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Generate impression based on findings.
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59-year-old female with history of partial wrist fusion. There has been resection of the distal ulna and placement of a distal radioulnar joint prosthesis consisting of a plate and screw device along the distal radius and an intramedullary rod through the distal ulna which is incompletely imaged on this study. Two orthopedic staples overlie the distal radius, presumably affixing it to the lunate, although it is difficult to determine which bones of the proximal carpal row are affixed due to underlying Madelung deformity. There is moderate diffuse soft tissue swelling about the wrist.
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Postoperative changes of Madelung correction as described above.
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Generate impression based on findings.
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43 year old with history of left breast biopsy at 2 o'clock position with results including FEA, presents for needle localization. On review of the prior studies, a wing clip is present at posterior two o'clock position. This is the target of this procedure.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 left breast was placed in an alphanumeric grid using lateral to medial 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 5 cm Kopans needle was placed adjacent to the clip. 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 the clip and spring wire to be within the specimen.
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Successful needle localization of the left breast clip.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.
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Generate impression based on findings.
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Male 37 years old; Reason: 37 male with acute leukemia, prolonged neutropenia. now with severe crampy abdominal pain, r/o typhlitis/colitis. aware study suboptimal without IV contrast History: abdominal pain The absence of intravenous and oral contrast limits evaluation of the solid organs and of the bowels. Given these limitations, the following observations were made:ABDOMEN:LUNG BASES: Trace pericardial effusion.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Splenomegaly measuring 14.6 cm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There are trace inflammatory changes in the region of the cecum and ascending colon with minimal mesenteric stranding and trace dependent fluid in the right paracolic gutter. There is no bowel wall thickening. The appendix is identified in the right lower quadrant and is unremarkable.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.Mild nonspecific pericolonic inflammatory changes about the ascending colon without bowel wall thickening to suggest typhlitis/colitis.
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Generate impression based on findings.
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Female; 62 years old. Reason: 62F with NSCLC and cocnern for liver mets. History: liver lesion CHEST:LUNGS AND PLEURA: Lingular mass abutting the left cardiac border measures approximately 2.7 x 3 cm, previously 2.8 cm x 3.1 cm and not significant changed (series 3/53). New mild hazy opacity in the anterior lingula, which may be due to post-obstructive change. Loculated left pleural effusion has decreased.Postsurgical changes are noted within the left hemithorax with basilar scarring/atelectasis.No new suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Cardiac size is normal without pericardial effusion. No coronary artery calcifications.CHEST WALL: New faint sclerotic focus in the T8 vertebral body, suspicious for metastasis.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: A hypoattenuating lesion in the lateral left lobe of the liver has increased in size and measures up to 15 mm, previously 9 mm (series 3/104). New small, subtle hypoattenuating lesions in the medial left lobe of the liver. Multiple additional hypoattenuating lesions in both lobes of the liver are grossly stable. These lesions are again concerning for hepatic metastases. Stable mild biliary tree dilation.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: New faint sclerotic focus in the L2 and L5 vertebral bodies, suspicious for metastases.OTHER: No significant abnormality noted.
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1.Stable left lingular mass. No new suspicious pulmonary nodules or masses.2.Suspicion of progression of hepatic metastases.3.New faint sclerotic foci in the spine, suspicious for metastases.
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Generate impression based on findings.
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55 year-old female with fall and decreased range of motion A subtle cortical step off along the distal radius is highly suggestive of a a nondisplaced fracture. The carpus is intact.
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Findings suggestive of a subtle nondisplaced distal radius fracture. Follow up radiographs may be considered for confirmation.
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Generate impression based on findings.
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Prostate cancer, evaluate baseline. CHEST:LUNGS AND PLEURA: Emphysematous changes throughout the lungs, predominating at the lung apices. Numerous pleural-based nodules bilaterally. For reference purposes, 1.0 x 0.8 cm pleural-based nodule in the lingula (image 199; series 4) should be followed.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Bony metastases. Correlate with today's bone scan.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Osseous metastatic disease.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Osseous metastatic disease.
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Innumerable bony metastases; correlate with today's bone scan. Multiple pleural-based nodules which should be followed.
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Generate impression based on findings.
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0-day-old male with increasing respiratory distress and O2 requirementVIEW: Chest/abdomen AP (two view) 02/04/15 Aortic arch, cardiac apex, and stomach are left-sided. Cardiothymic silhouette is normal. No pleural effusion or pneumothorax. No focal pulmonary opacities.Nonobstructive bowel gas pattern. No pneumatosis intestinalis, pneumoperitoneum, or portal venous gas.
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Normal examination.
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Generate impression based on findings.
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18 year-old male with catheter placement through the gastrostomy siteVIEWS: Abdomen AP (one views) 02/04/15 Limited examination due to large amount of residual contrast within the small and large bowel. Amorphous stool is noted throughout the colon with large amount of stool within the rectum.Enteric tube tip terminates in the mid upper abdomen. Small scattered radiodensities are seen throughout the abdomen is new since the prior exam may be ingested material. Two previously seen ventriculoperitoneal shunt tube catheters terminate in the left hemiabdomen. A third new ventriculoperitoneal catheter is seen in the left upper abdomen. No pneumoperitoneum.
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Large stool burden with fecaloma. Multiple metallic radiodensities may represent ingested material.
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Generate impression based on findings.
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A patient submitted outside study for review. Submitted for review are digital mammographic images (12/13/14, 1/14/15), ultrasound images of right breast (1/14/15), images from stereotactic biopsy of right breast and post-procedural right digital mammographic images (1/27/15) performed at Mercy Hospital. For comparison, mammographic images (12/21/06) are available. DIGITAL MAMMOGRAPHIC IMAGES (12/13/14, 1/14/15):The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. There are multiple pleomorphic calcifications in the right breast, at lower outer quadrant. An area of calcifications measures 58 x 48 mm (AP x R) on CC view, and 60 x 63 mm (AP x CC) on ML view.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in left breast. ULTRASOUND IMAGES OF RIGHT BREAST (1/14/15):An il-defined hypoechoic lesion, measuring 5 mm, is present at 9 o'clock position, 6-cm from nipple, and a group of oval and linear hypoechoic lesions are present at 9:30 position, 7 cm from the nipple. These lesions are probably located within the area of pleomorphic calcifications on the mammogram. In the right axilla, a few benign appearing lymph nodes are visualized.IMAGES FROM STEREOTACTIC BIOPSY OF RIGHT BREAST AND POST-PROCEDURAL RIGHT DIGITAL MAMMOGRAPHIC IMAGES (1/27/15):Anterior-lateral part of the group of pleomorphic calcifications are sampled. Specimen radiograph shows multiple calcifications within the specimens. Postprocedural right mammographic images show a U shaped marker clip at 9 o'clock position, mid depth, locating antero-lateral aspect of the area of pleomorphic calcifications.Per outside radiology report, the pathology report was malignant; ductal carcinoma in situ, grade 2-3.
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Biopsy proven DCIS in the right breast. Pleomorphic calcifications distributes segmentally in the lateral aspect, predominantly lower portion of the breast. Ultrasound images suggest a presence of invasive components. Breast MRI may be useful to evaluate an extent of the disease.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.
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Generate impression based on findings.
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57 years, Male. Reason: r/o ileus, free air. recent stem cel transplant History: diarrhea, abd pain, fevers, hypotension Nonobstructive bowel gas pattern. No free intraperitoneal air. Surgical clips in the upper abdomen.
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Nonobstructive bowel gas pattern without free intraperitoneal air.
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Generate impression based on findings.
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62-year-old male with history of pain. Severe osteoarthritis affects the glenohumeral joint, with large osteophytes. Additional ossification along the superior aspect of the humeral head may represent an osteophyte or loose body. The acromiohumeral interval appears relatively well maintained.
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Severe osteoarthritis.
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Generate impression based on findings.
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62-year-old female with history of hand fractures. There is an oblique fracture through the distal second metacarpal diaphysis in anatomic alignment. Fracture line is slightly less distinct indicating some 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. There is mild soft tissue about the hand. Mild osteoarthritis affects the interphalangeal joints.
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Healing fractures as above.
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Generate impression based on findings.
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Mantle cell NHL status post autologous stem cell transplant in 2011. Evaluate for disease relapse. There is no evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. The major cervical vessels are patent. There is mild multilevel degenerative cervical spondylosis. The airways are patent. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear. There is a right lens implant.
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No evidence of recurrent lymphoma in the neck.
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Generate impression based on findings.
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6-year-old male with arthralgias, Soft tissue swelling around the ankleVIEWS: Right ankle AP/oblique/lateral (3 views) 02/04/15 Minimal soft tissue swelling over the medial malleolus. No acute fracture or malalignment is evident. No joint effusion.
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Minimal soft tissue swelling over the medial malleolus without evidence of acute fracture or malalignment.
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Generate impression based on findings.
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Cervical radiculopathy and osteopenia. Please evaluate for evidence of compression fracture. Evaluation of the lower cervical spine is limited on the lateral view due to overlying anatomy. Given this limitation, I see no fracture. The bones are demineralized compatible with the stated diagnosis of osteopenia. Mild degenerative disk disease affects the lower cervical spine. There may also be mild narrowing of the C6/7 neural foramina bilaterally.
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Demineralized bones and mild degenerative arthritic changes without fracture evident. If there is strong clinical concern for fracture, CT may be considered.
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Generate impression based on findings.
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Left neck cyst and pain. There is apparent paucity of opacification and surrounding fat stranding of a segment of the left external jugular vein. There is skin thickening and mild subcutaneous stranding in the left cheek, as well as skin thickening in the right cheek. There is no evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. There is mild plaque at the carotid bifurcations. There are small posterior disc-osteophytes at C4-5 and C5-6. The airways are patent. The imaged intracranial structures are unremarkable. There is left intraocular silicone oil and diffuse calcifications along the left globe walls. There is also staphylomatous deformity of the bilateral globes. There are extensive emphysematous changes in the partially-imaged lungs.
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1. Apparent paucity of opacification and surrounding fat stranding of a segment of the left external jugular vein may represent thrombophlebitis, although phase of contrast enhancement can be a confounding factor. Otherwise, no evidence of head and neck mass lesions or abscess. Nevertheless, follow up with MRI may be useful, if clinically warranted. 2. Skin thickening and mild subcutaneous stranding in the left cheek may represent an inflammatory process, such as acneiform rash. 3. Extensive pulmonary emphysema.
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Generate impression based on findings.
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Male 42 years old; Reason: What's the liver lesion look like? History: liver lesion on US ABDOMEN:LUNG BASES: Nonspecific 5-mm pleural-based nodule in the right middle lobe. Left basilar atelectasis. Cardiomegaly. Cardiac conduction device in situ.LIVER, BILIARY TRACT: There is a 0.7-cm hypo-enhancing lesion in the right hepatic lobe (series 11, image 15) which appears to correspond to the hyperechoic lesion on recent US. This is nonspecific and too small to characterize however it does not demonstrate any suspicious features. The appearance is not consistent with classic appearance of a cyst or hemangioma.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: 1.5 cm left adrenal nodule with attenuation suggestive of a myelolipoma or fat rich adenoma, favor myelolipoma.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.Subcentimeter hypodense lesion in the right hepatic lobe is too small characterize but does not demonstrate any suspicious features. In the absence of known primary malignancy or chronic liver disease, favor benign etiology. If needed a 12 month follow up exam can be obtained.2.1.5 cm left adrenal nodule with attenuation suggestive of a myelolipoma or fat rich adenoma, favor myelolipoma.
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Generate impression based on findings.
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Left shoulder pain. Rule out fracture, tear. I see no fracture or malalignment. The acromiohumeral interval is within normal limits, although this does not exclude the possibility of a rotator cuff tear. I see no specific findings to account for the patient's pain.
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No fracture or other specific findings to account for the patient's pain. If there is strong clinical concern for rotator cuff tear, MRI may be considered for further evaluation.
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Generate impression based on findings.
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Status post right total hip arthroplasty The AP view of the right hip reveals components of a total hip arthroplasty device situated in near-anatomic alignment. Skin staples, a drain, and foci of gas density in the soft tissues reflect recent surgery.The AP view of the pelvis reveals the aforementioned postoperative changes on the right. Severe osteoarthritis affects the left hip.
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Postoperative changes of total hip arthroplasty as above.
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Generate impression based on findings.
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Diffuse large B cell lymphoma in CR after 6 cycles of R-CHOP completed in 7/2014. There is no significant interval change in the irregular soft tissue lesion in the left supraclavicular fossa, which measures approximately 12 x 16 mm. There is no evidence of significant cervical lymphadenopathy elsewhere in the neck. The thyroid and major salivary glands are unremarkable. The major cervical vessels are patent. There is an incomplete posterior arch of C1, which is an anatomic variant. There is mild degenerative spondylosis at C4-5 and C5-6. The airways are patent. The imaged paranasal sinuses are clear. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear. There is scar tissue in the right anterior chest wall skin at the site of a prior catheter site.
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Persistent left supraclavicular lesion compatible with treated lymphoma, without evidence of disease progression.
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Generate impression based on findings.
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Lung cancer on Tarceva. CHEST:LUNGS AND PLEURA: Large right pleural effusion not significantly changed in volume. Post therapeutic changes on the right with continued decrease in size of necrotic hypoperfused mass in the right middle lobe with surrounding collapsed lung. Residual 2.5 x 1.9 cm nodular masslike hypoattenuating area in the lateral right middle lobe (3/43) occurs just distal to an obstructed subsegmental branch airway which was previously patent. Mass in this area previously was difficult to measure but at least 4.5-cm in diameter.Irregular subcentimeter nodule on the right (4/38) is smaller, previously a peripheral wedge-shaped opacity. Previously seen left posterior costophrenic angle opacity is now linear and scarlike. Additional poorly defined nodular opacities in the right lung appear less distinct.MEDIASTINUM AND HILA: Normal heart size. No pericardial fluid or visible coronary calcifications on this non-gated study. Right hilar architectural distortion with post surgical/post therapeutic changes. Minimal residual soft tissue adjacent to the bronchus intermedius.CHEST WALL: Sclerotic skeletal metastases are better seen on today's study but were present on the last study (the manubrium, spine, right humeral head) .ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Hypoattenuating poorly defined lesions in the liver, increased in number. Cholelithiasis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Renal cortical thinning. Hypoattenuating lesions incompletely characterized but may represent cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: L2 pathologic fracture.OTHER: No significant abnormality noted.
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1. Although the overall area of consolidation in the right middle lobe is smaller, one of the subsegmental airways is now obstructed proximal to a mass-occupying focus of presumed residual tumor.2. Improvement in parenchymal lung metastases.3. Skeletal metastases similar in number.4. Hypoattenuating hepatic lesions increased in number, suspicious for metastases.
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Generate impression based on findings.
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Second metatarsal pain. Stress fracture? I see no findings to suggest a stress fracture on this study. There is a small accessory navicular bone as well as an os peroneum, both normal variants.
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No stress fracture evident. If further imaging evaluation is clinically warranted, repeat radiographs may be obtained in 10-14 days; alternatively, MRI may be considered.
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Generate impression based on findings.
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Left wrist pain. Assess fracture. Evaluation of fine detail is limited by overlying cast material. Again seen is a comminuted fracture of the distal radius with fracture fragments in gross anatomic alignment, appearing similar to the prior study accounting for slight positional differences.
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Distal radius fracture as above.
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Generate impression based on findings.
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History of breast cancer status post right lumpectomy in 2003. 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. Stable postsurgical architectural distortion at the right breast lumpectomy bed. Stable benign calcifications.No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast.
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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: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram.
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Generate impression based on findings.
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Pain Four views of the right knee reveal severe osteoarthritis of the medial compartment with bone-on-bone apposition on the skiers view. There is also mild depression of the articular surface of the medial femoral condyle with mild underlying sclerosis suggesting the possibility of avascular necrosis. There are tricompartmental osteophytes. There is also a large joint effusion. A subcentimeter ossicle within the posterior aspect of the joint may represent a loose body.Moderate osteoarthritis affects the left knee as seen on the frontal view views.Round and tubular densities in the medial soft tissues of both knees reflect venous varicosities.
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Osteoarthritis and other findings as above.
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Generate impression based on findings.
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71 year old female with proven metastatic left supraclavicular lymph node and left axillary lymph node, currently on chemotherapy, presents for ultrasound study for assessment. Personal history of left breast cancer status post partial mastectomy, radiation and tamoxifen (for 5 years) in 1999. There are two abnormal hypoechoic masses in the left axilla; one at upper aspect, and the other at lower lateral aspect. The mass at superior part of the axilla, which was not measured previously, measures 8 x 7 mm. The mass at the lower lateral aspect, which is a proven metastatic lymph node, measures 19 x 14 x 19 mm (previously 29 x 19 x 34 mm).At left supraclavicular region, again detected a hypoechoic mass, which is a proven metastatic lymph node, measuring 20 x 12 x 22 mm (previously 30 x 21 x 36 mm). A marker clip is present within the mass.
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Decrease in size of metastatic lymph nodes in left axilla and left supraclavicular region BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.
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Generate impression based on findings.
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Right arm pain. History of bony metastases in setting of worsening pain. Evaluate for fracture. Again seen is a destructive lytic lesion of the distal ulnar diaphysis. Subjectively, the lesion appears slightly more lucent on the current study than on the prior study, suggesting progression of osteolysis. Furthermore, there is a cortical break noted along the dorsal aspect of the lesion with adjacent periosteal reaction compatible with a nondisplaced fracture. There is perhaps slight minimal angular deformity of the at the fracture site, but this is equivocal.Soft tissue swelling along the middle phalanx of the fifth finger is incompletely imaged on this study.
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Nondisplaced pathologic fracture of the distal ulna and other findings as described above.
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Generate impression based on findings.
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History direct injury, pain and swelling, bony abnormality. Evaluate for second toe fracture or dislocation. There is an oblique fracture through the distal aspect of the proximal phalanx of the second toe with slight dorsal angulation of the distal fracture fragment. There is mild deformity of the base of the second proximal phalanx which may reflect old trauma. Overall, the bones appear demineralized, suggesting osteopenia. Mild osteoarthritis affects the first metatarsophalangeal joint.
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Second toe fracture as described above. This was text paged to Joan Bigane at the time of dictation.
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Generate impression based on findings.
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Male, 62 years old, right-sided weakness. No evidence of parenchymal edema or mass effect is seen. Gray-white differentiation is preserved.Vague periventricular hypoattenuation is evident particularly at the frontal horns. The ventricles and sulci are slightly prominent with the ventricular system somewhat out of proportion to the sulci. No evidence of intracranial hemorrhage or any abnormal fluid collection is seen.The osseous structures of the skull are intact. The paranasal sinuses and mastoid air cells are clear.
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1. No CT evidence of acute territorial ischemia or any other definite acute intracranial abnormality.2. The ventricles and sulci are mildly prominent with the ventricles somewhat out of proportion to the sulci. This could reflect a pattern of predominantly central volume loss, though a mild communicating or normal pressure hydrocephalus would also be in the differential diagnosis. Correlation with clinical symptomatology and comparison with prior imaging if available would be helpful.
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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 hardware complication. There is mild soft tissue swelling anteriorly which limits evaluation of the extensor mechanism.Mild 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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Spondylolisthesis status post fusion. Postop. For sake of consistency with prior studies, I will designate 5 lumbar vertebrae with hypoplastic ribs at L1. Again seen are posterior rods with screws entering the L4 through S1 vertebrae, with additional screws entering both iliac wings. I see no hardware complications. Also again seen is a spacer device at L5/S1 appearing similar to the prior study. Bone graft material is noted along the posterior aspect of the lower lumbar spine. The previously seen drain has been removed.
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Postoperative changes of lumbosacral fusion as described above
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Generate impression based on findings.
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Female 57 years old Reason: Cryptogenic cirrhosis, decompensated, please assess doppler flow for transplant evaluation History: As above LIMITED ABDOMENLIVER: The liver measures 15.7 cm in length and demonstrates morphology. There is no focal liver lesion.BILIARY TRACT: Status post cholecystectomy. No intra-or extrahepatic biliary duct dilatation.PANCREAS: The pancreas is largely obscured by bowel gas.SPLEEN: Splenomegaly measuring 15.5 cm. RIGHT KIDNEY: The right kidney measures 10.8 cm. The left kidney measures 10.8 cm. There is no hydronephrosis.OTHER: Diffuse abdominal ascites.
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1. Cirrhotic liver morphology with splenomegaly and diffuse abdominal ascites.2. Reversal of flow in the main portal vein.
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Generate impression based on findings.
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Male, 53 years old, dizziness and nausea/vomiting. Gray-white differentiation is grossly preserved in both the anterior and posterior circulation, but please note that assessment in the posterior fossa, including the brainstem and cerebellum, is slightly compromised by artifact.No definite evidence of parenchymal edema or mass effect is seen. Within the right centrum semi-ovale, a 1 cm region of relative hyperattenuation is seen.No other focal lesions are detected. There is no other evidence of intracranial hemorrhage or any abnormal extra-axial fluid collections. Ventricles are normal in size and morphology.The osseous structures of the skull are intact. Paranasal sinuses and mastoid air cells are clear.
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1. No CT evidence of acute ischemia. Please note, however, that assessment in this regard is somewhat compromised in the posterior fossa due to artifact related to the skull base.2. A 1 cm hyperattenuating lesion is identified within the right centrum semi-ovale. The etiology of this finding cannot be determined on CT, though the lack of significant mass effect or surrounding edema would argue for a non-acute process. Nevertheless, the differential diagnosis includes vascular lesions/malformations, a mineralized lesion, and blood product among others.3. MRI of the brain with contrast and possibly MRA should be considered for further evaluation.
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Generate impression based on findings.
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Female 52 years old; Reason: 51 y/o female with diffuse large B cell lymphoma in CR after 6 cycles of R-CHOP completed in 7/2014. Compare to prior study. History: None CHEST:LUNGS AND PLEURA: No suspicious pulmonary lesions.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No mediastinal or hilar lymphadenopathy. Reference cardiophrenic lymph node measures 5 mm on image 83/series 3, unchanged.Soft tissue in the left supraclavicular region measures 1.7 x 1.4 cm (image 5/series 3) previously, 1.6 x 1.5 cm.Soft tissue in the left Vb measures 10 mm on image 7/series 3ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The right renal collecting system is prominent.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Round right adnexal soft tissue mass may represent a pedunculated fibroid.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the lumbar spine. Grade 1 anterolisthesis of L4 on L5 due to bilateral pars defects.OTHER: No significant abnormality noted.
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1.Stable exam.
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Generate impression based on findings.
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Clinical question: Rule out hemorrhage. Signs and symptoms: On heparin. Nonenhanced head CT:Examination demonstrate no evidence of any acute or new finding since prior study.Subacute ischemic stroke in the left MCA territory and with involvement of the left frontal and right basal ganglia remains similar to prior study. A very subtle focus of high density within this region could represent calcification of basal ganglial or a tiny focus of hemorrhage without change since prior study.Additional right posterior parietal ischemic stroke also remains stable in size and density and without evidence of hemorrhage.Ventricular system remains within normal size and with maintained midline.
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1.No evidence of an acute or new finding since prior study.2.Ischemic strokes in the left MCA territory of the frontal and basal ganglia and right posterior parietal remain stable since prior study.
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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, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. There has been interval involution of a left breast cyst, previously identified via ultrasound.
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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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Asymptomatic female presents for routine screening mammography. Family history of breast cancer in maternal aunt. 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. Scattered, benign morphology masses seen in both breasts are stable.
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Bilateral benign morphology 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: 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, 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. Personal history of carcinoid of the colon and liver. Family history of breast cancer in mother, diagnosed at the age of 43. 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. Scattered benign 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: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram.
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Generate impression based on findings.
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Female, 52 years old, with right intraparenchymal hemorrhage, assess for interval change. A large parenchymal hematoma centered in the right thalamus is again seen without significant interval change in size. Degree of hyperattenuation has perhaps decreased slightly from the prior examination. Edema surrounding this lesion is similar in geographic extent to the prior examination. Likewise, significant generalized mass effect with a midline shift to the left of 13-14 mm is also unchanged.A left frontal approach ventriculostomy catheter remains in place with the catheter tip situated in the body of the left lateral ventricle at approximately the level of the foramen of Monro. Since the prior examination, ventricular caliber has increased, most significantly affecting the left lateral ventricle. For example, at the level of the atrium, the left lateral ventricle measures up to 17 mm in diameter, previously 12 mm. The quantity of intraventricular blood product casting the right lateral ventricle and the third ventricle, as well as dependent blood product within the left occipital horn, is not significantly changed. Attenuation of the intraventricular blood product has decreased slightly from prior.
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1. Stable size of a large parenchymal hematoma centered in the right thalamus.2. Stable surrounding edema and associated mass effect.3. Stable quantity of intraventricular blood product. However, the caliber of the left lateral ventricle has increased from the prior exam.
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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. No suspicious masses, microcalcifications or areas of architectural distortion are present. Scattered benign calcifications are present in the right breast.
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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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Mesothelioma, follow-up CHEST:LUNGS AND PLEURA: Stable appearance with numerous nodular pleural foci with extension largely within fissures throughout the right hemithorax. Postsurgical diaphragmatic Nash and changes related to the pleurectomy are again seen. Reference measurement are as follows:1. inferior right major fissure (image 59 series 5) remains 1.6 cm when measured similarly2. anterior pleural surface adjacent to the pericardium (image 63 series 5), unchanged measuring 1.8 cm3. previously described lesion at the level the right pulmonary vein (image 52 series 3) unchanged measuring 2.4 cmNo new intrapulmonary abnormalities. Mild emphysematous changes. No effusions.MEDIASTINUM AND HILA: Aberrant right subclavian artery, a normal variant.No lymphadenopathy.No cardiac or pericardial abnormalityCHEST WALL: Minimal rib deformity, postsurgical unchanged involving the right seventh and eighth ribsABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Small scattered hypodensities unchanged and uncertain significanceADRENAL 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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Stable exam. Scattered recurrent changes throughout the right hemithorax largely within the fissures unchanged appearance since prior study. Reference measurements provided
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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 great grandmother and maternal grandmother. Two standard digital views (total of 12 images) 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. Scattered benign calcifications, including arterial calcifications, are seen in both breasts.
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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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Lung cancer diagnosed in 2008 status post resection. CHEST:LUNGS AND PLEURA: Postsurgical changes right upper lobe posterior segmentectomy. Left upper lobectomy. No signs of localized recurrence at the resection sites. Focal scarring adjacent to a right lower lobe osteophyte.Chronic branching lesion in the right middle lobe unchanged, continuing to favor benignity.MEDIASTINUM AND HILA: Multiple nonspecific nodules in the thyroid gland.30 Hounsfield unit somewhat irregularly marginated soft tissue nodule in the anterior mediastinum measuring 3.6 x 2.4 cm on series 3 image 36 (previously 3.6 x 2.2 cm), inseparable from the anterior wall of the left brachiocephalic vein and abutting the posterior cortex of the sternum. This extends from approximately the level of the clavicular heads in the anterior mediastinum to the level of the aortic arch. Small adjacent soft tissue nodules along the caudal margin of this lesion are unchanged.No visible coronary artery calcifications.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Vascular calcifications and punctate 1 to 2-mm nonobstructing nephroliths. PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Degenerative changes of the spine.OTHER: No significant abnormality noted.
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No new findings to suggest recurrent or metastatic disease. Anterior mediastinal mass suggestive of thymoma measures minimally smaller.
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Generate impression based on findings.
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The ventricles and sulci are within normal limits. There is no midline shift or mass effect. There is no intracranial hemorrhage. There are no areas of abnormal attenuation. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear.
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No acute intracranial abnormality.
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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 composed of scattered fibroglandular density. Two focal asymmetries are identified in the right superior breast. No suspicious masses, microcalcifications or areas of architectural distortion are present in the left breast.
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Focal asymmetries in the right breast. Additional imaging, including spot compression views and possible ultrasound, are recommended for further evaluation. If the patient's prior mammograms can be obtained, that would be helpful for comparison purposes.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EB - Additional Mammo/Ultrasound Workup Required.
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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. 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. Scattered benign calcifications are seen in both breasts. BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram.
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Generate impression based on findings.
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Female, 71 years old, with headache and sense of right frontal heaviness. Assess for subdural. Had right frontal contusion twice in the last 4 weeks. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. Gray-white differentiation is preserved. There may be minimal peri-ventricular hypoattenuation which is a nonspecific finding but commonly reflective of age indeterminate microvascular ischemic disease. The ventricular system is normal in size and morphology.The osseous structures of skull are intact. The paranasal sinuses and mastoid air cells as visualized are clear.
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1. No acute intracranial abnormality.2. Specifically, no evidence of any subdural collections or significant traumatic sequelae in the brain.
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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 great aunt and sister. 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. Focal asymmetry in the right outer breast is present (best seen on the CC view). There are no suspicious masses, microcalcifications or areas of architectural distortion present in the left breast.
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Focal asymmetry in the right breast best seen on the CC view. An attempt to obtain the patient's prior mammograms should be made first and if findings cannot be proven stable then further evaluation with diagnostic mammography and ultrasound will be necessary. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: OC - OLD FILM FOR COMPARISON
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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, unchanged in pattern and distribution. There is a focal asymmetry in the central left breast, far posterior depth (only seen on the CC view). No suspicious masses, microcalcifications or areas of architectural distortion are present in the right breast.
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Asymmetry in the central left breast. Additional imaging, including spot compression views and possible ultrasound, 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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Male 59 years old; Reason: pt with hx of metastatic RCC with liver lesions; needs surveillance scans History: none CHEST:LUNGS AND PLEURA: Reference left upper lobe pulmonary nodule measures 1.2 x 1.0 cm (image 35/series 4) previously, 1.1 x 0.9 cm.MEDIASTINUM AND HILA: Reference mediastinal lymph node measures 1.9 x 1.6 cm (image 41/series 3) previously, 1.8 x 1.4 cm.CHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. Hepatic and portal veins are patent.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post right nephrectomy.Left kidney is unremarkable. There are small cortical cysts.RETROPERITONEUM, LYMPH NODES: Small nonspecific retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Small focus of gas within the urinary bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Colonic diverticulosis.BONES, SOFT TISSUES: Post surgical changes in the left hip.OTHER: No significant abnormality noted
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.1.No significant size change of the reference left upper lobe nodule or mediastinal lymph node.2.Gas within the urinary bladder of unclear etiology.
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Generate impression based on findings.
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Pain and swelling. Possible fracture. Three views of the left ankle reveal a nondisplaced spiral fracture of the distal fibula that extends down to the joint line. No other fractures are identified.
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Distal fibular fracture in anatomic alignment
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Generate impression based on findings.
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Jammed in door and nailbed injury. Finger fracture? I see no fracture or malalignment.
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No fracture evident.
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Generate impression based on findings.
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Male 57 years old; Reason: re-staging scans s/p 9 infusions of investigational immunotherapy; please compare to scans dated 6/19/14 (baseline) History: hx of metastatic bladder cancer CHEST:LUNGS AND PLEURA: Right middle lobe subsegmental atelectasis. Scattered pulmonary micronodules are unchanged.MEDIASTINUM AND HILA: Right-sided central venous catheter with tip in the distal SVC. Right hilar lymph node measures 2.7 x 2.4 cm (series 3, image 51), previously 2.8 x 2.3 cm. Mild coronary artery calcification.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Right hepatic metastatic deposit measures 3.8 x 3.3 cm (series 3, image 80), previously 4.4 x 3.4 cm. No new lesions are identified.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral extrarenal pelvises. There is mild ureteral wall thickening and hyper enhancement and mild periureteral stranding, expected in the setting of ileal conduit. There is no hydronephrosis.RETROPERITONEUM, LYMPH NODES: Infrarenal IVC filter in situ.BOWEL, MESENTERY: Right lower quadrant ileal conduit. Mild prominent mesenteric lymph nodes are unchanged. Small fat containing ventral hernia is unchanged.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post cystoprostatectomy.BLADDER: Status post cystoprostatectomy.LYMPH NODES: Mildly prominent bilateral inguinal lymph nodes are unchanged.BOWEL, MESENTERY: Multiloculated lesion at the penile base measures 5.8 x 8.0 cm (series 3, image to 14), previously 4.9 x 5.7 cm.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.Stable right hilar lymphadenopathy.2.Hepatic metastasis demonstrates slight interval decrease in size compared to prior study.3.Multiloculated lesion at the penile base has further increased in size.4.Periureteral stranding and ureteric mural enhancement, not unexpected in the setting of ileal conduit, likely secondary to chronic inflammation/reflux.
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Generate impression based on findings.
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Status post TSA Components of a reverse total shoulder arthroplasty are situated in near anatomic alignment. A cerclage wire also surrounds the proximal humerus. Bullet fragments overlying the shoulder appear similar to those seen on the prior study. There is an approximately 2-cm collection of gas density situated anterolateral to the coracoid process. While this may reflect recent intervention I cannot exclude the possibility of an abscess.
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Total shoulder arthroplasty as above. A collection of gas density in the soft tissues anterolateral to the coracoid is of uncertain etiology, and while it may reflect recent intervention, I cannot exclude the possibility of an abscess. This was relayed in person to Dr. Bennett of the Orthopedic Surgery service at the time of dictation.
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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 and tomosynthesis 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. Benign low lying left axillary lymph node.
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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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Breast cancer, patient with supraclavicular node please assess effect of therapy LUNGS AND PLEURA: No interval change or new suspicious masses or nodules. No effusions with minimal dependent appearing changes in both bases presumably chronic and scarring. Persistent small lung volumesMEDIASTINUM AND HILA: No lymphadenopathy, specifically changes above the thoracic inlet, please refer to concomitant neck CT given greater sensitivityModerate coronary calcifications. Cardiac and paracardiac are otherwise unremarkableSmall hiatal herniaCHEST WALL: Small nodular focus of soft tissue with extensive calcifications in the lateral upper left breast, unchanged, please correlate with dedicated imaging and physical exam. No associated distinct lymphadenopathy.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Cholecystectomy without additional abnormality observed in this limited view of the upper abdomen
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1. Minimal pulmonary scarring without evidence of suspicious interval intrapulmonary metastatic disease.2. Changes within the left breast compatible with patient's history and primary site of malignancy
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Generate impression based on findings.
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Head and neck cancer prior chemo radiation, surveillance. Mild dyspnea. LUNGS AND PLEURA: Scarring in the left lower lobe at site of prior pneumonia. Postradiation fibrosis in the lung apices. Emphysema, moderate, not significantly changed. No new nodules. Subpleural lymph node at the cranial margin of the left major fissure.MEDIASTINUM AND HILA: Severe coronary artery calcifications. Mild cardiomegaly. No pericardial fluid or lymphadenopathy.CHEST WALL: Pectus excavatum deformity with narrow AP dimension of the thorax.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Limited scanning range. Probable cyst of the left hepatic lobe. Vascular calcifications. Incompletely visualized probable cyst upper pole left kidney.
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No signs of metastatic disease. Severe coronary artery calcifications.
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Generate impression based on findings.
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Abdominal swelling. Mass or lump. Left groin swelling intermittent. Possibly large lymph node; evaluate for abdominal and pelvic adenopathy. 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: Nonobstructive right upper pole renal calculus.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: Presumed uterine fibroids. Tubal ligation clips.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Nonobstructive right upper pole renal calculus. Presumed uterine fibroids. No adenopathy.
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Generate impression based on findings.
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Prostate carcinoma with rising PSA CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Stable aneurysmal dilatation of the ascending aorta. Maximal AP diameter of the ascending aorta 4.3 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 abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomyBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Stable negative examination. No evidence for acute, inflammatory, or metastatic process.
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Generate impression based on findings.
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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 composed of scattered fibroglandular density. No suspicious masses, microcalcifications or areas of architectural distortion are present. Scattered benign 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.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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Reason: 15 year old female with Hodgkin's disease, signs of disease outside of mediastinal and supraclavicular lymph nodes? RADIOPHARMACEUTICAL: 6.2 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 92 mg/dL. Today's CT portion grossly demonstrates multiple enlarged lymph nodes in the anterior superior mediastinum, paratracheal region and lower neck. Bilateral adnexa contain central low-density which likely correspond with functional cysts. There are multiple bilateral pulmonary nodules. There is soft tissue density near the splenic hilum and pancreatic tail likely lymph nodes. Today's PET examination demonstrates increased activity in the anterior superior mediastinum and supraclavicular region, most intense in the lower neck with an SUV max of 11.3, suspicious for tumor activity. There is increased activity involving multiple pulmonary nodules bilaterally, with a dominant nodule on PET in the right lower lobe with an SUV max of 2.3, which is more than blood pool activity with an SUV max of 1.4, suspicious for tumor activity. There are two discrete foci of increased activity near the splenic hilum and pancreatic tail which appear to correlate with soft tissue density in this region on CT likely lymph nodes, suspicious for additional tumor activity. There are two foci of mild activity in the bilateral adnexa which correlates with functional ovarian cysts. There is a focus of increased activity in the endometrium likely physiologic related to the proliferative phase of the menstrual cycle.
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Increased activity involving multiple lymph nodes in the anterior superior mediastinum, supraclavicular region and left upper quadrant are suspicious for tumor activity. Bilateral FDG avid pulmonary nodules are also suspicious for additional tumor activity.
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Generate impression based on findings.
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Male, 79 years old, with history of head and neck squamous cell carcinoma, status post chemoradiotherapy in 2010, with recurrence in late 2013 in the parotid space, status post surgical resection and extensive reconstruction. Evidence of extensive prior surgery and therapy is again seen including left parotidectomy, neck dissection, partial resection of the left posterior mandible and the left mastoid tip, with soft tissue flap reconstruction. No evidence of local tumor recurrence is seen anywhere along the operative region, but please note that some areas are obscured by dental streak artifact.No evidence of pathologic adenopathy is seen on either side of the neck by size criteria. Residual salivary glands and thyroid are stable and unremarkable. The left IJ vein is absent presumably status post sacrifice. Emphysema is redemonstrated in the lung apices along with apical scarring. No concerning osseous lesions are detected.
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Stable post surgical and treatment related findings with no evidence of tumor recurrence.
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Generate impression based on findings.
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Assess fracture Examination of the images reveal a fracture of the coronoid process that appears comminuted and minimally displaced. There is a joint effusion. No change in position from the previous CT examination
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Coronoid process fracture
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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.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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Left pleural effusion. LUNGS AND PLEURA: Marked interval improvement with improved aeration of the lungs, specifically the left lung. The moderate layered left pleural effusion with fluid tracking into the major fissure is again observed and similar, however the underlying atelectasis and/or intrapulmonary changes at essentially resolved.Both lungs currently demonstrate minimal atelectasis, greater on the left, without new superimposed suspicious nodules or masses. No specific findings to suggest infection. Mild centrilobular emphysemaMEDIASTINUM AND HILA: No lymphadenopathy. Persistent anterior mediastinal soft tissues consistent with reactive or suggested residual thymic tissue, appearance unchanged.Small new pericardial effusion without additional cardiac or pericardial abnormality.CHEST WALL: Mild scoliosis with degenerative changes similar to prior exam. No suspicious lytic or blastic lesions observedUPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Cholecystectomy without additional abnormalities observed in this limited evaluation of the upper abdomen
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1. Marked interval improvement without new intrapulmonary abnormalities. Persistent nonspecific moderate to large left pleural effusion with minimal underlying atelectasis. This interval change is not confirm prior underlying cause any continued imaging may again be prudent until clearance.2. Minimal residual reactive thymic tissue. Interval resolution of previously described borderline lymph nodes
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Generate impression based on findings.
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Lung cancer. Aspergillosis. CHEST:LUNGS AND PLEURA: Severe emphysema. Interval clearance of left lower lobe consolidation seen on recent PET CT; the subpleural nodule in the left lower lobe has decreased in size, measuring 5 x 8 mm, previously 7 x 13 mm, favoring a postinflammatory process (4/69).Left apical nodular density measuring 5-6 mm, not significantly changed.Right upper lobe pleural thickening and masslike consolidation is stable.Unchanged micronodules, some of which are calcified.MEDIASTINUM AND HILA: Severe coronary artery calcifications. Normal heart size. No lymphadenopathy.CHEST WALL: Periosteal reaction surrounding fragmentation of the right third through fifth ribs unchanged.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis without signs of cholecystitis.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: Severe atherosclerotic calcifications of the aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Diverticulosis without signs of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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Interval resolution of left lower lobe pneumonia. Stable masslike consolidation in the periphery of the right upper lobe. No new findings.
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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. There is a focal asymmetry in the right upper outer breast. There are no suspicious masses, microcalcifications or areas of architectural distortion in the left breast. Scattered benign calcifications are present in both breasts.
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Focal asymmetry in the right upper outer breast. Additional imaging, including spot compression views and possible ultrasound, 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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Neck pain post cervical fusion There is a posterior stabilization device with screws entering the C3 through T2 vertebrae. The left T1 screw overlies the superior endplate of the vertebral body, with its tip projecting anterior to the C7/T1 disk space, but I see no findings to suggest acute hardware complication. Moderate degenerative disk disease affects C5/6 and there is a slight retrolisthesis of C5. There is perhaps slight narrowing of the C5/6 neuroforamina bilaterally. Mild degenerative disk disease affects C3/4 and C4/5.
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Postoperative changes of cervical fusion and degenerative disk disease as described above.
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Generate impression based on findings.
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Assess fracture Three views of the right ankle reveal disuse osteoporosis. there is a single sideplate along the lateral distal fibula with two syndesmotic screws. The previous fibular fracture has healed. There appears to be fusion at the syndesmosis. No change in position from previous exam
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Sideplate and syndesmotic screws in the fibula in anatomic alignment.
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Generate impression based on findings.
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Female; 87 years old. Reason: history of endometrial cancer with prior lung nodule for comparison History: surveillance LUNGS AND PLEURA: Pleural-based nodule in the medial left upper lobe measures 16 x 8 mm, unchanged (series 4/24). No additional pulmonary nodules or masses. No pleural effusions.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Normal heart size without pericardial effusion. Moderate coronary artery calcifications/stents. Mitral annular calcifications. Stable subcentimeter hypoattenuating lesion in the left thyroid lobe.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Stable subcentimeter hypoattenuating lesions in the partially visualized kidneys are too small to characterize but likely due to cysts.
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Stable nonspecific pleural based nodule in the left upper lobe, for which additional 6 month follow-up is recommended to ensure stability.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Personal history of left cyst aspiration in 1998 and Non-Hodgkins lymphoma in 2006. Family history of breast cancer in maternal grandmother. 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. A few focal asymmetries in both breasts are stable.
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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: NSB - Screening Mammogram.
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Generate impression based on findings.
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7-month-old female with hypoxia/tachypneaVIEWS: Chest AP/lateral (two views) 02/04/15 Cardiothymic silhouette is normal. No pleural effusion or pneumothorax. Increased lung volumes and peribronchial cuffing is suggestive of reactive airway disease/bronchiolitis pattern. Bibasilar and lingular opacities.
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Worsening bronchiolitis pattern with increased bilateral opacities and lung volumes.
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Generate impression based on findings.
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Chronic sinusitis. The paranasal sinuses are clear. The nasal cavity is also clear. The nasal septal is deviated slightly towards the left. The lamina papyracea and ethmoid roofs are intact. The carotid grooves and optic canals are covered by bone. The nasopharynx, facial soft tissues, orbits, and imaged intracranial structures appear to be unremarkable. The mastoid air cells and middle ear cavities are clear. There is mild irregularity, sclerosis, and subchondral cyst formation in the bilateral mandibular condyles.
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1. No evidence of sinusitis or nasal polyposis.2. Mild bilateral temporomandibular joint degenerative changes.
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Generate impression based on findings.
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49 year old female with a fungating mass in the left breast, and palpable mass in the right breast, presents for imaging assessment. 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 elements. A large lobulated mass is present at upper outer quadrant in the right breast. This mass measures 78 x 58 mm ( AP x CC) on MLO view. Mammogram for the left breast was not performed due to the presence of fungating mass.Ultrasound of the right breast detects a lobulated mass measuring more than 5 cm, which is highly suggestive of malignancy. Increased vascular flow is present at the periphery of the mass. Central aspect of the mass appears echogenic, suggesting necrotic component. In the right axilla, there are multiple normal appearing lymph nodes. One of the lymph nodes contains a round hypoechoic lesion within the hilum, suggesting a metastatic component.Limited ultrasound is performed for the left breast. Detected is a highly suspicious, irregularly-shaped hypoechoic mass with increased blood flow. The mass extends into the overlying skin. Accurate measurement cannot be obtained due to its large size. In the left axilla, there is an ill-defined hypoechoic mass measuring 23 x 15 mm, likely a satellite lesion or a metastatic lymph node. Within the superior aspect of the left axilla, there is a lymph node with thickened cortex, suggesting a metastatic lymph node.
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Bilateral breast masses; both are highly likely malignant. Probable metastatic lymph nodes in the left axilla, and possible metastatic deposit in one of the lymph nodes in the right axilla.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: T - Take Appropriate Action - No Letter.
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Generate impression based on findings.
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77-year-old male with hip pain Pelvis and hips: Mild to moderate osteoarthritis affects each hip. The pelvis appears otherwise unremarkable.Right knee: Hardware components of a total knee arthroplasty device are situated in near-anatomic alignment without evidence of complication.Left knee: Marked medial joint space narrowing and tricompartmental osteophytes. There appears to be a small calcified loose body within the posterior aspect of the joint.Lumbar spine: Severe multilevel degenerative disk disease and vertebral body osteophytes and lower lumbar facet joint osteoarthritis. Vertebral body heights are maintained.
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Postoperative and degenerative arthritic changes as described above.
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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. 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 almost entirely fatty, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. Scattered benign calcifications, including in the left upper inner breast and arterial calcifications, 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: 2 - Benign finding.RECOMMENDATION: NSA - Screening Mammogram.
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Generate impression based on findings.
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58-year-old male with pain, evaluate for fracture Glenohumeral alignment is within normal limits. There is a curvilinear fracture fragment situated inferior, medial and slightly anterior to the glenoid, consistent with an osseous Bankart fracture. An additional small fracture fragment is situated just inferior to the glenoid. There is a subtle lucency through the greater tuberosity, consistent with a nondisplaced fracture. The visualized soft tissues are unremarkable.
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Osseous Bankart fracture and nondisplaced greater tuberosity fracture as described above.
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Generate impression based on findings.
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Toe pain, acute onset. Pain at base of right great toe. Rule out fracture. I see no fracture. There is a mild hallux valgus deformity as well as mild osteoarthritis of the first metatarsophalangeal joint. I see no discrete tophus or erosion. Mild osteoarthritis also affects the interphalangeal joints as well as the third metatarsophalangeal joint. An elongated ossicle proximal to the navicular tuberosity likely represents a normal variant accessory navicular bone. There are plantar and posterior calcaneal spurs which are not necessarily of any current clinical significance.
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Osteoarthritic changes without fracture evident.
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Generate impression based on findings.
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Surveillance imaging for sarcoma CHEST:LUNGS AND PLEURA: Interval enlarging and now moderate to large bilateral pleural effusions greater on the right. Underlying atelectasis without additional superimposed focal suspicious nodules or masses. Minimal subpleural scarring is again observed. Radiation changes observed largely left apex unchangedMEDIASTINUM AND HILA: Moderate nonspecific bilateral thyroid enlargement without discrete focal lesions, incompletely visualized yet grossly unchangedScattered calcified lymph nodes compatible with old healed granulomatous disease exposure no suspicious new lymphadenopathyModerate nonspecific cardiomegaly without pericardial abnormality. Moderate coronary calcificationsCHEST WALL: Mild scoliosis with scattered mild to moderate degenerative changes. Left mastectomyABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Multiple well-defined hypodensities scattered throughout the liver unchanged and consistent with hepatic cysts. Gallbladder unremarkableSPLEEN: Calcified granulomasADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts unchangedPANCREAS: 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: Scattered degenerative changes similar to prior without suspicious new lytic or blastic lesionsOTHER: No significant abnormality noted.
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Mildly increasing bilateral pleural effusions without underlying specific cause. No specific findings to suggest metastatic disease
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Generate impression based on findings.
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Rib pain. Breast cancer. Evaluate for metastatic disease or fracture Three views of the ribs reveal a deformity of the right sixth rib which is suspicious for an old fracture. I do not see any acute abnormalities. I do not see metastatic disease
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Possible old fracture of the right sixth rib
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Generate impression based on findings.
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Intermittent tinnitus which has been pulsatile in the past. She sometimes describes this as either a high pitched ringing or as a "static" sounds. Along with this tinnitus, the patient also admits to having sensitivity to loud noises and sometimes has to put "tissue in her ears" for relief. Lastly, the patient does not have any dizziness today, but admits to vertiginous episodes in the past. Right: There appears to be dehiscence of the superior semicircular canal posteriorly. The inner ear structures are otherwise unremarkable. The external auditory canal is patent. The middle ear and mastoid air cells are well-pneumatized and clear. The ossicular chain is intact. The facial nerve describes a normal course. The jugular bulb and carotid canal are intact. Left: The external auditory canal is patent. The middle ear and mastoid air cells are well-pneumatized and clear. The ossicular chain is intact. The inner ear structures are unremarkable. The facial nerve describes a normal course. The jugular bulb and carotid canal are intact.
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Apparent right superior semicircular canal dehiscence posteriorly.
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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. Two standard digital views with additional bilateral MLO 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. 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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Asymptomatic female presents for routine screening mammography. Two standard digital views with additional bilateral CC 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. Focal asymmetry in the right inferior breast is present. There are no suspicious masses, microcalcifications or areas of architectural distortion in the left breast.
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Focal asymmetry in the right breast. Additional imaging, including spot compression views and possible ultrasound, 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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63-year-old female with pain particularly at the basilar joints, history of SLE Right hand: Alignment is within normal limits. Mild osteoarthritis affects the basilar joint. No discrete erosions or evidence of inflammatory arthritis.Left hand: Mild to moderate triscaphe joint and basilar joint osteoarthritis. No erosions.Right knee: There is severe medial and patellofemoral joint space narrowing and tricompartmental osteophytes as well as mild varus deformity about the knee. Left knee: There is severe medial and patellofemoral joint space narrowing and tricompartmental osteophytes consistent with osteoarthritis. No joint effusion.
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Degenerative arthritic changes as described above.
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Generate impression based on findings.
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There is redemonstration of a homogeneously enhancing dural based extra-axial mass along the planum sphenoidale which currently measures 1.9-cm transverse by 2.3-cm AP by 1.0-cm CC. This previously measured 1.7-cm transverse by 2.1-cm AP by 0.9 cm CC on the most recent comparison, and is therefore slightly increased in size. In addition, the mass previously measured 1.3-cm transverse by 0.9-cm AP by 1.0-cm CC on the baseline exam of July 2012. There is again mild mass effect upon the adjacent gyri recti, without evidence of parenchymal edema.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift. There is redemonstration of multiple areas of scattered T2/FLAIR hyperintensity within the supratentorial subcortical, deep, and periventricular white matter. There are no areas of abnormal signal or new pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is mild-moderate mucosal thickening in the left maxillary sinus.
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1. Redemonstration of dural based enhancing extra axial mass along the planum sphenoidale, most suggestive of a meningioma. This is slightly increased in size since the most recent comparison exam and more conspicuously increased in size especially in the AP dimension since the more remote baseline exam. Persistent mild localized mass effect.2. Stable appearance of scattered nonenhancing nonspecific white matter lesions.
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Generate impression based on findings.
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"Pain to hardware head". Again seen is a presumed postoperative defect of the occipital bone with two underlying vascular clips that appear similar to the prior study. A previously seen plate and screw device along the occipital bone is no longer seen. An approximately catheter fragment measuring approximately 4cm in length is seen projecting vertically into the skull with its inferior edge overlying the approximate location of the foramen magnum. Presumed postoperative changes of the posterior arch of C1 appear similar to those seen on the prior study accounting for slight positional differences.
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Postoperative changes as described above.
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Generate impression based on findings.
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Through colostomy > on CT colocutaneous fistula The scout film reveals a left lower quadrant colostomy and nonobstructive bowel gas pattern. There is a 2 cm calcified nodular focus in the left upper quadrant, which has been stable since 2013. On the skin surface there is a cutaneous tract arising in the 12 o'clock position just superior to the colostomy. Upon hand injection, barium flowed freely through the colostomy and opacified the colon through the mid transverse colon. A fistula was not identified at this time likely due to Foley catheter balloon occlusion. The Foley catheter was removed from the ostomy. An 8 Fr catheter was placed into the fistula. A 4 cm tract extending from the skin surface was identified communicating with the subjacent colon.
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1.Colocutaneous fistula, 4 cm in length, arising from the 12 o'clock position just superior to the colostomy, and communicating with the subjacent colon. 2.Left upper quadrant calcified focus, stable since 2013. If clinically warranted, dedicated rib radiographs may be helpful.
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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 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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Mesothelioma CHEST:LUNGS AND PLEURA: Right lung and pleura are unremarkable.Left hemithorax volume loss with circumferential pleural thickening including nodular thickening of the fissure, consistent with provided history of mesothelioma. No pleural fluid. Reference measurements on the left as follows:Level of the left pulmonary artery (4/40): 12 o'clock position 0 mm, 3 o'clock position 8mm.Level of the main pulmonary artery (4/45): 2 o'clock position 14 mm, 5 o'clock position 6-mm.Level of the left atrium (4/63): 2 o'clock position 14-mm, 5 o'clock position 10-mm.MEDIASTINUM AND HILA: Mediastinal lipomatosis. Mild coronary artery calcifications. Normal heart size. No pericardial fluid. Enlarged left cardiophrenic lymph node measures 16mm (4/74). Tortuous thoracic aorta at the arch.CHEST WALL: Single mildly enlarged left internal mammary chain lymph node (4/26). Scattered small intercostal lymph nodes in the posterior chest wall.Tumor extends into the subpleural fat plane in the postero-medial thorax near the level of the diaphragm (4/94).Subcentimeter left subpectoral lymph node (4/9 and a very small left subclavicular lymph node (4/6) are nonspecific but should continue to be monitored given asymmetry.Healed left ninth rib fracture.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cyst.PANCREAS: Pancreas is partially fatty replaced with a 14-mm soft tissue nodule in the tail which may be an area of preserved pancreatic parenchyma however is incompletely assessed. No ductal dilatation.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.High-density material in a non-dilated appendix.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1. Left hemithorax nodular pleural thickening and volume loss consistent with history of mesothelioma. Nodular thickening of the fissures is consistent with visceral pleural involvement. Tumor extends into but not through the extrapleural fat plane on the left. 2. Ipsilateral enlarged cardiophrenic lymph node. Small ipsilateral internal mammary chain and intercostal lymph nodes are not normally visible; nodal metastases cannot be excluded.3. Additional small lymph nodes in the left subpectoral and subclavicular regions should continue to be monitored.4. No evidence of intra-abdominal extension of tumor.5. Solid nodule in the tail of the pancreas may reflect a preserved focus of pancreatic tissue however a primary neoplastic process cannot be excluded in the setting of fatty replacement elsewhere. Dedicated pancreatic protocol CT or M.R.C.P. may be of use if further evaluation is required.6. Mild coronary artery calcifications.
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Generate impression based on findings.
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Stepped on staple. Evaluate for metallic foreign body Three views of the left foot show an osteotomy of the first metatarsal head fixed with a single screw. There is also an osteotomy of first proximal phalanx, all consistent with bunionectomies
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Postsurgical changes. No radiographic foreign bodies
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Generate impression based on findings.
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13-year-old female with knee painVIEWS: Knees standing AP/notch, right knee lateral, left knee lateral, knees merchant (right knee 4 views, left knee 4 views ) 02/04/15 No joint effusion is present. No acute fracture or malalignment is evident. The extensor mechanism appears intact. The articular surfaces are smooth. No loose bodies are present.
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Normal examination.
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Generate impression based on findings.
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Point tenderness at T8. Rule out fracture. I see no compression fracture. There is mild multilevel degenerative disk disease particularly affecting the upper thoracic spine. Alignment is within normal limits.
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Mild degenerative disk disease. No fracture evident.
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Generate impression based on findings.
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23-year-old female with AML status post HSCT with 3 months neutropenia, and continued fevers, and continued headache CHEST:LUNGS AND PLEURA: No pleural effusions. Improvement of right pleural effusion and overlying atelectasis now with minimal bibasilar scarring/atelectasis. No suspicious nodules or masses are identified.MEDIASTINUM AND HILA: Right upper extremity PICC and right internal jugular venous catheter tip is in the SVC. Heart size is normal. Small pericardial effusion. No significant mediastinal or hilar lymphadenopathy.CHEST WALL: No axillary, cardiophrenic, or retrocrural lymphadenopathy.ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. No intrahepatic or extrahepatic biliary ductal dilatation. The gallbladder is within normal limits.SPLEEN: The spleen is within normal limits.PANCREAS: The pancreas is within normal limits.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No evidence of hydronephrosis or perinephric inflammation.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: The bowel is normal limits without evidence of obstruction. The appendix is visualized and within normal limits. Coils are seen in the right lower quadrant with small amount of crescent shaped soft tissue density measuring less than 2 cm in length adjacent to be cecum.BONES, SOFT TISSUES: The osseous structures are within normal limits.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: The bowel is normal limits without evidence of obstruction. The appendix is visualized and within normal limits. Coils are seen in the right lower quadrant with small amount of crescent shaped soft tissue density measuring less than 2 cm in length adjacent to be cecum.BONES, SOFT TISSUES: The osseous structures are within normal limits.OTHER: No significant abnormality noted
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1.No specific evidence of infection is seen in the chest, abdomen or pelvis.2.Resolution of right pleural effusion and atelectasis. Minimal dependent, bibasilar atelectasis/scarring persist.3.Coils in the right hemiabdomen likely reflect postsurgical changes of ovarian pexy although no soft tissue density to represent the ovary is identified.
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Generate impression based on findings.
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47-year-old male, follow-up fracture An external fixation device with screws entering the tibial diaphysis, calcaneus, and first metatarsal is visualized without evidence of hardware complication. Serpentine calcifications within the proximal and distal tibia and distal femur, consistent with bone infarctions appear similar to prior exams.The comminuted pilon fractures of the distal tibia and fibula are again visualized with fracture fragments in gross anatomic alignment. There is persistent soft tissue swelling about the ankle.
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External fixation of comminuted pilon fractures without evidence of hardware complication.
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Generate impression based on findings.
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Flank pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Cholelithiasis without acute inflammationSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Interval increase in size of nonobstructing left renal calculus now measuring 0.9 x 0.7 cm best seen on image 44 series 4. A punctate nonobstructing lower pole right renal calculus also noted.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: 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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Nonobstructing left renal calculus as described. Nonobstructing punctate right renal calculus as described. No evidence for acute inflammation or renal obstruction.
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Generate impression based on findings.
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58 year-old female with history of pain. Redemonstrated is a nondisplaced vertical fracture through the medial aspect of the patella. Fracture lines are slightly less distinct indicating some interval healing. Mild osteoarthritis affects the knee. Mild osteoarthritis also affects the left knee as seen on the frontal view.
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Healing patellar fracture as above.
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Generate impression based on findings.
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Head trauma on anticoagulation; evaluate for intracranial hemorrhage. No acute intracranial hemorrhage is identified. No intracranial mass, evidence of mass-effect or significant midline shift is present. There is unchanged left cerebellar hemisphere encephalomalacia. There are scattered areas of hypoattenuation in the periventricular and subcortical white matter, which are nonspecific, but likely represent age-indeterminate small vessel ischemic changes. The ventricles and sulci are prominent, consistent with moderate volume loss. A cavum septum pellucidum is present, which is a normal variant. There are retention cysts in the right maxillary sinus. The mastoid air cells are clear. Cerumen is present in the bilateral external auditory canals. A small subgaleal hematoma overlies the sagittal suture, measuring up to 5 mm, without underlying calvarial fracture. A previously described right parietal scalp lesion appears mildly smaller when compared to prior, likely representing a sebaceous cyst.
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1.Small posterior parietal subgaleal hematoma without underlying skull fracture or acute intracranial hemorrhage.2.Chronic left cerebellar hemisphere infarction.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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50 year-old male with history of pain. There is a side plate and screw device affixing a comminuted intra-articular distal radius fracture in anatomic alignment. There is no evidence of hardware complication. Amorphous density volar to the distal radius presumably represents bone graft material. Again seen is an ulnar styloid fracture with approximately 4 mm of displacement.
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Orthopedic fixation of distal radius fracture as above.
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