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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Family history of breast cancer in maternal aunt and ovarian cancer in maternal grandmother. Personal history of benign left breast biopsy. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Previously biopsied benign breast mass in the left lateral breast is stable. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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Stable benign left breast mass. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram.
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Generate impression based on findings.
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NG tube placement Dobbhoff tube in the gastric body. Fractured Dobbhoff tube lateral to the newly placed Dobbhoff. Nonspecific bowel gas pattern.
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New Dobbhoff tube in the gastric body. Fractured Dobbhoff tube lateral to the newly placed Dobbhoff.
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Generate impression based on findings.
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Female 77 years old Reason: hypoxia, mobile mass noted in the R PA during EBUS History: dyspnea PULMONARY ARTERIES: Large acute pulmonary embolus extending from the right main pulmonary artery at the bifurcation of the right lower and right middle lobar branches into multiple lobar, segmental, and subsegmental branches. No pulmonary embolus on the left. Borderline enlargement of the pulmonary artery measuring up to 31 mm. There is mild reflux of contrast into the hepatic veins.LUNGS AND PLEURA: There is complete collapse of the left lung with a large left-sided pleural effusion.Evaluation of a seen the left lung is limited due to atelectasis. Obstruction of the lobar/segmental left upper and lower lobe bronchi suggesting tumoral involvement.Patchy peripheral and nodular opacities at the right middle and lower lobes may represent hemorrhage, infarction or metastastic disease. Scattered opacities in the right apex may related to aspiration/infection. MEDIASTINUM AND HILA: Multiple mediastinal lymph nodes compatible with adenopathy lymphadenopathy. Mildly enlarged heart size without pericardial effusion or evidence of right heart strain. Atherosclerotic calcifications of the aorta and its branches with severe coronary artery calcifications.CHEST WALL: Moderate degenerative changes of the thoracic spine with mild anterior wedging of several midthoracic vertebrae of indeterminate age. Subchondral sclerosis of the T9 vertebra is most likely degenerative in nature. UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Multiple, incompletely evaluated hepatic hypodensities, some of which are ill-defined and suspicious for metastasis.Indeterminate right and left adrenal nodules.
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1.Large acute right-sided pulmonary embolism extending from the lobar level distally in the right middle and lower lobe. 2.Complete collapse of the left lung. Evaluation of a left lung mass is limited, however there is obstruction of the left upper and lower lobar bronchi. 3.Patchy peripheral opacities in the right middle and lower lobe which could represent hemorrhage, infarction, or metastatic disease. 4.Multiple, indeterminate hepatic hypodensities, some of which are ill-defined and are suspicious for metastasis.The findings were discussed with the primary clinical service by the resident on call at 7:30 p.m. on 2/3/2015.PULMONARY EMBOLISM: PE: Positive.Chronicity: Acute.Multiplicity: Single.Most Proximal: Lobar.RV Strain: Negative.
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Generate impression based on findings.
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Status post VDRO, evaluate new SPICA placement.VIEWS: Pelvis AP (one views) 2/4/2015, 04:29 The femoral heads are well positioned within the acetabula bilaterally. Blade plate and screw devices affix the femoral varus derotational osteotomies. The bilateral acetabula are dysplastic. A rectal catheter and spica are in place.
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Femoral heads well directed into the acetabula.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Family history of breast cancer in mother. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram.
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Generate impression based on findings.
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NGT placement NG side port at the GE junction. Nonobstructive bowel gas pattern. Degenerative arthritic changes affect the lower lumbar spine.
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NG side port at the GE junction; recommend advancing.
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Generate impression based on findings.
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NGT placement Exam limited by motion artifact. NG tube tip in the distal esophagus. Nonobstructive bowel gas pattern. The pelvis is excluded from the field of view.
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NG tube tip in the distal esophagus. Subsequent radiograph has been performed demonstrating interval advancement.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Personal history of cervical cancer, diagnosed at age of 30. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram.
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Generate impression based on findings.
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Respiratory distress and intubation.VIEW: Chest AP (one view) 2/4/2015, 04:12 Endotracheal tube tip is below thoracic inlet and above carina. The right upper extremity PICC terminates in the right atrium. Gastrostomy tube tip position is unchanged.The cardiothymic silhouette is normal. New streaky left upper lobe opacity suggestive of atelectasis, and additional bibasilar opacities unchanged.
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Unchanged bibasilar opacities, with new streaky left upper lobe opacity suggestive of atelectasis.
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Generate impression based on findings.
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71 years, Male. Reason: s/p lvad, leukemia, assess for ischemia or obstruction History: diarrhea, pain LVAD and other hardware is unchanged. Nonobstructive bowel gas pattern. Sutures in the left hemiabdomen. Left basilar scarring.
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Nonobstructive bowel gas pattern.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Family history of breast cancer in maternal aunt, diagnosed at the age of 70. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram.
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Generate impression based on findings.
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62-year-old male with history of Hodgkin lymphoma status post stem cell transplant in 2011. Evaluate disease status. CHEST:LUNGS AND PLEURA: No change in the right apical scarring, likely related to prior radiation therapy. Postsurgical changes in the right upper lobe again noted. No suspicious pulmonary nodules or masses. Again noted is the right lower lobe calcified nodule compatible with granuloma.No pleural effusions or pneumothorax.MEDIASTINUM AND HILA: No significant change in the mildly enlarged mediastinal lymph nodes some of which are calcified and likely related to prior granulomatous disease. Reference precarinal lymph node measures 1.0 x 0.6 cm (series 3, image 45), unchanged. No hilar lymphadenopathy.Heart size is normal with small pericardial effusion which is unchanged.CHEST WALL: Postsurgical changes of right axillary lymph node dissection again noted.ABDOMEN:LIVER, BILIARY TRACT: Stable hypodense hepatic segment two lesion which is too small to characterize but likely benign. No new focal hepatic lesions. No intra-or extrahepatic right ductal dilatation.SPLEEN: Splenic granulomata.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Stable scattered small retroperitoneal lymph nodes without adenopathy. Dense atherosclerotic calcifications affect the abdominal aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild degenerative changes affect the spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Reference right femoral lymph node measures 1.0 x 0.6 cm (series 3, image two of 5), unchanged. No new pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Mild degenerative changes affect the visualized spine.OTHER: No significant abnormality noted
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Stable reference lymph nodes without evidence of new lymphadenopathy.
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Generate impression based on findings.
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Respiratory failure and endotracheal tube placement.VIEW: Chest AP (one view) 2/4/2015, 03:55 Endotracheal tube tip is below thoracic inlet and above carina. Right upper extremity PICC tip is obscured by the spinal instrumentation, but can be traced as far centrally as the SVC. Right internal jugular central venous catheter tip is in superior vena cava. Spinal rods and hooks are again seen, unchanged in position. Tubing which projects over the right hemithorax most likely represents a soft tissue drain.The cardiothymic silhouette is normal. Unchanged left lower lobe opacity with associated air bronchograms. New right upper and right lower lobe opacities. Small bilateral pleural effusions unchanged. Residual right thoracic curve noted.
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New right upper and right lower lobe opacities, which may reflect residual pulmonary edema, although infection or atelectasis are possibilities. Unchanged left basilar opacity and small bilateral pleural effusions.
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Generate impression based on findings.
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History of left mastectomy in 2007 for IDC followed by chemotherapy and tamoxifen. Status post right breast lift and implant placement. History of breast carcinoma in maternal aunt diagnosed at the age of 40. No new right breast complaints. Palpable lump at left mastectomy site. Two standard views of the right breast with two implant displaced views were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Retropectoral saline implant is unchanged in position and contour.No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. LEFT ULTRASOUND
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Clustered cysts superior to the left mastectomy scar, likely representing fat necrosis and oil cyst formation. Given this high probability benign finding, short term imaging follow-up or surgical removal during planned breast reconstruction were discussed with the patient. She will discuss management options with her plastic surgeon. No mammographic evidence of malignancy in the right breast. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: B - Surgical Consultation.
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Generate impression based on findings.
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68 years, Male. Reason: Patient is bed bound, has J tube, is having some abdominal pain. evaluate for ileus, air, obstruction History: abdominal pain Catheter projects over the left hemiabdomen, likely representing the patient's J tube. Nonobstructive bowel gas pattern. Geometric opacity projects over the pelvis, possibly external to the patient. Left lower lobe consolidation.
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Nonobstructive bowel gas pattern.
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Generate impression based on findings.
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69-year-old male with history of hip pain. Mild to moderate osteoarthritis affects the hip. We see no acute fracture.
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Osteoarthritis without acute fracture.
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Generate impression based on findings.
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72-year-old male with history of ankle pain. There is mild soft tissue swelling about the ankle, but we see no acute fracture. Alignment is anatomic. Mild osteoarthritis affects the tibiotalar joint. There is a small tibiotalar joint effusion.
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Mild ankle joint osteoarthritis and small joint effusion without acute fracture.
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Generate impression based on findings.
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11 year old female with respiratory distress.VIEW: Chest AP (one view) 2/4/2015, 06:07 The endotracheal tube tip is below the thoracic inlet and above the carina. Leftward curvature of the thoracolumbar spine greater than 150 degrees persists. Postoperative changes related to right varus derotational osteotomy again seen, with the femoral head directed into the acetabulum. The right lower hemithorax is opacified with mediastinal shift to the right. The right heart border is not visualized. The left lung is well aerated.
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Right middle and possible right lower lobe atelectasis unchanged.
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Generate impression based on findings.
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The ventricles and sulci are within normal limits. 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.Dedicated thin section imaging through the hypoglossal canal demonstrates no asymmetric enhancement along the left hypoglossal canal, and there is no definite mass lesion. The tongue itself is not well included within the field of view to evaluate for denervation atrophy.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is mild left mastoid air cell fluid opacification
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1. Unremarkable contrast-enhanced MRI of the brain. No definite hypoglossal abnormality.2. Mild nonspecific left mastoid air cell fluid opacification.
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Generate impression based on findings.
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Hodgkin lymphoma status post autologous transplant. The lack of intravenous contrast administration limits the sensitivity for detecting mass lesions. Within this limitation. there is no evidence of significant cervical lymphadenopathy or mass lesions. The Waldeyer ring structures are not significantly enlarged. The thyroid and salivary glands appear unchanged. The osseous structures appear unchanged. There are atherosclerotic calcifications in the bilateral carotid bifurcations. The intracranial structures are grossly unremarkable. There is right maxillary sinus mucosal thickening. There are unchanged reticular opacities in the right lung apex, which likely represent scarring.
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No evidence of recurrent lymphomas in the neck. although the exam is limited by lack of intravenous contrast administration.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. No suspicious masses, microcalcifications or areas of architectural distortion are present. Multiple benign lymph nodes project over the axilla.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Personal history of bilateral benign breast biopsies. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. Linear markers are placed on scars overlying both breasts. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.Mammography is optimally performed when prior studies are available to detect changes. If the patient's prior mammograms are submitted, then an addendum to this report will be made.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.Mammography is optimally performed when prior studies are available to detect changes. If the patient's prior mammograms are submitted, then an addendum to this report will be made.BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram.
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Generate impression based on findings.
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Evaluate bleeding at therapeutic PTT. There is interval slight decrease in size of the hematoma centered in the right thalamus with surrounding edema and extension into the intraventricular system. The ventricles and subdural spaces are unchanged in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable. There are bilateral lens implants.
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Expected evolution of the hematoma centered in the right thalamus with surrounding edema and extension into the intraventricular system.
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Generate impression based on findings.
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Right-sided abdominal pain. ABDOMEN:LUNG BASES: 9 mm left lower lobe partially solid, partially ground glass nodule (image 16, series 4), likely of no clinical significance.LIVER, BILIARY TRACT: Mild intrahepatic biliary ductal dilatation is present. The gallbladder is mildly distended without evidence of wall thickening, cholelithiasis or pericholecystic fluid.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Mild nonspecific prominence of the superior right renal collecting system is evident. Bifid right renal pelvis, a normal variant.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The appendix is identified in the right lower quadrant, measuring up to 9 mm in maximal diameter with associated mild mucosal hyperattenuation, but without convincing wall thickening. No periappendiceal fat stranding or fluid collection is evident. Nonspecific isolated enlarged pericecal lymph node measures 1.0 cm in axis (image 76, series 3), which may be reactive in etiology.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Bilateral hypoattenuating adnexal structures are present, measuring up to 3 cm in diameter on the right. Fluid within the endometrial cavity is likely physiologic in etiology.BLADDER: The bladder is nondistended.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: The appendix is identified in the right lower quadrant, measuring up to 9 mm in maximal diameter with associated mild mucosal hyperattenuation, but without convincing wall thickening. No periappendiceal fat stranding or fluid collection is evident. Nonspecific isolated enlarged pericecal lymph node measures 1.0 cm in axis (image 76, series 3), which may be reactive in etiology.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.Equivocal findings of appendicitis.2.Probable bilateral ovarian cysts, measuring up to 3 cm on the right.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Personal history of right cyst aspiration. Family history of breast cancer in paternal aunt. Two standard digital views of both breasts were performed 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. Faint cluster of incompletely characterized calcifications are identified in the left lower outer breast, mid depth. No suspicious masses, microcalcifications or areas of architectural distortion are present in the right breast. A cluster of coarse calcifications in the right upper outer breast most likely represent a hyalinizing fibroadenoma.
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Faint cluster of calcifications in the left lower inner breast. Additional imaging, including spot magnification views, are recommended for further evaluation. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EC - Additional Mammo/Ultrasound Workup Required.
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Generate impression based on findings.
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Patient is status-post extraction of the bilateral third mandibular and right third maxillary molars. There is heterogeneous, primarily low density attenuation, foci of air, and mild adjacent inflammatory changes in the extraction socket of the right mandibular third molar, which may represent edema versus developing phlegmon/abscess. A small amount of hyperattenuating material in the extraction socket be related to subacute blood products. A right mesiodens is present. There are prominent bilateral jugular chain and prominent to mildly enlarged right submandibular region lymph nodes. The facial bones and temporomandibular joints are intact. The orbits are unremarkable. There is mucosal thickening of the right maxillary sinus. The mastoid air cells are clear.
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1. There has been extraction of the bilateral third mandibular and right third maxillary molars. 2. While there is no definitive evidence of inflammation in the right mandibular molar extraction socket, a developing phlegmon or abscess cannot be completely excluded. Please correlate clinically and with physical exam.3. There are prominent bilateral cervical lymph nodes, which are likely reactive.
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Generate impression based on findings.
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68-year-old male with history of total hip revision. Right hip: The previously seen right hip arthroplasty has been removed and replaced with a long stem total hip arthroplasty in anatomic alignment. Three cerclage wires affix a proximal femoral osteotomy in anatomic alignment. Surgical drains and foci of gas within the soft tissues reflect recent surgery. Pelvis: Again seen are the aforementioned postoperative changes at the right hip. There is a left total hip arthroplasty device present, although the distal extent of the prosthesis is not included on the field of view. Severe degenerative disc disease affects the visualized lower lumbar spine.
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Right total hip arthroplasty and other findings as above.
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Generate impression based on findings.
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62-year-old female whose recent right breast biopsy revealed ADH presents for needle localization. On review of the prior studies, a marker clip is present far posterior 6 o'clock position. The procedure, risks including bleeding and infection, and benefits of needle-wire localization were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time out form was completed to confirm patient identity and site of procedure. The right breast was placed in an alphanumeric grid using medial to lateral approach. When the target was positioned in the aperture of the grid, the skin was cleansed with chlorhexidine. Local anesthesia was obtained using 2% Lidocaine. Using coordinates from the grid, a 7 cm Kopans needle was placed adjacent to the cip. On orthogonal digital mammography, adequate positioning of the needle was confirmed after adjusting depth so the needle tip was approximately 2cm deep to the center of the target. A spring wire was then deployed. Repeat two view orthogonal digital mammograms reveal the spring wire to be in adequate position. The digital mammogram was annotated and reviewed with Dr. Jaskowiak prior to the patient's procedure. Patient tolerated the procedure well and was sent to the holding area in stable condition. Dr. Abe performed the procedure.Orthogonal digital specimen radiographs revealed clip and spring wire to be within the specimen.
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Successful needle localization of the right breast clip.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Family history of breast cancer in maternal aunt and cousin. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. Stable benign circumscribed mass in the left lower breast. Scattered benign calcifications, including arterial calcifications, are present bilaterally.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSA - Screening Mammogram.
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Generate impression based on findings.
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Large B-cell lymphoma CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Stable bilobar attenuation foci. Stable cholelithiasis.SPLEEN: Stable low-attenuation splenic focus.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable bilateral renal cystsRETROPERITONEUM, LYMPH NODES: Stable reference left periaortic lymph node is seen on image 136 of series 3 measuring 1.3 x 2.1 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Stable enlarged prostateBLADDER: 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 examination. No new adenopathy.
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Generate impression based on findings.
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Female 44 years old Reason: PE? History: tachycardia PULMONARY ARTERIES: No evidence of pulmonary embolism. The pulmonary artery is normal in caliber without evidence of right heart strain.LUNGS AND PLEURA: Scattered calcified and noncalcified micronodules which are nonspecific. Left pleural calcification noted. No pleural effusion. No suspicious nodules or masses. No focal consolidation to suggest infection.MEDIASTINUM AND HILA: Calcified mediastinal lymph nodes likely secondary to prior infection. No hilar or mediastinal lymphadenopathy. Normal heart size without pericardial effusion. No visualized coronary artery calcifications in this non-gated study.CHEST WALL: Right chest wall port with tip at the SVC/RA junction. Midline surgical staple.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Bilateral mild hydronephrosis with partially visualized nephroureteral stents. Large gallstone without evidence of cholecystitis.
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No evidence of pulmonary embolus. No acute cardiopulmonary abnormality.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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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Bilateral benign morphology masses are stable, several of which have been shown to be simple cysts via prior ultrasound exams. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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Stable bilateral benign masses. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSC - Screening Mammogram.
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Generate impression based on findings.
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Shortness of breath. PULMONARY ARTERIES: Diagnostic quality study, no PE.LUNGS AND PLEURA: Calcified pleural plaque on the right. Right apical scarring unchanged. Mild emphysema. Left basal scarring unchanged.MEDIASTINUM AND HILA: Moderate cardiomegaly with severe left ventricular enlargement. Left subclavian ICD tip in the right ventricle near the apex; the right ventricular cavity is severely compressed by left ventricular dilatation. Right atrium is dilated. The left atrium is low normal in size, also compressed by the LV. Calcification in the expected location of the left main coronary artery.CHEST WALL: Left chest wall pacemaker generator.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Liver is hyperattenuating relative to the spleen, correlate for possible history of Amiodarone use as this could be an indicator of Amiodarone hepatotoxicity. Splenic granulomas.Striated nephrograms. Left colon postoperative change.
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1. No evidence of acute pulmonary embolus. 2. Dense liver parenchyma has a wide differential diagnosis including but not limited to amiodarone toxicity. 3. Severe enlargement of the left ventricle which compresses the right ventricular cavity.4. Asymmetric scarring at the right apex appears unchanged compared to 8/2014 and can be confirmed by submission of remote outside prior studies if they can be obtained by the referring clinical service. Otherwise, this can be conservatively followed by PA and lateral chest radiographs 6-12 months if required.5. Striated nephrograms could be due to hypotension, pyelonephritis or acute tubular necrosis.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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Asymptomatic female presents for routine screening mammography. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSA - Screening Mammogram.
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Generate impression based on findings.
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PHARYNX/LARYNX: There is extensive calcification along the palatine tonsils bilaterally which appear diminutive in size, likely relating to tonsilliths. The nasopharynx, oropharynx, hypopharynx, and larynx are otherwise unremarkable. The upper trachea and esophagus are unremarkable. There is no abnormal soft tissue mass.GLANDS: The submandibular glands are small in size bilaterally. The sublingual and parotid glands have an unremarkable noncontrast appearance. The thyroid gland is unremarkable. ORAL CAVITY: The oral tongue and floor of mouth are unremarkable.CERVICAL SOFT TISSUES: Scattered small cervical lymph nodes are identified.OTHER: There is extensive atherosclerotic calcification along the aortic arch, as well as along the brachiocephalic artery, the origin of the left common carotid artery, and scattered along the left subclavian artery. There is also mild-moderate scattered calcification along the right subclavian artery. There is minimal scattered calcification along the common carotid arteries, slightly greater on the left side. There is extensive calcification of the carotid bifurcations bilaterally with likely at least moderate narrowing of the proximal internal carotid arteries bilaterally. There is probable focal calcification at the origin of the left vertebral artery. There is additional mild atherosclerotic calcification along the cavernous internal arteries bilaterally and the bilateral V4 segments.There is a prominent oval structure within the posterior soft tissues of the neck just to the right of midline and which abuts the skin surface. This is nonspecific but likely represents a sebaceous cyst. There are mild multilevel spondylotic changes along the cervical spine, with up to moderate-severe right foraminal narrowing at C6-C7. There are bilateral apical blebs, as well as a few areas of scattered irregular pulmonary opacity in the right upper lobe and right lower lobe with adjacent pleural thickening of the right major fissure.
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1. Extensive vascular calcification as detailed above. Probable at least moderate narrowing of the proximal internal carotid arteries bilaterally. Carotid doppler or CTA of the neck may be obtained for further evaluation as clinically indicated.2. Prominent cervical spondylotic changes with up to moderate-severe right foraminal narrowing at C6-C7.3. Nonspecific areas of pulmonary opacity scattered in the right lung, some of which may be infectious/inflammatory etiology as well as areas of atelectasis.
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Generate impression based on findings.
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Female; 68 years old. Reason: SOB, tachycardia History: SOB, tachycardia PULMONARY ARTERIES: Central filling defects in a right lower lobe distal segmental artery extending (series 8/199) and a left upper lobe subsegmental artery, most compatible with acute pulmonary emboli. Additional filling defects in a right upper lobe segmental artery (series 8/107), lingular segmental artery (series 8/125), and left upper lobe segmental artery (series 8/85) all appear more eccentric with somewhat flat edges, most compatible with age-indeterminate pulmonary emboli.Normal caliber of the main pulmonary artery. No evidence of right heart strain.LUNGS AND PLEURA: Small pleural effusions with adjacent bibasilar compressive subsegmental atelectasis. Scattered patchy predominately peripheral groundglass opacities in both upper lobes are likely due to hemorrhage.MEDIASTINUM AND HILA: Prominent mediastinal lymph nodes, but there is no definite mediastinal or hilar lymphadenopathy by CT size criteria. Normal heart size without pericardial effusion. Severe calcifications of the coronary arteries.CHEST WALL: Degenerative arthritic changes of the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Partially visualized gallbladder contains high density material, which may be due to sludge and/or stones; gallbladder wall thickening cannot be excluded.
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1. Acute and additional age-indeterminant pulmonary emboli as detailed above.2. Patchy groundglass opacities in both upper lobes most likely due to hemorrhage.3. Small pleural effusions with basilar atelectasis.4. Gallbladder sludge and/or stones. Gallbladder wall thickening cannot be excluded. Ultrasound can be obtained for further characterization as clinically indicated.PULMONARY EMBOLISM: PE: Positive.Chronicity: Acute.Multiplicity: Multiple.Most Proximal: Segmental.RV Strain: Not applicable.
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Generate impression based on findings.
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72-year-old male with history of knee prosthesis. Hardware components of a right total knee arthroplasty are situated in anatomic alignment. Lucency beneath the tibial tray and heterotopic bone along the patella appear similar to the prior study. There is a small joint effusion. Moderate osteoarthritis affects the left knee as seen on the frontal view.
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Total knee arthroplasty as above.
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Generate impression based on findings.
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61-year-old male, assess prosthesis Hardware components of a left total hip arthroplasty device are situated in near anatomic alignment without evidence of complication. Osteoarthritis affects the contralateral hip as seen on the frontal view.
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THA without evidence of complication.
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Generate impression based on findings.
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76-year-old male with left knee pain There is marked medial joint space narrowing and tricompartmental osteophytes consistent with severe osteoarthritis. Mild varus deformity about the knee. Calcifications within the distal femurs bilaterally likely represent bone infarcts. Vascular calcifications are present in the soft tissues.
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Severe osteoarthritis.
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Generate impression based on findings.
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51 year-old female status post right tibia ORIF Sideplate and screws affix the distal tibia fracture in near anatomic alignment without evidence of complication. The fracture line is indistinct, compatible interval with healing.
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Distal tibia fracture fixation without evidence of complication.
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Generate impression based on findings.
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85-year-old female status post TKA revision for infection Knee and femur: Hardware components of a total knee arthroplasty device with long femoral and tibial stems are situated in near-anatomic alignment without evidence of complication. No new osseous destruction to indicate recurrence. The proximal femur is intact.
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TKA without evidence of complication.
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Generate impression based on findings.
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53-year-old male with edema and warmth in right ankle, history amputations and alteration Right foot: Status-post fifth metatarsal osteotomy. There is soft tissue swelling about the great toe with underlying fragmentation of the proximal phalanx and disruption of the articular surface of the IP joint concerning for osteomyelitis.Left foot: Status post fifth metatarsal osteotomy. No fracture or bone destruction.Right ankle: Alignment is anatomic. Small plantar and calcaneal heel spurs are noted.Left ankle: Alignment is within normal limits. Arthritic changes affect the talonavicular joint. Plantar and calcaneal heel spurs are present.
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Fragmentation of the proximal phalanx of the great toe with overlying soft tissue swelling concerning for osteomyelitis.
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Generate impression based on findings.
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There are multiple subcentimeter supratentorial and infratentorial enhancing lesions. The largest lesions include those in the left perirolandic region, which measures up to 8 mm, and in the left cerebellar hemisphere, which measures up to 7 mm. There is no evidence of mass-effect or significant midline shift. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and sulci are prominent, consistent with moderate age-related volume loss. There are nonspecific scattered punctate foci and confluent areas of abnormal T2 hyperintensity within the periventricular and subcortical white matter. The skull and extracranial soft tissues are unremarkable. The frontal sinuses appear hypoplastic.
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Multiple subcentimeter supratentorial and infratentorial enhancing lesions are consistent with metastases.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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86-year-old female status with right index finger lesion Interval increase in size of expansile lucent lesion involving the majority of the proximal phalanx of the second finger. There is overlying soft tissue swelling. Moderate degenerative changes affect the remaining hand.
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Interval increase in size of expansile lesion of the proximal phalanx of the second finger, the differential for which includes giant cell reparative granuloma and less likely ABC or malignant transformation of an enchondroma.
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Generate impression based on findings.
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Postop prosthetic assessment Three views of the right knee show components of a total knee arthroplasty device situated in near-anatomic alignment without radiographic evidence of hardware complication. The patellar tendon is not well defined, but I see no patella alta deformity.Mild to moderate osteoarthritis affects the left knee as seen on the frontal view.
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Total knee arthroplasty as above.
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Generate impression based on findings.
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Subdural hematoma status post evacuation. There are postoperative findings related to right subdural hematoma evacuation with interval decrease in size and overall attenuation of the right cerebral convexity collection with diminished mass effect upon the brain parenchyma. There is also decreased midline shift, now minimal, and decreased effacement of the right lateral ventricle. There is no evidence of new intracranial hemorrhage.
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Postoperative findings related to right cerebral convexity subdural hematoma evacuation with interval decrease in size of the hematoma.
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Generate impression based on findings.
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Reason: head and neck cancer for tumor assessment History: as above CHEST:LUNGS AND PLEURA: No evidence of pulmonary or pleural metastases.Mild upper lobe centrilobular emphysema and basilar atelectasis and scarring is unchanged.Small pleural effusions or pleural thickening, left greater than right, is unchanged.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy noted.Severe native coronary artery calcifications are present, the patient having undergone bypass surgery.Severe multichamber cardiac enlargement is present.Multiple ICD leads are unchanged in position.Moderate esophageal dilatation, fluid-filled, is consistent with esophageal dysmotility. Right subclavian port catheter tip in SVC.CHEST WALL: Status post median sternotomy.Marked degenerative abnormalities affect the thoracic spine.ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Hepatic cystlike hypodensities are unchanged, likely benign. SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple exophytic renal cysts are unchanged, some hyperdense consistent with hemorrhagic cysts. PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Tortuous and calcified aorta extending into the proximal iliacs.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Multiple colonic diverticula are present.BONES, SOFT TISSUES: Degenerative abnormalities of the lumbar spine.An anterior abdominal wall hernia appears larger. OTHER: No significant abnormality noted.
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1. No evidence of metastatic disease.2. Esophageal dysmotility along with lung base abnormalities could indicate an etiologies such as scleroderma.3. Severe cardiomegaly.
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Generate impression based on findings.
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History of left mastectomy for invasive ductal carcinoma and associated DCIS in 2007. Patient received radiation and chemotherapy. History of benign right breast biopsy. Personal history of ovarian cancer. No new breast complaints. History of breast cancer in mother diagnosed at the age of 69 and maternal grandmother diagnosed at the age 38. Three standard views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. A percutaneously placed clip in the lower inner quadrant is unchanged in position. Benign appearing lymph nodes project over the right axilla.No dominant mass, suspicious microcalcifications or areas of architectural distortion in the right breast.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram.
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Generate impression based on findings.
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34-year-old female with pain Alignment is anatomic. No elbow joint effusion or fracture is noted. The forearm is intact.
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No specific findings to account for the patient's symptoms.
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Generate impression based on findings.
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Male 75 years old Reason: evaluate kidneys for hydronephrosis, include right pelvic kidney please History: hx of right pelvic transplant kidney RENAL TRANSPLANT:LOCATION: Right lower quadrantPERITRANSPLANT TISSUES: No peri transplant fluid collectionKIDNEY: No significant abnormality noted.COLLECTING SYSTEM/URETER: Minimal prominence of the transplant collecting system.URINARY BLADDER: No significant abnormality notedOTHER: The main renal artery and renal vein are patent.
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No parenchymal abnormality or peritransplant fluid collection. Minimal prominence of the collecting system.
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Generate impression based on findings.
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Postop prosthetic assessment Three views of the right knee show components of a total knee arthroplasty device situated in near anatomic alignment. However, there has been an increase in lucency underlying the tibial component, as well as an increase in varus alignment of the tibia relative to the femur, indicating loosening of the tibial component. There is a moderate to large joint effusion as well.Three views of the left knee are provided. Components of a total knee arthroplasty device are situated in near anatomic alignment. Thin lucency about the distal end of the tibial stem appears similar to that seen on the prior study and hence may not be of any clinical significance. There appears to be a small joint effusion.
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Bilateral total knee arthroplasty devices as described above, with findings indicating loosening of the right tibial component.
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Generate impression based on findings.
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22-year-old female with history of metacarpal fracture Interval removal of K wire. There is mild residual deformity of the metatarsal of the thumb consistent with healed fracture.
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Healed first metatarsal fracture.
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Generate impression based on findings.
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Female; 52 years old. Reason: eval for PE History: pleuritic chest pain left sided, cough, elevated d dimer PULMONARY ARTERIES: No acute pulmonary embolus. Normal caliber of the main pulmonary artery. No evidence of right heart strain.LUNGS AND PLEURA: Small right pleural effusion, decreased since prior study. Small left pleural effusion, increased since prior study. Mild to moderate bibasilar compressive subsegmental atelectasis. Mild septal thickening, most likely due to pulmonary edema. No suspicious pulmonary nodules or masses. Mild emphysema.MEDIASTINUM AND HILA: Mildly enlarged mediastinal lymph nodes may be reactive. Stable mild cardiomegaly. Moderate pericardial effusion, increased since prior study. No visible coronary artery calcifications. Right jugular central venous catheter tip in the inferior right atrium. Interval removal of left jugular central venous catheter.CHEST WALL: Body wall anasarca.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.
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1. No acute pulmonary embolus.2. Findings suggestive of mild to moderate CHF with cardiomegaly, pleural and pericardial effusions, pulmonary edema, and body wall anasarca.3. Right jugular central venous catheter tip in inferior right atrium.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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38-year-old male with history of obstructive hydrocephalus, status post VPS placement. There has been interval placement of a right posterior occipital approach ventriculostomy catheter, with the tip causing mild tenting of the septum pellucidum; the tip terminates approximately 5 mm to the left of midline. Given differences in technique, there appears to be minimal decrease of hydrocephalus, when compared to most recent MR of the brain dated 1/23/15. There is mild non-dependent pneumocephalus overlying the right frontal lobe, likely post-surgical in nature. There is redemonstration of postsurgical changes related to suboccipital craniectomy with mesh placement and resection of the posterior arch of C1, including stable appearance of encephalomalacia in the medial cerebellum. A high density focus along the inferior aspect of the left tentorium measures 14 x 13 mm, which appears similar in density and shape to previous CT in 4/2012, although internal foci of air have resolved. This corresponds to the enhancing area seen on recent MRI, and may be postsurgical in nature. There is no evidence of intracranial hemorrhage. The basal cisterns patent. The imaged paranasal sinuses and mastoid air cells are clear. There is evidence of prior right parietal burr hole.
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1. Interval placement of a right posterior occipital approach ventriculostomy catheter, which causes mild leftward tenting of the septum pellucidum. 2. There is minimal decrease in the degree of hydrocephalus when compared to most recent MRI brain, given differences in technique.3. Hyperattenuating left infratentorial focus perhaps relates to surgical material, and is similar in shape and density when compare to CT dated 4/10/12.
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Generate impression based on findings.
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56 year-old female with history of benign percutaneous biopsy of the left breast for a fibroadenoma. No new complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. A questionable asymmetry is present at right retroareolar region. No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in either breast. Focused ultrasound was performed for the right retroareolar region. Mildly dilated duct is detected. No abnormal findings or solid lesions are present.
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No mammographic or sonographic evidence of malignancy. As long as the patient's physical examination remains unremarkable, bilateral diagnostic mammogram is recommended annually. Results and recommendations were discussed with the patient. BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram.
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Generate impression based on findings.
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2 year old female with fever and coughVIEWS: Chest AP/lateral (two views) 02/04/15 Cardiothymic silhouette is normal. No pleural effusion or pneumothorax. No focal pulmonary opacities. Mild peribronchial cuffing 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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5-year-old male with cough, fever, wheezingVIEW: Chest AP (one view) 02/04/15 Cardiothymic silhouette is normal. No pleural effusion or pneumothorax. No focal pulmonary opacities. Minimal peribronchial cuffing 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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evaluate Dobbhoff placement Dobbhoff tip in the gastric fundus. The NG tube has been removed. Retained contrast in the barium. Nonobstructive bowel gas pattern. The pelvis is excluded from the field of view.
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Dobbhoff tip in the gastric fundus and interval removal of NG tube.
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Generate impression based on findings.
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Female 70 years old Reason: Patient with prior right fem-popliteal artery bypass and various endarterectomies in past. Please eval flow. Bypass now occluded and patient with worsening claudication. History: worsening claudication. Right foot skin discoloration ANGIOGRAPHY: The abdominal aorta has moderate to severe atherosclerotic calcification and mural thrombus. There is a single area of focal ectasia in the infrarenal aorta measuring 2.6 cm in diameter (Series 3 Image 75). The origins of the celiac, superior mesenteric, bilateral renal arteries are patent. Moderate atherosclerotic stenosis noted in the right renal artery. The inferior mesenteric artery is diminutive from its origin, but patent. Both hypogastric arteries are occluded. The common iliac and external iliac arteries are patent. Right Leg:The right common femoral artery is occluded proximal to the origin of the femoral-popliteal bypass graft. The profunda femoris is partially reconstituted by collateral vessels while the native superficial femoral artery and popliteal artery / popliteal artery stentgraft are completely occluded. Small collateral vessels partially reconstitute the peroneal and anterior tibial arteries to the level of the ankle mortise. Peroneal artery is the dominant runoff vessel to the foot.Left Leg:The moderate-severe atherosclerotic disease affects the common and external iliac arteries. There is high grade luminal narrowing in the distal common femoral artery. A femoral-popliteal bypass graft is occluded from its origin. The superificial femoral artery is occluded throughout. There is minimal distal flow through the distal profunda femoris. Below-knee amputation.ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right renal cyst, unchanged. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Status post hysterectomy. Ovaries not visualized.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Mild uncomplicated sigmoid diverticulosis. Note is also made of a giant sigmoid diverticulum which is similar to prior. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedLOWER EXTREMITIES:Left below knee amputation with sharp osteotomy margins and no associated fluid collections. Post traumatic changes in the left femur distal metadiaphsis.
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Significant global atherosclerosis sclerosis as described above. With regard to the right foot, mild common iliac stenosis, the profunda femoris artery is severely diseased, SFA and bypass grafts/stents in the thigh are occluded and dominant runoff is a reconstituted peroneal artery.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 breast bloody discharge for 5 months. History of melanoma, renal cancer, and prostate cancer. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty. A focal asymmetry is noted in the lateral retroareolar left breast. No dominant mass, suspicious microcalcifications or areas of architectural distortion in the right breast. LEFT ULTRASOUND
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Suspicious subcentimeter retroareolar mass in the left breast. Ultrasound guided biopsy is recommended. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.
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Generate impression based on findings.
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Status post evacuation of subdural hemorrhage. There are two right-sided and one left-sided burr holes status post subdural hemorrhage evacuation. There is interval resolution of the bilateral subdural collections. There is no evidence of new intracranial hemorrhage. There are persistent scattered punctate and confluent areas of abnormal low attenuation in the periventricular and subcortical white matter, consistent with chronic small vessel ischemic disease and infarcts. The ventricles and basal cisterns are mildly prominent, consistent with parenchymal volume loss. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are otherwise unremarkable.
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Interval resolution of bilateral subdural collections without evidence of acute intracranial hemorrhage.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.
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Generate impression based on findings.
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Female; 35 years old. Reason: eval for infection, MAI, cavitation History: CF exacerbation, history of positive sputum MAC LUNGS AND PLEURA: Severe bronchiectasis with upper lobe zone predominance and scattered associated mucous plugging, consistent with history of cystic fibrosis. Overall, the findings are slightly progressed since prior study with new small cavitary lesions without internal debris in both lungs, the largest of which measures 20 x 16 mm in the right middle lobe (series 7/59).MEDIASTINUM AND HILA: Unchanged mild mediastinal lymphadenopathy. Normal heart size without pericardial effusion. No visible coronary artery calcifications.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Cholecystectomy clips and mild pneumobilia. Splenomegaly. Upper abdominal ascites, partially visualized. The liver is at least upper limits of normal in size.
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Pulmonary findings consistent with cystic fibrosis mildly progressed since prior study. Diffuse endobronchial debris with worsening of cystic bronchiectasis and the development of pneumatoceles may be indicative of active infection.
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Generate impression based on findings.
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Right shoulder pain The bones appear slightly demineralized. Mild osteoarthritis affects the acromioclavicular joint. A 1 cm globular density along the anterior aspect of the proximal humeral diaphysis likely represents calcium hydroxyapatite in the biceps tendon sheath. Glenohumeral joint alignment is within normal limits.
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Mild AC joint osteoarthritis, and findings compatible with calcium hydroxyapatite deposition in the biceps tendon sheath.
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Generate impression based on findings.
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49-year-old male 60 days status post stem cell transplant SKULL: No discrete lytic lesions.CERVICAL SPINE: No discrete lytic lesions. Small anterior osteophytes are noted at C5/6.THORACIC SPINE: No discrete lytic lesion.LUMBAR SPINE: No discrete lytic lesions. Compression fracture of the L1 vertebral body is new from the prior exam, but otherwise age indeterminate.RIBS: No discrete lytic lesions. Bilateral calcified axillary lymph nodes are again noted.PELVIS: No discrete lytic lesions.UPPER EXTREMITY: Small lucencies within the proximal humerus bilaterally are not significantly changed. The forearms are unremarkable.LOWER EXTREMITY: No discrete lytic lesions. There is the suggestion of a broad-based exostosis along the distal posterior right femur, unchanged, as well as small calcified loose bodies likely in a Baker's cyst.
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1. Unchanged small lucencies within the proximal humeri. No new lytic lesions.2. Age indeterminate L1 vertebral body compression fracture.
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Generate impression based on findings.
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15 year-old female with Hodgkin's disease. ABDOMEN:LUNG BASES: Multiple bilateral pulmonary nodules are seen in the lung bases, the largest measuring 7 mm in the left lower lobe (series 4, image 4) and 5 mm in the right lower lobe (series 4, image 5). No pleural effusions.LIVER, BILIARY TRACT: No focal hepatic lesions. No intrahepatic or extrahepatic biliary ductal dilatation. The gallbladder is within normal limits.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No hydronephrosis or perinephric inflammation.RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal lymphadenopathy.BOWEL, MESENTERY: The bowel is within normal limits without evidence of obstruction. The appendix is well-visualized and within normal limits.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant internal or external iliac lymphadenopathy.BOWEL, MESENTERY: The bowel is within normal limits without evidence of obstruction. The appendix is well-visualized and within normal limits.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Multiple bilateral pulmonary nodules are seen in the lung bases, the large measuring 7 mm in the left lower lobe. Differential considerations may include infection (fugal or mycobacterial) or malignancy.
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Generate impression based on findings.
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64 year old with history of lumpectomy for low-grade DCIS in the left breast in 2/22/08. No current breast complaints. 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 elements, unchanged in pattern and distribution. Two percutaneously placed clips in the right breast; one at the 9 o'clock position posteriorly, and the other at the 3 o'clock position in mid-right breast, and one percutaneously placed clip in the left breast at lower inner quadrant are unchanged. Multiple surgical clips are seen in the left breast. A small mass at left posterior upper outer aspect is unchanged. Multiple calcifications are essentially unchanged in both breasts. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains unremarkable, bilateral diagnostic mammogram is recommended annually. Results and recommendations 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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30 year-old male with history of Hodgkin lymphoma status post allogenic stem cell transplant. Evaluate for disease status. CHEST:LUNGS AND PLEURA: Scattered pulmonary micronodules are stable. No new suspicious nodules or masses.No pleural effusions or pneumothorax.MEDIASTINUM AND HILA: Stable confluent mediastinal lymphadenopathy with reference prevascular conglomeration measuring 4.2 x 1.6 cm (series 3, image 45), previously measuring 4.4 x 1.6 cm. Reference left hilar lymph node measures 1.2 x 0.7 cm (series 3, image 50), previously measuring 1.3 x 0.8 cm.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant change in the small retroperitoneal lymph nodes without evidence of lymphadenopathy.BOWEL, MESENTERY: Reference left lower mesenteric lymph node measures 1.3 x 0.9 cm (series 3, image 129), not significantly changed. Additional scattered mesenteric lymph nodes are not significantly changed.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Mildly prominent bilateral inguinal and iliac lymph nodes are not significantly changed.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.Stable pulmonary micronodules/nodules in right upper lobe and reference lymph nodes. 2.No new sites of disease.
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Generate impression based on findings.
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Female; 50 years old. Reason: 50 yo F with multifactorial COPD exacerbation, w/ mass shown on previous CT History: shortness of breath, wheezing CHEST:LUNGS AND PLEURA: Stable cavitary lesion in the right upper lobe with unchanged solid component measuring 1.5 x 1.7 cm (7/34). No new suspicious pulmonary nodules or masses.New patchy groundglass and mild tree-in-bud opacities in both lower lobes, most suspicious for aspiration though cannot exclude multifocal infection. Interval increased bibasilar dependent subsegmental atelectasis. Emphysema. Trace pleural effusions.MEDIASTINUM AND HILA: Stable mildly enlarged mediastinal and right hilar lymph nodes. Normal heart size without pericardial effusion. No coronary artery calcifications.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No focal liver lesions. Mild dilation of the common bile duct measuring up to 11 mm, which could be within normal variation status post cholecystectomy.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. Stable cavitary lesion in the right upper lobe with unchanged solid component, which remains nonspecific in etiology and for which serial long-term follow-up is needed to ensure stability.2. New patchy groundglass and mild tree-in-bud opacities in both lower lobes, most suspicious for aspiration though cannot exclude multifocal infection.
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Generate impression based on findings.
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History of right lumpectomy in 1993 for carcinoma. Patient received radiation and chemotherapy. Patient indicates she has had a pea-sized lump in her lumpectomy scar for over 5 years. History of breast cancer in sister. Three standard views of both breasts were performed digitally with a lateral exaggerated right CC view 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 scar marker overlies the right breast. Postsurgical volume loss, architectural distortion, increased density, and large dystrophic calcification is associated with the lumpectomy bed and stable. Scattered benign calcifications are present. No dominant mass, suspicious microcalcifications, or suspicious areas of architectural distortion 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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10-year-old female for evaluation of left wrist fractureVIEWS: Left wrist AP/oblique/lateral (3 views) 02/03/15 No acute fracture or malalignment is evident. No displacement of the pronator quadratus fat pad.
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Normal examination.
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Generate impression based on findings.
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The study is significantly degraded by motion.There is transcortical diffusion restriction in the left anterolateral frontal lobe extending into the left insular cortex, with corresponding T2/FLAIR hyperintensity, consistent with an acute to subacute middle cerebral artery territory infarction. A focal area of susceptibility is noted posteriorly within the area of infarction, suggesting superimposed intraparenchymal petechial blood products. There is mild local sulcal effacement.The ventricles and sulci are within normal limits for age. The basal cisterns remain patent. There is no midline shift or mass effect. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with mild chronic small vessel ischemic changes. There is a focal area of T2 hyperintensity in the left basal ganglia suggestive of prior lacunar infarct. No extra-axial fluid collection is identified.There is mild irregularity and narrowing of the left M1 and M2 segment flow-voids. The midline structures and craniocervical junction are within normal limits. There is expansile appearing T1 hyperintensity in the expected location of the right posterior ethmoid sinus, which extends towards a pneumatized portion of the pneumatized right anterior clinoid process, with nonvisualization of the septae of the posterior air cells. This corresponding lobulated appearing mild T2 hypointensity. On CTA, this area of the sinus is mildly hyperdense without definite enhancement. There is resultant opacification of the right sphenoethmoidal recess.There is moderate mucosal thickening of the left maxillary sinus. There is mild mucosal thickening in the medial right sphenoid sinus with opacification laterally. There is also mild scattered bilateral ethmoid mucosal thickening.
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1. Acute to subacute infarct in the left middle cerebral artery territory with small focus of superimposed intraparenchymal petechial blood products.2. Mild underlying chronic small vessel ischemic changes.3. Irregularity of left M1 and M2 segments, which is better delineated on recent CTA. 4. An expansile T1 hyperintense, mildly T2 hypointense lobulated structure centered in the right posterior ethmoid sinus, most suggestive of a mucocele, although possibility of fungal infection cannot be entirely excluded and clinical correlation is recommended. Associated right lateral sphenoid opacification, likely obstructive.
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Generate impression based on findings.
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53-year-old female with history of microscopic hematuria. Evaluate upper tracts. Patient with history of allergy to iodinated contrast which was not listed on the requisition. Per conversation of the technologist with Dr. Smith, clinical service requested a noncontrast renal stone protocol instead.ABDOMEN: Lack of intravenous contrast enhancement limits evaluation of solid organs.LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No nephrolithiasis or ureteral calculus. No hydroureteronephrosis. Evaluation for a renal mass is limited given lack of intravenous contrast enhancement.RETROPERITONEUM, LYMPH NODES: Mild to moderate atherosclerotic calcifications affect the abdominal aorta.BOWEL, MESENTERY: No significant abnormality noted.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 significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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No nephrolithiasis, ureteral calculus, or hydroureteronephrosis. If there is clinical concern for a renal mass, further evaluation with dedicated kidney protocol imaging is recommended.
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Generate impression based on findings.
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Pain Three views of the left knee are provided. Mild osteoarthritis affects the knee. Alignment is within normal limits. I see no joint effusion.Mild osteoarthritis also affects the right knee as seen on the frontal view.
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Mild osteoarthritis.
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Generate impression based on findings.
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Male 63 years old; Reason: 62 year old man with mantle cell NHL s/p autologous stem cell transplant in 2011. Evaluate for disease relapse. Compare to prior scans. History: none CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Reference mediastinal lymph node measures 0.5 x 0.4 cm (series 3, image 40), previously 0.6 x 0.5 cm.CHEST WALL: Subcentimeter right axillary node measures are 0.6 x 0.5 cm (series 3, image 30), previously 0.6 x 0.4 cm.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Unchanged appearance of a right renal hypoattenuating lesion, likely representing a renal cortical cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Reference right obturator lymph node measures 1.9 X 0.7 cm (series 3, image 194) previously 1.8 x 0.6.BOWEL, MESENTERY: Diverticular disease without CT evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.Stable examination without significant lymphadenopathy.
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Generate impression based on findings.
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Hip total arthroplasty primary uncemented, right. Osteoarthrosis. The upper pelvis is not included on the field-of-view the study. Preliminary components of a right total hip arthroplasty device are situated in near anatomic alignment. Severe osteoarthritis affects the left hip.
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Preliminary components of right total hip arthroplasty in near-anatomic alignment.
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Generate impression based on findings.
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41 year old female who was recalled from screening mammogram for a partially obscured mass in the right upper outer quadrant. Three standard views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Masses in the right upper outer quadrant and right lower retroareolar breast persist on spot compression views, with circumscribed margins evident. No suspicious microcalcifications or areas of architectural distortion in either breast. ULTRASOUND
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Multiple subcentimeter benign-appearing circumscribed masses in the right breast. As long as the patient's physical examination remains normal, right 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 female for evaluation of pneumoniaVIEWS: Chest AP (one views) 02/03/15 Aortic arch, cardiac apex, and stomach are left-sided. Cardiothymic silhouette is normal. No pleural effusion or pneumothorax. Small medial retrocardiac opacity may represent atelectasis. Minimal bronchial wall thickening suggestive of bronchiolitis/reactive airway disease.Gastrostomy tube is present.
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Bronchiolitis/reactive airway disease pattern.
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Generate impression based on findings.
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15 year old female with neck pain for one week.VIEWS: Cervical spine AP, lateral, odontoid (3 views) 2/4/2015 Straightening of the cervical lordosis without underlying fracture or malalignment seen. The vertebral body heights and intervertebral disc spaces are preserved. The prevertebral soft soft tissues are normal.
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Straightening of cervical lordosis may reflect muscular spasm or other abnormality, but no underlying fracture or malalignment is evident.
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Generate impression based on findings.
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11-year-old male with autism with limpVIEWS: Pelvis AP, left femur AP/lateral (3 views) 02/04/15 The femoral heads are well seated in the acetabula. No joint effusion at the knee. No acute fracture or malalignment is evident.
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Normal examination.
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Generate impression based on findings.
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Intertrochanteric fracture. Postop. An intramedullary rod and screw device affixes an intratrochanteric fracture of the proximal femur in near anatomic alignment. Callus formation about the fracture indicates some interval healing. Overall, the bones appear demineralized, suggesting osteopenia/osteoporosis. Arterial calcifications are noted in the soft tissues.
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Orthopedic fixation of healing intertrochanteric fracture.
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Generate impression based on findings.
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Female 36 years old Reason: stump cholecystitis History: RUQ pain; pt s/p choley LIVER: The liver measures 14.9 cm. There is no focal liver lesion. The main portal vein is patent and demonstrates normal directional flow.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. No significant abnormality in the cholecystectomy bed. No biliary dilatation.PANCREAS: Unremarkable appearance of the pancreatic head and proximal body. The distal body and tail are poorly visualized.KIDNEYS: The right kidney measures 9.9 cm. The left kidney measures 10.7 cm. There is no hydronephrosis.OTHER: The spleen measures 8.2 cm.
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No significant abnormality in the cholecystectomy bed. No intra-or extrahepatic biliary duct dilatation.
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Generate impression based on findings.
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Maxillary sinusitis. Possible dental abscess. Several teeth are absent, and there are multiple dental fillings. Poorly defined lucency in the left mandibular body likely represents the site of prior tooth extraction; however I see no focal lucencies to confirm an abscess of the maxilla or mandible.
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No specific radiographic features of bony abscess. If further evaluation is clinically warranted, dedicated dental radiographs may be considered.
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Generate impression based on findings.
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59-year-old female with history of pain after fall. We see no acute fracture, malalignment, or other radiographic findings to account for the patient's pain.
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No radiographic findings to account for the patient's pain.
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Generate impression based on findings.
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62 year old female with history of pain. Left knee: There is a nondisplaced/nondepressed medial tibial plateau fracture. The fracture lines appear slightly less distinct indicating some interval healing. We see no patellar fracture. There is a small joint effusion. Moderate osteoarthritis affects the knee.Left wrist: There is an oblique fracture through the distal second metacarpal diaphysis in anatomic alignment. Fracture line is slightly less distinct indicating interval healing. Additionally, there is a transverse fracture through the neck of the fifth metacarpal with approximately 30 to 40 degrees of volar angulation. The fracture line remains visible, although callus formation indicates some interval healing. There is a band of sclerosis traversing the distal radius which could represent a healing/healed fracture.
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Healing fractures as above.
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Generate impression based on findings.
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Female; 86 years old. Reason: Pleur-x with tip attached to PleurVac overnight, interval changes in pleural effusion History: as above LUNGS AND PLEURA: Stable appearance of right Pleurx catheter with tip at the apex and slightly outside of the pleural fluid collection. Interval decreased right pleural effusion, but there has been mild interval increase in loculated air within the right pleural space. Stable right pleural thickening measuring up to 12 mm (series 3/59).Stable right paramediastinal fibrosis. Stable volume of aerated right lung with the right lower lobe again nearly completely collapsed. Stable emphysema and left apical fibrosis. Small left pleural effusion with mild associated left basilar subsegmental atelectasis, slightly increased since prior study. MEDIASTINUM AND HILA: Stable nodular enlargement with substernal extension of the thyroid gland.Small mediastinal lymph nodes unchanged. Moderate cardiomegaly with small volume of pericardial fluid unchanged. Mild coronary artery calcifications.CHEST WALL: Stable degenerative arthritic changes with multilevel compression deformities of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Stable hypoattenuating lesion at the dome of the liver, most likely a cyst.
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Interval decreased right pleural effusion with increased loculated air within the right pleural space. Stable positioning of right Pleurx catheter.
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Generate impression based on findings.
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50 years, Female. Reason: assess placement of esophageal stent History: pt with h/o sarcomatoid renal cancer and h/o esophageal ulcer s/p stent placement here with worsening epigastric pain. Esophageal stent has migrated distally into the stomach and now projects over the left upper quadrant. Nonobstructive bowel gas pattern. Scattered surgical clips.
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Migration of esophageal stent distally into the stomach.
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Generate impression based on findings.
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Female, 22 years old. RFO trigger: Removal of lap sponges used for splenic packing. No unexpected radiopaque foreign body. Nonobstructive bowel gas pattern. Free/interstitial air likely postoperative in etiology. Scattered surgical clips.
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No unexpected radiopaque foreign body. Findings were discussed with the attending physician, Dr. Hurst, via telephone on 2/4/2015 at 11:00.
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Generate impression based on findings.
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There is extensive susceptibility from scattered foci of pneumocephalus relating to the recent surgery, with mild mass effect on the anterior right left frontal lobes. There is prominent right parietal subgaleal and bilateral occipital scalp fluid and edema. There is minimal nonenhancing FLAIR hyperintense extra-axial fluid as well as extracranial fluid along the right posterior fossa. The previously seen homogeneously enhancing mass in the right cerebellopontine angle is no longer visualized, consistent with gross. There is no abnormal enhancement within the right internal auditory canal.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift. There are no areas of abnormal signal or pathological enhancement. There is no diffusion abnormality.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is moderate nonspecific fluid opacification of right mastoid air cells.
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Expected postoperative changes following gross total resection of previously seen enhancing right cerebellopontine angle mass, with no definite residual enhancing tissue seen. Continued postoperative imaging follow-up is recommended once the immediate postoperative changes resolve.
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Generate impression based on findings.
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Left distal femur pathologic fracture through giant cell tumor of bone. Evaluate for metastasis. Again seen is a plate and screw device fixing methacrylate within the distal femur, appearing similar to the prior study. Bone formation along the distal femur has perhaps matured slightly when compared with the prior study. I see no hardware complications. I see no specific features of tumor recurrence or metastases.
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Postoperative changes of giant cell tumor curettage/packing and distal femur fixation as above.
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Generate impression based on findings.
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Thumb injury and pain. Concern for fracture. Mild to moderate osteoarthritis affects the metacarpophalangeal joint and interphalangeal joint of the thumb. I see no discrete fracture line. There is mild flattening of the articular surface of the first metacarpal head which I suspect is arthritic in etiology. A 2-mm density seen on the lateral view volar to the first metacarpal neck does not have the typical appearance of an acute fracture fragment and I do not see an underlying donor site. There is mild soft tissue swelling along the thumb.
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Mild soft tissue swelling and arthritic changes as described above, without definite fracture. If there if strong clinical concern for fracture, repeat radiographs may be obtained in 10 to 14 days.
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Generate impression based on findings.
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Pleural mesothelioma. CHEST:LUNGS AND PLEURA: Left hemithorax visceral and parietal pleural thickening, volume loss and coarse nodular septal thickening compatible with tumor. No conclusive signs of contralateral disease in the pleural. Reference measurements on the left as follows:1. Top of the aortic arch level (3/28): 6 o'clock position 15-mm (previously 9-mm), 9 o'clock position 21-mm (unchanged).2. Level of the aortopulmonary window (3/37): 6 o'clock position 18-mm (previously 14 mm), 8 o'clock position 29-mm (previously 18-mm.3. Level where of the left superior pulmonary vein crosses the main pulmonary artery (3/51): 5 o'clock position 18 mm (previously 14-mm), 8 o'clock position 27-mm (previously 12-mm).Soft tissue thickening of the airways in the left lung; the lobar and segmental airways are thickened and attenuated. In the left lower lobe and lingula, the airways are intermittently obstructed and the parenchyma in these areas is consolidated. Small subpulmonic fluid collection on the left.MEDIASTINUM AND HILA: Small pericardial fluid collection, unchanged, with nodular thickening of the pericardium consistent with tumor involvement. Bilateral cardiophrenic lymph nodes mildly enlarged, slightly more prominent compared to the previous study. Normal heart size. No visible coronary calcifications. Main pulmonary artery appears enlarged, unchanged.Bilateral mild mediastinal lymphadenopathy, for reference a low right paratracheal lymph node measures 17-mm, previously 10-mm (3/37).Soft tissue tumor and mild lymphadenopathy surrounds the airways of the left hilum, which appear mildly attenuated.CHEST WALL: Mild left internal mammary chain and left intercostal lymphadenopathy. Tumor extends into the extrapleural fat anteriorly (3/39). There is subtle hyperattenuating soft tissue and surrounding soft tissue stranding along the left inferolateral chest wall, presumably at the site of biopsy tract, with an adjacent soft tissue nodules in the subcutaneous fat (3/88), this is suspicious for tract seeding.Mild left subpectoral and axillary lymphadenopathy. For reference a new left axillary lymph node measures 15-mm.Several small left low cervical lymph nodes are identified. Additionally, there are mildly enlarged a right tracheoesophageal lymph nodes at the thoracic inlet level.Postoperative changes of mastectomy and breast reconstruction with a prosthesis on the left. A small fluid collection that surrounds be left prosthesis hands a fluid collection in the right chest wall is presumably a seroma given the presence of air in this region on the prior study.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Peri-splenic fat is stranded and there is some minimal adjacent soft tissue nodularity extending up to the edge of the spleen (3/98), this is difficult to assess on the prior unenhanced exam. The spleen is enlarged in craniocaudal length.ADRENAL GLANDS: Nodular thickening of the lateral limb of the left adrenal gland (3/105 and 3/101)) is unchanged, please refer to outside PET scan report.KIDNEYS, URETERS: Left kidney is atrophic and the left renal artery is miniscule in size.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Small left paraortic lymph nodes (3/112, 3/109) measuring up to 11-mm, correlate with outside PET scan.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: The left hemidiaphragm is thickened and irregular.OTHER: No significant abnormality noted.
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1. Left hemithorax visceral and parietal pleural thickening, ipsilateral nodular pleural thickening consistent with lymphangitic tumor and bilateral low cervical and mediastinal lymphadenopathy. Ipsilateral hilar lymphadenopathy with narrowing and intermittent obstruction of the lingular and left lower lobe airways.2. Chest wall lymphadenopathy in the internal mammary chain and intercostal regions consistent with the pattern seen in mesothelioma. The axillary lymphadenopathy is new and could be reactive given recent postsurgical appearance of the chest suggesting mastectomy and breast reconstruction.3. Linear enhancement and a soft tissue nodule in the left lateral chest wall suspicious for tract seeding.4. Thickening of the left hemidiaphragm with soft tissue nodularity and stranding of the adjacent sub-diaphragmatic/ perisplenic fat.5. Mildly enlarged left para-aortic lymph nodes.
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Generate impression based on findings.
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89-year-old female with history of right total hip arthroplasty. Right hip: Hardware components of a right total hip arthroplasty are situated in near-anatomic alignment without radiographic evidence of hardware complication.Pelvis: Again seen are the aforementioned postoperative changes at the right hip. Moderate osteoarthritis affects the left hip and sacroiliac joints.
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Right total hip arthroplasty and osteoarthritis as above.
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Generate impression based on findings.
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85-year-old female with history of pain. The bones are demineralized suggesting osteopenia/osteoporosis.Left shoulder: Moderate osteoarthritis affects the glenohumeral joint which has progressed when compared to prior. There is slight lateral downsloping of the acromion process.Right shoulder: Mild to moderate osteoarthritis affects the glenohumeral joint which has progressed when compared to prior. There is slight lateral downsloping of the acromion process.
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Osteoarthritis as above.
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Generate impression based on findings.
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Postop prosthetic assessment Three views of the left knee show components of a total knee arthroplasty device situated in near anatomic alignment without radiographic evidence of complication.Moderate osteoarthritis affects the right knee as seen on the frontal view.
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Total knee arthroplasty as above.
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Generate impression based on findings.
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20 year-old male with history of fracture. There is an orthopedic pin traversing the bases of the third, fourth, and fifth metacarpals with its tip projecting over the base of the second metacarpal affixing a fracture of the base of the fifth metacarpal in anatomic alignment.
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Orthopedic fixation of fifth metacarpal fracture as above.
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Generate impression based on findings.
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16-year-old male with history of ankle fracture. The bones are demineralized secondary to disuse. The previously seen medial malleolar fracture is no longer visible indicating healing.
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Healing medial malleolar fracture as above.
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Generate impression based on findings.
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43 year old female with strong family history of breast cancer presents for annual mammogram. No current breast complaints. Two standard and pushback views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. Bilateral retropectoral saline implants are unchanged in position and contour. Stable calcifications and a few asymmetries are present in both breasts. No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in either breast.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. In light of her strong family history, consultation at the cancer risk clinic is recommended. Breast MRI might be suitable for annual screening along with annual mammogram. Results and recommendations were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram.
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