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Generate impression based on findings.
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Male 81 years old; Reason: restaging scans s/p 12 weeks of investigational therapy; please compare to previous scans History: hx of metastatic renal cancer The absence of intravenous and oral contrast limits evaluation of the solid organs and of the bowels. Given these limitations, the following observations were made:CHEST:LUNGS AND PLEURA: Status post wedge resection of right upper lobe nodule. Multiple solid pulmonary metastases are again noted. Reference left lower lobe nodule is stable measuring 1.5 x 1.0 cm (series 4, image 70), previously 1.6 x 1.3 cm. Please note typo in prior report stating this is a right lower lobe nodule.Reference large nodule along the suture line has increased measuring 2.6 x 2.3 cm (series 4, image 48), previously 2.0 x 2.0 cm.Additional pulmonary metastatic lesions are also subjectively increased in size.There is a new right pleural effusion.MEDIASTINUM AND HILA: Precarinal node measures 2.0 X 1.2 cm (series 3, image 46), previously 1.9 x 1.0 cm. Calcified left hilar nodes. No pericardial effusion. Atherosclerotic calcifications of the aortic arch.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Unchanged hypoattenuating lesion centrally within the spleen which is nonspecific and incompletely evaluated on this noncontrast study. Splenic granulomata.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post right nephrectomy. Postsurgical changes in the nephrectomy bed without evidence of local recurrence. Left upper pole cyst is unchanged.Left lower pole hypoattenuating lesion is stable in size.RETROPERITONEUM, LYMPH NODES: Arteriosclerosis of the abdominal aorta and branch vessels.BOWEL, MESENTERY: Scattered mildly prominent mesenteric nodes are unchanged.BONES, SOFT TISSUES: Ill-defined lucencies within the thoracic and lumber spine are nonspecific and are unchanged. Lucent lesion in the left femoral neck is unchanged.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: The prostate gland is enlarged.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Loculated pocket of simple fluid in the pelvis has reduced in size compared to prior study.BONES, SOFT TISSUES: Ill-defined lucencies within the thoracic and lumber spine are nonspecific and are unchanged. Lucent lesion in the left femoral neck is unchanged.OTHER: No significant abnormality noted
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1.Progression of pulmonary disease with increase in size of multiple metastatic deposits and new right pleural effusion.2.No evidence of local recurrence in the right nephrectomy bed.3.Nonspecific splenic and bone lesion are unchanged.
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Generate impression based on findings.
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66-year-old female with history of hip pain. Evaluate for fracture. The bones are demineralized suggesting osteopenia/osteoporosis.Right hip: Mild osteoarthritis affects the hip.Pelvis: Evaluation of the sacrum is limited due to overlying bowel gas. Mild osteoarthritis affects both hips. Degenerative disc disease affects the visualized lower lumbar spine. Small bone marrow biopsy defects are present in bilateral iliac wings.
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Osteoarthritis as above.
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Generate impression based on findings.
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Redemonstrated are extensive T2 hyperintensities, most prominent in the periventricular white matter, corpus callosum and more peripherally and to a lesser degree in the brainstem and bilateral cerebellar hemispheres. There is progression of abnormal T2 signal in the right middle frontal gyrus and posterior limb of the right internal capsule. There is an associated focus of enhancement in the right middle frontal gyrus and at least two enhancing punctate foci in right corona radiata. There is thinning of the corpus callosum with significant parenchymal volume loss, compatible with long-standing disease. There is no acute intracranial hemorrhage or extra-axial collection. There is no midline shift or herniation. The skull and extracranial soft tissues are unchanged.
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1. Extensive predominantly periventricular T2 hyperintensities, compatible with multiple sclerosis. Progression of and/or new abnormal T2 signal in the right middle frontal gyrus and posterior limb of the right internal capsule with associated foci of enhancement. 2. Significant parenchymal volume loss.
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Generate impression based on findings.
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Breast cancer and supraclavicular node please assess response to therapy. 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 to moderate plaque at the carotid bifurcations. There is a right internal jugular venous catheter. Low attenuation within the inferior right internal jugular vein likely represent mixing artifact. There is multilevel mild degenerative spondylosis of the cervical spine. The airways are patent. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear.
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No evidence of residual left supraclavicular lymphadenopathy, indicating treatment response.
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Generate impression based on findings.
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There is a stable thin left frontal parietal extra-axial collection measuring up to 4 mm. There has been interval development of an additional right frontal parietal extra-axial collection measuring 3 mm. This remains greater than CSF density without definite intrinsic hyperdensity. There is a mildly heterogeneous appearance of the calvarium and other osseous structures likely relating to patient's underlying malignancy in subsequent stem cell transplant.Postoperative changes are seen within the right parietal region and along the posterior fossa, relating to previous ependymoma resection. The ventricles and sulci are stable, with ex vacuo dilatation of the fourth ventricle. There is no midline shift or mass effect. There is no intracranial hemorrhage, within the limitations of only postcontrast imaging. There are no areas of abnormal attenuation or pathological enhancement. There is moderate right and moderate severe left mastoid air cell fluid opacification. There is partial opacification of the middle ears bilaterally similar to that of the prior exam.Frontal sinus: The right frontal sinus is diminutive. The frontal sinus and frontoethmoidal recesses are clear.Anterior ethmoids: The anterior ethmoid air cells are clear.Maxillary sinuses: The maxillary sinuses are clear. The ostiomeatal units are clear.Posterior ethmoids: The posterior ethmoid air cells are clear.Sphenoid sinus: The right sphenoid sinus has cleared. The left sphenoid sinus and bilateral sphenoethmoidal recesses are clear. There is mild leftward nasal septal deviation with 3-mm leftward directed bony spur which abuts the neck of the left inferior turbinate. The nasal turbinate morphology is within normal limits. The nasal cavity is clear.The lamina papyracea are intact. The roof of the ethmoids is slightly higher on the right.
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1. No acute intracranial hemorrhage. Interval development of very thin right frontoparietal subdural collection which is slightly greater than CSF density, in addition to stable appearance of previously seen left frontal parietal subdural collection.2. Similar pattern of bilateral mastoid air cell and middle ear fluid opacification which is nonspecific. Please correlate clinically.3. No significant sinus inflammatory changes. Interval clearing of right sphenoid sinus.
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Generate impression based on findings.
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35-year-old female with history of shoulder pain. Evaluate for avascular necrosis. The bones are slightly demineralized. There are no specific radiographic findings of avascular necrosis. The distal clavicle remains slightly elevated in relation to the acromion which may represent chronic separation, although this appears similar to the prior study. Small enthesophytes project laterally from the acromion process, unchanged.
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No radiographic evidence of avascular necrosis or other specific findings to account for the patient's pain. If further imaging is required, MRI may be considered.
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Generate impression based on findings.
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50 year old female s/p gastric bypass in 2014, presents with nausea and vomiting and intolerance to solids. Scout image showed a nonobstructive bowel gas pattern, lumbar spinal hardware, and a presumed spinal nerve device projected over the left hemipelvis. Single contrast visualization of the esophagus showed no gross morphologic abnormality or evidence of obstruction. Postsurgical changes consistent with prior gastric bypass were seen, with normal flow of contrast through the proximal anastomosis, into the gastric remnant, and across the distal anastomosis into the small bowel. Contrast passed through the Roux limb and into the distal small bowel without incident. There was no evidence of anastomotic stricture, gastro-gastric fistula, or leak.During the exam, spontaneous gastroesophageal reflux was observed to the level of the thoracic inlet. Fluoroscopic evaluation of esophageal peristalsis demonstrated a normal primary peristaltic wave.TOTAL FLUOROSCOPY TIME: 7:02 mm:ss
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1.Expected postsurgical changes s/p gastric bypass, without evidence of anastomotic stricture, fistula, or leak. 2.Spontaneous GE reflux to the level of the thoracic inlet.
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Generate impression based on findings.
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62-year-old male with history of ankle fracture. There is an oblique fracture through the distal fibula extending to the level of the tibiotalar joint with slight lateral translation of the distal fracture fragment. Tiny density distal to the medial malleolus could conceivably represent a small avulsion fracture fragment.
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Distal fibular fracture and other findings as above.
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Generate impression based on findings.
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Male 46 years old Reason: 46yM w hx of IBD and disseminated histo, repeat CT for fu History: as above LUNGS AND PLEURA: Interval improvement in right middle lobe solid nodule seen on previous exam (Series 5, image 53), now measuring 0.4 x 0.4 cm, previously measuring 1.1 x 0.9 cm. The nodule is now well-defined and without adjacent parenchymal changes. Additional scattered micronodules are unchanged.No pleural effusion.MEDIASTINUM AND HILA: Interval resolution of mediastinal and hilar lymphadenopathy. Heart size is normal without pericardial effusion. No visualized coronary artery calcifications in this non-gated study.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Right upper pole hyperdense renal lesion is incompletely imaged but appears unchanged measuring approximately 1.0 cm x 1.0 cm (series 3, image 113).
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Interval decrease in size in the right middle lobe solid nodule with resolution of hilar/mediastinal adenopathy. In an immunocompromise patient, the findings likely represent resolving fungal or mycobacterial infection with a healing granuloma.
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Generate impression based on findings.
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19 year-old male with history of fifth finger fracture. Redemonstrated is a fracture through the proximal phalanx of the fifth finger with slight dorsal angulation of the distal fracture fragments appearing similar to the prior study.
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Fifth finger fracture as above.
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Generate impression based on findings.
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Call back from screening mammogram for a mass in the right breast.. An ML view and two spot compression views of the right breast were performed digitally and reviewed with the aid of R2 CAD, 9.3. There is a circumscribed mass in the 9 o'clock position of right breast.Focus ultrasound of this area detects a simple cyst measuring 25 x 14 mm at 9 o'clock position, corresponding to the circumscribed mass on mammogram. There are several smaller cysts near this simple cyst.
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No mammographic or sonographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendations were discussed with the patient. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram.
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Generate impression based on findings.
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69 year old female with history of acute onset of lower back pain. The bones appear demineralized suggesting osteopenia/osteoporosis. Moderate degenerative disc disease affects L5-S1 with grade 1 anterolisthesis of L5 which is new when compared to the prior study. Moderate degenerative disc disease also affects the remainder of the lumbar spine. There is mild facet joint osteoarthritis of the lower lumbar spine. Calcifications projecting over the pelvis likely represent uterine fibroids. There is calcification of the abdominal aorta.
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Degenerative disc disease as above with mild anterolisthesis of L5 which is new when compared to prior.
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Generate impression based on findings.
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11-year-old male with hip issueVIEWS: Pelvis frog leg (1 views) 02/04/15 The femoral heads are well seated in the acetabula. There is apparent slight medial displacement of the right femoral epiphysis and slight widening of the associated physis. Stool is present within the rectum.
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Findings suggestive of possible early slipped capital femoral epiphysis.These findings were discussed with Dr. Sullivan via telephone at 15:13 on 2/4/2015, and a plan was made for further follow up.
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Generate impression based on findings.
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Dysphagia to solids The exam was negative for penetration and aspiration.
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The exam was negative for penetration and aspiration.
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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 (1/5/15, 1/15/15), ultrasound images of right breast (1/15/15), images from ultrasound guided biopsy of right breast and post procedural right mammographic images (1/19/15) performed at Riverside Medical Center. For comparison, mammographic images with ductogram (2/21/13) and ultrasound images (2/21/13) are available. DIGITAL MAMMOGRAPHIC IMAGES (1/5/15, 1/15/15):The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. A spiculated mass is present at 3 o'clock position in the left breast. Linear calcifications are associated with this mass at posterior aspect, and there are indeterminate calcifications extending from the mass towards the nipple. Some of these calcifications appear suspicious linear morphology.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in either breast. ULTRASOUND IMAGES OF RIGHT BREAST (1/15/15):Ill-defined hypoechoic mass is visualized at 3 o'clock position, measuring 19 x 11 mm. Multiple, slightly dilated ducts are visualized near the mass.IMAGES FROM ULTRASOUND GUIDED BIOPSY OF RIGHT BREAST AND POST PROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (1/19/15):Ultrasound guided biopsy of the right breast mass at two o'clock position was performed with vacuum-assisted device. The needle placement appears appropriate. A marker clip was placed after sampling. Post procedural right mammographic images show a marker clip placed at immediate medial to the suspicious mass at 3 o'clock position.Per outside pathology report, the result was malignant; invasive ductal carcinoma, grade 3.
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Biopsy proven invasive carcinoma in the right breast. Indeterminate calcifications are extending from the tumor to the nipple. Breast MRI may be useful in evaluating an extent of the disease. Stereotactic biopsy can also be performed for sampling the indeterminate calcifications in the right breast.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.
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Generate impression based on findings.
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dysphagia The exam was positive for penetration and aspiration.
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The exam was positive for penetration and aspiration.
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Generate impression based on findings.
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Evaluate clavicular fracture.VIEWS: Clavicle AP and clavicle view (two views) 2/4/2015 There is a vertically oriented fracture through the mid clavicular diaphysis with approximately 2 cm medial displacement of the distal fracture fragment, which is approximately 1 shaft width below the proximal fragment.
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Clavicular fracture as above.
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Generate impression based on findings.
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70 years, Male. Reason: abdominal distention secondary to SBO, interval changes? Feeding tube tip in antropyloric region. Persistent pattern of small bowel obstruction, stable to slightly improved since prior radiograph. Cholecystectomy clips.
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Persistent small bowel obstruction pattern, stable to slightly improved.
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Generate impression based on findings.
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64 years, Male. Reason: Evaluate placement of IVC filter. Interval placement of IVC filter, which projects over the L2/L3 vertebral bodies to the right of midline. NJ tube tip in the proximal jejunum at the ligament of Treitz. Unchanged left abdominal pigtail drain. Nonobstructive bowel gas pattern.
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Interval placement of IVC filter which is in the expected location. Nonobstructive bowel gas pattern.
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Generate impression based on findings.
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52-year-old female with history of pain. Cervical spine: The lower cervical spine is not well visualized on the lateral projection due to overlying anatomy. There is an anterior plate with screws entering the vertebral bodies of C5 and C6. There is bone graft material present at C5-6. Prevertebral soft tissue swelling has decreased. Mild degenerative disc disease affects C6-7. There is straightening of the normal cervical lordosis.Lumbar spine: For the purposes of this study, we will designate 5 lumbar vertebrae with hypoplastic ribs at L1. There is a mild levoscoliosis. Moderate facet joint osteoarthritis affects the lower lumbar spine. There is a grade 1 anterolisthesis of L4 and L5. Vertebral body heights are preserved. Minimal multilevel degenerative disc disease affects the remaining lumbar spine.
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1.Postoperative changes of the cervical spine.2.Lower lumbar spine facet joint osteoarthritis as above.
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Generate impression based on findings.
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76 years, Male. Reason: Re-evaluate NG tube location History: Dysphagia, dysarthria, stroke Dobbhoff tube in the gastric fundus. Visualized bowel gas pattern is nonobstructive. Retained contrast in the colon.
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Dobbhoff tube in the gastric fundus.
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Generate impression based on findings.
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27 years, Male. Reason: assess for obstipation, ileus History: 26 y.o. with family history of celiac disease and chronic right/middle upper abdominal pain, history of constipation Moderate colonic stool burden without evidence of bowel obstruction.
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Moderate colonic stool burden without evidence of bowel obstruction.
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Generate impression based on findings.
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53 years, Female. Reason: assess for obstipation, ileus History: 53 y.o. woman with constipation, abdominal pain life-long, worsening symptoms Moderate colonic stool burden without evidence of bowel obstruction. Calcifications in the right upper quadrant and central pelvis suggest gallstones and uterine fibroids, respectively.
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Moderate colonic stool burden without evidence of bowel obstruction.
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Generate impression based on findings.
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56-year-old male with history pain. Redemonstrated is a transverse fracture though the base of the fifth metatarsal appearing similar to the prior study. The fracture fragments are in near-anatomic alignment. There are old healed diaphyseal fractures of the third, fourth, and fifth metatarsals. Moderate osteoarthritis affects the first MTP joint with small bone fragments adjacent to the joint which may reflect old trauma. There is a mild hallux valgus deformity. Osteoarthritis also affects the midfoot, tibiotalar, and subtalar joints. There is widening of the anterior aspect of the tibiotalar articulation which may reflect capsular laxity or ligamentous disruption. An ossicle projecting posterior to the talus likely represents an os trigonum, a normal variant. There is diffuse soft tissue swelling. Small curvilinear density in the lateral aspect of ankle may represent a small foreign body. Lucencies within the bones of the ankle and midfoot are better seen on prior ankle radiographs and may reflect bony erosions.
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1.Transverse fracture of the base of the fifth metatarsal with additional old postraumatic and degenerative arthritic changes as described above.2.Widening of the anterior tibiotalar articulation is of uncertain significance, but may represent capsular laxity or ligamentous disruption.
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Generate impression based on findings.
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63 years old, Male, Reason: ? masses , nodes History: thyrodi cancer s/p thryodiectomy 1974withotu any follow-up imaging MEASUREMENTS: Patient status post thyroidectomy.RIGHT LOBE: In the right mid thyroidectomy bed, in the level 6 area, there is a hypoechoic mildly heterogeneous nodule measuring 0.4 x 0.5 x 0.6 cm.LEFT LOBE: No suspicious lesions in the left thyroidectomy bed.ISTHMUS AREA: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Right level 4 lymph node measuring 1.0 x 0.6 x 0.3 cm has a heterogeneous appearance without a definite fatty hilum identified and is suspicious for local lymphadenopathy. Multiple benign appearing lymph nodes bilaterally.OTHER: Anterior to the ear is a well-circumscribed hypoechoic mildly heterogeneous nodule with posterior enhancement measuring 1.2 x 1.3 x 0.7 centimeters. This is favored to be benign and may represent a sebaceous cyst.
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1.Right level 6 nodule in thyroidectomy bed measuring up to 0.6 cm is concerning for possible recurrence and is amenable to biopsy.2.Right level 4 lymph node with heterogeneous appearance is suspicious for local lymphadenopathy and is amenable to biopsy.3. Nodule anterior to the left ear; nonspecific, but a benign etiology is favored.
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Generate impression based on findings.
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54-year-old male who is history of lung cancer with mediastinal adenopathy. Evaluate for disease status. ABDOMEN:LUNG BASES: There is a moderate-sized partially visualized right pleural effusion with peripheral enhancement concerning for an empyema and is unchanged compared to the previous examination. Please refer to dedicated CT chest report for further details.LIVER, BILIARY TRACT: No focal hepatic lesions. No intra-or extrahepatic biliary ductal dilatation. Cholelithiasis without evidence of pericholecystic inflammatory changes.SPLEEN: Small volume perisplenic ascites (series 7, image 54) is unchanged.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Interval increase in peritoneal and mesenteric nodularity consistent with carcinomatosis, measuring up to 2.1 centimeters in thickness (series 7, image 74).BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: As above.BONES, SOFT TISSUES: Few scattered sclerotic foci within the vertebral bodies are noted, specifically T11 and L1. Mild to moderate degenerative changes affect the visualized spine.OTHER: No significant abnormality noted
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1.Interval increase in carcinomatosis.2.Scattered sclerotic lesions within the vertebral bodies are nonspecific and may represent metastatic disease. Nuclear medicine bone scan may be considered for more sensitive evaluation of osseous metastatic disease.3.Findings suspicious for right basilar empyema, unchanged. Please refer to concurrent CT chest report for further details regarding pulmonary disease.
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Generate impression based on findings.
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59 years, Male. Reason: DHT placement History: as above Jejunal tube tip distal to the ligament of Treitz. Surgical drains project over the abdomen. IVC filter noted. Incompletely visualized bowel gas pattern is suggestive of ileus. Left basilar consolidation.
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Jejunal tube tip distal to the ligament of Treitz.
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Generate impression based on findings.
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There is evidence of prior bilateral uncinectomy, widening of the maxillary infundibulae, partial resection of the ethmoid air cell complex, and widening of the left sphenoethmoidal recess. The frontal sinuses are hypoplastic. The prior mild mucosal thickening of the ethmoid air cells has resolved. The sphenoid sinuses and sphenoethmoidal recesses are clear. There is mild peripheral mucosal thickening in the maxillary sinuses, which unchanged. The right maxillary sinus is hypoplastic. The maxillary neo-infundibulum on the right remains more narrow than the left, however both are patent. The nasal cavity is essentially clear. There is mild nasal septal deviation. The nasal turbinates are unremarkable. The lamina papyracea and fovea ethmoidalis 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.
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Stable appearance of postoperative findings related to prior endoscopic sinus surgery with minimal residual mucosal thickening of the paranasal sinuses that is improved.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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Transient right sided weakness and numbness several times a day. Evaluate left ICA stenosis due to vasospasm. CT HEAD:Again demonstrated are stable postoperative changes of a previous right-sided craniotomy for clipping of a right anterior choroidal artery aneurysm which causes artifact and obscures adjacent structures. Artifact is also noted in the region of the left posterior communicating artery from aneurysm coiling. There is no evidence for acute intracranial hemorrhage mass effect or edema. A single small area of hypoattenuation in the left superior parietal lobule corresponds to signal abnormality on the prior MRI and may reflect encephalomalacia from a previous ischemic injury. The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.BRAIN CTA: The distal left ICA is probably smaller in caliber than the distal right ICA but this is stable to perhaps slightly improved compared to the prior exam. Full evaluation of the proximal part of the communicating segment of the internal carotid arteries as well as the region of the anterior communicating artery is limited by metal artifact. Mild scattered irregularity of the vasculature otherwise which may be technical or due to atherosclerosis but there is no high grade stenosis or new aneurysm noted.
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1.Stable post-surgical changes from a craniotomy and clipping of a right anterior choroidal artery aneurysm without evidence of recurrence although this is limited by artifact.2.Status-post left posterior communicating artery clipping without evidence of recurrence but is again limited by artifact.3.Stable to perhaps slightly improved caliber of the distal left ICA artery.4.Within the limitations of extensive artifact, there is mild scattered irregularity of the intracranial vasculature which may be technical or due to atherosclerosis but there is no high grade stenosis or new aneurysm noted.5.Small area of likely encephalomalacia in the superior left parietal lobule not as well seen previously, perhaps from prior ischemic injury.
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Generate impression based on findings.
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66-year-old female with history of breast cancer who presents for staging exam. ABDOMEN: Motion artifact degrades evaluation.LUNG BASES: Large heterogeneously enhancing mass in the right breast measuring up to 9.2 x 7.1 cm (series 3, image 5) with multiple enhancing satellite foci in the right breast. These findings are likely consistent patient's known breast carcinoma with satellite lesions. Additionally, there are multiple enhancing foci within the left breast/chest wall, highly suspicious for metastatic disease. Bilateral small pleural effusions, right greater than left. Please refer to CT chest report 2/3/2015 for further details.LIVER, BILIARY TRACT: No focal hepatic lesions identified. No intra-or extrahepatic biliary ductal dilatation. High-density material layering in the dependent portion of the gallbladder is likely sludge.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: There is mild nodularity of the omentum (series 3, image 36) suspicious for carcinomatosis, although the study is limited by motion artifact. Small bowel containing umbilical hernia without evidence of small bowel obstruction.BONES, SOFT TISSUES: As below.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Fibroid uterus.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: As above.BONES, SOFT TISSUES: Heterogeneous appearance of osseous structures highly suspicious for tumor involvement. Severe compression deformity of L1 and moderate compression deformity of T10 vertebral bodies. There is cortical destruction of the left inferior pubic ramus compatible with a pathological fracture.OTHER: No significant abnormality noted
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1.Findings suspicious for carcinomatosis, although evaluation is limited by motion artifact.2.Diffuse osseous metastases. 3.Minimally displaced left inferior pubic ramus pathologic fracture.4.Severe L1 and moderate T10 compression deformities.5.Large right breast heterogeneously enhancing mass with multiple associated satellite lesions, most consistent with patient's known breast carcinoma. Additional enhancing foci are present within the left breast, most likely metastatic disease. Please refer to dedicated CT chest report 2/3/2015 for further details.
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Generate impression based on findings.
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77 years old Male. Reason: Richter's transformation to DLBCL. History: 76 yo man with Richter's transformation to DLBCL with c-myc mutation by IHC now s/p 4 cycles DA -EPOCH-R. This study was performed for restaging.RADIOPHARMACEUTICAL: 9.45 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 99 mg/dL. Today's CT portion of the neck demonstrates no significant pathology. Please see diagnostic CT reports for details of the chest, abdomen, and pelvis.Today's PET examination demonstrates three foci of intense FDG uptake in the soft tissue masses in the left anterior abdominal wall with SUVmax of 38.1, which are consistent with residual tumor. A focus of increased activity is seen in a lymph node in the gastrohepatic ligament with SUVmax of 23. Two foci of increased activity are seen in the right pelvic peritoneal and in the retroperitoneal cavities corresponding to the peritoneal thickening and retroperitoneal soft tissue density. The SUVmax peritoneal thickening in the right pelvis is 20.7. Linear of increased activity is seen in the right upper quadrant of abdomen, corresponding to the stent placement in the bile ducts.Physiologic activity is seen in the liver, spleen, kidneys, intestines and bladder. Diffuse increased metabolic activity in the skeleton is most likely due to bone marrow stimulation effect.
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1.Multiple hypermetabolic soft tissue masses in the abdominal wall, hypermetabolic peritoneal and retroperitoneal soft tissue densities and hypermetabolic gastrohepatic lymph node, consistent with the patient's diagnosis of lymphoma.2.No evidence of FDG avid tumor in the neck and chest.Diagnostic CTs of the chest, abdomen, and pelvis also performed at today's visit will be reported separately.
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Generate impression based on findings.
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77-year-old male with lymphoma status post 4 cycles of therapy who presents for restaging. CHEST:LUNGS AND PLEURA: Scattered pulmonary micronodules (series 4, images 49, 67, and 72) are stable to decreased in size. No new suspicious pulmonary nodules or masses. No pleural effusions or pneumothorax.MEDIASTINUM AND HILA: Hypoattenuation within the main right pulmonary artery (series 701, image 47) extending into the right upper lobar artery as well as its segmental branches (series 701, images 40 through 44) compatible with pulmonary emboli.Reference left cardiophrenic mass is not measurable on the current exam.Heart size is normal without pericardial effusion.CHEST WALL: Left chest port with tip in the SVC.ABDOMEN:LIVER, BILIARY TRACT: Near complete resolution of previously identified perihepatic mass anteriorly. Interval placement of a common bile duct stent with moderate pneumobilia, which is likely post instrumental in etiology.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable mild right hydronephrosis. Hypoattenuating lesion in the inferior pole of right kidney measuring up to 30 Hounsfield units is incompletely characterized.RETROPERITONEUM, LYMPH NODES: Near complete resolution of previously identified right retroperitoneal conglomerate lymphadenopathy. Residual nodularity within the retroperitoneum noted (series 701, image 152).Prominent gastrohepatic lymph node (series 701, image 95) is present.BOWEL, MESENTERY: As below.BONES, SOFT TISSUES: Interval decrease in size of the conglomerate lymphadenopathy involving the anterior abdominal wall (series 701, image 181).OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Significant interval improvement in the pelvic lymphadenopathy. Reference right lower quadrant conglomerate lymphadenopathy measures 2.7 x 1.9 cm (series 701, image 169), previously measuring 5.7 x 4.4 cm.Reference right hemipelvis lymphadenopathy measures 4.9 x 2.5 cm (series 701, image 194), previously measuring 9.6 x 6.5 cm.BOWEL, MESENTERY: Postoperative changes of partial colectomy. Interval improvement in previously noted circumferential thickening of the transverse colon as well as infiltration of the gastric wall.BONES, SOFT TISSUES: Multilevel degenerative changes affect the lumbar spine with sclerotic focus within L5 vertebral body, which is likely a benign bone island.OTHER: No significant abnormality noted
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1.Multiple right pulmonary emboli.2.Significant interval regression of multiple large conglomerations of lymph nodes in the abdomen and pelvis.3.Interval regression of infiltration of the stomach and the bowel wall with lymphoma.4.Interval decrease in size of the pulmonary/pleural micronodules.5.Persistent mild right hydronephrosis.6. Interval placement of a common bile duct stent with moderate pneumobilia, which is likely post instrumental in etiology.Findings relayed to Dr. Sonali Smith over the phone at approximately 4:15 p.m.
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Generate impression based on findings.
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75-year-old male with metastatic GE junction adenocarcinoma per EMR (this is discrepant from requisition information which states "pancreatic adenocarcinoma").RADIOPHARMACEUTICAL: 9.3 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 102 mg/dL. Today's CT portion grossly demonstrates a right chest wall port catheter with tip terminating in the right atrium, severe atherosclerotic calcifications including coronary arterial calcifications. There is mild circumferential thickening of the distal esophagus; mass previously seen in the gastric cardia is not clearly evident on this limited CT exam. Diffuse bilateral groundglass pulmonary opacities favoring the lung bases are improved from the previous exam. Layering gallbladder sludge/stones are again noted. There has been significant interval decrease in size and number of retroperitoneal and mesenteric lymph nodes extending inferiorly to the level of the renal vasculature.Today's PET examination demonstrates decreased size and hypermetabolic activity in the gastric cardia (SUV max 5.4 from previously 16.3). There is however a new mildly hypermetabolic focus in the distal esophagus, which may be due to esophagitis or new tumor activity. There has been near complete interval resolution of hypermetabolic activity associated with retroperitoneal and mesenteric lymph nodes extending inferiorly to the level of the renal hila. For reference, a left retroperitoneal lymph node at the T1-L1 level previously measured SUV max of 8.1 and no longer demonstrates abnormal increased metabolic activity.Mild hypermetabolic activity associated with aortic calcifications likely reflect atherosclerotic inflammation. There is also mild diffuse bilateral pulmonary parenchymal activity associated with the aforementioned ground glass opacities, reflecting inflammation.
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1.Decreased size and hypermetabolic activity of gastric cardia mass. However, new distal esophageal hypermetabolic focus is also present, which may be due to esophagitis or new tumor activity. 2.Near complete interval resolution of mesenteric and retroperitoneal lymph node metastases.
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Generate impression based on findings.
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Female 36 years old Reason: 35Yrs female with a history of malignant peritoneal mesothelioma s/p exploratory laparotomy, RSO on 11/18/2011, s/p adjuvant pemetrexed and cisplatin x 6 cycles, completed mid-2012, s/p VATS and attempted pleurodesis in 10/2012 for recurrent effusion, th History: Malignant peritoneal mesothelioma CHEST:LUNGS AND PLEURA: Interval postoperative changes from right thoracotomy, parietal pleurectomy and right lower lobe wedge resection. Interval development of small right pleural effusion. No evidence of pleural nodularity. Patchy groundglass opacity seen on previous exam in the right lower lobe is no longer visible likely secondary to wedge resection. MEDIASTINUM AND HILA: Previously measured cardiophrenic lymph node is stable in size measuring 17 mm (series 5, image 67). Anterior mediastinal soft tissue at the level of the aortic arch appears slightly decreased in size compared to the prior study. Persistent focal defect in the left ventricular apex is noted.Heart size is normal without pericardial effusion. CHEST WALL: Interval removal of right Pleurx catheter.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Small hypodensity in the right lobe seen on previous exam is no longer visualized.SPLEEN: No significant abnormality noted. Accessory splenule 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 significant abnormality noted.BONES, SOFT TISSUES: Stable focal sclerosis in the T7 vertebrae.OTHER: No significant abnormality noted.
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1.Interval postoperative changes with new small right pleural effusion. 2.Stable anterior mediastinal soft tissue and cardiophrenic lymph node without evidence of pleural nodularity. 3.Persistent focal defect in the left ventricular apex of uncertain etiology. Recommend echocardiogram to further evaluate.
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Generate impression based on findings.
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Lung cancer, secondary malignant neoplasm of the retroperitoneum and peritoneum. Mediastinal lymphadenopathy. Pre-chemo. LUNGS AND PLEURA: Right hemithorax volume loss and near-circumferential pleural thickening. For reference, right pleural thickening measures up to 14-mm in the costophrenic angle region (4/77), not significantly changed.The majority of the right lung is consolidated, with collapse of the lower lobe due to occlusion of the bronchus intermedius, present previously. Progressive consolidation, septal thickening and centrilobular nodular opacities in the aerated portion of the right upper lobe ranging in density from groundglass to solid.Numerous micronodules in the left lung, probably not visible previously on the prior examination due to differences in technique, some of which appear calcified suggestive of granulomas, but noncalcified lesions should be monitored. Focal ground glass opacity in the left costophrenic angle is new (6/92), nonspecific.Moderate posteriorly loculated right pleural fluid collection, similar in volume.MEDIASTINUM AND HILA: Fluid and soft tissue density debris in the bronchus intermedius and right lower lobe airways.Normal heart size. Physiologic volume of pericardial fluid. Possible faint coronary calcifications.Several subcentimeter right paratracheal and tracheoesophageal lymph nodes, abnormal in multiplicity (4/23-28), unchanged.12-mm lymph node adjacent to the bronchus intermedius, unchanged (4/50).CHEST WALL: Right posterolateral 7-9th rib subacute to chronic fractures with minimal displacement. Right chest wall soft tissue strandingUPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Limited scanning range. Cholelithiasis.. Hepatic fat fluid and stranding extending from the thickened right hemi- diaphragm to the anterior mesentery will be described in separately reported abdominal CT.
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1. Pleural thickening of the right measures up to 14-mm, with an associated loculated pleural fluid collection.2. Majority of the right lung is consolidated which may be post therapeutic however extent of underlying tumor cannot be assessed. Right lower lobe collapse appears chronic, with a soft tissue density filling defect in the bronchus intermedius which may be due to debris however any endobronchial tumor component cannot be excluded. Consider baseline PET scan.3. Right paratracheal and tracheoesophageal lymph nodes abnormal in multiplicity, similar to previous. 4. Progressive consolidation, nodularity and septal thickening in the right upper lobe since the prior study. It is unclear whether this is due to lymphangitic tumor or a combination of venous occlusion with edema and post therapeutic pneumonitis.5. Thickening of the right hemidiaphragm with extensive soft tissue stranding and nodularity in the upper abdominal fat and mesentery, suspicious for intraperitoneal disease, please refer to separately reported abdomen portion of CT.
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Generate impression based on findings.
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Reason: 54 y/o with h/o CLL and t-AML, being treated for pneumonia; now for re-eval of infection History: currently being treated for pneumonia; re-eval of infection LUNGS AND PLEURA: Right upper lobe consolidation slightly decreased with demonstration new air bronchograms., However areas of consolidation noted in the left upper lobe. Increasing bilateral pleural effusions compared to the prior exam.MEDIASTINUM AND HILA: Right central venous catheter with its tip in the SVC.Cardiac size normal evidence of a pericardial effusion.Hypoattenuating blood pool compatible with anemia.Mild coronary artery calcification.No hilar or mediastinal lymphadenopathy identified.CHEST WALL: No axillary lymphadenopathy.Extensive degenerative changes throughout the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Cholelithiasis. Incompletely evaluated right renal hypodensity.
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Multifocal areas of consolidation demonstrating interval progression since the prior exam with increasing bilateral pleural effusions compatible with infection.
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Generate impression based on findings.
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infertility Scout AP film of the pelvis was normal. Opacification of the uterine cavity revealed a normal uterine cavity without mucosal irregularity or filling defects. The right fallopian tube opacifies without spillage. The left fallopian tube is obstructed.TOTAL FLUOROSCOPY TIME: 2 minutes 3 seconds
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1.Obstructed left fallopian tube and no spillage on either side.2.Normal uterine cavity.
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Generate impression based on findings.
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49-year-old female with pain There is a small linear osseous fragment dorsal to the dorsal aspect of the talus, likely representing an avulsion fracture. No additional fracture of the foot or ankle. No significant soft tissue swelling about the ankle.
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Dorsal talar avulsion fracture
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Generate impression based on findings.
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59 year old female with a palpable lump in the left breast presents for mammographic workup. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. Scattered calcifications have mildly progressed in a benign fashion. A triangular marker is placed at lower outer quadrant of left breast, indicating the area of palpable concern. An ill-defined round mass is demonstrated near the palpable marker. No suspicious microcalcifications or suspicious areas of architectural distortion are noted in either breast. With the examination, a mobile mass is palpated at 5 o'clock position in the left breast. Focused ultrasound is performed. It detects a round simple cyst measuring 12 x 9 mm. No solid lesions or suspicious findings are detected.
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No mammographic or sonographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendations were discussed with the patient. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram.
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Generate impression based on findings.
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60 year-old male with pain, evaluate for healing Fractures of the distal fibula and medial malleolus are again visualized in near-anatomic alignment. The fracture lines are indistinct, suggesting some interval healing. There is mild soft tissue swelling about the ankle.
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Healing distal fibula and medial malleolus fractures in near-anatomic alignment.
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Generate impression based on findings.
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The ventricles and sulci are within normal limits, although there is minimal slight asymmetric prominence of the left cerebral sulci relate to minimal volume loss. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. As suspected on the prior CT exam, the cerebellar tonsils are somewhat caudally positioned, extending up to 7 mm below the level of the foramen magnum on the right, with a slightly pointed configuration. There is moderate-severe crowding of structures at this level. The remainder of midline structures and craniocervical junction are within normal limits.
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1. Findings suggestive of Chiari one malformation, for which clinical correlation is recommended.2. Otherwise, unremarkable limited noncontrast MRI brain.
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Generate impression based on findings.
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Male, 33 years old. RFO trigger: Transplant surgery. Counts correct. No unexpected radiopaque foreign body. Feeding tube coiled in stomach with tip in gastric body. Left nephroureteral stent partially visualized. Nonobstructive bowel gas pattern.
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No unexpected radiopaque foreign body. Findings discussed with the attending physician, Dr. Becker, via telephone on 2/4/2015 at 15:00.
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Generate impression based on findings.
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0-day-old male with worsening respiratory distress with umbilical line placementVIEW: Chest/abdomen AP (2 view) 02/04/15, 1508 hrs Enteric tube tip is in the gastric antropyloric region. Umbilical venous catheter tip is at the inferior cavoatrial junction. Umbilical artery catheter is coiled with tip at the T11 level.Cardiothymic silhouette is normal. No pleural effusion or pneumothorax. No focal pulmonary opacities. Nonspecific bowel distention. No pneumatosis intestinalis, pneumoperitoneum, or portal venous gas.
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Umbilical artery catheter is coiled with tip at the T11 level. Nonspecific bowel distention.
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Generate impression based on findings.
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Clinical question: Patient reports gun shot wound to the abdomen with remaining bullet fragments in the spinal cord/nerve root injury status post multiple abdominal surgeries. Elucidation of the anatomy for possible epidural injections. Nonenhanced thoracic spine CT:There is normal bony density and the anatomical alignment of the vertebral column. There is no detectable metallic/bullet fragments in the field of study.There is no appreciable significant degenerative changes of the thoracic spine. There is no finding to suggest presence of spinal canal or neural foraminal compromise at any level.There is no evidence of abnormality of the paraspinal soft tissues.Nonenhanced lumbar CT:There is normal anatomical alignment of the vertebral column.There is a single well demarcated round metallic fragment representing a bullet fragment lying immediately posterior to the right lamina of L2 vertebrae and immediately lateral to the spinous process. It measures approximately 10.7 x 12.6-mm in size.There is evidence of minimal invagination of the bullet fragment into the adjacent bone and without evidence of extension into the spinal canal. There is also no evidence of any additional metallic fragments in the field of study.A large Schmorl's node along the inferior endplate of L2 is noted.There is mild degenerative changes of facet and no appreciable significant disk disease.There is no finding to suggest spinal stenosis or neural foraminal compromise however CT of lumbar spine is not the appropriate tests for assessment of intracanicular space.
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1.Enhanced CT of thoracic spine is within normal limits. In particular there is no evidence of bullet fragments in the field of view.2.Enhanced CT of lumbar spine demonstrate a single well demarcated round bullet fragment measuring at 10.7 x 12.6-mm lying immediately posterior to the right lamina of L2 and lateral to the spinous process. Unremarkable exam otherwise and without evidence of any additional metallic fragments.
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Generate impression based on findings.
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20-year-old male with history of right ring finger avulsion fracture. Redemonstrated is a focal lucency along the dorsal aspect of the articular surface of the base of the middle phalanx which likely represents a nondisplaced central slip avulsion fracture appearing similar to prior. There is mild soft tissue swelling about the PIP joint.
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Ring finger avulsion fracture as described above.
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Generate impression based on findings.
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72 year-old female with recurrent breast cancer status post neoadjuvant chemotherapy.RADIOPHARMACEUTICAL: 11.8 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 95 mg/dL. Today's CT portion grossly demonstrates stable bilateral renal cysts.Today's PET examination demonstrates interval resolution of previously seen markedly hypermetabolic activity associated with left supraclavicular and left axillary conglomerate lymph node masses. There is symmetric, diffuse bone marrow activity in the visualized skeleton without corresponding CT abnormality, likely representing benign hematopoietic stimulation related to treatment for neutropenia. No additional FDG avid lesions are identified to suggest hypermetabolic tumor activity.The previously seen punctate hypermetabolic focus in the right midthoracic spine is no longer evident, which may be due to interval resolution or increased background osseous hypermetabolic activity as described above.
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Interval resolution of markedly hypermetabolic activity associated with the left supraclavicular and left axillary lymph node conglomerate masses. No specific evidence of current hypermetabolic tumor activity.
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Generate impression based on findings.
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There is an oblique fracture through the angle of the posterior body of the left mandible, with approximate 1 cm inferior as well as medial displacement of the distal fracture fragment. The fracture is minimally comminuted. The anterior root of ADA number 18 is identified although there may be a tiny nondisplaced fracture through the tooth at the level of the superior margin of the alveolar process. The remainder of the tooth is not seen. The fracture line does extend through the mandibular canal margins, best appreciated on coronal imaging. The temporomandibular joints are intact. ADA number 17 is not visualized. No orbital fracture is identified. The globes are intact. There is no evidence of intraorbital hematoma or stranding.There is mild mucosal thickening within the right greater than left maxillary sinuses. There is leftward nasal septal deviation with a prominent bony spur. Filling defect within the right external auditory canal likely represents cerumen. The visualized mastoid air cells are clear. There is diffuse left greater than right facial soft tissue swelling with thickening especially of the left platysma.
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Oblique minimally comminuted and displaced fracture through the posterior left mandibular body, with fractured ADA number 18. Abdomen dilute joints are intact. Fracture line extends through left mandibular canal, and correlation for inferior alveolar nerve injury is recommended. Significant left greater than right facial soft tissue swelling.
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Generate impression based on findings.
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Malignancy or source of weight loss. Abdominal pain CHEST:LUNGS AND PLEURA: Several pleural-based nodules are noted, one with rim calcification measuring 2.1 x 0.8 cm (image 42; series 6). These are probably benign given appearance. No intrapulmonary masses. Minimal scarring bilaterally.MEDIASTINUM AND HILA: Coronary stents.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No focal liver lesions.SPLEEN: 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: High-grade calcific and SMA stenosis (image 102; series 4) along with occlusion of the celiac axis. These findings are highly suggestive of chronic mesenteric ischemia given the patient's clinical presentation. Inferior mesenteric artery appears patent.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Colonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Periumbilical hernia containing fat. Calcifications within the fat centrally in the pelvis (image 174; series 4) are of unclear etiology or significance. Consider prior mesenteric fat infarction or panniculitis.
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Occlusion of the celiac axis with high-grade, calcific stenosis of the superior mesenteric artery. The findings are most suggestive of chronic mesenteric ischemia given the patient's clinical finding history. Findings were discussed with Dr. Yang at the time of dictation.
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Generate impression based on findings.
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Female 25 years old; Reason: 25F s/p lap chole (1/27) c/b cystic duct leak s/p IR drainage, ERCP; low drain output, leukocytosis, and tachycardia. concern for undrained fluid collection History: tachycardia, leukocytosis ABDOMEN:LUNG BASES: Bilateral pleural effusions, left greater than right. There is bibasal atelectasis. Superimposed consolidation is not excluded. LIVER, BILIARY TRACT: Status post cholecystectomy. Biliary stent in situ.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Prominent small bowel loops in the left upper quadrant suggestive of ileus.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Interval insertion of extrahepatic biliary drain. Multiloculated abdominal fluid collections throughout the abdomen. Loculated subcapsular fluid collection containing significant air extending anteroinferiorly along the liver contour has increased and measures 4.2 x 15.2 cm, previously 2.4 x 11.3 cm (series 13, image 102). Loculated fluid containing gas and what appears to be feculent material, centrally within the abdomen, measures 4.5 x 5.8 cm (series 13, image 110). Multiple large pockets of free air, increased compared to prior study, predominantly in the lower abdomen/pelvis (series 13 image 122, image 134).PELVIS:UTERUS, ADNEXA: IUD within the uterusBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Multiloculated pelvic fluid collections. The largest measures 11.0 x 5.0 cm in the right adnexa/pouch of Douglas (series 13, image 148).
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1. Multiloculated fluid collections throughout the abdomen and pelvis concerning for biliary ascites and consistent with provided history of bile leak. 2. Abdominal collection containing what appears to be feculent material with increasing lower abdominal/pelvic free air, raising the possibility of bowel perforation.Findings discussed with Dr. Kempton by myself Dr. Ward 02/04/15.
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Generate impression based on findings.
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45 year old male with history of ulcerative colitis s/p proctocolectomy and ileoanal J pouch creation. Scout radiograph showed a nonobstructive bowel gas pattern. Transit time to the colon was 30 minutes. Fluoroscopic evaluation demonstrated postsurgical changes s/p proctocolectomy and ileoanal J pouch creation. Convergence of several bowel loops in the mid abdomen in a stellate configuration may represent nonobstructive adhesions. There was normal mucosa throughout the small bowel, with no ulcers, sinus tracts, or fistulae. No separation of bowel loops was present to suggest fibrofatty proliferation. Overall appearance of the small bowel and postsurgical changes appears stable when compared to prior exam from 2010. TOTAL FLUOROSCOPY TIME: 4:55 mm:ss
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1.Stable postsurgical changes as described above with possible nonobstructive adhesions in the mid abdomen. 2.No evidence of active small bowel inflammation.
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Generate impression based on findings.
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Female; 25 years old. Reason: 25F s/p lap chole (1/27) c/b cystic duct leak now s/p IR drainage, ERCP; persistent leukocytosis and tachycardia; concern for PE given fam hx of hypercoaguability History: leukocytosis, tachycardia PULMONARY ARTERIES: Suboptimal opacification of the pulmonary arteries limits evaluation for pulmonary embolus beyond the level of the lobar arteries. Within this limitation, no evidence of a large, central pulmonary embolus. Normal caliber of the main pulmonary artery. No evidence of right heart strain.LUNGS AND PLEURA: Moderate nonspecific bibasilar atelectasis/consolidation. Small left pleural effusion.MEDIASTINUM AND HILA: Cardiomegaly. No pericardial effusion. No coronary artery calcifications. No mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Right upper quadrant surgical drain. Mild ascites in the left upper quadrant. See report from dedicated CT abdomen and pelvis performed concomitantly.
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1. Limited study without evidence of large, central pulmonary embolus. If there is ongoing clinical concern for pulmonary embolus, repeat examination is recommended.2. Moderate nonspecific bibasilar atelectasis/consolidation and small left pleural effusion.3. See report from dedicated CT abdomen pelvis performed concomitantly.PULMONARY EMBOLISM: PE: Indeterminate.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable.
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Generate impression based on findings.
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Clinical question: Patient reports gun shot wound to the abdomen with remaining bullet fragments in the spinal cord/nerve root injury status post multiple abdominal surgeries. Elucidation of the anatomy for possible epidural injections. Nonenhanced thoracic spine CT:There is normal bony density and the anatomical alignment of the vertebral column. There is no detectable metallic/bullet fragments in the field of study.There is no appreciable significant degenerative changes of the thoracic spine. There is no finding to suggest presence of spinal canal or neural foraminal compromise at any level.There is no evidence of abnormality of the paraspinal soft tissues.Nonenhanced lumbar CT:There is normal anatomical alignment of the vertebral column.There is a single well demarcated round metallic fragment representing a bullet fragment lying immediately posterior to the right lamina of L2 vertebrae and immediately lateral to the spinous process. It measures approximately 10.7 x 12.6-mm in size.There is evidence of minimal invagination of the bullet fragment into the adjacent bone and without evidence of extension into the spinal canal. There is also no evidence of any additional metallic fragments in the field of study.A large Schmorl's node along the inferior endplate of L2 is noted.There is mild degenerative changes of facet and no appreciable significant disk disease.There is no finding to suggest spinal stenosis or neural foraminal compromise however CT of lumbar spine is not the appropriate tests for assessment of intracanicular space.
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1.Enhanced CT of thoracic spine is within normal limits. In particular there is no evidence of bullet fragments in the field of view.2.Enhanced CT of lumbar spine demonstrate a single well demarcated round bullet fragment measuring at 10.7 x 12.6-mm lying immediately posterior to the right lamina of L2 and lateral to the spinous process. Unremarkable exam otherwise and without evidence of any additional metallic fragments.
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Generate impression based on findings.
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Hemorrhage in the gastrointestinal tract, unspecified. Assess for mesenteric artery graft a small bowel fistula as cause of small bowel bleeding versus other wall lesion. 85-year-old with history bifurcated superior mesenteric and celiac artery bypass graft two years ago. Now with GI bleeding and red blood in small bowel capsule study.? Graft enteric fistula. ABDOMEN:LUNG BASES: Minimal scarring at both lung bases. Title hernia.LIVER, BILIARY TRACT: Status post cholecystectomy. Rim calcified, benign appearing liver nodule (image 28; series 8).SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality noted. Pancreatic tail calcification.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: High-grade bilateral renal artery stenoses. Right renal artery cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Bifurcated bypass graft to the celiac and superior mesenteric artery appears patent. High-grade stenosis at the SMA anastomosis (image 30; series 80678). While there is no definite evidence of an arterial-enteric fistula, there is a small saccular aneurysm extending posterior laterally immediately distal to the aforementioned stenosis (image 59; series 8) which is in close approximation to a small bowel loop. It is possible that this is the site of recent bleeding identified on capsule endoscopy. No other suspicious areas are identified. PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Right hip replacement.OTHER: No significant abnormality noted
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No definite CT evidence (i.e., active extravasation) of an arterial-enteric fistula as clinically queried however, the distal aspect of the bypass graft to the superior mesenteric artery exhibits a high grade stenosis and a small saccular aneurysm which is in close approximation to a small bowel loop in the mid-abdomen. This would be the most suspicious area for a fistula, if one is present. Finding could be better evaluated with conventional angiography as clinically indicated.Findings were discussed with Drs. Semrad and Milner at the time of dictation.
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Generate impression based on findings.
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18 year-old male baseball player with pain with flexion Osseous alignment is within normal limits. No fracture or joint effusion.
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No specific findings to account for the patient's pain. If there is concern for soft tissue injury, MRI may be considered for further evaluation.
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Generate impression based on findings.
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75-year-old male with history of prostate cancer, rising PSA, concern for bone mets. No abnormal osseous foci are identified to indicate metastatic disease. Foci of increased radiotracer activity at the T9 and T10 vertebral bodies correspond with degenerative changes seen on CT, as does a small focus in the lateral aspect of the left acetabulum.
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No definite evidence of bone metastases.
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Generate impression based on findings.
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Male; 83 years old. Reason: mets lung cancer. S/p 6 cycles of chemo with disease progression. Pls c/s previous study and evaluate dz status. History: lung ca CHEST:LUNGS AND PLEURA: Left lower lobe spiculated mass measures up to 43 x 23 mm, unchanged (series 4/52). However, the mass has mildly increased in size in its inferior portion. For example, it measures 41 x 30 mm on image 55, previously 36 x 26 mm.Small scattered nodules in the medial right upper lobe and right lower lobe have slightly increased (series 4/images 32 and 42 and coronal series 80248/36). For example, a nodule in the azygoesophageal recess measures up to 15 mm (series 4/42), previously 9 mm. A new right upper lobe pulmonary micronodule is seen on image 45. Cluster of nodules in the left upper lobe with tree in bud pattern is stable.Moderate centrilobular emphysematous.No pleural effusions.MEDIASTINUM AND HILA: Reference right paratracheal lymph node remains 12 mm, unchanged (series 3/32). Reference right hilar conglomerate lymph node measures 14 mm, previously 15 mm (series 3/40).Normal heart size without pericardial effusion. Severe coronary and some annular calcifications. Small hiatal hernia.CHEST WALL: Reference is lymph node measures 10 mm, previously 10 mm (series 3/18). Scattered degenerative changes with wedge deformities of mid thoracic vertebrae all appear unchanged.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Left hepatic lobe hypoplasia and/or surgical removal. No focal liver lesions. Extensive gallstones and/or sludge unchanged. SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Scattered unchanged subcentimeter 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: Stable degenerative changes without suspicious lytic or blastic lesions.OTHER: No significant abnormality noted.
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1. Mildly increased size of left lower lobe mildly spiculated mass compatible with primary lung carcinoma.2. Mildly increased nodules, as well as a new nodule, in the right lung, most suggestive of progression of disease.3. Grossly stable lymphadenopathy in the chest.
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Generate impression based on findings.
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History of asymmetry in the right upper outer quadrant. No new breast complaints Three standard views of both breasts (total 10 images) 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. Scattered benign calcifications are noted in both breasts. No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in either breast.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendations were discussed with the patient. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram.
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Generate impression based on findings.
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Reason: NGT placement History: as above Nasogastric tube tip projects over the gastric antrum. IVC filter projects over expected location of the inferior vena cava. Curvilinear wiring over the pelvis and right lower quadrant is indeterminate, but seen on prior study, in a similar location. Surgical staples and pelvic drain seen. Levoscoliosis. Nonobstructive gas pattern.
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Line and tube placement as above.
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Generate impression based on findings.
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Male 67 years old; Reason: Prostate cancer, evaluation of disease as baseline for initiation of investigational therapy. please complete PCWG2 form There is widespread increased osseous activity throughout the upper cervical spine, thoracic spine, lumbar spine, multiple bilateral ribs, pelvis, right clavicle and skull which correlate with the innumerable osseous sclerotic foci on CT consistent with osseous metastatic disease.
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Widespread osseous metastatic disease as described above.
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Generate impression based on findings.
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66-year-old female with lung cancer. This study was performed for restaging.RADIOPHARMACEUTICAL: 11.3 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 100 mg/dL. Today's CT portion grossly demonstrates no significant abnormality in the neck or pelvis.Today's PET examination demonstrates stable size but decreased hypermetabolic activity associated with the previously described right upper lobe subpleural opacity and pleural thickening, which suggests against tumoral activity.A new, moderately hypermetabolic, somewhat linear focus in the left lower lobe is associated with 8mm peribronchial nodular density on CT immediately adjacent to the descending aorta. While tumor activity is difficult to entirely exclude, given the recent resolution of left lower lobe pneumonia, this finding is suggestive of inflammatory change. Additional faintly hypermetabolic paramediastinal foci bilaterally appear stable, likely inflammatory in etiology.
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1.Decreased hypermetabolic activity associated with the right upper lobe subpleural opacity, which is unlikely to represent tumor activity.2.New hypermetabolic focus in the left lower lobe likely represents inflammatory change given the recent resolution of pneumonia in this location. Short-term 6 month follow-up CT should be considered to ensure stability or resolution of the associated 8mm nodular opacity.
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Generate impression based on findings.
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67-year-old female with history of ovarian cancer who presents for disease re-evaluation. CHEST:LUNGS AND PLEURA: Scattered micronodules and nodules are stable compared to previous exam. No pleural effusions or pneumothorax.MEDIASTINUM AND HILA: No significant interval change in the mediastinal lymphadenopathy. Reference subcarinal lymph node measures 2.8 x 1.7 cm (series 80284, image 54), previously measuring 2.7 x 1.8 cm.CHEST WALL: No significant change in the sclerotic bone lesions involving the thoracic vertebral bodies and sternum.ABDOMEN:LIVER, BILIARY TRACT: There has been interval increase in size and number of hepatic metastatic lesions with reference segment 5 lesion measuring 7.4 x 5.5 cm (series 80284, image 92), previously measuring 5.4 x 4.0 cm. Hepatic metastatic disease results in attenuation of the branches of the right and left portal veins.Cholelithiasis.SPLEEN: Multiple subcentimeter splenic hypoattenuating foci are unchanged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Nonobstructive left nephrolithiasis. No hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small volume abdominal and pelvic ascites is new compared to the previous exam. No significant interval change in the peritoneal nodularity suggestive of carcinomatosis.BONES, SOFT TISSUES: Interval worsening of diffuse anasarca. No significant interval change in the subcentimeter soft tissue nodules in the anterior abdominal wall (series 80284, image 166).OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: As above.BONES, SOFT TISSUES: Interval worsening of diffuse anasarca. No significant interval change in the sclerotic lesions in the right iliac bone and vertebral bodies.OTHER: No significant abnormality noted.
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1.Interval increase in size and number of hepatic metastatic disease.2.New small volume abdominal and pelvic ascites.3.Stable mediastinal adenopathy and osseous metastatic disease.
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Generate impression based on findings.
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Although direct comparison to prior imaging is made difficult by the time interval between scans, the degree of moderate ventricular dilatation remains stable. Flow void is visualized through the cerebral aqueduct and there is also flow artifact in the distal aqueduct and fourth ventricle indicating patency. There is minimal marginal FLAIR hyperintensity that may represent gliosis, without definite evidence of transependymal CSF flow. There is no evidence of Chiari malformation. No intra- or extra-axial fluid collection/hemorrhage, mass, midline shift or herniation. No diffusion weighted abnormalities are identified. The cortical sulci and basal cisterns are normal in size and configuration. The visualized orbits are unremarkable.
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Stable degree of diffuse ventricular dilatation. No new abnormality.
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Generate impression based on findings.
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30 year old female with history of malrotation s/p LADD procedure in November 2014, now presents with continually worsening abdominal pain. Fluoroscopic evaluation demonstrated normal passage of contrast through the stomach into the proximal small bowel. The duodenum did not cross the midline and proximal small bowel loops were in the right abdomen, compatible with persistent malrotation. Transit time to the colon was 1 hour and 30 minutes. Previously described nonobstructive adhesions were not well visualized on today's study. Assessment of the terminal ileum was also difficult due to multiple overlying bowel loops in the pelvis that could not be easily displaced upon compression.Small bowel mucosa was unremarkable, without evidence of ulcers, sinus tracts, or fistulae. No separation of bowel loops was present to suggest fibrofatty proliferation. No definite persistent intraluminal filling defects. The proximal colon was grossly normal. TOTAL FLUOROSCOPY TIME: 3:44 mm:ss
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Intestinal malrotation with normal small bowel transit time. No specific findings to account for the patient's pain.
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Generate impression based on findings.
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Female 70 years old; Reason: Diagnosis of severe emphysema. Lung Transplant work-up History: SOBRADIOPHARMACEUTICAL: 11.1 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 99 mg/dL. Today's CT portion grossly demonstrates a right upper lobe nodule. There are emphysematous changes bilaterally. There are small bilateral hilar as well as mediastinal lymph nodes. There are severe coronary artery calcifications. There are low-attenuation lesions in the liver. There is cholelithiasis without evidence of cholecystitis.Today's PET examination demonstrates no discrete focus of marked hypermetabolic activity in the right upper lobe nodule with an SUV max of 8.7, consistent with tumor. There are several foci of increased activity in both hila as well as mediastinal subcarinal and precarinal lymph nodes which are nonspecific and more likely represent inflammatory process or granulomatous disease. There is a focus of increased activity in what appears to be a focally dilated ureter or adjacent soft tissue density likely a lymph node. There is no FDG activity seen in the low density liver lesions. There are no additional suspicious FDG avid lesions identified.
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1.Findings consistent with tumor activity in the right upper lobe lung nodule.2.Mild symmetric activity involving bilateral hilar as well as mediastinal lymph nodes are likely related to an inflammatory process or granulomatous disease. 3.Focal increased activity in what appears to be a focally dilated ureter or an adjacent hypermetabolic lymph node.
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Generate impression based on findings.
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51-year-old male with pain, redness, status post gunshot wound Intramedullary rod with screws affixes a comminuted fracture of the distal tibial diaphysis with numerous associated osseous fragments and metallic bullet fragments. Surgical clips overlie the soft tissues. There is mild diffuse soft tissue swelling about the foot which is otherwise intact.
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Orthopedic fixation of distal tibia fracture in near-anatomic alignment without evidence of hardware complication.
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Generate impression based on findings.
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30 year old female presents with infertility. Opacification of the uterine cavity revealed a normally oriented uterus without mucosal irregularity or filling defects. The left tube freely opacified with free spillage into the left peritoneal cavity indicating patency. The right tube did not opacify, and contrast seen within the right peritoneal cavity was likely secondary to contamination from the contralateral side. TOTAL FLUOROSCOPY TIME: 2:17 mm:ss
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Findings compatible with obstruction of the right fallopian tube. Normal left fallopian tube.
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Generate impression based on findings.
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Female 66 years old; Reason: chronic pancreatitis, heartburn and vomiting Visually there was significant and progressive gastric emptying. Using anterior and posterior geometric means, residual gastric activity at the following postprandial intervals was calculated as follows:30 mins: 84.2 % of peak activity (normal >70 %)1 hour: 49.2 % of peak activity (normal 30-90 %) 2 hours: 12.1 % of peak activity (normal <60 %) 4 hours: 4.3 % of peak activity (normal <10 %)
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Gastric emptying within normal limits.
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Generate impression based on findings.
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80 year-old female with reported fracture at outside hospital There is a large joint effusion. Lucency extending between the tibial spines indicates a nondisplaced tibial plateau fracture.
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Nondisplaced tibial plateau fracture as described above. Large joint effusion.
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Generate impression based on findings.
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Male 71 years old; Reason: metastatic glucagonoma to liver, therasphere MAPPING There is increased activity in the right lobe liver with multiple foci of intense activity which correlates with tumor. There is free technetium in the salivary glands. There is mild activity in the stomach, proximal small bowel as well as bilateral kidneys related to free technetium.Liver lung shunt fraction is 2.4%.
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1. No evidence of abnormal activity identified outside of the liver within the abdomen.2. Liver lung shunt fraction is 2.4%.
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Generate impression based on findings.
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Male 72 years old; Reason: 2 mo. hx of pelvic pain, weight loss, and firm, fixed left inguinal mass concerning for cancer History: Left inguinal mass ABDOMEN:LUNG BASES: Emphysematous changes with bibasal atelectasis left greater than right.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: Asymmetric hypo enhancement of the left kidney with mild left hydronephrosis and hydroureter to the level of the below described confluent retroperitoneal mass. The appearance is consistent with ureteric obstruction. Moderate left perinephric stranding. RETROPERITONEUM, LYMPH NODES: Extensive diffuse confluent retroperitoneal lymphadenopathy encasing the aorta and left renal vasculature. The left renal vein in particular is markedly attenuated but appears patent. This confluent nodal mass at the level of the renal artery measures approximately 8.9 x 6.2 cm (series 3, image 45).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: There is severe masslike thickening of the bladder wall suspicious for primary bladder malignancy.LYMPH NODES: Extensive pelvic lymphadenopathy, greater on the left side. A reference left external iliac node measures 3.9 x 4.4 cm (series 3, image 104). Extensive inguinal lymphadenopathy. A reference left inguinal node measures 2.4 x 2.2 cm (series 3, image 133).BOWEL, MESENTERY: Multiple soft tissue implants within the pelvis and lower abdomen suspicious for peritoneal carcinomatosis.BONES, SOFT TISSUES: Metallic artifact in the region of the right acetabulum/groin.OTHER: No significant abnormality noted.
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1. Masslike thickening of the bladder wall concerning for primary bladder neoplasm with extensive pelvic and retroperitoneal lymphadenopathy as well as peritoneal carcinomatosis. 2. There is hypoenhancement of the left kidney with mild left hydronephrosis and hydroureter secondary to obstruction from the above-described extensive confluent retrograde lymphadenopathy.
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Generate impression based on findings.
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Male 55 years old; Reason: mesothelioma History: mesothelioma The comparison chest radiograph performed on 2/4/2015 demonstrates right pleural effusion and thickening.The ventilation images show a wedge-shaped defect in the the right lower lobe which persists throughout the equilibrium phase. There is no abnormal Xe-133 retention during the wash-out phase. The perfusion images show absent perfusion in the periphery of the right lower lobe which is matched with the ventilation defect and correlates with the right pleural effusion and thickening seen on chest x-ray. Quantitation of relative single breath ventilation (using the posterior image):Left lung: 57% (upper lung 14%; middle lung 29% lower lung 14%)Right lung: 43% (upper lung 14%; middle lung 24%; lower lung 5%)Quantitation of relative pulmonary arterial perfusion (using anterior and posterior geometric means):Left lung: 60% (upper lung 15%; middle lung 37%; lower lung 8%)Right lung: 40% (upper lung 9%; middle lung 27%; lower lung 4%)
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1. Low probability for pulmonary embolism.2. Right lower lobe matched ventilation perfusion defect as quantified above.
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Generate impression based on findings.
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Stricture or kinking of the ureter. Etiology of obstructive pyelonephritis. Renal failure. The following observations are made given the limitations of an unenhanced study.ABDOMEN:LUNG BASES: Small bilateral pleural effusions (right greater than left) with overlying compressive atelectasis. Hiatal hernia.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple punctate nonobstructive bilateral renal calculi. There is mild perinephric inflammation surrounding the right kidney. Mild right pelvocaliectasis is noted with an indwelling ureteral stent which appears appropriately positioned. Along the distal right ureter, there are multiple calcifications, presumably representing ureteral calculi which measure up to 7 mm in diameter (image 130; series 10).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: Foley catheter decompresses the bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Bilateral nonobstructive renal calculi. Multiple distal right ureteral calculi with indwelling right ureteral stent. Perinephric inflammation compatible with right-sided pyelonephritis; no evidence of perinephric abscess.
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Generate impression based on findings.
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8-month-old male with prolonged fevers and increased work of breathing, tachypneaVIEWS: Chest AP/lateral (two views) 02/04/15 Cardiothymic silhouette is normal. No pleural effusion or pneumothorax. Right lower lobe streaky opacity likely represents atelectasis. Large lung volumes and bronchial wall cuffing suggestive of bronchiolitis/reactive airway disease.
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Bronchiolitis/reactive airway disease pattern with right basilar atelectasis.
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Generate impression based on findings.
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18 year-old male with hemoglobin SS complaining of right hip and knee painVIEWS: Right knee AP/oblique/lateral, left knee AP//lateral, pelvis AP/frog leg lateral (8 views) 02/04/15 No acute fracture or malalignment is evident. No joint effusion. No loose bodies are present. The articular surfaces are smooth. No specific evidence for avascular necrosis.
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Normal examination.
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Generate impression based on findings.
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39 year old female with fall two days ago, pain with thumb flexion No fracture or other specific findings to account for the patient's symptoms.
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Normal exam.
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Generate impression based on findings.
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Reason: 77 year old female patient diagnosed with HCC is here for a THERASPHERES MAPPING along with a nuclear medicine MAA There is increased activity in the lungs. Liver lung shunt fraction is 4.5%. There is activity in the right lobe of the liver with a focally more intense area of activity consistent with tumor in the upper right lobe of the liver. There is minimal free technetium in the salivary glands with mild activity in the bilateral kidneys related to free technetium.
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1. No evidence of abnormal activity identified outside of the liver within the abdomen.2. Liver lung shunt fraction is 4.5%.
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Generate impression based on findings.
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Reason: 54 yo male with neuroendocrine tumor; please evaluate for metastatic disease There is a discrete focus of increased activity in the head of the pancreas consistent with known neuroendocrine tumor. There is focally increased activity in the bilateral lower poles of the thyroid gland. There is no additional abnormal focus of activity to indicate an octreotide avid lesion.There is normal physiologic radiotracer distribution is seen in the spleen, kidneys, liver, bowel and bladder.
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1. Increased activity in the pancreatic head consistent with known endocrine tumor.2. Focally increased activity in the bilateral lower poles of the thyroid gland may be due to normal variation of the thyroid uptake or additional neuroendocrine tumor. Suggest correlation with thyroid ultrasound.
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Generate impression based on findings.
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25-year-old female with history of T-cell lymphoma status post stem cell transplant. Restaging.RADIOPHARMACEUTICAL: 8.6 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 105 mg/dL. Today's CT portion grossly demonstrates symmetric soft tissue thickening of the nasopharyngeal wall and symmetric enlargement of the bilateral palatine tonsils, appearing similar to that seen on the comparison exam. Right chest wall port catheter tip in SVC. Cholelithiasis.Today's PET examination demonstrates increased hypermetabolic activity associated with the nasopharyngeal wall thickening and bilateral palatine tonsils, which has increased from the previous exam. There are also single bilateral level 2 cervical hypermetabolic lymph nodes (SUV max of the right node 7.5), possibly new from the prior study, though comparison is limited due to extensive brown fat activity on the previous exam. These findings could represent inflammatory changes or lymphomatous involvement. No additional hypermetabolic activity in the chest, abdomen, or pelvis to suggest additional sites of FDG avid tumor.
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Bilateral hypermetabolic level 2 cervical lymph nodes as well as interval increase in hypermetabolic activity associated with symmetric soft tissue thickening in the nasopharyngeal wall and bilateral palatine tonsils, which may reflect inflammatory changes versus lymphomatous involvement.
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Generate impression based on findings.
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64-year-old male with duodenal mass on EGD who presents for characterization of the mass. ABDOMEN:LUNG BASES: Right basilar pleural calcification is unchanged dating back to 2012. No suspicious pulmonary nodules or pleural effusions.Trace pericardial effusion is unchanged compared to previous exam.LIVER, BILIARY TRACT: Hypoattenuating solid mass in the second portion of the duodenum measuring 1.4 x 1.1 cm (series 80292, image 49) corresponds to the location of the mass identified on the EGD. This is most likely a spindle cell tumor.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral hypoattenuating renal lesions consistent with simple cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild degenerative changes affect the visualized spine.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: No significant abnormality noted
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1.Hypoattenuating solid mass in the second portion of the duodenum corresponds to the location of the mass identified on the EGD. 2.No evidence of lymphadenopathy or metastatic disease in the abdomen or pelvis.
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Generate impression based on findings.
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cerebrovascular accident No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci, and cisterns are symmetric and unremarkable. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The mastoid air cells are clear. The right posterior ethmoid air cells show opacification.
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No evidence of acute ischemic or hemorrhagic lesion.
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Generate impression based on findings.
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head trauma No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear.
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No evidence of acute ischemic or hemorrhagic lesion.
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Generate impression based on findings.
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23-year-old male with right lower quadrant rebound tenderness, nausea and vomiting. Evaluate for appendicitis. ABDOMEN:LUNG BASES: Left basilar streaky and nodular opacities suggestive of aspiration with associated atelectasis; superimposed infection cannot be excluded.LIVER, BILIARY TRACT: Mild periportal edema likely reflects fluid status. Hypoattenuation along the falciform ligament most likely focal fat deposition.SPLEEN: 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: Bowel wall thickening of the fluid filled ileum as well as mild mucosal edema suspicious for enteritis. No evidence of small bowel obstruction. Additionally, the right colon is fluid filled. The appendix is not identified; however, no secondary signs of appendicitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: As above.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.Findings as above suggestive of enteritis involving the ileum without evidence of small bowel obstruction. Clinically correlate for infection; ischemia is considered less likely.2.Appendix is not identified; however, no secondary signs of appendicitis.3.Left basilar atelectasis and and opacities suggestive of atelectasis; superimposed infection cannot be excluded.
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Generate impression based on findings.
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syncope No evidence of acute ischemic or hemorrhagic lesion.Diffuse mild brain atrophy which is age appropriate.Patchy bilateral periventricular white matter low attenuations indicate non specific small vessel disease. Comparing to prior study, the extent of the lesion appears to be slightly progressed.The ventricles, sulci, and cisterns are symmetric and unremarkable. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear.
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1. No evidence of acute ischemic or hemorrhagic lesion.2. Mild to minimal brain atrophy and mild non specific small vessel ischemic disease.
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Generate impression based on findings.
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prior ischemic infarction and ICH No evidence of acute ischemic or hemorrhagic lesion.Previously shown right occipital and left temporo-occipital lobe ischemic strokes demonstrate evolution with volume loss including ex vacuo change of adjacent ventricle. No change of right thalamic chronic ischemic infarction and non specific small vessel disease on bilateral periventricular white matter since prior exam.The ventricles, sulci, and cisterns are symmetric and unremarkable. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear.
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1. No evidence of acute ischemic or hemorrhagic lesion.2. Normal evolution of right occipital and left temporo-occipital ischemic infarction results volume loss.3. No change of non specific small vessel disease since prior exam.
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Generate impression based on findings.
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28 year-old male with abdominal pain and ascites. History of desmoplastic small round cell tumor. Evaluate ABDOMEN:LUNG BASES: Left basilar nodule measures 2.1 x 1.4 cm (series 4, image 23), most likely metastatic in etiology. Mild bilateral basilar atelectasis. There is a cardiophrenic node which measures 4.5 x 2.6 cm (series 3, image 25), consistent with a metastatic lesion.LIVER, BILIARY TRACT: There is extensive perihepatic carcinomatosis resulting in scalloping of the liver contour. No intrahepatic biliary ductal dilatation.The portal confluence is patent but is narrowed from mass effect from the peritoneal carcinomatosis.SPLEEN: Extensive perisplenic carcinomatosis resulting in scalloping of the splenic contour.PANCREAS: Mass effect upon and posterior displacement of the pancreas from the confluent peritoneal carcinomatosis.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is extensive peritoneal disease with mass effect upon and encasement of the bowel as well as the stomach without evidence of small bowel obstruction. The extensive peritoneal disease results in mass effect upon the liver, portal confluence, spleen, and pancreas. The peritoneal disease near completely fills the pelvis with extensive mass effect on the pelvic structures. Large volume abdominal and pelvic ascites is present.Reference perisplenic lesion measures 4.5 x 3.2 cm (series 3, image 52).Reference perihepatic lesion superior to the liver measures 4.7 cm (coronal series 80276, image 43).BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Extensive peritoneal disease resulting in mass effect upon the prostate.BLADDER: Extensive peritoneal disease resulting in mass effect and anterior displacement of the bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: As above.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.Extensive confluent peritoneal disease which results in scalloping of the liver and splenic contour as well as extensive mass effect upon the pancreas, bowel, and the pelvic structures. Reference measurements as above.2.Large volume ascites.3.Findings consistent with thoracic metastatic disease at the lung bases. Further evaluation with dedicated CT chest may be considered if clinically indicated.
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Generate impression based on findings.
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known cavernous malformation follow up Re demonstration of right deep white matter, centrum semiovale, cavernous malformation. There is no change in size and CT characteristics since prior exam.The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear.
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1. No change of right centrum semiovale cavernous malformation in terms of size (10mm) and CT characteristics since prior exam.2. Otherwise unremarkable.
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Generate impression based on findings.
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Male 71 years old; Reason: eval infection or other acute process History: emesis, tachy, febrile ABDOMEN:LUNG BASES: Patchy air space opacities in the right base suggestive of infection/aspiration. Incompletely imaged hilar and mediastinal adenopathy. A right hilar node measures 1.3 cm in maximum short axis dimension. Status post aortic valve replacement. Incompletely imaged fatty lesion within the right chest wall suggestive of a lipoma.LIVER, BILIARY TRACT: Hepatic steatosis. Hyperattenuating lesion within the left hepatic lobe measuring 2.8 x 1.9 cm (series 3, image 33) which is incompletely evaluated on this single phase of contrast but may represent a hemangioma.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Nonspecific 1.9 x 1.2 cm hyperattenuating left adrenal lesion. In the absence of known primary malignancy, favor benign etiology.KIDNEYS, URETERS: Non obstructing right renal stone measuring 7 mm in maximum dimension. Hypoattenuating right renal lesion is suggestive of renal cyst. Hypoattenuating left renal lesion is too small to characterize. Mild left renal scarring.RETROPERITONEUM, LYMPH NODES: Arteriosclerosis of the abdominal aorta and branch vessels.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: The prostate gland is enlarged measuring 5.2 x 4.7 cm.BLADDER: Bladder wall thickening is likely secondary to prostatic hypertrophy.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: At least two punctate sclerotic foci within the left ribs nonspecific but may represent bone islands.OTHER: No significant abnormality noted.
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1.Hyperattenuating liver lesion which is incompletely characterized on this single phase of contrast but may represent a hemangioma.2.Left adrenal nodule is nonspecific. In the absence of known primary malignancy, favor benign etiology.3.Right basal pneumonia/aspiration with nonspecific lymphadenopathy which is incompletely characterized on the study.
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Generate impression based on findings.
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42-year-old male with history of right flank pain and small fragments in urine. History of right partial nephrectomy in 2014 for RCC. 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: Adjacent to the right kidney is an approximately 5.7 x 3.6 x 3.4-cm fluid collection which extends into the right anterolateral abdominal wall. There is mild adjacent inflammatory stranding, and one delayed images, this collection partially fills with contrast, consistent with urinoma.Right renal post partial nephrectomy changes are noted.The left kidney is within normal limits.RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No small bowel obstruction or free air. The appendix is within normal limits.BONES, SOFT TISSUES: Punctate sclerotic focus in the left posterior iliac bone (sagittal image number 86) is unchanged, likely benign bone island.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: No significant abnormality noted
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Small fluid collection adjacent to the right kidney extending into the anterolateral abdominal wall and filling with contrast on delayed images, consistent with urinoma.
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Generate impression based on findings.
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follow up of left thalamic ICH Re demonstration of the left thalamic ICH,IVH with midline shift toward right side.The degree of midline shift at the level of foramen of Monroe appears to be stable (about 11mm).The size of ICH and the amount of IVH appear to be stable.Right frontal approach ventriculostomy tube and the tip position are stable.Previously shown right hemispheric SAH is not demonstrated as more.The paranasal sinuses and mastoid air cells are clear.
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1. No interval change of left thalamic ICH, IVH and mass effects since prior exam.2. Stable ventriculostomy tube position.
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Generate impression based on findings.
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confusion, word finding difficulties Subtle multifocal low attenuations on the left frontal lobe indicate possible ischemic lesion. No evidence of acute hemorrhagic lesion.The ventricles, sulci, and cisterns are symmetric and unremarkable. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear.
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Subtle low attenuations on the left frontal lobe indicate possible acute ischemic lesion. Brain MRI can be considered for further evaluation.
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Generate impression based on findings.
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No acute facial bone fracture is identified. There is an anterior septal hematoma measuring greater than 14 mm in diameter. There is moderate to severe rightward nasal septum deviation, which contacts the middle turbinate and causes mass effect on the right inferior turbinate. There is reticulation of the subcutaneous fat around the nose, consistent with edema. Bilateral concha bullosa are present. The temporomandibular joints are intact.No orbital fracture is identified. The globes are intact. There is no evidence of intraorbital hematoma or stranding.The roots of the left second maxillary molar project into the floor of the maxillary sinus. The frontal sinuses are hypoplastic. There is mucosal thickening of the anterior ethmoid air cells and bilateral maxillary sinuses. The mastoid air cells and middle ear cavities are clear. Cerumen is present in the external auditory canals.
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1. Anterior septal hematoma and edema of the nasal soft tissues, without definitive nasal bone fracture.2. Moderate to severe rightward deviation of the nasal septum.
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Generate impression based on findings.
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Female 43 years old Reason: PE? evolution of PNA? s/p HCAP treatment. pre-LVAD eval. History: as above PULMONARY ARTERIES: No acute pulmonary embolus. Pulmonary artery is enlarged measuring up to 33 mm suggestive of pulmonary arterial hypertension. No evidence of right heart strain.LUNGS AND PLEURA: Interval decrease in size of ill-defined pulmonary nodules likely representing resolving infection.Interval decrease in left pleural effusion, compressive atelectasis, ground glass opacities, and septal thickening. Scattered calcified micronodules compatible with previous granulomatous infection, unchanged.MEDIASTINUM AND HILA: Persistent mediastinal lymphadenopathy, slightly improved from previous. Large prevascular lymph node measures 11 mm (series 7, image 80), previously 15 mm. Moderate cardiomegaly and pericardial effusion is unchanged. No coronary artery calcifications in this non-gated study. Right PICC with tip in the SVC.Interval removal of right IJ catheter.CHEST WALL: Left chest wall ICD.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.
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1.No acute pulmonary embolus.2.Interval improvement in ill-defined pulmonary nodules consistent with resolving infection.3.Improved left pleural effusion.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Negative.
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Generate impression based on findings.
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7-year-old female with intubatedVIEW: Chest AP (one view) 02/05/15 ET tube tip is just above the carina pointing towards right mainstem bronchus. Right internal jugular central venous catheter with tip in the right internal jugular vein. Enteric tube tip is in the gastric antral pyloric region. NG tube tip is in the gastric body. Vagal nerve stimulator device overlies the left chest with leads in the left neck.Cardiothymic silhouette is normal. Low lung volumes. Increased left lower lobe opacity with blunting of left costophrenic angle. Mild elevation of the right minor fissure suggestive of upper lobe subsegmental atelectasis. No pneumothorax. Mild rightward curvature of the thoracic spine.
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ET tube tip abuts the carina. Increased left lower lobe atelectasis with probable small pleural effusion.
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Generate impression based on findings.
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Male, 60 years old.RFO NG tube with tip at the GE junction. Right abdominal drain. Residual contrast within the duodenum and proximal jejunum. Contrast within the bladder. Nonobstructive bowel gas pattern. No unexpected radiopaque foreign bodies.Left retrocardiac consolidation/atelectasis.
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No unexpected radiopaque foreign bodies. Findings were discussed with Dr. Wyers via telephone at 17:20 on 2/4/2015 by the radiology resident on call, Dr. Westin.
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Generate impression based on findings.
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53 year old female with history of left upper quadrant pain, nausea and vomiting. Evaluate left upper quadrant fluid collection. ABDOMEN:LUNG BASES: Small left pleural effusion, minimally decreased in size from prior. Overlying associated subsegmental atelectasis, with additional subsegmental atelectasis dependently on the right.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: History of splenectomy.PANCREAS: Postoperative findings of prior distal pancreatectomy, with the remaining portion of the pancreas appearing unchanged. The adjacent vasculature is patent.The previously described left anterior abdominal fluid collection (3/40) measures 4.4 x 2.3 cm, slightly decreased in size from the previous 4.9 x 2.6 cm. The left percutaneous drain placed on 1/20/2015 is appropriately located within the anterior portion of the collection.The posterior portion of this collection, layering against the left lateral abdominal wall (3/36), measures 3.5 x 1.6 cm, unchanged from prior measurement.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The cyst-gastrostomy stents, and the nasojejunal tube are in their expected locations. Anterior/incisional hernia is again noted, without obstruction or bowel wall thickening.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Along the left lower abdominal wall are multiple subcutaneous nodules (3/90) the largest of which measuring 1.6 x 1.8 cm. These have increased in size from prior scans and may be inflammatory in nature, however cannot exclude metastases.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Postoperative findings of colectomy and J-pouch are unchanged.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.Slight interval decrease in size of the fluid collection in the distal pancreatectomy surgical bed, with percutaneous drain appropriately positioned in the superior portion of the collection.2.The additional, more posterior fluid collection is unchanged in size.3.Subcutaneous nodules are again noted, slightly increased in size from prior.
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Generate impression based on findings.
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Female 11 years old Reason: f/u exam History: intubated, epilepsy with seizures.VIEW: Chest AP (one view) 2/5/15 at 511 hours. Thoracolumbar levoscoliosis unchanged. Cardiac silhouette is not sizable. Persistent chronic atelectasis of the right lung base. Interval ET tube removal.
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Interval removal of ET tube.
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Generate impression based on findings.
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Male, 71 years old.RFO NG tube with tip in the body of the stomach. Surgical clips at the GE junction. Two right upper quadrant drains. Nonobstructive bowel gas pattern. Moderate amount of free intraperitoneal air, likely related to recent surgery.Sternotomy hardware. Bibasilar atelectasis/scarring and small pleural effusions. Skin staples project over the right upper quadrant and both hips. No unexpected radiopaque foreign bodies.
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No unexpected radiopaque foreign bodies. Findings discussed with Dr. Choi via telephone at 21:13 on 2/4/2015 by the radiology resident on call, Dr. Westin.
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Generate impression based on findings.
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23-year-old male with jaw pain There is an oblique fracture of the posterior left mandibular body as seen on recent CT. Partial loss of the adjacent mandibular molar is noted. The paranasal sinuses are clear. Unerupted maxillary molars are also noted.
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Left mandibular body fracture.
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Generate impression based on findings.
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Female 40 years old; Reason: 40 yo F hx of multiple myeloma with diarrhea and abdominal pain. infectious work up neg. eval for possible etiology such as colitis History: abdominal pain, diarrhea ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Mild prominence of the central intrahepatic ducts, unchanged compared to CT thoracic spine 01/09/15.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mild arteriosclerosis of the abdominal aorta and branch vessels.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Diffuse anasarca. Multiple lytic lesions throughout the osseous skeleton consistent with patient's none history multiple myeloma. For example within the right iliac bone (series 3, image 92), within the sacrum (series 3, image 97).OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Diffuse anasarca. Multiple lytic lesions throughout the osseous skeleton consistent with patient's none history multiple myeloma. For example within the right iliac bone (series 3, image 92), within the sacrum (series 3, image 97).OTHER: No significant abnormality noted.
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1.No evidence of colitis. No specific cause for patient's abdominal pain and diarrhea is identified.2.Multiple lytic bone lesions consistent with provided history multiple myeloma.
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Generate impression based on findings.
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75-year-old male with left hip pain There is a nondisplaced, impacted fracture of the left femoral neck. A trochanteric femoral nail is noted affixing the right hip without evidence of hardware complication. There is poor visualization of the proximal femur on the crosstable lateral view. Vascular calcifications are present in the soft tissues.
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Impacted nondisplaced left femoral neck fracture.
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