaphysis with minimal posterior angulation of the distal fracture fragments. Additionally, there is a transverse fracture of the medial malleolus with mild medial displacement of the distal fracture fragment. There is also a minimally displaced fracture of the "posterior malleolus".
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Distal tibia/fibular fractures as above.
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Generate impression based on findings.
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70 years male, evaluate broken Dobhoff tube Approximately 12 cm length of fractured Dobhoff tube terminates in the gastric fundus, unchanged.
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Fractured Dobhoff tube in the gastric fundus, unchanged.
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Generate impression based on findings.
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Right breast lump for 2 weeks, previously larger with more pain, now decreased in size. Left breast aspiration in 2010. History of breast cancer in mother. Three standard views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. A round density at the medial margin of the breasts is partially imaged. Multiple masses and calcifications are present which need to be compared to the outside studies to ensure stability. No areas of architectural distortion are noted in the right breast. ULTRASOUND
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Focal heterogenous hyperemic soft tissue, likely representing fat necrosis or inflammatory changes given the history of significant improvement. Given the decreasing symptoms, cancer is very unlikely. Clinical correlation and management are recommended and the patient will see Dr. Jaskowiak today. If symptoms worsen or the lesion is not resolved in the short term, repeat examination with ultrasound may be considered.Submission of her prior studies also remains recommended. She filled out paperwork to have these sent to us. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: O - Old Study For Comparison.
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Generate impression based on findings.
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64 year old male with new vomiting with oral intake, refractory to treatment, leading to malnutrition. Evaluate for gastroparesis. Visually there was significant and progressive gastric emptying. Using anterior and posterior geometric means, residual gastric activity at the following postprandial intervals was calculated as follows:30 mins: 78.5 % of peak activity (normal >70 %)1 hour: 58.2 % of peak activity (normal 30-90 %) 2 hours: 18.1 % of peak activity (normal <60 %) 3.5 Hours: 5.2 % of peak activity (normal <10 % by 4 hours)
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Gastric emptying within normal limits.
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Generate impression based on findings.
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Evaluate NG tube placement NG tube tip in the region of the gastric antrum / pylorus. Persistent dilated small bowel loops with air in the colon suspicious for at least a partial small bowel obstruction.
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NG tube tip in the region of the gastric antrum / pylorus.
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Generate impression based on findings.
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Male; 55 years old. Reason: mesothelioma History: mesothelioma CHEST:LUNGS AND PLEURA: Moderate predominantly posterior and basilar right loculated pleural effusion. There are subtle, ill-defined areas of increased right pleural thickening and nodularity, particularly superiorly (e.g. series 3/images 27 and 32). However, there are no well-defined, measurable pleural masses. Minimal right basilar subsegmental atelectasis. No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Prominent mediastinal and right hilar lymph nodes, the largest of which is in the precarinal space and measures 8 mm in short axis (series 3/45). However, no definite mediastinal or hilar lymphadenopathy by CT size criteria. Normal heart size without pericardial effusion. Severe calcifications of the coronary arteries.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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Right loculated pleural effusion with subtle areas of increased right pleural thickening and nodularity, compatible with stated history of mesothelioma.
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Generate impression based on findings.
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There is a punctate focus of increased DWI signal without corresponding T2 hyperintensity in the right inferior midbrain which is favored to represent artifact. There are a few scattered T2 hyperintensities in the subcortical and periventricular white matter, the largest in the left parietal lobe measuring 11 x 9 mm (1601/16), which are unchanged.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is a hypo-enhancing lesion within the posterior pituitary gland which is T1 hyperintense and T2 hypointense measuring 7 mm, mildly larger than on the prior exam.
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1.Posterior pituitary lesion is mildly larger than on the prior exam. Differential includes a microadenoma, perhaps with proteinaceous/hemorrhagic degeneration, or a proteinaceous/hemorrhagic Rathke's cleft cyst.2.Periventricular and subcortical T2 hyperintensities are nonspecific but unchanged and may be related to migraines or chronic vascular lesions.
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Generate impression based on findings.
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Dobhoff position Dobhoff tip in the gastric fundus. Bilateral percutaneous nephrostomy tubes. Mildly prominent small bowel loops in the right lower quadrant; favor ileus. Retained contrast in the colon. Surgical clips in the pelvis.
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Dobhoff tip in the gastric fundus; recommend advancing.
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Generate impression based on findings.
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Unstable fracture.VIEW: Left ankle with varus stress (one view) 02/03/15 Fracture of distal fibula at and soft tissue swelling are again seen.The distance between the fibula and talus is increased.
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Probable unstable ankle fracture with ligamentous injury of talofibular ligaments and/or syndesmotic ligaments.
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Generate impression based on findings.
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Male 65 years old; Reason: restaging CT after chemo last in 10/2014 then surgery 12/3/14 showing unresectable disease at that time. Duodenal stent occlusion 1/2/15 s/p revision. Restaging now prior to palliative chemo. History: diarrhea CHEST:LUNGS AND PLEURA: Subcentimeter nodule along the left major fissure likely represents an intrapulmonary lymph node.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Right chest wall port terminates at the cavoatrial junction.OTHER: ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. There is intrahepatic biliary ductal dilatation. The common bile duct is mildly dilated up to the level of the duodenum. The portal vein is patent.There is gallbladder wall thickening. SPLEEN: No significant abnormality notedPANCREAS: Pancreatic duct is dilated measuring up to 7 mm.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple bilateral renal cysts. No hydronephrosis or nephrolithiasis.RETROPERITONEUM, LYMPH NODES: Reference upper abdominal lymph node adjacent to portal vein measures 2.4 x 2.4 cm (image 99/series 3) previously, 2.6 x 2.1 cm.BOWEL, MESENTERY: There is a gastroduodenal stent in place. Its distal portion impresses upon the IVC and aorta.Soft tissue about the duodenum likely representing a necrotic lymph node measures 3.5 x 3.4 cm (image 111/series 3) previously, 4.2 x 3.7 cm.The bilobed mass has decreased in size with the larger component measuring 5.5 X 4.7 cm (image 131/series 3) previously, 6.7 x 4.9 cm.There is infiltration of the fat planes in the upper abdomen.Extensive peritoneal and omental thickening in the region indicative of omental disease.There is small amount of ascites in the upper abdomen. There is some mesenteric edema in the upper abdomen.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: Peritoneal nodularity.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.Decrease in the size of the reference upper abdominal mass. 2.There is persistent dilatation of the biliary tree due to partial obstruction near the level of the duodenum.
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Generate impression based on findings.
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Female 68 years old; Reason: PET avid paraaortic LN History: history of endometrial cancer and breast cancer, history of left lumpectomyRADIOPHARMACEUTICAL: 8.1 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 100 mg/dL. Today's CT portion grossly demonstrates postsurgical changes in the the left breast. There are several borderline enlarged abdominal retroperitoneal lymph nodes. Two hypodense left hepatic lesions are likely cysts. Today's PET examination demonstrates interval resolution of the previously abnormal left breast focus consistent with interval lumpectomy. There are multiple new medium sized hypermetabolic lymph nodes in the anterior superior mediastinum consistent with new metastatic disease (SUV max 11.8). There is marked metabolic activity involving several abdominal intraperitoneal lymph nodes which have progressed in size, number and metabolic activity compared to prior study (SUV max of 18.4, previously 9.0) consistent with additional disease progression. Punctate focus in the left maxilla consistent with periodontal disease.
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Multiple new markedly hypermetabolic upper mediastinal lymph nodes consistent with progression of metastatic disease. There is also interval progression of metastatic disease of the abdominal retroperitoneal lymph nodes.
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Generate impression based on findings.
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Fracture, post reduction Evaluation of fine detail is limited by overlying cast material. Again seen is a comminuted fracture of the distal fibular diaphysis with minimal posterior displacement of the distal fracture fragment, similar to that seen on the prior study. Also again seen is a transverse fracture through the medial malleolus, now with minimal medial displacement of the distal fracture fragment. Tibiotalar alignment is near-anatomic. There is also a vertical fracture of the "posterior malleolus" in near anatomic alignment.
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Ankle fractures as described above.
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Generate impression based on findings.
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Fall. Rule out fracture/dislocation. I see no fracture or malalignment. Vertebral body heights and intervertebral disk spaces are within normal limits. Tiny osteophytes project from the anterior aspects of the lumbar and lower thoracic vertebrae. There is a T-shaped contraceptive device in the pelvis. Surgical suture material is noted in the right lower quadrant.
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No fracture evident.
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Generate impression based on findings.
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35 years female with cystic fibrosis, abdominal pain, nausea and vomiting, concern for DIOS Cholecystectomy clips and pneumobilia. Splenomegaly. Nonobstructive bowel gas pattern. Moderate colonic stool burden. Scattered surgical clips.
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Moderate colonic stool burden without evidence of bowel obstruction.
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Generate impression based on findings.
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Ms. Campos is a 31 year old female presenting with intermittent bilateral breast tenderness for the past 3 months. Per patient, she has noticed that the pain occurs cyclically q3 to 4 weeks. She denies any discrete mass. 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. There is no suspicious mass, suspicious microcalcifications or areas of architectural distortion identified in either breast.
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No mammographic evidence of malignancy. Patient's bilateral breast tenderness should be managed clinically. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended starting at the age of 40. All results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed.
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Generate impression based on findings.
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Status post left total knee arthroplasty Components of a total knee arthroplasty device are situated in near-anatomic alignment without radiographic evidence of complication. Skin staples, a drain, and foci of gas density in the soft tissues reflect recent surgery. Ossification adjacent to the medial epicondyle of the distal femur likely represents prior trauma to the medial collateral ligament.
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Postoperative changes of total knee arthroplasty as above.
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Generate impression based on findings.
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Female 30 years old; Reason: abdominal pain History: abdominal pain Visually there was significantly delayed gastric emptying identified. Again seen is proximal small bowel unwinding in the right hemiabdomen consistent with known history of malrotation.Using anterior and posterior geometric means, residual gastric activity at the following postprandial intervals was calculated as follows:30 mins: 94.7 % of peak activity (normal >70 %)1 hour: 85.3 % of peak activity (normal 30-90 %) 2 hours: 77.9 % of peak activity (normal <60 %) 4 hours: 42.9 % of peak activity (normal <10 %)
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Significantly delayed gastric emptying.
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Generate impression based on findings.
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vulvar SCC s/p radical vulvectomy / XRT and diverticular disease with colovaginal fistula s/p sigmoid resection / diverting loop ileostomy, preop assessment, evaluate for colovaginal fistula The scout film reveals a right lower quadrant ileostomy, nonobstructive bowel gas pattern, and pelvic sutures / clips.Omnipaque flowed freely through the rectum. Initially there was a small outpouching filled with contrast along the dorsal margin of the proximal rectum. Upon subsequent imaging with alternate projections, this finding proved to be normal bowel. The surgical anastomosis was unremarkable without evidence of contrast extravasation or fistulous tract. The appendix was not visualized, but is known to be surgically absent. No significant tortuosity or redundancy of the colon is noted. Although the study is not designed to evaluate for polyps or masses, none are seen.
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Limited air augmented single contrast barium enema without evidence contrast extravasation or fistulous tract.
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Generate impression based on findings.
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59 year old female with history of left lower extremity pain and weakness. There are 5 non-rib bearing lumbar vertebrae in addition to a transitional lumbosacral vertebrae. Moderate facet joint osteoarthritis affects the lower lumbar spine. There is minimal anterolisthesis of L4 on L5. Moderate to severe degenerative disc disease affects the lower thoracic spine. Mild irregularity of the pubic symphysis is likely degenerative in etiology.
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Degenerative disc disease and facet joint osteoarthritis as above.
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Generate impression based on findings.
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Reason: Pt is a 66 yo male w/ hx of DLBCL and Myeloma; pre-auto sct evaluation RADIOPHARMACEUTICAL: 10.7 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 94 mg/dL. Today's CT portion grossly demonstrates right chest port catheter with tip in SVC as well as a left supraclavicular catheter with tip also in the SVC. There is a postsurgical appearance in the right axilla. There are several borderline enlarged retroperitoneal lymph nodes. There is a mottled appearance to some of the pelvic bones which may reflect previous tumor. Today's PET examination demonstrates marked hypermetabolic right axillary lymph node activity significantly progressed from previous study (SUV max 12.5, previously 5.0) highly suspicious for tumor progression. Several markedly hypermetabolic anterior mediastinal foci which are difficult to define precisely but are in a paraaortic and paraesophageal distribution, new from previous study (SUV max 15.8), very suspicious for additional tumor progression. There is a punctate abnormal hypermetabolic soft tissue focus in the fat adjacent to the left psoas muscle (SUV max 6.6) also new and suspicious for additional tumor progression. No additional suspicious foci are identified. No suspicious osseous foci.Several mild right apical foci likely inflammatory in nature. New suspicious activity in the left supraclavicular region is inflammatory related to left supraclavicular tunneled catheter.
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Progression of significantly hypermetabolic lymph nodes in the right axilla, mediastinum and left abdomen, highly suspicious for soft tissue tumor progression.
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Generate impression based on findings.
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45 year old with bilateral subcentimeter masses on prior screening exam. 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. There has been interval near complete resolution of the bilateral subcentimeter breast masses. No new dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Stable intramammary lymph node in the left upper outer breast. Bilateral benign calcifications are noted.
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No mammographic evidence of malignancy. Near complete interval resolution of bilateral breast masses. This could be due to involution of cysts or resolution of skin lesions. 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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Pain Mild osteoarthritis affects the midfoot. Minimal osteoarthritis affects the first metatarsophalangeal joint. There are plantar and posterior calcaneal spurs. Note is made of an os peroneum, a normal variant.
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Mild osteoarthritis.
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Generate impression based on findings.
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12-year-old male with painVIEWS: Right and left calcaneus axial/lateral (4 views) 02/03/15 The apophysis of the calcaneus is normal bilaterally. Subtalar joint appears normal. No acute fracture or malalignment is evident. No significant soft tissue swelling.
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Normal examinations.
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Generate impression based on findings.
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35-year-old female with history of right shoulder pain. Evaluate for a rotator cuff tear. ROTATOR CUFF: There is no evidence of contrast within the subacromial or subdeltoid bursa to suggest a full-thickness rotator cuff tear. There is no evidence of muscular atrophy. There is contrast extravasating into the subscapularis muscle which is of uncertain clinical significance.SUPRASPINATUS OUTLET: The supraspinatus outlet is unremarkable.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenoid labrum is grossly intact.BICEPS TENDON: The biceps tendon is unremarkable.ADDITIONAL
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No evidence of rotator cuff tear. Other findings as above.
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Generate impression based on findings.
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There is deformity involving the right medial orbital wall with mild medial herniation of the orbital fat and slight irregularity in contour of the right medial rectus muscle. Findings compatible with remote medial blowout fracture and unchanged since 2011. The frontal sinus and frontoethmoidal recesses are clear. The anterior ethmoid air cells are clear. The posterior ethmoid air cells are clear. The maxillary sinuses are clear. The ostiomeatal units are clear. The sphenoid sinus and bilateral sphenoethmoidal recesses are clear. Unchanged nonspecific small foci of sclerosis along the anteromedial aspect of the left frontal sinus as well as involving the left posterior ethmoid sinus, possibly small osteoma. There is leftward deviation of the nasal septum anteriorly and unchanged in appearance since 2011. Small right septal spur posteriorly. Visualized brain parenchyma is unremarkable.
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1. Paranasal sinuses are clear without evidence of sinusitis.2. Remote right medial orbital wall blowout fracture.3. Unchanged appearance of the nasal bones and deviated nasal septum compared to 2011 without evidence of acute fracture.
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Generate impression based on findings.
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Bladder carcinoma CHEST:LUNGS AND PLEURA: Bibasilar tree in bud opacities again noted consistent with chronic inflammatory process.MEDIASTINUM AND HILA: Intra-thoracic stomach.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Interval increase in size and number of confluent bilobar hepatic metastases. A representative segment 7 right lobe lesion best seen on image 80 of series 3 measures 4 x 3 cm; this is in comparison to 1.7 x 1.5 cm on 12/12/2014. A segment 2 left lobe lesion best seen on image 87 of series 3 measures 3.2 x 3 cm; this is in comparison to 1.6 x 1.8 cm on 12/12/2014.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right nephrectomy site clear.RETROPERITONEUM, LYMPH NODES: Metastatic retroperitoneal adenopathy increased in size from prior study. A representative aortocaval lymph node best seen on image 118 of series 3 measures 1.1 x 1.5 cm.; this is in comparison to 0.9 x 0.4 cm on 12/12/2014.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Interval increase in size and confluence of numerous bilobar hepatic metastatic lesions. Interval increase in size of retroperitoneal metastatic adenopathy.No change in bibasilar tree in bud opacities suggestive for chronic lung base inflammatory process.
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Generate impression based on findings.
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Left breast lumpectomy in 2005. Focal pain near lumpectomy scar. 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 scar marker overlies the left breast. Unchanged postsurgical architectural distortion is present in the left breast. Scattered benign calcifications are present bilaterally. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. ULTRASOUND
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Stable post-surgical changes in the left breast. No sonographic abnormality detected. 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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Ms. Brown is a 60 year old female with a strong family history of breast cancer in her mother (diagnosed at the age of 75) and sister (diagnosed at the age of 39). 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. Multiple fine, punctate loosely scattered microcalcifications are again identified bilaterally, most conspicuously in the rightupper outer quadrant, which remain stable. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast.
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Stable bilateral calcifications. 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: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.
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Generate impression based on findings.
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28-year-old female with history of MVC. Mild degenerative disc disease affects C5-6 with anterior and posterior vertebral body osteophytes. There is a slight cervical kyphosis, but we see no acute fracture or spondylolisthesis. There is apparent narrowing of the C3-4 neuroforamina bilaterally which may be an artifact of positioning, as we see no frank degenerative disease at these levels. There is poor dentition.
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Degenerative disk disease without acute fracture or spondylolisthesis.
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Generate impression based on findings.
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Reason: Pleural mesothelioma please compare to prior exam per recist criteria. History: Pleural mesothelioma CHEST:LUNGS AND PLEURA: Nodular pleural thickening throughout the left hemithorax consistent with mesothelioma. Loculated pleural effusion at the left base, unchanged with increased basilar atelectasis.Reference measurements as follows:1. The level of the aortic arch (series 3/29): At the 12 o'clock position 14 mm, increased from 9 mm.At the 4 o'clock position 6 mm increased from 3 mm.2. At the level pulmonary artery (series 3/47): 11 mm at 11 o'clock, increased from 7 mm.8 mm at 4 o'clock, increased from 7 mm.3. At the level of the inferior pulmonary vein (series 3/56): 5 mm at 6 o'clock, unchanged.MEDIASTINUM AND HILA: Reference prevascular lymph node (series 3/27) 10 mm in short axis increased from 5 mm.Additional prevascular, subcarinal and AP window lymph nodes have also increased.Increased soft tissue in the left infrahilar area, consistent with tumor.No pericardial effusion.No visible coronary artery calcification.CHEST WALL: Extension of tumor through the left hemidiaphragm, increased from previous.Soft tissue nodule in the left chest wall (series 3/33), increased from previous suspicious for tumor.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Small nodule anterior to the spleen measuring 11 mm, slightly decreased.SPLEEN: Extensive involvement of the peri-splenic fat by tumor, increased from previous.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small cysts, unchanged.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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Interval increase in reference and non reference tumor measurements.
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Generate impression based on findings.
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64-year-old female with history of pancreatic cancer status post percutaneous biliary catheter, now with elevated lipase. Evaluate for pancreatitis. ABDOMEN:LUNG BASES: Persistent small bilateral pleural effusions.LIVER, BILIARY TRACT: Stable percutaneous biliary drainage catheter with tip in the duodenum. Mild intrahepatic biliary ductal dilatation, unchanged.Subcentimeter hepatic hypodensities are not significantly changed. Stable calcification in the hepatic dome. SPLEEN: No significant abnormality notedPANCREAS: Interval increase in size of the pancreatic head mass measuring 4.2 x 1.4 cm (series 3, image 60) and interval increase in the associated pancreatic ductal dilatation. No evidence of peripancreatic inflammatory changes to suggest pancreatitis. No surrounding fluid collections.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable left lower pole hypoattenuating lesion consistent with a cyst. An additional hypoattenuating left renal lesion that measures approximately 21 Hounsfield units (series 3, image 46) is unchanged.RETROPERITONEUM, LYMPH NODES: Mild to moderate atherosclerotic calcifications affect the abdominal aorta.BOWEL, MESENTERY: Enteric tube with tip in the jejunum. No evidence of small bowel obstruction or colitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Fibroid uterus is again noted.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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1.Interval increase in size of the pancreatic head mass and associated diffuse pancreatic ductal dilatation.2.No definite CT findings to suggest pancreatitis. 3.No definite evidence of metastatic disease.4.Small bilateral pleural effusions.
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Generate impression based on findings.
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56 year old female with history of pain. There is poorly defined sclerosis along the medial aspect of the humeral head/neck which is of uncertain etiology or significance. The distal clavicle is slightly elevated relative to the acromion, which may represent a chronic low-grade separation, but this is equivocal. We see no acute fracture. There is no evidence of periosteal reaction or soft tissue masses.
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Poorly defined sclerosis in the medial aspect of the humeral head/neck which is nonspecific and may be benign in etiology possibly representing Paget's disease or bone infarction, however we cannot exclude the possibility of metastatic disease particularly in a patient with a known primary malignancy. MRI may be considered for further evaluation.
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Generate impression based on findings.
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Female 48 years old Reason: high fluid levels in esophagus on CT done Oct 2014, evaluate for achalasia History: abnormal CT of esophagus Preliminary view of the chest is unremarkable. Double contrast, single contrast and mucosal relief views were obtained. The hypopharynx was evaluated with phonation and is grossly unremarkable.Fluoroscopy capture of swallowing evaluation of the cervical esophagus demonstrates a small nonobstructive web along the right aspect of the proximal cervical esophagus. There is a normal peristaltic wave in the cervical esophagus which nearly completely attenuated at the thoracic inlet. The entire thoracic esophagus is hypo- to aperistaltic with diffuse tertiary waves (not associated with pain). Average diameter the esophagus is 1.3 cm.In the distal third of the esophagus there is a 2.1-cm in diameter pulsion diverticulum extending off the left wall of the esophagus. There is no evidence of beaking of the terminal segment of esophagus to suggest achalasia.No masses or strictures are seen. There is no evidence of hiatal herniaTwo-minute delayed erect view shows retention of contrast throughout the entire thoracic esophagus. This precludes formal evaluation of reflux which is likely present.Limited evaluation of the stomach and duodenum unremarkable.
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Severe motor abnormality of the esophagus; relatively hypoperistaltic esophagus with tertiary waves and mild dilatation throughout, complicated by a large distal esophageal pulsion diverticulum. No evidence of achalasia.Cervical esophageal web.FLUOROSCOPY TIME: 4 minutes 54 seconds.
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