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Generate impression based on findings.
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55-year-old female with history of lumbar fusion. There are postoperative changes of a posterior stabilization device with screws entering the vertebral bodies of L3-L5. Screw fracture fragments are again noted within L4 and L5. There is no evidence of hardware complication. There is an intervertebral disc spacer device present at L4-5. There is bony bridging along the medial aspect of L4-5 appearing similar to prior. In addition, mature bone graft along the lateral aspect of the spine appears similar to the prior exam when accounting for technical differences. We see no evidence of instability between flexion, neutral, and extension views. Mild degenerative disc disease affects the remaining lumbar levels. There is a partially visualized spinal stimulator device with leads projecting over the anterior aspect of the right sacrum.
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Posterior spinal fusion without evidence of complication.
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Generate impression based on findings.
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22-day-old male with desaturations with feedsEXAMINATION: Oropharyngeal motility study 02/03/15 Beth Harrison, speech and language therapist, supervised the examination.69 seconds of fluoroscopy was used.Thin liquid was administered through slow flow aqua nipple. Half-strength nectar liquid was administered through slow flow aqua nipple. Nectar thick liquid was administered through slow flow clear nipple and medial flow nipple.The oral phase was remarkable for large boluses being extracted from slow flow nipple with thin liquids. There was decreased coordination and endurance over time with half-strength liquids via slow flow nipple. There was penetration to the level of the vocal cords with half-strength nectar thick liquids via slow flow nipple. No cough was demonstrated.Aspiration was noted with thin liquids via slow flow nipple. The patient desaturated to 87% with no cough demonstrated.The patient tolerated nectar thick liquids via clear rim standard flow nipple.
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Laryngeal penetration and tracheal aspiration as described above. The patient tolerated nectar thick liquids via clear rim standard flow nipple.Please see the speech and language therapist's report for feeding recommendations.
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Generate impression based on findings.
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82-year-old male with history of knee pain. Severe osteoarthritis affects the knee, particularly in the medial compartment, with near bone-on-bone apposition. There are tiny patellar osteophytes. There are extensive arterial calcifications and surgical clips within the medial soft tissues. There is chondrocalcinosis of the lateral meniscus. Relatively mild osteoarthritis affects the right knee as seen on the frontal views.
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Osteoarthritis as above.
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Generate impression based on findings.
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Again seen are postsurgical changes of bilateral ethmoidectomies and uncinectomies. There is moderate opacification of the right frontal sinus, similar to prior. Opacification extends into the right frontal recess which is surgically widened. Minimal opacification seen in the left frontal sinus. There is mild opacification along the ethmoid cavity. There is also mild mucosal thickening involving the floors of the bilateral maxillary sinuses, which is improved since 9/7/2011. There is moderate opacification of the sphenoid sinuses, left worse than right and similar to 9/7/2011. Bilateral maxillary infundibula are patent. There is nodular opacification along the lateral aspect of the to the right middle turbinate which increased since prior and may represent a polyp.Bilateral mastoid air cells and middle ear cavities are clear and there are no air-fluid levels. The lamina papyracea are intact bilaterally. The floor of the anterior cranial fossa and cribriform plate region are unremarkable. The nasal septum is minimally deviated rightward. Bilateral orbits and the posterior nasopharynx appear unremarkable.
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1. Mild to moderate mucosal thickening involving the paranasal sinuses, as described above. Frontal and sphenoid sinus opacification is similar to prior. Mucosal thickening involving the inferior bilateral maxillary sinuses is improved but persistent compared to remote prior study from 9/7/2011. 2. There is nodular opacification along the lateral aspect of the the right middle turbinate which is increased since prior and may represent a polyp.
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Generate impression based on findings.
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Female 62 years old; Reason: HCC advance rule out bone involvement No abnormal osseous foci are identified to indicate metastatic disease. Urine contamination in the left flank region has resolved on subsequent images. Prolonged renal parenchymal retention bilaterally suggestive of medical renal disease.
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1. No suspicious findings to suggest bone metastases.2. Findings suggestive of medical renal disease.
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Generate impression based on findings.
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Polymyositis and history of dysphagia The exam was positive for penetration and negative for aspiration.
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The exam was positive for penetration and negative for aspiration.
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Generate impression based on findings.
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Ms. Scott is a 74 year old female with a personal history of right breast lumpectomy in 2003 for IDC followed by hormonal therapy. Family history of breast cancer in sister, diagnosed at the age of 53. No current breast related complaints. Three standard views of both breasts with additional left CC view 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 linear marker was placed on the scar overlying the right breast. There are stable postsurgical changes including architectural distortion, increased density, and skin retraction present within the right lumpectomy site. Scattered benign calcifications, including arterial calcifications, are seen bilaterally. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast.
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Stable postsurgical changes of the right breast. 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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Head and neck cancer The exam was positive for penetration and aspiration.
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The exam was positive for penetration and aspiration.
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Generate impression based on findings.
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Reason: History of metastatic breast cancer on treatment. Compare to prior imaging, evaluate for response and extent of disease. History: History of metastatic breast cancer on treatment. Compare to prior imaging, evaluate for response and extent of disease. CHEST:LUNGS AND PLEURA: Motion limits sensitivity.No suspicious pulmonary masses.No pleural effusions.MEDIASTINUM AND HILA: Left chest Port-A-Cath with its tip in the SVC.Scattered prominent mediastinal lymph nodes unchanged with reference AP window lymph node (image 30 series 6) measuring 8 mm.Reference right hilar lymph node (image 39 series 6) is stable measuring 10 mm.Cardiac size is normal evidence of pericardial effusion.CHEST WALL: Right axillary lymph node (image 17 series 6) measures 13 mm previously measuring 14 mm.Right breast mass (image 56 series 6) stable measuring 24 mm x 9 mm.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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1.No interval change without new sites of disease identified.2.Stable small mediastinal, hilar, and right axillary lymph nodes.3.Right breast mass unchanged.
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Generate impression based on findings.
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Male 73 years old; Reason: bladder ca There is marked abnormal osteoblastic activity throughout L2 to L4 vertebral body levels more pronounced along the posterior elements in a somewhat diffuse pattern. Although the bone scan appearance raises question of Paget's disease, on corresponding CT there is a permeative lytic process of the posterior elements most notably at L2 and also L3 vertebral bodies, compatible with metastatic disease. Additional abnormal activity along the superior aspect of the left sacrum and small focus along the right sacroiliac joint are also compatible with metastatic disease.
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Multiple marked osteoblastic lesions throughout the lumbar spine and pelvis compatible with osseous metastatic disease.
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Generate impression based on findings.
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Lung carcinoma ABDOMEN:LUNG BASES: Please see separate chest CT reportLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable bilateral renal cystsRETROPERITONEUM, 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 acute, inflammatory, or metastatic intra-abdominal process.
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Generate impression based on findings.
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The ventricles and sulci are prominent, including the cerebellar sulci, consistent with moderate age-related volume loss. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. A small developmental venous anomaly is present in the posterior left occipital lobe. The midline structures and craniocervical junction are within normal limits.
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1. No abnormal signal, pathologic enhancement, or structural abnormality is identified. 2. There is moderate diffuse global atrophy, which is greater than expected for patient's age.
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Generate impression based on findings.
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Male 31 years old Reason: 31yo M with penetrating ileocolonic Crohn's, entero-enteric fistulas, eval for strictures History: ileitis, colitis The scout film shows a nonobstructive bowel gas pattern with several air-fluid levels. Transit was delayed as the patient had received morphine on the morning of the examination. For this reason after the 1 1/2 hour film, the patient was allowed to return to the floor and was brought back to radiology subsequently.Transit time to the terminal ileum was 4 hours 20 minutes. The duodenal and jejunal small bowel fold pattern is normal. There is long segment involvement of distal ileum with skip areas. There are least 3 areas of segmental high grade narrowing involving the distal ileum. The most proximal (demonstrated on series number 5 14:26 hours) with asymmetric outpouching and a second long segment narrowing is seen on the same image. There are several short sinus tracts seen on fluoroscopic compression.(One movie loop was recorded using fluoroscopy capture). The terminal ileum demonstrates high-grade attenuation. There is a possible ileoileal fistula.No ulcers seen. The degree of mild generalized dilatation may be related to the morphine and I do not believe the strictures are significantly mechanically obstructive.The cecum is not visible and highly contracted. The manual insufflation of air outlines a diffusely diseased mid and distal transverse colon, descending colon and sigmoid colon with nodularity and multifocal areas of narrowing.The bowel loops were freely mobile during fluoroscopically monitored palpation in the patient had no tenderness to compression. Fluoroscopy time 6 minutes 28 seconds.
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Multifocal areas of stricturing with skip areas involving the distal ileum and terminal ileum with some short segment sinus tracts and possible ileoileal fistula. No ulcers. No evidence of mechanical obstruction. Conical cecum.
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Generate impression based on findings.
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Respiratory failure. Internal jugular catheter.VIEW: Chest AP (one view) 02/03/15, 1458 Endotracheal tube tip is at carina. Feeding tube tip is distal to proximal body of stomach and not included on image. Right jugular line tip is at junction of internal jugular and subclavian veins. Left vagal nerve stimulator device has leads extending into left neck.Cardiothymic silhouette is normal. Minimal streaky opacities are noted in the perihilar region. Right pleural effusion and smaller. Subpulmonic left pleural effusion is seen.Soft tissue edema continues.
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Decrease in size of right pleural effusion.
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Generate impression based on findings.
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Diffuse pulmonary alveolar hemorrhage. New crackles on exam.VIEWS: Chest AP/lateral (two views) 2/3/15 at 1459 hrs. Central and kidneys the RA/SVC junction. NG tube is present. Tip is not visualized. Cardiac silhouette size is normal. Streaky opacity of the left lower lobe. No effusions or pneumothorax.
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Left lower lobe streaky opacity unchanged.
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Generate impression based on findings.
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72-year-old female with history of lumbosacral fusion. There are posterior stabilization rods with screws entering the vertebral bodies of L3 through S1. We see no evidence of hardware complication. Intervertebral disc spacer devices are present at L3-4, L4-5, and L5-S1. Severe degenerative disc disease affects L2-3 with mild multilevel degenerative disc disease affecting the thoracic spine. There is mild kyphosis of the upper thoracic spine. There is approximately 20 degrees of levoscoliosis of the lumbar spine measured from the superior endplate of L3 to the inferior endplate of L5. There is 2 cm of positive coronal balance as well as 10 cm of positive sagittal balance. Surgical clips project over the left upper quadrant.
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Postoperative changes of lumbosacral fusion, degenerative disc disease, and scoliosis as above.
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Generate impression based on findings.
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80 year-old female with fevers and pneumonia. Evaluate. Lack of intravenous contrast enhancement limits evaluation of solid organs and the bowel.CHEST:LUNGS AND PLEURA: Right upper and lower lobe consolidation with associated ground-glass opacity most suspicious for infection. Airspace opacity in the left lower lobe (series 5, image 62) also noted. Small right and trace left pleural effusions. No pneumothorax.MEDIASTINUM AND HILA: Endotracheal tube with tip approximately 1.5 cm above the carina. Moderate cardiomegaly without pericardial effusion.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. No intra-or extrahepatic biliary ductal dilatation. High-density material within the gallbladder is likely sludge.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No findings to suggest small bowel obstruction or colitis.BONES, SOFT TISSUES: Moderate to severe degenerative changes affect the visualized spine. 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: Moderate to severe degenerative changes affect the visualized spine with grade 1 retrolisthesis of L1 over L2 and grade 1 anterolisthesis of L4 over L5.OTHER: No significant abnormality noted.
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1.Findings most suspicious for multifocal pneumonia in the right upper, right lower, and left upper lobes. 2.Small right and trace left pleural effusions. 3.Within limitation of non-enhanced examination, no evidence of infection or drainable fluid collection within the abdomen or pelvis.
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Generate impression based on findings.
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Male 23 years old; Reason: evaluate for hydrocele vs cyst vs varicocele History: intermittent left testicular pain RIGHT TESTIS: The right testis is normal in echogenicity without mass or evidence of torsion.LEFT TESTIS: Left testis normal in echogenicity without mass or evidence of torsion.RIGHT EPIDIDYMIS: Small right epididymal cyst measures 0.7 x 0.4 x 0.6 cm.LEFT EPIDIDYMIS: Small left epididymal cyst measures 0.5 x 0.3 x 0.5 cm.OTHER: Evidence of a left varicocele measuring up to 0.3 cm
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1.Small left varicocele. 2.No masses, acute inflammation, or evidence of torsion.
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Generate impression based on findings.
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Fracture.VIEWS: Left forearm PA/lateral (two views) 02/03/15 A cast has been applied. Both bones fracture of the distal forearm is again seen. Posterior angulation of distal radial fracture fragment persists.
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Both bones fracture of distal forearm in cast.
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Generate impression based on findings.
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15-year-old male with fractureVIEWS: Right ankle AP/oblique/lateral (3 views) 02/03/15 Two screws remain in place in the tibial epiphysis without evidence of hardware complication. Alignment is anatomic. No joint effusion. Persistent periosteal reaction along the lateral aspect of the tibia.
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Continued healing of distal tibial fracture.
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Generate impression based on findings.
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Female 58 years old; Reason: eval disease (brca) on chemo- compare to prior film History: breast ca CHEST:LUNGS AND PLEURA: Left apical lesion measures 4mm (image 21/series 6), unchanged.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Bilateral thyroid nodules. There is a right chest wall Port-A-Cath with the tip terminating in thecavoatrial junction. There are postsurgical changes related to left mastectomy and left axillary lymph node dissection.Vertebral body sclerotic lesion.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter segment IVb lesion is too small to characterize.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: 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: Right acetabular metastasis and bilateral femoral lesions.OTHER: No significant abnormality noted.
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1.Osseous metastatic disease.
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Generate impression based on findings.
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There are multiple new surgical clips, along the left submandibular space bilaterally along the neck along the cervical vessels. Postop changes are seen within the soft tissues along the lower left eighth and upper left neck. There is again a tracheostomy tube in place with tip terminating 15 mm cranial to the carina. There is extensive streak artifact from the tube which again limits evaluation of surrounding structures. Within these limitations, the overall caliber of the distal trachea just above the level of the carina appears improved, now measuring 8 mm in greatest axis dimension/AP as compared to previous 6-mm. However, the tracheal walls again appear to directly abut the tracheostomy tube. There is redemonstration of diffuse mucosal edema involving the supraglottic, glottic, and subglottic regions. The ill-defined and edematous appearance of the aryepiglottic folds and vocal cords is similar. There is again effacement of the prepontine sinuses, with slight aeration of the valleculae. The laryngeal ventricles are not well delineated. Paraglottic fat is again partially effaced. Diffuse airway narrowing persists.GLANDS: The postcontrast appearance of the salivary glands is unremarkable. The visualized thyroid gland is unremarkable. ORAL CAVITY: The oral tongue and floor of mouth are unremarkable.CERVICAL SOFT TISSUES: There are no pathologically enlarged cervical lymph nodes.OTHER: Aerated secretions are present in the left maxillary sinus with a probable underlying mucosal retention cyst.
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Redemonstration of tracheal narrowing surrounding the tracheostomy tube consistent with history of tracheomalacia. Slight increased caliber of the distal trachea just above the level of the carina. Persistent diffuse soft tissue swelling of the hypopharyngeal and laryngeal structures with resultant airway effacement, although now with interval postoperative changes relating to tracheal reconstruction.
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Generate impression based on findings.
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Male, 26 years old.evaluate for RFO, multiple surgical teams, counts are correct Stent in right iliac fossa transplant kidney. Surgical drain in the right hemiabdomen. No unexpected radiopaque foreign body. Nonspecific bowel gas pattern.
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No unexpected radiopaque foreign body. Findings communicated to Dr. Thistlethwaite in the OR by telephone at 3:35 pm on 2/3/2015.
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Generate impression based on findings.
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11 year old female postopVIEWS: Left tibia-fibula AP/lateral (two views) 02/03/15 Again seen is an osteotomy through the proximal tibial diaphysis with external fixation device in place. There is widening of the osteotomy space. No significant periosteal reaction or callus formation is seen to suggest bone bridging or healing. Skin staples are again noted.
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Widening of the osteotomy space without evidence of bridging or healing.
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Generate impression based on findings.
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75-year-old female with history of hand injury. We see no acute fracture. There is a mild deformity at the base of the first finger which we suspect represents old trauma. Severe osteoarthritis affects the basilar joint. Osteoarthritis also affects the DIP joints particularly at the fifth finger which is held in slight flexion. There is mild soft tissue swelling about the tip of the index finger.
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Osteoarthritis without acute fracture.
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Generate impression based on findings.
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60 year-old female with history of shoulder pain. Mild osteoarthritis affects the acromioclavicular and glenohumeral joints. The humeral head is high riding which may be secondary to a chronic rotator cuff tear or atrophy. There is an os acromiale, a normal variant. We see no acute fracture. There is mild dextroscoliosis of the upper thoracic spine with mild multilevel degenerative disc disease.
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Osteoarthritis and high riding humeral head which may reflect rotator cuff tear or atrophy.
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Generate impression based on findings.
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63 year old female status post left lumpectomy and sentinel node biopsy for IDC and DCIS background (3/2013), presents today for routine follow up. The patient received radiation therapy (completed in 5/2013). No current breast complaints. Family history of breast carcinoma in her sister. 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. Postsurgical findings from the lumpectomy, including multiple surgical clips, architectural distortion and increased density, are stable in the left outer breast. Surgical clips are also seen in the left axilla. Left breast skin thickening and prominence of the breast parenchyma are compatible with prior radiation therapy. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Benign calcifications again noted.
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Post-treatment findings in the left breast and axilla. 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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Ms. Blanton is a 77 year old female with bacteremia/fungemia. Recent CT scan demonstrated asymmetrical left breast enlargement. Per patient, the left breast has been swollen and tender for the past 3 weeks. Upon physical exam, the left breast is asymmetrically larger than the right breast. There are patchy areas of erythema along with skin thickening present in the left breast. However, no discrete mass is appreciated. Upon physical exam of the right breast, no discrete mass or skin thickening is appreciated.A limited left breast ultrasound was performed for the patient’s area of concern. There is diffuse skin thickening present, measuring up to 4 mm, along with edematous breast parenchyma. However, there is no discrete fluid collection identified. No suspicious cystic or solid mass is identified.A limited right breast ultrasound was performed for comparison purposes. There is minimal skin thickening along with minimal edematous breast parenchyma. There is no discrete fluid collection identified. No suspicious cystic or solid mass is identified.
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Asymmetrically edematous left breast with diffuse skin thickening. No suspicious sonographic findings or discrete drainable fluid collections are identified.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed.
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Generate impression based on findings.
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71 years, Female. Reason: assess for stool burden; hx of constipation History: constipation, abdominal "heaviness" Moderate colonic stool burden without evidence of bowel obstruction. Degenerative arthritic changes affect the lower lumbar spine.
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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, 35 years old, status post retrosigmoid craniotomy for CPA tumor. Expected findings are seen status post right retrosigmoid craniotomy including scattered intracranial air, and a small amount of extra-axial fluid/blood products subjacent to the craniotomy site.Adequacy of tumor resection is not well assessed on CT. No evidence of parenchymal edema, mass effect or significant parenchymal/extra-axial hemorrhage is seen. The ventricular system remains normal in size and morphology.
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1. Expected findings status post right retrosigmoid craniotomy for tumor resection from the right CP angle. Adequacy of tumor resection will be better assessed on MRI.2. No significant surgical complications are detected.
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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 are situated in near-anatomic alignment without radiographic evidence of hardware complication. Skin staples, a drain, and foci of gas density in the anterior soft tissues reflect recent surgery.
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Total knee arthroplasty
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Generate impression based on findings.
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Male 62 years old; Reason: abdominal pain, concern for pancreatitis History: abdominal pain` ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No evidence of pancreatitis. No fluid collections. The vessels are patent.ADRENAL GLANDS: 11 mm right adrenal nodule.KIDNEYS, URETERS: Left renal sinus mass measures 3.2 x 2.9cm. The enhancing mass abuts the hilar vessels.There are bilateral renal cysts. Right renal has a thin septation. There is a possible nodule.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.3.2 cm left renal mass findings suspicious for renal cell carcinoma.2.No CT findings of acute pancreatitis.3.Complex right renal cyst with a septation and like to represent a Bosniak 2F.4.11 mm right adrenal nodule.5.Findings discussed with Dr. Rao with a suggestion for Urology consultation.
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Generate impression based on findings.
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62-year-old female with history of pain. Left knee: Severe osteoarthritis affects the knee particularly in the medial tibiofemoral compartment with bone on bone apposition. There is exuberant osteophyte formation. There is perhaps a small joint effusion.Right knee: Severe osteoarthritis affects the knee particularly in the medial tibiofemoral compartment with bone on bone apposition. There is exuberant osteophyte formation. There is perhaps a small joint effusion.
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Severe osteoarthritis as above.
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Generate impression based on findings.
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There is a lumbar levo-scoliosis and severe multilevel degenerative changes including endplate degenerative change, facet arthropathy, ligamentum flavum thickening, and loss of disc height. There is mild left lateral listhesis of L3 on L4 and minimal left lateral listhesis of L2 on L3. There is borderline distention of the gallbladder as well as distention of the common bile duct up to 14 mm. There are subcentimeter presumed cysts within the left kidney. There are diverticula within the left colon and there is atherosclerotic calcification of the abdominal aorta. T11-T12: There is mild bilateral facet arthropathy that results in mild spinal canal stenosis and mild right neural foramen stenosis.T12-L1: There is mild right facet arthropathy that in combination with scoliosis results in moderate to severe right neural foramen stenosis and mild effacement of the thecal sac on the right. There is no significant spinal canal or left neural foramen stenosis. L1-L2: There is mild right facet arthropathy and associated ligamentum flavum thickening as well as a mild disc bulge. These findings result in severe right neural foramen stenosis and no significant spinal canal or left neural foramen stenosis. There is also a small central apparent disc protrusion vs. thickened posterior longitudinal ligament located between the L1-L2 and L2-L3 levels. L2-L3: There is severe right and mild left facet arthropathy with associated ligamentum flavum thickening and a mild disc bulge. There is a small ill-defined region of poor contrast penetration within the right posterior lateral portion of the thecal sac adjacent to the facet joint that may represent thecal sac effacement or clumped nerve roots. The above findings result in mild to moderate spinal canal stenosis and no significant neural foramen stenosis.L3-L4: There is severe bilateral facet arthropathy with associated ligamentum flavum thickening including associated bony spurs that project into the spinal canal bilaterally as well as a moderate disc bulge. These findings result in severe spinal canal stenosis with near complete blockage of contrast as well as severe bilateral neural foramen stenosis. L4-L5: There is severe left facet arthropathy with associated ligamentum flavum thickening as well as a mild disc bulge. These findings result in severe spinal canal stenosis as well as severe left neural foramen stenosis. L5-S1: There is severe bilateral facet arthropathy without significant spinal canal, or neural foraminal narrowing.
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1.Scoliosis and severe multilevel degenerative change as detailed above, most significantly affecting the L3-L4 level where there is severe spinal canal stenosis and severe bilateral neural foramen stenosis.2.Nonspecific gallbladder and common bile duct distention that could be further evaluated with ultrasound or dedicated abdominal cross-sectional imaging.
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Generate impression based on findings.
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Female 66 years old Reason: r/o PE History: SOB, tachycardia, hx of CA PULMONARY ARTERIES: No evidence of pulmonary embolism to the segmental level. The pulmonary artery is normal in caliber without evidence of right heart strain.LUNGS AND PLEURA: Nonspecific scattered micronodules which are too small to characterize but could represent metastatic disease. No evidence of infection. No pleural effusion. MEDIASTINUM AND HILA: There is an enlarged left superior mediastinal lymph node measuring 2.4 x 1.8 cm (series 7, image 57). Normal heart size without pericardial effusion. Mild coronary artery calcifications. CHEST WALL: Large right breast mass measuring 9.7 x 6.2 cm (series 7, image 21). The right breast mass has skin thickening with internal air, likely secondary to previous biopsy. There are also small masses in the left breast. Additional enlarged axillary, internal mammary and subpectoral lymph nodes. For reference, a right axillary lymph node measures 4.7 x 2.9 cm (series 7, image 108). A left axilla lymph node measures 3.4 x 3.4 cm (series 7, image 62). Widespread axial and appendicular osseous metastasis in the spine, scapulae, ribs, and sternum. There is collapse of the L1 vertebrae with questionable extension into the spinal canal.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.
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1.No evidence of pulmonary embolus to the segmental level. 2.Large right breast mass with extensive metastatic involvement, including the contralateral breast, and diffuse axial and appendicular skeletal involvement. 3.Collapse of the L1 vertebral body with questionable extension into the spinal canal. Recommend MR of the spine for evaluation of possible intraspinal metastatic disease.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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Male, 84 years old, with history of metastatic parotid squamous cell carcinoma. Head:No mass effect or edema is seen to suggest the presence of intracranial metastases.Again noted is encephalomalacia involving the left temporal lobe with ex vacuo dilatation of the left temporal horn. Patchy periventricular and basal ganglia hypoattenuation is also unchanged and suggestive of age indeterminate microvascular ischemic disease.No evidence of intracranial hemorrhage or abnormal extra-axial collections. Ventricles are stable in size and morphology.A left eyelid weight remains in place. The osseous structures of the skull are intact. Mild ethmoid air cell mucosal thickening is demonstrated.Neck:Evidence of left parotidectomy is seen with persistent ill-defined soft tissue thickening within the operative bed and involving the adjacent soft tissues and skin. There has been no significant interval change in the appearance of these findings. No new discrete or nodular lesions are appreciated.No pathologic adenopathy is detected in the neck by size criteria. The mucosal surfaces are free of suspicious mass lesions. The remaining salivary glands and thyroid are unremarkable. A patulous, fluid-filled esophagus is demonstrated. Paraseptal emphysema is again seen in the lung apices.No concerning or destructive bony lesions are detected. The thoracic kyphosis is exaggerated. Severe degeneration of the glenohumeral joints is partially visualized. Degeneration of the left TMJ is also seen.
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1. Without the benefit of IV contrast, no definite evidence of locally recurrent tumor or pathologic adenopathy is detected in the neck.2. No evidence of intracranial metastases.
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Generate impression based on findings.
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Male; 74 years old. Reason: Adenocarcinoma of the lung please compare to prior scan per recist criteria. History: Lung Cancer LUNGS AND PLEURA: Numerous new pulmonary nodules in both lungs, particularly the upper lobes.Reference right upper lobe mass measures 5 x 7 cm, previously 5.6 x 7.0 cm (series 8/37) and is slightly decreased.Reference adjacent smaller mass measures 2.6 x 2.8 cm, previously 2.6 x 2.3 cm (series 8/48), and is slightly increased and more confluent with the larger mass.Reference right lower lobe mass, which is contiguous with the upper lobe mass, remains partially obscured by radiation reaction, measures 6.8 x 4.3 cm, previously 6.8 x 4.5 cm (series 8/56) and not significantly changed.No significant change in bilateral radiation reaction with traction bronchiectasis.MEDIASTINUM AND HILA: Redemonstration of multiple moderately enlarged mediastinal lymph nodes, grossly stable.Reference subcarinal lymph node is unchanged, measuring 19 mm in short axis (series 7/55).Severe coronary artery calcification.Normal heart size without significant pericardial effusion.Small sliding hiatal hernia is unchanged.CHEST WALL: Previously seen lucency in the T1 vertebral body is less conspicuous on today's examination, and may have been artifactually present on the prior study. No definite osseous metastases.Degenerative disease of the spine.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Partially visualized hypodensity in the left kidney likely represents a benign cyst.Scattered atherosclerotic calcification of the aorta.
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1. Numerous new pulmonary nodules in both lungs, compatible with progression of disease.2. Moderate mediastinal lymphadenopathy is grossly stable.
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Generate impression based on findings.
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Female 35 years old; Reason: right hydronephrosis, ? UPJ obstruction The posterior abdominal radionuclide angiogram demonstrates prompt, symmetrical perfusion of the kidneys. The left kidney demonstrates prompt uptake and excretion without collecting system dilatation or obstruction. The right kidney demonstrates uptake and excretion into a moderate to markedly dilated pelvicalyceal system. The estimated contribution of the right kidney to total renal function is 43% and that of the left kidney is 57%. There are no abnormalities of the ureters or bladder.Following administration of the diuretic, there was prompt washout of collecting system radiotracer from the left kidney into the bladder without evidence of current obstruction. There also was rapid washout of collecting system radiotracer from the dilated right kidney. Extrapolating from the steepest portions of the curves, the T1/2 washout from the dilated right collecting system was 4 minutes indicating no current obstruction. The T1/2 washout from the left collecting system was 7 minutes also indicating no current obstruction. Note is made of a medium-sized focus in the upper collecting system of the right kidney which demonstrates persistent radiotracer uptake longer than the remaining pelvicalyceal system, however which also washes out significantly. This likely represents pooling in a particularly prominent renal calyx.
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1. Significantly dilated right pelvicalyceal system but with rapid washout and no evidence of current obstruction. 2. Mildly diminished right renal parenchymal function.
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Generate impression based on findings.
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54-year-old female with history of cervical cancer, evaluate for progression.RADIOPHARMACEUTICAL: 12.3 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 90 mg/dL. Today's CT portion grossly demonstrates enlarged mediastinal or hilar lymph nodes. There is a left lower lumbar paraspinal soft tissue lesion with destruction of the adjacent L5 vertebral body.Today's PET examination demonstrates a large, markedly hypermetabolic mass in the left pelvis in the soft tissues immediately lateral to the L5 vertebral level with destruction of adjacent bone (SUV max 9.1 from previously 8.1; the previous SUV max has been corrected for differences in mean liver SUV). While similar in FDG avidity, the lesion has increased significantly in size, consistent with tumor progression in this location.There is new mild hypermetabolic activity associated with a small prevascular mediastinal lymph node (SUV max 2.3), very suspicious for tumor progression. Elsewhere in the mediastinum, there is symmetric, bilateral hilar and paratracheal hypermetabolic lymph nodes, which have increased slightly in size, number, and metabolic activity (SUV max 3.3 previously 2.1; the previous SUV max has been corrected for differences in mean liver SUV). This finding is suspicious for additional tumor progression or alternatively may represent progression of granulomatous inflammation given the symmetric distribution.
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Significant progression of hypermetabolic pelvic tumor as well as likely progression of tumor in the mediastinum.
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Generate impression based on findings.
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12 -year-old female with increased oxygen requirementVIEWS: Chest AP/lateral (two views) 02/03/15 Vagal nerve stimulator device projects over the chest wall with leads in the left neck.Unchanged levoscoliosis of the thoracolumbar spine. Cardiothymic silhouette is normal. No pleural effusion or pneumothorax. Increased bronchial wall thickening suggestive of bronchiolitis/reactive airway disease. Resolution of right upper lobe opacity. No focal pulmonary opacities.
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Bronchiolitis/reactive airway disease pattern.
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Generate impression based on findings.
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12-year-old female for evaluation of fractureVIEWS: Left first digit PA/lateral (two views) 02/03/15 Again seen is minimal buckling of the posterior cortex of the distal phalanx with surrounding periosteal reaction indicative of interval healing.
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Healing fracture of the distal phalanx the first digit.
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Generate impression based on findings.
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Female 47 years old; Reason: OUTPATIENT ORDER FOR 1 MONTH POST OP TO BE DONE IN FEB-Patient with type b dissection and rupture of 7.5 cm AAA s/p emergent open repair 12/31 with bilateral iliac stents. 1 month follow up. Thanks History: NONE CHEST:LUNGS AND PLEURA: Scattered emphysematous changes. No dominant lung lesion. Pleural spaces are clear.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. There is a type B. dissection that originates distal to the takeoff of the left subclavian artery. There is flow in both lumens.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Spleen is enlarged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Type B dissection extends to the distal abdominal aorta. In the infrarenal abdominal aorta there are postsurgical changes with a graft placement. The native aneurysm sac measures 4.7 x 4.5 cm (image 121/series 8). There is infiltration of the fat planes in the retroperitoneum. There is delayed enhancement along the left superior aspect of the aneurysmal sac (image 116 /series 10) which is slightly hypoattenuating to the aortic lumen. This is not present on the arterial phase.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.Type B dissection extending from distal to the level of the left subclavian artery to the abdomen.2.Postsurgical changes in the infrarenal abdominal aorta with a graft placement. Enhancement within the native sac outside the graft which does not match the aortic contrast enhancement and not seen on the arterial phase. This is favored to represent postsurgical change rather than hemorrhage into the sac.
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Generate impression based on findings.
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67-year-old female with newly diagnosed small cell lung cancer. Initial staging exam.RADIOPHARMACEUTICAL: 8.5 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 86 mg/dL. Today's CT portion grossly demonstrates partial opacification of the bilateral maxillary sinuses, suggestive of chronic sinusitis. There is a spiculated right apical 1 cm lesion, compatible with known primary small cell lung cancer. Bulky, enlarged paratracheal and right hilar lymph nodes are present, some calcified. Innumerable splenic granulomata are noted. Surgical tacks are noted in the anterior peritoneal wall. Extensive arterial atherosclerotic disease is present, including coronary arterial calcifications. Multiple soft tissue nodules are additionally noted in the subcutaneous fat of the anterior pelvis, anterior upper abdomen, and right lateral breast.Today's PET examination demonstrates markedly hypermetabolic activity associated with the aforementioned spiculated right upper lobe lesion (SUV max 9.4). There are multiple enlarged, markedly hypermetabolic mediastinal lymph nodes/masses in the mid right paratracheal, precarinal, and right hilar regions, consistent with mediastinal lymph node metastases (SUV max 22.0). A large, markedly hypermetabolic right supraclavicular lymph node mass (SUV max 21.5) is consistent with additional metastatic disease.Medium-sized, markedly hypermetabolic midline upper abdominal lesion in the vicinity of the pancreatic head or immediately adjacent tissues (SUV max 13.7) is consistent with metastasis. Additional markedly hypermetabolic body wall metastases are present in the subcutaneous fat and muscles surrounding the anterior chest, abdomen, and pelvis. For reference, the anterior pelvic wall metastasis just right of midline measures SUV max of 13.7.Subtle, rounded hypermetabolic focus near the superior endplate of L5 is suspicious for osseous metastasis (SUV 7.6), although may also represent degenerative inflammation.
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1.Hypermetabolic right upper lobe spiculated mass, compatible with known primary small cell lung cancer.2.Bulky, markedly hypermetabolic right mediastinal lymph node metastases.3.Additional hypermetabolic metastatic disease in right supraclavicular nodes, the vicinity of the pancreatic head, body wall, and possibly the L5 vertebral body.
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Generate impression based on findings.
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7-week-old female with ALTE, noisy breathing, possible aspirationVIEWS: Chest AP/lateral (two views) 02/03/15 Aortic arch, cardiac apex, and stomach are left-sided. No pleural effusion or pneumothorax. No focal pulmonary opacities. Large lung volumes and minimal bronchial wall thickening suggestive of bronchiolitis/reactive airway disease.
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Bronchiolitis/reactive airway disease pattern.
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Generate impression based on findings.
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66-year-old female with newly diagnosed right lower lobe lung cancer. Evaluate for mediastinal and extrathoracic disease.RADIOPHARMACEUTICAL: 9.4 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 87 mg/dL. Today's CT portion grossly demonstrates well-defined hypoattenuation in the right posterior parietal/occipital lobe at the superior edge of the field of view in the brain. There is a large, approximately 5 cm right infrahilar lung mass likely representing known primary lung cancer. Numerous small to medium sized pulmonary nodules are scattered throughout both lungs. A mixed solid and ground glass, lobular right upper lobe lesion measuring approximately 5 cm is additionally noted. Enlarged mediastinal lymph nodes are seen in the right paratracheal, right hilar, and subcarinal regions. Arterial atherosclerotic disease including coronary arterial calcifications are present. Suture material is seen along the lesser curvature of the stomach. An ill-defined, hypoattenuating central hepatic lesion is additionally noted. Soft tissue nodules anterior to the right rectus abdominous muscle are also seen.Today's PET examination demonstrates a large, markedly hypermetabolic right infrahilar mass (SUV max 24.3), compatible with patient's diagnosis of primary lung cancer. Multiple markedly hypermetabolic mediastinal lymph nodes in the right hilar, subcarinal, and paratracheal regions (SUV max 8.2) are compatible with metastatic disease. Numerous multiple bilateral lung nodules are associated with markedly hypermetabolic activity (SUV max 10.2), consistent with bilateral pulmonary parenchymal metastases. The mixed solid and ground glass right upper lobe lesion mentioned in CT findings above demonstrates only mild FDG avidity (SUV max 3.8), and given the CT appearance and lower FDG uptake as compared with the aforementioned right lower lobe and metastatic lesions, this may represent a second, low-grade synchronous primary lung cancer.Medium-sized, significantly hypermetabolic central hepatic lesion is present (SUV max 6.5), compatible with liver metastasis. Two metabolic foci involving the right rectus abdominous muscle (SUV max 6.2) are noted, highly suspicious for additional distant body wall metastases.On the superior-most image of the brain, the ill-defined hypoattenuation in the right parietal/occipital lobe corresponds with suggestion of decreased metabolic activity on PET. This may represent an area of infarction, but is incompletely evaluated particularly given its location at the edge of field of imaging. Metastatic disease with surrounding edema is also conceivable, though considered much less likely. Dedicated brain CT or MRI may be considered if clinically indicated.
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1.Large, markedly hypermetabolic right lower lobe mass, consistent with patient's diagnosis of lung cancer.2.Extensive mediastinal and bilateral pulmonary parenchymal metastases.3.Hypermetabolic hepatic and pelvic body wall metastases. 4.Findings suggestive of second synchronous primary low grade lung cancer in the right upper lobe.5.Incompletely evaluated right parietal lobe hypoattenuation, which may represent infarct versus much less likely underlying brain metastasis. Dedicated brain CT or MRI may be considered as clinically indicated.
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Generate impression based on findings.
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58-year-old female with metastatic breast cancer status post 4 cycles Taxotere/Herceptin. Please evaluate disease status.RADIOPHARMACEUTICAL: 10.7 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 130 mg/dL. Today's CT portion of the neck grossly demonstrates bilateral thyroid nodules. Please also refer to concurrent CT chest, abdomen and pelvis.Today's PET examination demonstrates a right acetabular hypermetabolic lesion, which has markedly decreased in size and metabolic activity (SUV max 6.2 from previously 32.1), indicating a significant metabolic response to therapy. The mild residual activity may reflect healing bone versus mild residual tumor activity.No additional sites of FDG-avid metastates are present.A left thyroid nodule is again seen demonstrating mildly hypermetabolic activity, though has decreased in activity (SUV max 4.0 from previously 7.0). This could represent a benign or malignant thyroid nodule.
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1.Marked interval improvement in right acetabular hypermetabolic metastasis. Mild residual activity may represent healing bone versus mild residual tumor activity. Otherwise no FDG avid disease.2.Hypermetabolic left thyroid focus may represent a benign or malignant nodule.Diagnostic CTs of the chest, abdomen, and pelvis also performed at today's visit will be reported separately.
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Generate impression based on findings.
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Female 47 years old; Reason: status of liver and other metastases History: metastatic breast CA, on chemo. Restaging, response to therapy. Rising tumor marker.RADIOPHARMACEUTICAL: 8.6 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 87 mg/dL. Today's CT portion grossly demonstrates postsurgical changes in the right breast as well as right abdominal wall. The numerous hypodense hepatic lesions. There are scattered largely sclerotic osseous lesions.Today's PET examination demonstrates multiple large hypermetabolic hepatic metastases which are significantly increased in size, number and metabolic activity consistent with progression of hepatic metastatic disease (SUV max 16.8, previously 6.1). There is a new punctate subtle hypermetabolic focus along the inferior endplate of L5 (SUV max 4.1) with corresponding small lytic lesion is suspicious for new bone metastasis, although this could also represent benign change. No additional FDG avid lesions are identified.Right vaginal focus not significantly changed likely a benign process.
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1.Numerous markedly hypermetabolic hepatic metastases are significantly progressed from prior study.2. Additional subtle punctate hypermetabolic focus at L5 is equivocal but suspicious for new osseous metastasis.
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Generate impression based on findings.
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Clinical question: Patient with acute mental status changes. Signs and symptoms: SOB, not protecting the airway Nonenhanced head CT:There is no detectable acute intracranial process. CT however he is insensitive for early detection of acute nonhemorrhagic ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white differentiation.Unremarkable calvarium and soft tissues of the scalp.Unremarkable orbits, paranasal sinuses and mastoid air cells.
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Unremarkable nonenhanced head CT.
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Generate impression based on findings.
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Clinical question: 38-year-old female with no signs of PMH presenting with transient vision changes and weakness. Signs and symptoms: As above. Nonenhanced head CT:There is no detectable acute intracranial process. CT however these intensity for early detection of acute nonhemorrhagic ischemic stroke. Consider MRI if clinical concern persists.The cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation is unremarkable.Unremarkable calvarium, scalp, orbits, paranasal sinuses and mastoid air cells.
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Unremarkable exam. Consider MRI if clinical concern persists.
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Generate impression based on findings.
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Clinical question: Renal hemorrhage status post fall. Signs and symptoms: As above. Nonenhanced head CT:There is no detectable acute posttraumatic intracranial, calvarial or soft tissues of the scalp findings. CT already is insensitive for early detection of acute nonhemorrhagic ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation.Incidental note is made of a tiny fatty deposit in lying in the occipital region suggestive of a tiny lipoma of no clinical significance.Unremarkable calvarium and soft tissues of the scalp.Unremarkable orbits, paranasal sinuses and mastoid air cells.
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Unremarkable nonenhanced head CT.
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Generate impression based on findings.
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Clinical question: Intracranial hemorrhage, skull fracture. Signs and symptoms: Status post assault with hard object to head; left frontal hematoma. Nonenhanced head CT:There is no detectable acute posttraumatic intracranial or calvarial findings.Left frontal scalp and subgaleal hematoma measuring approximately 10 mm in height is the technique. No underlying calvarial abnormality.There are subtle the subcortical foci of low-attenuation which are highly suspicious for age indeterminant small vessel ischemic strokes. Unremarkable cerebral cortex, cortical sulci, ventricular system and the CSF spaces.Paranasal sinuses demonstrate moderate left maxillary sinus disease and mild right ethmoid sinus disease. Images through the orbits demonstrate a chronic blowout fracture of right lamina papyracea.
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1.No acute posttraumatic intracranial findings.2.Left frontal scalp and subgaleal hematoma measuring 10 mm in height.3.Findings highly suggestive of mild age indeterminate small vessel ischemic strokes.4.Chronic blowout fracture of right lamina papyracea.5.Mild chronic sinusitis as detailed.
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Generate impression based on findings.
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Clinical question: Intracranial lesion. Signs and symptoms: Ataxia; headache; this ear tinnitus. Nonenhanced head CT:There is no detectable acute intracranial process. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter initiation.Unremarkable calvarium, soft tissues of the scalp, orbits, paranasal sinuses and mastoid air cells.
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Unremarkable nonenhanced head CT.
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Generate impression based on findings.
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seizures No evidence of acute ischemic or hemorrhagic lesion.Patchy bilateral periventricular white matter and centrum semiovale low attenuations indicate non specific small vessel disease.The ventricles, sulci, and cisterns are symmetric and unremarkable. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear.
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1. No evidence of acute ischemic or hemorrhagic lesion.2. Non specific small vessel disease as described above.
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Generate impression based on findings.
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Clinical question: Rule out bleed. Signs and symptoms: Small and laceration. Nonenhanced head CT:There is no detectable acute posttraumatic intracranial, calvarial or soft tissues of the scalp findings. CT is insensitive however for early detection of acute nonhemorrhagic ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation for patient's stated age of 80. Unremarkable barium. Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.
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Unremarkable nonenhanced head CT.
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Generate impression based on findings.
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A region of hypoattenuation is noted in the left MCA distribution within the left angular gyrus, left dorsal insular cortex and left superior temporal gyrus. There is mild mass effect but no midline shift or herniation. Additional regions of mild scattered periventricular and subcortical hypoattenuation likely represent chronic small vessel ischemic disease.The ventricles and sulci are normal in size. There are no extraaxial fluid collections or subdural hematomas. The visualized portions of the paranasal sinuses and mastoid air cells are clear.
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Acute MCA distribution infarct involving the left parieto-temporal region. There is mild mass effect but no midline shift or herniation.
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Generate impression based on findings.
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worst headache of my life No evidence of acute ischemic or hemorrhagic lesion.Previously reported right side subtle hypoattenuation is likely to be an artifactual lesion. The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear.
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No evidence of acute ischemic or hemorrhagic lesion.
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Generate impression based on findings.
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Clinical question: Status left wrist. Signs and symptoms: Status epilepticus. Nonenhanced head CT:Examination demonstrate no detectable acute intracranial process. CT however these in sensitive for early detection of acute nonhemorrhagic ischemic strokes.There is prominence of ventricular system and supratentorial cortical sulci for patient's stated age and suggest underlying parenchymal volume loss. This appearance is not appreciably different than prior MRI exam from January of 2015 study. There are diffuse subcortical and periventricular low attenuation white matter as was seen on prior MRI exam and consistent with age indeterminate small vessel ischemic strokes of moderate to advanced degree. Calvarium is intact and mastoid air cells as well as middle ear cavities remain well pneumatized.Images to the orbits are unremarkable.Extensive opacification and fluid levels of the paranasal sinuses could represent sinusitis or be secondary to patient's intubation.
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1.No acute intracranial process. CT is in sensitive for early detection of acute nonhemorrhagic stroke.2.Age indeterminate small vessel ischemic strokes and resultant parenchymal volume loss without significant change since prior MRI exam.3.Diffuse opacification of all paranasal sinuses and air fluid levels in maxillary sinuses could be secondary to instrumentation. Possibly chipped sinusitis cannot be entirely excluded.
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Generate impression based on findings.
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Clinical question: MISTIE study Follow up for left thalamic hematoma. Signs and symptoms: As above. Nonenhanced head CT:A large irregular and dissecting thalamic and basal ganglia acute hematoma is again identified without convincing evidence of interval change in its size or density since prior exam from approximately 24 hours earlier. It measures a maximum of 48 x 53-mm in transaxial dimensions. Subtle surrounding vasogenic edema and overall associated mass effect and 12-mm deviation of midline to the right also demonstrate no definitive evidence of change.There is significant mass effect on the left lateral ventricle and mildly dilated right lateral ventricle. Compared to prior exam this is slight interval increased size of right lateral ventricle. There is no change in the position of right frontal approach ventricular catheter with the tip in the anterior third ventricle. Hemorrhage within the right lateral ventricle demonstrates no significant change in these layered at the level of the right trigone and occipital horn of lateral ventricle.
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1.There is slight interval increased size of right lateral ventricle since prior study.2.Stable position of right frontal approach ventricular catheter with the tip in the anterior third ventricle.3.Stable acute hematoma of the left thalamus/basal ganglia and in associated mass-effect with 12-mm midline shift to the right.
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Generate impression based on findings.
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28-year-old male with right lower quadrant pain. Evaluate for appendicitis. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No evidence of cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. No intra-or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of small bowel obstruction or colitis.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 evidence of small bowel obstruction or colitis. Appendix is normal.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.Appendix is normal. 2.No acute findings to account for patient's pain.
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Generate impression based on findings.
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Female 45 years old Reason: improvement of fluid collection seen on CT History: abdominal pain UTERUS, ADNEXAE: The uterus is surgically absent.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: A pigtail drainage catheter is again noted in the right hemipelvis with interval reduction in size of right pelvic sidewall multiloculated pelvic fluid collection. Additional loculated fluid pockets remain in the left hemipelvis and presacral region, are also reduced in size, measuring up to 4.5 x 2.5 cm (series 3, image 46). There are associated inflammatory changes.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Stable calcification and dilatation of any right gonadal vein, incompletely evaluated on this study.
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The right pelvic sidewall collection drained by a pigtail catheter has decreased in size. Additional left pelvic sidewall/presacral multiloculated fluid collections are also decreased.
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Generate impression based on findings.
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Clinical question: 42 year-old female with polymyositis; dysphasia, respiratory weakness and recent headaches. Signs and symptoms: As above. Nonenhanced head CT:There is no detectable acute intracranial process. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells.
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Unremarkable nonenhanced head CT.
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Generate impression based on findings.
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66 year old female with abdominal pain. Evaluate for mesenteric ischemia. Angiogram: No evidence of aortic dissection. There is aneurysmal dilatation of the distal descending thoracic aorta measuring up to 3.2 cm in dimension (series 9, image 38). There is severe narrowing at the origins of the celiac axis and superior mesenteric artery, which are both patent and without evidence of dissection or thrombus. The right renal artery is patent. Thrombus within the left renal artery is identified. Bilateral iliac stent grafts which are patent. There is nonocclusive thrombus within the right superficial femoral artery.ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No arterially enhancing lesions. No intra-or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality identified.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Mild right hydroureteronephrosis likely secondary to the severely distended bladder. Atrophic left kidney with decreased nephrogram, most likely secondary to the thrombus within the left renal artery.RETROPERITONEUM, LYMPH NODES: CT angiogram findings as above.BOWEL, MESENTERY: No bowel wall thickening, abnormally enhancing bowel, or other specific findings to suggest mesenteric ischemia. Nonspecific small amount of fluid adjacent to the distal descending colon (coronal 9, image 152).BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Severely distended bladder resulting in mild right hydroureteronephrosis.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: As above.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.No findings to suggest mesenteric ischemia as clinically questioned. Severe narrowing at the origins of the celiac axis and the SMA without evidence of dissection or thrombus.2.Thrombus within the left renal artery resulting in left renal atrophy and diminished nephrogram.3.Severely distended bladder resulting in mild right hydroureteronephrosis.4.Small amount of fluid surrounding the descending colon as above which is nonspecific; however, very early diverticulitis cannot be completely excluded.
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Generate impression based on findings.
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Proximal femoral endoprosthetic reconstruction.VIEWS: Left femur AP (one view) pelvis AP (one view) 2/3/2015, 1828, 1835 Interval placement of a longstem left femoral proximal endoprosthesis device, replacing the previously resected femur, in anatomic alignment and without evidence of hardware complication. A surgical drain is in place and a vascular clip is seen in the medial aspect. Reticulation of the overlying subcutaneous fat consistent with edema.
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Components of a proximal left femoral endoprosthesis in anatomic alignment and without evidence of hardware complication.
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Generate impression based on findings.
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39-year-old female with left-sided cramping abdominal pain. Heme positive urinalysis. Evaluate for stone. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality identified.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Postsurgical changes at the posterior aspect of the left kidney with calcifications. No new calcifications to suggest a new stone. No hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: Stable mildly prominent nonspecific retroperitoneal lymph nodes.BOWEL, MESENTERY: No findings to suggest small bowel obstruction or colitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No findings to suggest small bowel obstruction or colitis. Status post appendectomy.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.No obstructing nephrolithiasis or hydroureteronephrosis. 2.Post surgical changes of partial left nephrectomy are stable.
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Generate impression based on findings.
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Eight month old male with respiratory distress and feverVIEWS: Chest AP/lateral (two views) 02/03/15, 1936 hrs Cardiothymic silhouette is normal. No pleural effusion or pneumothorax. No focal pulmonary opacities. Large lung volumes and bronchial wall thickening suggestive of bronchiolitis/reactive airway disease.
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Bronchiolitis/reactive airway disease pattern.
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Generate impression based on findings.
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Female 48 years old; Reason: Evaluate for appendicitis, volvulus History: RLQ pain ABDOMEN:LUNG BASES: Mild bibasal atelectasis.Nonspecific calcified nodule in the right breast is nonspecific on CT but is not significantly changed compared to prior study of 2012.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Interval insertion of caval filter.BOWEL, MESENTERY: The appendix is identified in the right lower quadrant and is unremarkable.BONES, SOFT TISSUES: Wide necked fat containing umbilical hernia. New small left paracentral paraumbilical hernia containing omental fat.OTHER: Incompletely imaged spinal infusion catheters.PELVIS:UTERUS, ADNEXA: Interval hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.No evidence of appendicitis or other specific findings to explain patient's right lower quadrant pain.
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Generate impression based on findings.
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new NGT NG tip coiled in the fundus. Mildly prominent small bowel loops suggest ileus pattern. Amorphous calcific densities in the upper abdomen correlate with calcified low attenuation masses on CT, 11/11/2014. Right femoral venous catheter. Scattered surgical clips and midline skin stables.
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NG tip coiled in the fundus.
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Generate impression based on findings.
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8-month-old male with history of tracheomalacia, here for cough and shortness of breathVIEW: Chest AP (one view) 02/03/15, 1810 hrs Aortic arch, cardiac apex, and stomach are left-sided. Cardiothymic silhouette is normal. No pleural effusion or pneumothorax. No focal pulmonary opacities. Large lung volumes and minimal bronchial wall thickening suggestive of bronchiolitis/reactive airway disease.
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Bronchiolitis/reactive airway disease pattern.
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Generate impression based on findings.
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Pericardial effusion status post pericardiocentesis.VIEW: Chest AP (one view) 2/4/2015, 02:51 Interval placement of a pericardial drainage catheter with the tip projecting over the left ventricle. Bilateral pleural effusions persist, unchanged on the right and increased on the left. The cardiac silhouette is unchanged with persistent straightening of the left border. No pneumothorax is seen. Bilateral basilar predominant hazy opacities suggest mild pulmonary edema. Unchanged retrocardiac opacity consistent with atelectasis.
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Interval placement of a pericardial drainage catheter, with persistent enlargement of the cardiac silhouette and straightening of the left heart border. Increased left pleural effusion.
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Generate impression based on findings.
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82 year-old female with right rib pain after fall Ribs: Radiopaque markers overlie the right lower chest wall at the site of the patient's pain. No rib fracture is identified. The lungs are clear. Tortuous aorta with distal aortobiiliac stent graft and additional left iliac stent noted.Hips and pelvis: The bones are diffusely demineralized and there is soft tissue atrophy. No fracture or dislocation.
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No fracture or dislocation.
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Generate impression based on findings.
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History of elevation of depressed skull fracture; evaluate for acute hemorrhage. High density material scattered along the right aspect falx likely represents birth-related subdural hemorrhage. There is hypoattenuation in the bilateral parietal and occipital lobes, more conspicuous than in anterior brain and slightly asymmetrically prominent on the left. However, areas of hypoattenuation may extend transcortically, left greater than right, and edema/ischemia cannot be excluded. There is slight undersulcation of the brain, but appropriate for birth age. The ventricles and basal cisterns are normal in size and configuration for age. There is no mass effect or midline shift. There is an oblique linear lucency which extends posteriorly from the area of the right coronal suture, consistent with known history of right parietal fracture. The adjacent right superior frontal bone appears mildly concave, with adjacent extracranial air. There is slight lateral displacement of the dominant right parietal fracture fragment. There is evidence of a small craniotomy more posteriorly in the lateral mid right parietal bone, with subjacent air and mildly inwardly displaced tiny bony fragments. There is mild diastases of the bilateral lambdoid sutures, and the occipital bone is relatively displaced inward, likely secondary to molding during birth. Extracranial air tracks along the right frontoparietal calvarial surface. A thin hyperdense subgaleal hematoma overlies the parietal bones in the midline, measuring up to 2 mm. Additional surrounding lower density fluid across the midline raises the possibility of superimposed caput succedaneum. The paranasal sinuses are rudimentary, which is expected for patient's age. Fluid is present in the bilateral mastoid and middle ear cavities. An NG tube is noted. External bandages are present around the skull.
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1. Apparent hypoattenuation in the bilateral parietal and occipital lobes, which may in part be due to non-myelinated white matter in a patient of this age, although appearing more conspicuous in low density than front lobe white matter which would be atypical. There may also be some degree of artifactual occipital shading. However, areas of edema/ischemia cannot be excluded. Recommend MRI brain for further characterization. 2. Evidence of right parietal bone fracture just adjacent to the coronal suture, as detailed above. 3. There is fluid within the bilateral mastoids and middle ear cavities.4. There is evidence of minimal blood products along the falx, which is likely birth-related.5. There is diastases of the bilateral lamboid sutures, with relative inward displacement of the occipital bone, likely secondary to molding during birth. 6. There is a thin subgaleal hematoma overlying the sagittal suture at the apex with possible additional caput succedaneum.
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Generate impression based on findings.
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9-year-old male with history of Crohn's disease now with abdominal pain, vomiting, diarrheaVIEWS: Abdomen AP supine and erect (two views) 02/03/15, 1914 hrs Nonobstructive bowel gas pattern. Moderate stool burden. No pneumoperitoneum, pneumatosis intestinalis, or portal venous gas.
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Nonobstructive bowel gas pattern.
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Generate impression based on findings.
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Male, 53 years old.rule out RFO, surgery length greater than 8 hours NG tube in the distal esophagus. Interval removal of jejunal catheter. Percutaneous gastrostomy. Clip in the left upper quadrant. A drain projects over the right hemiabdomen. Nonobstructive bowel gas pattern. Curvilinear opacity over the pubic symphysis could be related to Foley balloon. No unexpected retained foreign body.Bilateral pleural catheters. Left basilar opacity.
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No unexpected retained foreign body. Findings discussed with Dr. Vigneswaran by telephone at 1710 hours on 2/3/2015 by the radiology resident on call.
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Generate impression based on findings.
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44-year-old male with pain and swelling after assault There is a minimally displaced comminuted fracture of the nasal bone. The frontal and maxillary sinuses are clear.
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Comminuted nasal bone fracture.
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Generate impression based on findings.
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71 year-old female who presents for evaluation of pancreatic mass. Patient with history of mass in body of pancreas on EGD/EUS. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No arterially enhancing lesions. No intra-or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: There is a questionable hypoattenuating focus in the pancreatic body posteriorly measuring approximately 4 x 7 mm (series 12, image 36).ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Questionable subcentimeter hypoattenuating focus in pancreatic body posteriorly, which may be a side branch IPMN. If further characterization or confirmation is needed, evaluation with MRCP may be considered.
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Generate impression based on findings.
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37-year-old male with pain, evaluate for great toe fracture Alignment is anatomic. No fracture is evident. There is mild soft tissue swelling about the great toe.
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No fracture or malalignment.
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Generate impression based on findings.
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31-year-old female with pain after fall Alignment is anatomic. No fracture is evident. The shoulder appears normal for the patient's age.
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No fracture or dislocation.
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Generate impression based on findings.
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14-month-old female with constipation, vomiting, and abdominal painVIEW: Abdomen AP (one view) 02/03/15, 1921 hrs Moderate amount of stool in the rectum and descending colon. No pneumoperitoneum, pneumatosis intestinalis, or portal venous gas. No specific evidence of obstruction.
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Moderate stool burden.
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Generate impression based on findings.
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19 year-old male with fall from height Hips: The hips appear normal for the patient's age.Lumbar spine: Vertebral body heights and disk spaces are maintained. No fracture is evident.Cervical spine: Limited exam due to lack of an odontoid view. Vertebral body heights and alignment are maintained. No fracture is evident.
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No fracture or dislocation.
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Generate impression based on findings.
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Pulmonary edema status post endotracheal tube placement.VIEW: Chest AP (one view) 2/4/2015, 03:01 The endotracheal tube tip is just above the carina. The left central venous catheter and right upper extremity PICC tips are in the superior vena cava.Small bilateral pleural effusions persist, perhaps slightly improved on the right and unchanged on the left. Retrocardiac atelectasis again seen. Mild cardiac enlargement, unchanged. Bibasilar airspace opacities suggestive of pulmonary edema are slightly improved.
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Slightly improved right pleural effusion and pulmonary edema pattern.
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Generate impression based on findings.
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Asymmetry in the posterior left breast seen on screening mammography. Family history of breast cancer in mother at 87 years of age. Three standard views of the left breast were performed digitally with spot compression views 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. The asymmetry in the posterior left breast on the MLO view persists with spot compression. Benign calcifications are present in the left breast. No suspicious microcalcifications or areas of architectural distortion in the left breast. ULTRASOUND
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Asymmetry in the posterior left breast, without sonographic abnormality is highly likely benign. As long as the patient's physical examination remains normal, left unilateral 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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4-year-old male with respiratory distress and tachypneaVIEWS: Chest AP/lateral (two views) 02/03/15 Cardiothymic silhouette is normal. No pleural effusion or pneumothorax. No focal pulmonary opacities. Large lung volumes and bronchial wall thickening is suggestive of bronchiolitis/reactive airway disease.
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Bronchiolitis/reactive airway disease pattern.
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Generate impression based on findings.
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60 year-old male status post fall Tibia and fibula: Oblique distal fibular fracture is again visualized. Ankle: There is lateral greater than medial soft tissue swelling. Spiral distal fibular fracture extends to the tibiotalar joint. An additional nondisplaced fracture of the posterior malleolus is noted. The medial malleolus is intact. There is no significant widening of the medial tibiotalar joint on the stress view.
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Ankle fracture as described above.
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Generate impression based on findings.
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Patient with seizures and endotracheal tube placement.VIEW: Chest AP (one view) 2/4/2015, 03:15 Endotracheal tube tip is below thoracic inlet and above carina. A nasogastric tube tip terminates in the body of the stomach. A left chest wall vagal nerve stimulator is again seen, position unchanged.The cardiothymic silhouette is normal. Persistent unchanged bibasilar subsegmental atelectasis.
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Persistent unchanged bibasilar subsegmental atelectasis.
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Generate impression based on findings.
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Female 75 years old; Reason: evaluate for malignancy and ascites History: ascites, anorexia, and occasional epigastric pain The absence of intravenous and oral contrast limits evaluation of the solid organs and of the bowels. Given these limitations, the following observations were made:CHEST:LUNGS AND PLEURA: Moderate/severe diffuse emphysematous changes. Moderate bilateral pleural effusions with compressive atelectasis, left greater than right. There is a degree of loculation on the left.MEDIASTINUM AND HILA: No significant abnormality noted. Mild coronary artery disease. Mild arteriosclerosis of the thoracic aorta. The ascending aorta measures 3.8 cm in maximum transverse dimension.CHEST WALL: Asymmetrically prominent breast tissue on the left would be better evaluated with mammography. Mild cardiomegalyABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Infrarenal abdominal aortic aneurysm measuring 3.1 x 3.3 cm (series 2, image 371).BOWEL, MESENTERY: Mild gastric varices are incompletely evaluated on this noncontrast study.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild abdominal ascites.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Air within the bladder, presumably relating to recent instrumentation. LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticular disease.BONES, SOFT TISSUES: Healed left inferior pubic ramus fracture.OTHER: Diffuse anasarca. Moderate pelvic ascites.
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1.Moderate/severe emphysematous changes with bilateral pleural effusions, and with loculation in the left.2.Abdominal and pelvic ascites with diffuse anasarca.3.No obvious neoplastic process noted on this noncontrast exam.4.Asymmetrically prominent breast tissue on the left side would be better evaluated with mammogram.
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Generate impression based on findings.
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27-year-old male with history of fall. We see no fracture. There is mild osteoarthritis of the proximal tibiofibular joint. Linear density overlying the tibiofemoral articulation is likely artifactual. There is no evidence of a joint effusion. The right knee appears normal as seen on the frontal view.
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Mild osteoarthritis at the tibiofibular articulation, but we see no fracture.
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Generate impression based on findings.
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5-year-old male with fluid overload and nephrotic syndrome.VIEW: Chest AP (one view) 2/4/2015, 03:25 Endotracheal tube tip is below thoracic inlet and above carina. The NG tube tip terminates out of the field-of-view. The right internal jugular central venous catheter tip is in the superior vena cava.The cardiothymic silhouette is normal. Small bilateral pleural effusions persist. Improved right upper lobe atelectasis and persistent unchanged bibasilar atelectasis. Mild pulmonary edema pattern unchanged.
|
Improved right upper lobe atelectasis and unchanged mild pulmonary edema pattern.
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Generate impression based on findings.
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36 year-old female with right thigh pain Hip: Alignment is anatomic. No fracture is evident. Vascular calcifications are noted in the soft tissues. Femur: The femur is intact. The knee appears unremarkable for the patient's age. Vascular calcifications are noted in the soft tissues.
|
No specific findings of the patient's symptoms.
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Generate impression based on findings.
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The image quality is significantly degraded by motion artifact. There is no evidence of intracranial hemorrhage. There is pronounced hypoattenuation of the cerebral white matter, particularly in the bilateral parieto-occipital regions. The lateral ventricles are on the smaller end of the normal spectrum. However, the basal cisterns are intact. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are grossly clear. The skull and extracranial soft tissues are unremarkable.
|
Apparent pronounced hypoattenuation of the cerebral white matter, particularly in the bilateral parieto-occipital regions, may be related to the stage of myelination. However, a superimposed process, such as posterior reversible encephalopathy syndrome or infection cannot be entirely excluded and the study is significantly limited by motion artifact. MRI may be useful for further evaluation, if clinically warranted. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.
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Generate impression based on findings.
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Left lateral neck enlarged lymph node not improving despite clindamycin. There is extensive left cervical lymphadenopathy associated with surrounding fat stranding and swelling of the adjacent musculature. Some of the level 5A lymph nodes contain areas of central low attenuation measuring up to 9 mm. There are also mildly enlarged upper mediastinal lymph nodes. There is diffuse opacification of the maxillary and ethmoid sinuses. There is opacification of the right middle ear and mastoid air cells with a retracted tympanic membrane. The thyroid and major salivary glands are unremarkable. The major cervical vessels are patent. The osseous structures are unremarkable. The airways are patent. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear.
|
Extensive left cervical lymphadenopathy with evidence of acute suppurative lymphadenitis, sinusitis, and right otomastoiditis.
|
Generate impression based on findings.
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NG tube location NG tube side port at the GE junction. Visualized bowel gas pattern is nonobstructive.
|
NG tube side port at the GE junction; recommend advancing.
|
Generate impression based on findings.
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83-year-old female with history of pain. The bones are demineralized suggesting osteopenia/osteoporosis.Right knee: Severe osteoarthritis affects the knee with near bone-on-bone apposition of the medial compartment. There are tricompartmental osteophytes. There is chondrocalcinosis of the lateral meniscus.Left knee: Moderate osteoarthritis affects the knee with narrowing of the medial compartment. There are tiny medial and patellofemoral osteophytes.Right shoulder: Severe osteoarthritis affects the glenohumeral joint. Mild osteoarthritis affects the acromioclavicular joint. Surgical clips project over the lower neck. Degenerative arthritic changes affect the visualized spine.
|
Osteoarthritis of the right shoulder and knees and other findings as described above.
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Generate impression based on findings.
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There is no significant change in size of the low attenuation subdural fluid collection along the left cerebral convexity with extension along the falx cerebri, which now measures up to 15 mm in width and has mild mass effect upon the underlying brain parenchyma. There is also no significant interval change in the small anterior right parafalcine subdural fluid collection. There is trace residual hyperattenuation along the left cingulate sulcus and trace subarachnoid hemorrhage along the left parietal lobe. The right frontal subdural collection with extension along the right falx cerebri is unchanged. There is evolution of the foci of intraparenchymal and subarachnoid hemorrhage in the bilateral frontal lobes, left greater than right. Trace hemorrhage is present within the bilateral occipital horns. There is stable rightward midline shift, measuring up to 7 mm. There are patchy areas of hypoattenuation in the anterior left frontal lobe. There is redemonstration of postoperative findings related to right frontal pterional craniotomy for resection of right anterior temporal lobe mass, with surrounding hypoattenuation. The ventricles and sulci are mildly prominent, consistent with parenchymal volume loss. There are scattered areas of hypoattenuation in the periventricular and subcortical white matter, which are nonspecific, but may represent chronic small vessel ischemic diease. There are bilateral lens implants. Small retention cysts are present in the bilateral maxillary sinuses. There is an air-fluid level in the right sphenoid sinus. The mastoid air cells are clear.
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1. No significant interval change in size of the bilateral subdural hematomas, left larger than right, as well as multiple small foci of intraparenchymal, subarachnoid, and intraventricular hemorrhage. 2. Left anterior frontal lobe contusions are more conspicuous on the recent MRI. 3. Stable postoperative findings related to right frontal pterional craniotomy and resection of right anterior temporal lobe mass.4. Possible acute sinusitis.Findings discussed with Dr. Daher on 2/4/2015 at 11 am.
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Generate impression based on findings.
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Seizures and subdural hematoma, assess ETT placement.VIEW: Chest AP (one view) 2/4/2015, 03:32 The endotracheal tube tip is below the thoracic inlet and above the carina. The nasogastric tube tip is in the body of the stomach. An obliquely oriented catheter extending inferiorly from the left is present, with its tip overlying the right aspect of L3.The cardiothymic silhouette is normal. Unchanged left pleural effusion. Improved, but persistent right upper lobe atelectasis, and new right basilar subsegmental atelectasis.
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Unchanged left pleural effusion with decreased right upper lobe and increased right lower lobe atelectasis.
|
Generate impression based on findings.
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58-year-old male with history of inflammatory polyarthritis. Left foot: Minimal degenerative arthritic changes affect the foot appearing similar to prior. We see no erosions or other specific findings of inflammatory arthritis.Right foot: Mild osteoarthritis affects the foot appearing similar to prior. There is minimal soft tissue swelling about the ankle. We see no erosions or other specific findings of inflammatory arthritis.Left hand: There is a chronic fracture of the proximal pole of the scaphoid with mild sclerosis of the proximal pole likely secondary to avascular necrosis. Degenerative arthritic changes of the wrist appear similar to the prior study. Moderate osteoarthritis affects the interphalangeal joints. We see no erosions or other specific findings of inflammatory arthritis.Right hand: There is deformity of the distal phalanx of the third finger which is likely the sequela of prior trauma. Mild osteoarthritis affects the remainder of the hand. Small lucency within the distal pole of the scaphoid may represent a cyst and appears similar to the prior study. We see no definite erosions or other specific findings of inflammatory arthritis.
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Arthritic changes appear predominantly degenerative in etiology. We see no definite erosions or other specific features of inflammatory arthritis. Other findings as described above.
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Generate impression based on findings.
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NG tube placement NG tube side port in the distal esophagus. Nonobstructive bowel gas pattern. Biiliac arterial stents. Retained contrast in the bladder.
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NG tube side port in the distal esophagus; recommend advancing.
|
Generate impression based on findings.
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Pain and swelling along lateral and anterior ankle joint. Evaluate for ankle joint DJD. Small tibiotalar joint osteophytes indicate mild osteoarthritis. I see no fracture or malalignment. There are tiny posterior and plantar calcaneal spurs.
|
Mild osteoarthritis.
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Generate impression based on findings.
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Left pleural effusion status post chest tube placement.VIEW: Chest AP (one view) 2/4/2015, 03:39 Left chest tube position unchanged.Left pleural effusion slightly improved, but now with increased lucency within the pleural space consistent with a pneumothorax. Left lower lobe atelectasis/consolidation unchanged. Streaky right basilar opacity slightly improved. The cardiothymic silhouette is normal.
|
Improved left pleural effusion, but now with a new left pneumothorax.
|
Generate impression based on findings.
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NG tube placement NG tube coiled in the fundus. Nonobstructive bowel gas pattern. Retained barium in the colon. Degenerative arthritic changes affect the lower lumbar spine.
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NG tube coiled in the fundus.
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Generate impression based on findings.
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Respiratory insufficiency, assess ETT placement.VIEW: Chest AP (one view) 2/4/2015, 03:44 Endotracheal tube tip is at thoracic inlet. A gastrostomy tube is in place, position unchanged.The cardiothymic silhouette is normal. The lung volumes are large. Unchanged small left pleural effusion. The right upper and right lower lobe opacities are unchanged, likely reflecting atelectasis. Previously seen left lower lobe opacity difficult to assess secondary to overlying tubing, but likely persists.
|
Unchanged left pleural effusion and right-sided atelectasis. Previously identified left lower lobe opacity difficult to assess secondary to overlying tubing, but likely persists.
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