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Generate impression based on findings.
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Female 56 years old Reason: bilat knee pain r/o osteo History: bilat knee pain r/o osteo Right knee: Bone mineralization is normal. There is mild medial compartment joint space loss. No significant joint effusion. There are tricompartmental osteophytes. No acute fracture or malalignment.Left knee: There is mild medial compartment joint space loss and tricompartmental osteophytes. Small joint effusion is present. No acute fracture or malalignment.There is no specific evidence of osteomyelitis.
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Bilateral knee osteoarthritis. Left knee effusion. No specific evidence of osteomyelitis. Consider joint aspiration.
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Generate impression based on findings.
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Reason: 50 y/o f with restrictive lung disease on PFTs, eval for ILD. Also obstruction, eval for bronchiolitis, emphysema, etc. Also CAD history, eval for pulmonary edema. History: shortness of breath LUNGS AND PLEURA: Linear scarlike opacities left lung base, but no evidence of pulmonary fibrosis.Airways appear normal without evidence of bronchiectasis or bronchial wall thickening.Expiration series shows no significant air trapping. Calcified granuloma right lung base.MEDIASTINUM AND HILA: Severe coronary artery calcifications with what appears to be at least one coronary stent. There is no mediastinal or hilar lymphadenopathy.CHEST WALL: Degenerative abnormalities affect the thoracic spine.Status post median sternotomy.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Status post gastric surgery, likely bariatric.Extensive vascular calcifications are seen in the upper abdomen.
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Left basilar scarring, but no evidence of interstitial lung disease or airways disease.
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Generate impression based on findings.
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Male 63 years old; Reason: 63M with h/o multiple CVA's with cognitive issues, MI's, DM off metformin since admit 1/30/15 History: new lung nodules on CT (NOTE: Please discuss any issues with pt's wife due to his cognitive issues)RADIOPHARMACEUTICAL: 14.5 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 99 mg/dL. Today's CT portion grossly demonstrates postsurgical changes from esophagectomy and gastric pull up. There are numerous bilateral pulmonary nodules and masses, largest in both apices. There is extensive groundglass abnormalities in both upper lobes. There is a small right and medium sized left pleural effusion. There is evidence of median sternotomy and CABG. There is a 1 cm retroperitoneal nodule superior to the left kidney.Today's PET examination demonstrates numerous moderately hypermetabolic bilateral pulmonary nodules and masses indicative of metastatic disease, the largest of which is in the right apex with an SUV max of 15.4. There are extensive mildly hypermetabolic groundglass opacities throughout the bilateral upper lobes consistent with superimposed infection. In addition there are hypermetabolic mediastinal lymph nodes, for example a subcarinal lymph node with an SUV max of 6.0 indicative of additional thoracic metastatic disease. There are multiple hypermetabolic hepatic metastases, most evident in the left lobe anteriorly with an SUV max of 8.2. There are additional upper abdominal hypermetabolic portohepatic and mesenteric lymph nodes as well as retroperitoneal hypermetabolic nodules indicative of additional abdominal metastatic disease (SUV max 10.0). There are multiple hypermetabolic osseous metastases in the thoracic spine, pelvis, ribs and bilateral hips; for reference the T1 lesion has an SUV max of 11.3.There is a curvilinear increased activity along the inferior left ventricular myocardium considered more likely related to ischemia than metastatic disease given the eccentric location.There are no additional suspicious FDG lesions identified.
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1.Widespread hypermetabolic thoracic, abdominal and osseous metastatic disease.2.Heterogeneous cardiac uptake is suggestive of ischemic disease. Correlation with cardiac scintigraphy may be useful.
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Generate impression based on findings.
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Seizure activity with history of migraines. NONCONTRAST CT HEADNo evidence of acute intracranial hemorrhage. No mass effect, midline shift or herniation. The ventricles, sulci, and cisterns are symmetric and unremarkable. No intra- or extra-axial fluid collection. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. CTA HEADThere is normal contrast opacification through anterior circulation, including the internal carotid arteries and anterior and middle cerebral arteries.Within the posterior circulation, there is normal contrast opacification of the vertebral-basilar, posterior-inferior cerebellar, anterior-inferior cerebellar, superior cerebellar, and posterior cerebral arteries. There is normal contrast opacification through a complete circle-of-Willis with a patent anterior communicating artery and bilateral posterior communicating arteries. No evidence of aneurysm, significant stenosis, occlusive thrombus, dissection, or vascular malformation is noted.
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1.No evidence of acute intracranial hemorrhage or mass effect.2.No evidence of significant steno-occlusive disease or aneurysms within the intracranial circulation.
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Generate impression based on findings.
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73-year-old male with history of metastatic prostate cancer, bony pain. Assess for progression. Multiple foci of abnormal radiotracer uptake in the scapulae, ribs, and vertebral bodies are increased in number and activity.Other increased radiotracer uptake in the cervical spine, shoulders, elbows, wrists, and knees likely reflect degenerative arthritic changes. Two foci in the right anterior sixth and seventh ribs are stable and are typical of post-traumatic lesions.
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Interval progression of bone metastases, as evidenced by increased number and activity of foci in the scapulae, ribs, and vertebral bodies.
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Generate impression based on findings.
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20 year old female patient submitted outside study for review. Submitted for review are ultrasound images of right breast (12/8/14) and limited right breast digital mammographic images (12/8/14) performed at South Shore Hospital. Per outside radiology report, the patient complained of right breast lump.ULTRASOUND IMAGES OF RIGHT BREAST (12/8/14):Sonographic images of right breast at 11-12 o'clock position were obtained. There is a questionable hypoechoic lesion measuring 8 mm at maximum diameter at 11-12 o'clock position. On Doppler study, blood flow is seen at the periphery of this lesion, or just next to this lesion.LIMITED RIGHT BREAST DIGITAL MAMMOGRAPHIC IMAGES (12/8/14):Two spot compression CC views of the right breast were obtained. No mass, suspicious microcalcifications or areas of architectural distortion are noted.
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Questionable lesion in right breast at 11-12 o'clock position on the ultrasound. Repeat ultrasound study is recommended.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: X - No Letter.
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Generate impression based on findings.
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34-year-old male with history of Hodgkin's lymphoma. Needs restaging after relapse. CHEST:LUNGS AND PLEURA: Interval increased small right pleural effusion and associated atelectasis. Previously seen right middle lobe nodule (4/80) measures 1.5 x 0.8 cm, increased from prior 4 mm.MEDIASTINUM AND HILA: Heart size within normal limits, and there is no pericardial effusion. No significant mediastinal or hilar lymphadenopathy. Persistent calcified hypoattenuating mass with peripheral calcification abuts the right atrium and likely represents a calcified pericardial cyst.CHEST WALL: Right posterolateral ninth rib expansile lytic lesion (7/191) with an approximately 6.6 x 4 cm soft tissue component, new from prior. Right chest dual lumen Port-A-Cath with tip in the SVC.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Nonobstructing right renal calcification.RETROPERITONEUM, LYMPH NODES: Left para-aortic lymph node has increased in size, measuring approximately 2 x 1.3 cm (701/110), previously 0.8 x 0.5 cm. Additional retroperitoneal lymph nodes have increased in size.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Multifocal, increased bilateral inguinal and iliac lymphadenopathy, with reference left inguinal lymph node (701/196) measuring 3 x 2.6 cm, previously 2 x 1.4 cm. Several lymph nodes have relatively low attenuation centrally.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.Increased lymphadenopathy as above.2.Interval increase in pulmonary nodule size and small pleural effusion.3.New right posterolateral chest wall ninth rib expansile lytic lesion with associated soft tissue mass.
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Generate impression based on findings.
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41-year-old male with shoulder pain after fall Glenohumeral alignment is within normal limits. No fracture or other specific finding to account for the patient's symptoms.
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No fracture or dislocation.
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Generate impression based on findings.
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Male; 62 years old. Reason: NHL, SCCA head/neck History: NHL, SCCA head/neck LUNGS AND PLEURA: Interval development of multiple micronodules in the right middle lobe, the largest of which measures 4 mm (series 4/55).Right upper lobe sub-solid nodule measures 6 mm (series 4/46), unchanged.Previously described left upper lobe and smaller right lower lobe nodules have resolved.Additional scattered pulmonary micronodules, some of which are calcified, are stable.No pleural effusions.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Normal heart size without pericardial effusion. Mild coronary artery calcifications.CHEST WALL: Slightly decreased fluid collection anterior to the sternum, likely representing a sebaceous cyst. Prominent bilateral axillary and subpectoral lymph nodes, but no lymphadenopathy by CT size criteria.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Small splenule. Fatty atrophy of the pancreas.. Stable small para-aortic lymph nodes. Very small hypoattenuating lesion at the dome of the liver is too small to characterize but likely a cyst.
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Multiple new nonspecific micronodules in the right middle lobe. The distribution is atypical for metastases, and these could be inflammatory. Follow up in no longer than 3 months is recommended. Note that previously seen retroperitoneal lymphadenopathy is not included in this scan, and the next CT should include at least the abdomen.
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Generate impression based on findings.
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23-year-old male with pain and swelling after basketball injury There is an oblique fracture of the distal aspect of the proximal phalanx of the little finger extending to the articular surface without significant displacement.
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Fifth finger fracture as described above.
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Generate impression based on findings.
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71 year-old female with rib pain along left side Radiopaque markers are placed along the left lower chest wall at the site of the patient's pain. The bones are demineralized limiting sensitivity, and there is moderate colonic stool and gas obscuring the lower ribs. No rib fracture is visualized.
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No evidence of rib fracture.
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Generate impression based on findings.
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Line placementVIEW: Chest AP and abdomen AP Nasogastric tube tip in the stomach. The umbilical venous catheter tip in the right atrium. The umbilical arterial catheter tip is looped within L2/4. Cardiothymic silhouette normal. No focal lung opacity. No pleural effusion or pneumothorax. Disorganized nonobstructive bowel gas pattern. No pneumatosis or pneumoperitoneum.
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Malpositioned umbilical arterial catheter.
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Generate impression based on findings.
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53-year-old male with history of electrical burn and limited finger movement with volar wrist pain. The bones are slightly demineralized. Alignment is normal limits. There is no fracture or other specific findings to account for the patient's pain.
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No specific findings to account for the patient's symptoms.
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Generate impression based on findings.
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2-year-old female with Langerhans histocytosis with pulmonary involvement LUNGS AND PLEURA: Significant interval improvement of bilateral pulmonary opacities. Small residual opacities are seen along the major fissure in the left lower lobe, right middle and lower lobe, and perihilar along the bronchovascular tree. The reference right lung base cavitary lesion measuring 2.6 cm has significantly improved with a residual ring like opacity measuring 1.4 cm (series 5, image 26). The reference nodule in the superior segment of the left lower lobe with now measures 3 mm, previously 1.5 cm. No pneumothorax or pleural effusion.MEDIASTINUM AND HILA: The heart size is mildly enlarged. No pericardial effusion. Right chest port catheter tip is at the inferior cavoatrial junction. The thymus appears to be normal in size. Punctate calcification just above the left mainstem bronchus measuring 3 mm is unchanged (series 4, image 18).CHEST WALL: No significant axillary, cardiophrenic, or retrocrural lymphadenopathy. The osseous structures are within normal limits.UPPER ABDOMEN: Limited examination due to lack of IV and oral contrast. No significant abnormality is noted.
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Significant interval improvement of bilateral pulmonary nodules and cavities with mild residual disease described above.
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Generate impression based on findings.
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History of osteomyelitisVIEWS: Right wrist AP and lateral Again noted periosteal reaction and sclerosis along the distal radius and ulna reflecting interval healing in a patient with known history of osteomyelitis of the wrist. There is minimal soft tissue swelling about the wrist joint. No acute fractures or dislocation.
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Healing osteomyelitis involving the distal radius and ulna.
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Generate impression based on findings.
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73-year-old female with history of myeloma and back pain. Postsurgical changes of kyphoplasty at T9. There is a moderate thoracic kyphosis. There is no evidence of acute compression deformities. Moderate to severe degenerative disc disease affects the visualized cervical spine. Lytic lesions noted within bilateral clavicles, likely secondary to patient's known history of myeloma.
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T9 kyphoplasty without acute abnormality. Other findings as above.
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Generate impression based on findings.
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There are unchanged postoperative findings related to left globe prosthesis and right lens prosthesis with atrophy of the left rectus muscles. There is unchanged right-sided proptosis without evidence of intraorbital mass or abnormal enhancement. There is no evidence of osseous lesion. The right optic nerve does not appear stretched. There are chronic deformities of both medial orbital walls, likely relating to prior trauma. There is a small retention cyst within the left maxillary antrum and minimal ethmoid mucosal thickening. There is no chiasmatic mass or parasellar abnormality. There is a significantly ectatic right vertebral artery.There is a patchy focus of low attenuation within the visualized right frontal white matter most compatible with age-indeterminate small vessel ischemic disease.
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Unchanged right sided proptosis without evidence of orbital mass.
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Generate impression based on findings.
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Female 54 years old; Reason: Evaluate for cancer, being considered for lung transplant, ?R lung nodule seen on CT History: Possible lung noduleRADIOPHARMACEUTICAL: 13.1 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 126 mg/dL. Today's CT portion grossly demonstrates bilateral bronchiectasis with fibrosis and scattered associated nodularity bilaterally but no dominant suspicious nodules noted. There is a peripherally hyperdense right inferior kidney nodule measuring approximately 2.3 cm. There is a second small lesion with similar high density in the superior left kidney measuring approximately 1.8 cm.Today's PET examination demonstrates no hypermetabolic lesions in either lung to suggest malignancy. However the right inferior renal lesion demonstrates some FDG activity (SUV max 2.8) and the second small lesion in the superior left kidney has an SUV max of 1.9. These most likely indicate solid lesions and while not significantly hypermetabolic are still suspicious for renal cell cancer as the many are only weakly avid.There are no additional suspicious FDG avid lesions identified
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1.No suspicious hypermetabolic pulmonary nodules identified to indicate lung cancer.2. However there are right inferior and left superior renal parenchymal lesions which are suspicious for renal cell carcinoma. Further evaluation with dedicated CT or MRI could be performed.
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Generate impression based on findings.
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Knee painVIEWS: Pelvis AP and frog leg No acute fracture or dislocation. Both the femoral heads are seated within the acetabula.
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Normal examination.
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Generate impression based on findings.
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Redemonstrated are post-surgical changes from a right frontoparietal craniotomy and right hemispherectomy. Dystrophic appearing calcifications are again seen along the dura, which are unchanged. Unchanged small right sided extra-axial collection. Again seen is a ventriculostomy tube coursing through the left parietal lobe into the left lateral ventricle with the tip at the lateral aspect of the trigone. The lateral ventricles and fourth ventricle are stable in size when compared to the prior exam. Unchanged shunt catheter in the right temporo-occipital region. Periventricular hypodensities are again present which are stable compared to the prior exam. No evidence of acute intracranial hemorrhage, new mass or mass-effect.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.
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1.Stable size of the ventricular system without evidence of hydrocephalus. .2.Stable post-surgical changes from a right hemispherectomy.3.Unchanged findings suggestive of periventricular leukomalacia along the left hemisphere.
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Generate impression based on findings.
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Female 68 years old. Re-evaluate solitary pulmonary nodule. LUNGS AND PLEURA: Persistent right lower lobe septated, cystic thin-walled lesion with adjacent scarring is again seen. The lesion is contiguous with a right lower lobe bronchiole and appears similar in size without significant interval change, and is likely post infectious in etiology.Scarring seen within the lingula, unchanged.No suspicious pulmonary nodules or masses.Scattered pulmonary micronodules many of which are calcified and likely represent prior granulomatous infection.No consolidation or pleural effusion.No pneumothorax. MEDIASTINUM AND HILA: Multiple, calcified and enlarged mediastinal and hilar lymph nodes appear similar to previous and are likely secondary to prior granulomatous infection.Heart size is normal without pericardial effusion.Atherosclerotic calcifications of the aorta and its branches with mild coronary artery calcifications.CHEST WALL: Moderate degenerative changes of the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Status post cholecystectomy.
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Stable right lower lobe cystic lesion is most likely benign and post-infectious in etiology. Follow up with low-dose thoracic CT in 12 months can be obtained to confirm stability.
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Generate impression based on findings.
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Frontal sinus: There is mild mucosal thickening of the right frontal sinus.Anterior ethmoids: Evidence of partial right sided ethmoidectomy. Moderate mucosal thickening of the left anterior ethmoid air cells. Mild circumferential mucosal thickening of the right ethmoidectomy cavity.Maxillary sinuses: Redemonstration of postoperative findings related to functional endoscopic sinus surgery, including right antrostomy. There is extensive mucoperiosteal thickening of the right maxillary sinus, however, the right antrostomy is clear. There is trace left maxillary sinus mucosal thickening. Left ostiomeatal unit is clear.Posterior ethmoids: Mild mucosal thickening of the residual right posterior ethmoid air cells. Near-complete opacification of the left posterior ethmoid air cells.Sphenoid sinus: Complete opacification of the left sphenoid sinus and left sphenoethmoidal recess. Mild mucosal thickening of the right sphenoid sinus with mild opacification of the right sphenoethmoidal recess.There is mild leftward nasal septal deviation. The nasal turbinate morphology is within normal limits. The are frothy secretions in the left posterior nasal cavity.The lamina papyracea are intact. The roof of the ethmoids is relatively symmetric.
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1. Interval mixed change in paranasal sinus disease. Extensive mucosal thickening of the right maxillary, left posterior ethmoid, and left sphenoid sinus, with opacification of the left sphenoethmoidal recess. Otherwise, mild pan-sinus mucosal thickening.2. Status post functional endoscopic sinus surgery on the right. Patent right antrostomy and left ostiomeatal unit.
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Generate impression based on findings.
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Evaluate healing fractureVIEWS: Left hand AP, oblique and lateral Again noted irregularity involving the metaphysis of the fourth proximal phalanx not significantly changed from prior study. No definite periosteal reaction noted.
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Probable Salter II fracture of the proximal fourth phalanx.
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Generate impression based on findings.
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Female; 62 years old. Reason: evaluation preoperatively for meso History: evaluation preoperatively for meso CHEST:LUNGS AND PLEURA: Extensive, confluent nodular left pleural thickening, compatible with the known history of mesothelioma. For future reference, the following measurements are provided:At the level of the aortic arch (series 4/29), 9 mm at 4 o'clock, 10 mm at 9 o'clock, and 11 mm at 11 o'clock.At the level of the left main pulmonary artery (series 4/41), 11 mm at 12 o'clock, 18 mm at 5 o'clock, and a 16 mm at 7 o'clock.At the level of the left ventricular apex current (series 4/65), 11 mm at 5 o'clock, 27 mm at 7 o'clock, and 20 mm at 11 o'clock.Tumor extends into the left lateral mediastinum with abutment of tumor along the proximal descending thoracic aorta (series 4/37) and the distal esophagus (series 4/73). Tumor extends along and likely involves most of the left pericardium. Tumor extends deeply into the left costophrenic angle with extension into the left perisplenic fat and abutment along the posterior spleen (series 4/86).Numerous groundglass nodules and solid nodules with surrounding groundglass in both lungs. For future reference, the largest in the right middle lobe measures 13 mm (6/58).Small amount of loculated left pleural fluid.MEDIASTINUM AND HILA: See above regarding left pleural tumor into the left lateral mediastinum and along the left pericardium. Small mediastinal and bilateral hilar lymph nodes, but no lymphadenopathy by CT size criteria. Normal heart size. No pericardial effusion. Mild coronary artery calcifications.CHEST WALL: Mild degenerative arthritic changes of the spine with mild superior endplate compression deformities of T11 and L2 vertebral body.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Small fat density lesion in the right lobe of the liver may be due to focal fat deposition (series 4/98). No suspicious liver lesions. Prominence of the common bile duct measuring up to 10 mm with a distal smooth tapering, which can be normal variation status post cholecystectomy.SPLEEN: Pleural tumor extends into the lateral perisplenic fat with abutment along the posterior spleen as described above.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.Postsurgical changes from gastric banding. Scattered colonic diverticula without evidence of diverticulitis. Submucosal fat in the partially visualized ascending and descending colon may be related to prior inflammation.BONES, SOFT TISSUES: Mild degenerative arthritic changes of the spine with compression deformities of T11 and L2 vertebral body. Small nonspecific lucency in the right aspect of the L1 vertebral body (series 4/90).OTHER: No significant abnormality noted.
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1. Extensive mesothelioma.2. Nodular opacities in both lungs are nonspecific and may be related to infection or inflammation. Metastatic disease or lung cancer primaries cannot be excluded.
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Generate impression based on findings.
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15-year-old female with tachypnea, PaO2 decreasing PULMONARY ARTERIES: Pulmonary artery opacification is adequate without evidence of pulmonary embolism. LUNGS AND PLEURA: Right upper lobe consolidation. Moderate right pleural effusion and minimal left pleural effusion is seen. Patchy bibasilar opacities likely represent atelectasis.MEDIASTINUM AND HILA: ET tube tip is just above the carina. Right internal jugular and right upper extremity PICC tips are at the superior cavoatrial junction.CHEST WALL: Spinal fixation rods and hook device is seen without evidence of hardware complication. Residual leftward curvature of the thoracic spine and rightward curvature of the thoracolumbar spine is seen.UPPER ABDOMEN: Enteric tube is seen coursing into the stomach. No significant abnormalities are noted.
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1.No evidence pulmonary embolism.2.Right upper lobe and bibasilar consolidation likely atelectasis.3.Moderate right pleural effusion and small left pleural effusion.
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Generate impression based on findings.
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87-year-old male with abnormal LFTs, weight loss, rib pain. Evaluate for malignancy.Per chart review, patient with history of bladder cancer CHEST:LUNGS AND PLEURA: Mild upper lobe predominant paraseptal and centrilobular emphysema. Mild bronchial wall thickening is again noted. No suspicious pulmonary nodules or masses. Scattered micronodules are unchanged. No pleural effusions or pneumothorax.MEDIASTINUM AND HILA: Marked atherosclerotic calcifications affect the thoracic aorta with focal aneurysm at the level of the aortic arch measuring 38 mm, unchanged. Heart size is normal without pericardial effusion. Marked coronary artery calcifications. No mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions on this nondedicated exam.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal hypoattenuating lesions, some of which are compatible with simple cysts and some of which are incompletely characterized but stable compared to previous exam.RETROPERITONEUM, LYMPH NODES: Extensive atherosclerotic calcifications affect the abdominal aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Penile prosthesis noted.BLADDER: Bladder wall thickening is nonspecific given underdistention of the bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Bilateral femoral head sclerosis may represent avascular necrosis.OTHER: No significant abnormality noted
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1.No focal hepatic lesions identified on this nondedicated examination. 2.Bilateral femoral head sclerosis suggestive of avascular necrosis.
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Generate impression based on findings.
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45-year-old female with history of patella fracture Again seen is a comminuted, intra-articular fracture of the patella with fracture fragments in near-anatomic alignment. A small joint effusion is again noted.
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Nondisplaced patella fracture without significant interval change.
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Generate impression based on findings.
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Ms. SimpsonWells is a 51 year old female with a personal history of right breast mastectomy in 09/2014 for recurrent IDC/DCIS treated with chemoradiation. Family history of breast cancer in paternal aunt. She has no current breast related complaints. Three standard views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in the left breast.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, left unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram.
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Generate impression based on findings.
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The paranasal sinuses are clear. The nasal cavity is also clear. There is no significant nasal septal deviation. The lamina papyracea and ethmoid roofs are intact. The carotid groove 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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No evidence of sinusitis.
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Generate impression based on findings.
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Female 58 years old; Reason: Pt w/ extensive state small cell lung CA; c/o severe pain in bilateral lower extremities. No suspicious osseous lesions are identified to indicate metastatic disease.
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No evidence of bone metastases. No bone scan explanation for the patient's bilateral lower extremity pain.
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Generate impression based on findings.
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67 year old female with history of urothelial cancer. Evaluate for progression of disease. IRB # 13-0540. CHEST:LUNGS AND PLEURA: Reference left upper lobe nodule (7/31) has increased in size, measuring approximately 4.1 x 3 .3 cm, previously 2 x 2.8 cm. Additionally, other pulmonary nodules have increased in size, and there are new nodules.Increased small bilateral pleural effusions and pleural nodularity.MEDIASTINUM AND HILA: Cardiomegaly and trace pericardial fluid. Severe coronary artery calcifications, as well as calcifications of the valves. Calcified mediastinal lymph nodes are again noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Hepatic granulomata, similar to prior, and additional hypoattenuating foci appearing similar to prior.SPLEEN: History of splenectomy.PANCREAS: Postoperative findings of distal pancreatectomyADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Postoperative findings of left nephrectomy, without evidence of local recurrence. Right kidney within normal limits, with two small cysts appearing unchanged.RETROPERITONEUM, LYMPH NODES: Reference left celiac lymph node (6/87) measures 1.3 x 0.7 cm, unchanged in size when measured using the same technique.BOWEL, MESENTERY: Colonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Patient is status post hysterectomy.BLADDER: No significant abnormality notedLYMPH NODES: Reference right external iliac lymph node (6/169) measures 7 mm in the short axis, unchanged.BOWEL, MESENTERY: Colonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Interval increased small right pleural effusion and pulmonary masses/nodules. Abdominal and pelvic findings are not significantly changed.
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Generate impression based on findings.
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No evidence of acute intracranial hemorrhage. There are no masses, mass effect or midline shift. The ventricles and sulci are normal in size. There are no extraaxial fluid collections or subdural hematomas. The visualized portions of the paranasal sinuses and mastoid air cells are clear.
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No evidence of acute intracranial hemorrhage or mass effect.
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Generate impression based on findings.
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75-year-old female with a new pleural effusion and metastatic disease. Evaluate CHEST:LUNGS AND PLEURA: New large right pleural effusion with associated compressive atelectasis. Multiple subcentimeter micronodules along with the right minor fissure, likely intrapulmonary lymph nodes.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Nonspecific clustered subcentimeter right cardiophrenic lymph nodes. Heart size is normal without pericardial effusion. Mild coronary artery calcifications.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hypoattenuating lesions in segments 6 (series 3, image 84) and segment 8 (series 3, image 75) are incompletely characterized.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small pelvic ascites is present.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.Large right pleural effusion and multiple subcentimeter nodules along the right fissure which are likely intrapulmonary lymph nodes. Findings may be inflammatory in etiology.2.Nonspecific cluster of subcentimeter right cardiophrenic lymph nodes.3.Small pelvic ascites.4.Two subcentimeter hypoattenuating hepatic lesions are too small to characterize.
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Generate impression based on findings.
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Male 29 years old; Reason: patient with subacute onset of left testicular pain, with some fullness on exam History: left testicular pain RIGHT TESTIS: Echogenicity of the right testicle is normal in appearance. No significant abnormalities noted.LEFT TESTIS: Echogenicity the left testicle is normal in appearance. No significant abnormalities noted. RIGHT EPIDIDYMIS: No significant abnormalities noted.LEFT EPIDIDYMIS: No significant abnormalities noted.OTHER: There is a small amount of extratesticular fluid bilaterally. In the area of discomfort in the left scrotum is evidence of a small varicocele.
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Small left varicocele.
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Generate impression based on findings.
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Ms. Chande is a 59 year old female with a personal history of left breast lumpectomy in 10/2012 IDC with lobular features, followed by radiation and Arimidex therapy. No current breast related complaints. Three standard views of both breasts along with a laterally exaggerated left CC view were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. A linear marker was placed on the scar overlying the left breast. There are stable postsurgical changes including architectural distortion, increased density, surgical clips and skin retraction present within the left lumpectomy site. Surgical clips are also seen in the left axilla. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast.
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Stable postsurgical changes of the left breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.
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Generate impression based on findings.
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Male 53 years old; Reason: evaluate for gastroparesis History: retained food on EGD and upper gi series Visually there was significantly delayed gastric emptying. Using anterior and posterior geometric means, residual gastric activity at the following postprandial intervals was calculated as follows:30 mins: 92.4 % of peak activity (normal >70 %)1 hour: 91.2 % of peak activity (normal 30-90 %) 2 hours: 72.3 % of peak activity (normal <60 %) 4 hours: 53.9 % of peak activity (normal <10 %)
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Significantly delayed gastric emptying.
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Generate impression based on findings.
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Male 74 years old; Reason: 73yo M with history of R testicular mass with ultrasound performed at OSH and told it was benign, feels it is enlarging, repeat ultrasound to assess. History: scrotal mass RIGHT TESTIS: Multiple subcentimeter simple testicular cysts the largest of which measures 0.5 x 0.5 x 0.5 cm. Differential considerations include intratesticular cyst or tunica albuginea cyst formation, particularly with respect to the peripherally located lesions. The echogenicity of the background testicle is normal in appearance.LEFT TESTIS: Subcentimeter simple testicular cysts are noted in the left testicle. Differential considerations include intratesticular cyst or tunica albuginea cyst formation, particularly with respect to the peripherally located lesions. The background testicle echogenicity is normal in appearance.RIGHT EPIDIDYMIS: A very large right epididymal cyst measures 4.8 x 2.2 x 5.4 cm.LEFT EPIDIDYMIS: No significant abnormalities noted.
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1. Very large right epididymal cyst.2. Multiple subcentimeter intratesticular cysts are present bilaterally as above. No suspicious testicular mass otherwise.
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Generate impression based on findings.
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Female 59 years old; Reason: metastasis? History: C3 lesion No abnormal foci of osteoblastic activity either a C3 or elsewhere in the skeleton.No evidence of metastatic disease as clinically questioned.
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Negative bone scan. Known C3 lesion is not actively osteoblastic and this may represent a benign lesion such as a hemangioma, although nonspecific. No evidence of osseous metastatic disease as clinically questioned otherwise.
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Generate impression based on findings.
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Reason: NG placement History: NG placement NG tube with tip in the body of the stomach. Nonobstructive bowel gas pattern. Calcification in the right mid abdomen likely represents a small renal calculus.Bibasilar atelectasis.
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NG tube with tip in the body of the stomach.
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Generate impression based on findings.
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Reason: Dobbhoff History: Dobbhoff Interval removal of NG tube. Interval placement of Dobbhoff tube with tip in the proximal stomach. Nonobstructive visualized bowel gas pattern. Note the lower pelvis is outside the field of view.
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Interval placement of Dobbhoff tube with tip in the proximal stomach.
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Generate impression based on findings.
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Altered mental status, smelling noxious odors, hearing voices. Please evaluate for pathology. There is no evidence of intracranial hemorrhage, mass, or mass effect. No abnormal parenchymal or meningeal enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable.
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No evidence of intracranial mass or abnormal enhancement. If there is continued suspicion for a structural lesion, consider MRI for further evaluation.
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Generate impression based on findings.
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83-year-old female with intermittent headaches after fall one month ago, history of bilateral dacrocystitis and nasolacrimal duct obstruction. No intracranial hemorrhage is identified. No intracranial mass, evidence of mass-effect or significant midline shift is present. The gray-white differentiation is maintained. The ventricles and sulci are prominent, consistent with moderate age-related volume loss. No extra-axial collections are identified. There is a stable punctate calcification in the left pons.There are scattered areas of hypoattenuation in the periventricular and subcortical white matter, which are nonspecific, but favored to represent age-indeterminant small vessel ischemic changes.There is soft tissue density material centered on the left medial canthus and lacrimal sac, which is more significant than prior CT of the sinuses dated 6/9/14. The lacrimal sac is no longer dilated by fluid. The bony left nasolacrimal duct remains distorted and narrowed compared to the right, secondary to the left maxillary mucocele.The left maxillary sinus remains completely opacified with heterogeneous soft tissue material, and the medial wall remains bowed outward into the nasal cavity. As a result, the left nasal cavity is narrowed relative to the right. There is associated opacification of the left ostiomeatal complex including several of the left anterior ethmoid air cells. There is extensive heterogenous material throughout right nasal cavity. The mastoid air cells are clear. The skull and scalp soft tissues are unremarkable.
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1. No evidence of intracranial hemorrhage or mass effect.2. Complete opacification and expansion of the left maxillary sinus consistent with mucocele with resultant occlusion of the left ostiomeatal complex.3. There is soft tissue density centered on the left medial canthus, which is more pronounced than on prior CT, and may relate to chronic occlusion of the left nasolacrimal duct.4. There is likely extensive debris in the right nasal cavity. Please correlate with direct inspection to exclude the possibility of retained foreign body.
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Generate impression based on findings.
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headache. No evidence of acute ischemic or hemorrhagic lesion on this scan.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. C-spineThe cranial-cervical junction is normal. There is normal cervical lordosis. The cervical spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal appearance. There are multiple various sized radiolucent lesions within almost all of cervical vertebral bodies with underlying prominent vertebral bony trabecula. These lesions are non specific thus if clinically indicated, cervical spine MRI with and without contrast could be considered for further evaluation. There are also disc space narrowings on C45 and C56 with osteophytes especially on the right side uncovertebral joints with show minimal narrowing of right side lateral recess on those levels.There is no definitive evidence of fracture or soft tissue swelling.The paraspinal soft tissues are unremarkable.
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1. No evidence of acute ischemic or hemorrhagic lesion.2. Multiple non specific radiolucencies on cervical spine, cervical spine MRI with and without contrast enhancement can be considered if clinically indicated.3. Disc degenerations with minimal lateral recess narrowings due to osteophytes on the right C45 and C56 disc level.
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Generate impression based on findings.
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9-year-old female with ulcerative colitis with increasing abdominal pain, poor weight gain, and worsening labworkEXAMINATION: MR enterography without and with IV contrast 02/05/15 ABDOMEN: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: kidneys and uretersRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is thickening and enhancement of the rectum, sigmoid colon, and descending colon up to the splenic flexure. Transverse colon and ascending colon appear within normal limits. The terminal ileum is within normal limits. No evidence of obstruction. No strictures or fistulas are seen. No loculated fluid collections.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: There is thickening and enhancement of the rectum, sigmoid colon, and descending colon up to the splenic flexure. Transverse colon and ascending colon appear within normal limits. The terminal ileum is within normal limits. No evidence of obstruction. No strictures or fistulas are seen. No loculated fluid collections.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Limited study due to patient motion. Thickening and enhancement of the rectum, sigmoid colon, and descending colon up to the splenic flexure is consistent with patient's given history of ulcerative colitis.
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Generate impression based on findings.
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Reason: ngt placement History: ng tube placement NG tube with tip at the GE junction. Nonobstructive visualized bowel gas pattern. Note the lower pelvis is outside the field of view.
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NG tube tip at the GE junction. Recommend advancement.
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Generate impression based on findings.
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For the purposes of numbering, there are 5 lumbar type vertebral bodies. Vertebral body heights are maintained. Alignment is maintained. There is no acute fracture. Multilevel degenerative changes are seen, as describe below:At L1-2 there is disk bulge without significant compromise to the spinal canal or neural foramina.At L2-3 there is disk bulge without significant compromise to the spinal canal or neural foramina.At L3-4 there is disk bulge with ligamentum flavum thickening resulting in mild spinal canal stenosis. There is mild right and moderate left neural foramina stenosis. There may be impingement of the left L3 nerve root. At L4-5 there is disk bulge and ligamentum flavum thickening resulting in mild spinal canal stenosis. There is mild bilateral neural foramina stenosis. There is advanced right-sided facet arthropathy.At L5-S1 there is no significant compromise to spinal canal or neural foramina.Paraspinous soft tissues are within normal limits.
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1. No destructive osseous lesions or compression fractures are seen in the lumbar spine. If there is high suspicion for metastatic disease, consider MRI for more sensitive evaluation. 2. Degenerative changes in the lumbar spine at multiple levels. There is moderate neural foramina stenosis at the left L3-L4 level which may be impinging on the left L3 nerve root.
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Generate impression based on findings.
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52 year old female with history of multiple right breast cysts. History of ovarian cancer in a maternal aunt. No current complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. Small cyst becomes smaller and only seen on MLO view. 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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25 year old female with history of rectal prolapse and constipation. There was prompt opacification of the rectum and sigmoid colon. Trial straining demonstrated an anterior rectocele measuring 1.2 x 1.0 cm on the lateral view (series 25). The straining AP view demonstrated small bilateral lateral rectoceles (series 27). Formal straining and evacuation showed appropriate passage of rectal contents with significant rectal prolapse extending well below the pubic symphysis. No evidence of sinus tracts or fistulae.TOTAL FLUOROSCOPY TIME: 2:44 mm:ss
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1.Anterior rectocele and small bilateral lateral rectoceles.2.Significant rectal prolapse extending well below the pubic symphysis on formal evacuation.
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Generate impression based on findings.
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Anisocoria. There is no evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. There is mild plaque at the carotid bifurcations. There is multilevel degenerative spondylosis. 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 mass lesions in the neck.
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Generate impression based on findings.
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Reason: Dobbhoff placement History: post Dobbhoff Interval removal of NG tube. Interval placement of Dobbhoff tube with tip in the pyloric region. Nonobstructive visualized bowel gas pattern. Surgical clips, IVC filter, midline skin staples, Primrose drain, and curvilinear wiring projecting over the pelvis, unchanged in positions. Levoscoliosis.
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Interval placement of Dobbhoff tube with tip in the pyloric region.
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Generate impression based on findings.
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History of stroke, now anticoagulated No evidence of acute intracranial hemorrhage. There is encephalomalacia centered in the right inferior parietal lobule extending to the adjacent right temporal lobe and right occipital lobe. There is associated ex vacuo effect and widening of adjacent sulci. Redemonstrated are linear areas of hyperattenuation involving the cortical surfaces of the right frontal and left occipital lobes. Unchanged small foci of hyperattenuation along the cortical surface of the left middle frontal gyrus.. There is also unchanged hypoattenuation in the right cerebellar hemisphere with patchy central high attenuation. Minimal foci of hyperdensity in the left cerebellar hemisphere. There is extensive atherosclerotic calcification in the distal vertebral arteries and carotid siphons. Again seen is moderate to severe opacification throughout the visualized paranasal sinuses right worse than left. Fluid is also present in the left mastoid air cells.
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1.No definite evidence of acute intracranial hemorrhage or new mass effect.2.Large chronic right middle cerebral artery infarct. 3.Stable gyriform hyperdensities in the right greater than left frontal lobes, left occipital lobe, and right cerebellar hemisphere. These findings remain unchanged since 1/29/2015 and likely represent calcifications related to prior ischemia and less likely acute hemorrhage.
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Generate impression based on findings.
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80 year-old male with known type B dissection admitted for her blood pressure management in January 2015. The patient presents for one month follow-up CTA. CT ANGIOGRAM: Type B dissection originating distal to the left subclavian artery and extending approximately 5 cm above the diaphragm. The thoracic aorta measures up to 4.4 cm in dimension (series 80869, image 16). There is evidence of organizing hematoma in the wall of the thoracic aorta. Moderate to severe atherosclerotic calcifications affect the abdominal aorta and the iliac arteries. Moderate to severe atherosclerotic calcifications affect the origins of the celiac axis and SMA, which are both patent without evidence of dissection. The common iliac, internal iliac, as well as external iliac arteries are patent without evidence of dissection or thrombus bilaterally.CHEST:LUNGS AND PLEURA: Multiple scattered regions of ground glass opacities are nonspecific and may be infectious or inflammatory in etiology. No pleural effusions or pneumothorax.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Moderate cardiomegaly without pericardial effusion and evidence of a coronary artery bypass. Severe atherosclerotic calcifications affect the coronary arteries.CHEST WALL: Left chest port with catheter tip in the right atrium.ABDOMEN:LIVER, BILIARY TRACT: 1.1-cm hepatic dome hypoattenuating focus compatible with a cyst.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple bilateral hypoattenuating lesions within the kidneys, some of which are compatible with simple cysts and others which measure higher attenuation at 20 Hounsfield units but do not demonstrate enhancement.RETROPERITONEUM, LYMPH NODES: Angiographic findings as above.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: Streak artifact from bilateral hip prosthesis limits evaluation of the pelvis.PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Bilateral hip prosthesis.OTHER: No significant abnormality noted
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1.Type B thoracic dissection as detailed above. No prior exam available for comparison, which was discussed with Ms. Braun, NP.2.Moderate to severe atherosclerotic calcifications affect the abdominal aorta and its branches, including origins of the celiac axis and SMA.3.Multiple scattered groundglass opacities throughout both lungs may be infectious or inflammatory in etiology.
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Generate impression based on findings.
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77 year-old female with upper and mid back pain after fall The bones are demineralized. There is a compression fracture of the T3 vertebral body which is new from the prior chest CT with mild associated kyphosis. The lower thoracic spine appears unremarkable for the patient's age.
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T3 vertebral body compression fracture.
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Generate impression based on findings.
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3-year-old female with back pain, evaluate for scoliosisVIEWS: Lumber spine AP/lateral (two views) 02/05/15 Mild anterior wedging of L1. Mild leftward curvature of the lumbar spine. No segmentation anomalies. No acute fracture or malalignment.
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Mild anterior wedging of L1 may be related to mild leftward curvature of the lumbar spine. No acute fracture is evident.Findings were discussed with Dr. Brayboy on 2/5/15 at 1648.
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Generate impression based on findings.
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66-year-old female status post nerve plaque, history of cancer The distal tips of bilateral nephroureterostomy catheters project over the pelvis. Surgical clips project over the lower abdomen and pelvis. The osseous structures are unremarkable for the patient's age. The sacrum is obscured by bowel gas.
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Unremarkable osseous structures.
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Generate impression based on findings.
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Reason: Dobbhoff History: Dobhoff Dobbhoff tube with tip in the proximal stomach. Nonobstructive bowel gas pattern.
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Dobbhoff tube with tip in the proximal stomach.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Personal history of bilateral benign breast biopsies. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. Bilateral coarse calcifications have progressed in a benign fashion, likely representing hyalinizing fibroadenomas.
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Bilateral benign calcifications. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSC - Screening Mammogram.
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Generate impression based on findings.
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Evaluate umbilical lineVIEW: Chest AP and abdomen AP ET tube tip below thoracic inlet and above the carina. The umbilical venous catheter tip in the umbilical vein. The umbilical arterial catheter tip at T10. Cardiothymic silhouette normal. Minimal patchy atelectasis bilaterally without pleural effusion or pneumothorax. Paucity of bowel gas within the abdomen. No pneumatosis or pneumoperitoneum.
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The umbilical venous catheter tip in the umbilical vein.
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Generate impression based on findings.
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48 year-old female with history of adenocystic carcinoma the trachea with lung metastases.RADIOPHARMACEUTICAL: 11.5 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 108 mg/dL. Today's CT portion of the head, neck, and pelvis demonstrates no significant pathology. Please see diagnostic CT reports for details of the chest and abdomen.Today's PET examination demonstrates significant interval decrease in hypermetabolic activity associated with the majority of treated pulmonary metastases. For reference, the most active current focus of a treated nodule is located in the medial right upper lobe (SUV max 2.2, from previously 3.6). Two treated nodules in the right lower lobe and one treated nodule in the left lower lobe demonstrate new mild hypermetabolic activity (SUV max 2.9), small to medium in size. Given the milder levels of uptake (as compared with other previously hypermetabolic nodules prior to treatment and current untreated hypermetabolic nodules) as well as the current CT appearance, this activity may reflect post-radiation inflammation.Untreated nodules demonstrate new or interval increase in activity. The most hypermetabolic current nodule is located anteriorly in the laterobasal segment of the left lower lobe (SUV max 2.5).Extensive brown fat hypermetabolism is noted. No suspicious extrathoracic FDG avid lesions are identified.
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1.Treated pulmonary metastases have decreased in metabolic activity overall. New fairly mild activity associated with three treated nodules likely reflects post-radiation inflammation.2.Untreated pulmonary metastases have new or increased hypermetabolic activity.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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71-year-old female with left hip pain There is marked joint space narrowing with subchondral cyst formation and osteophytes consistent with severe osteoarthritis affecting the hip. A small cleft within the posteromedial acetabulum corresponding to the edema seen on prior MRI may relate to old fracture deformity or osteoarthritis. No acute fracture is seen.
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Severe osteoarthritis as described above without evidence of acute fracture.
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Generate impression based on findings.
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FractureVIEWS: Left elbow AP and lateral There are 4 K wires affixing a supracondylar fracture in near anatomic alignment without evidence of hardware complication. There is periosteal reaction indicative of healing. The overlying cast obscures fine bony detail.
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Healing supracondylar fracture as described above.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Personal history of benign right breast biopsy. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. Bilateral partially obscured masses are identified. There are no suspicious microcalcifications or areas of architectural distortion.
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Bilateral partially obscured masses. An attempt to obtain patient's prior mammograms should be made for comparison purposes.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: OB - OLD FILM FOR COMPARISON
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Generate impression based on findings.
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66 year old female s/p Ivor esophagectomy for esophageal cancer. Evaluate for leak. Single contrast evaluation of the esophagus demonstrated irregular contour of the distal esophagus secondary to postsurgical changes and edema following recent Ivor esophagectomy. There was transient delay in passage of contrast into the distal esophagus across the anastomotic site, likely secondary to postoperative edema, but no evidence of high grade obstruction or leak.TOTAL FLUOROSCOPY TIME: 5:25 mm:ss
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Postsurgical changes s/p Ivor esophagectomy without evidence of high grade obstruction or leak.
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Generate impression based on findings.
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There is no definite evidence of proptosis. The bilateral globes are mildly elongated in the AP dimension, left greater than right. There is focal thinning suggested of the right globe just medial to the optic nerve insertion.The extraocular muscles and optic nerves are normal in size and density. No mass is seen in the orbits within the limitations of this noncontrast exam. No bone destruction or fracture of the orbital walls is seen. There is mild mucosal thickening of the right maxillary sinus. Bilateral concha bullosa are present, right greater than left. There appears to be chronic opacification of the left mastoid air cells.There is heterogeneous appearance of the visualized bone marrow which may relate to osseous demineralization, most pronounced in the maxilla. There are scattered periradicular and and periapical lucencies, left greater than right maxilla. A torus palatini present. The patient is partially edentulous.The ventricles and sulci are prominent, consistent with moderate age-related volume loss.
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1. No definitive evidence of proptosis, enlargement of the extraocular muscles, or orbital mass.2. The bilateral globes are mildly elongated in the AP dimension, which may relate to myopia.3. There is also possible focal thinning of the right posterior globe, medial to the optic nerve insertion, suggestive of developing staphyloma.4. There are scattered periradicular and periapical lucencies, left greater than right maxilla. Please correlate with dental exam.
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Generate impression based on findings.
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There is a inflammatory changes with soft tissue thickening along the right slightly greater than left upper eyelid. There is also diffuse enlargement and enhancement of the right lacrimal gland with a ill-defined margins suggesting inflammatory changes. There is mild localized mass effect upon the adjacent right lateral rectus muscle. The left lacrimal gland is small in size but also demonstrates mild ill-defined appearance and enhancement. No significant associated osseous erosions are appreciated. The extraocular muscles and optic nerves are normal in size and density.There is complete opacification presents with lack of aeration of the left ostiomeatal unit. There is mild leftward nasal septal deviation with small leftward directed nasal spur which abuts the head of the left inferior turbinate. There is additional scattered moderate left and mild right ethmoid air cell mucosal thickening. There is also mild mucosal thickening in the sphenoid sinuses. There is incidental developmental nonunion of the posterior arch of C1. The visualized parotid glands have an unremarkable CT appearance.
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1. Inflammatory changes of the right greater than left upper eyelids as well as diffuse enlargement, and enhancement of the right lacrimal gland as well as mild inflammatory changes suggested involving the left. No definite associated osseous erosions. Differential diagnosis includes Sjogren's, orbital pseudotumor, sarcoidosis, and much less likely malignancy such as lymphoma.2. Complete opacification of left maxillary sinus. Please correlate clinically.
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Generate impression based on findings.
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50 year-old male with history of abdominal pain and bloody stool. Evaluate for infectious colitis. ABDOMEN:LUNG BASES: Fibrotic changes. Suture material seen along the right leaflet of the diaphragm. Correlate for prior surgery.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Status post splenectomy. There are a few small dorsally located accessory spleens and anteriorly, one large hypertrophied accessory spleen measuring 4.6 cm in diameter, series 3 image 22.PANCREAS: No significant abnormality notedADRENAL GLANDS: 2.3 x 2 cm left adrenal nodule nonspecific series image 25.The right adrenal gland is normal.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Numerous small retroperitoneal nodes.BOWEL, MESENTERY: Confluent diffuse wall thickening involving the descending colon, transverse colon descending colon and sigmoid colon and less marked in the rectosigmoid and rectal area. Average wall thickness is about 9 mm as measured on coronal image 37. The wall is both soft tissue and some low density indicating submucosal edema. There is no significant fat stranding or fluid in the mesentery except possibly in the region of the hepatic flexure image #80. No intramural air or free air.Scattered small mesenteric nodes.Small bowel is normal.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 described in the abdomen, wall thickening involving sigmoid colon and rectum. Intermediate fluid density, possibly some mucosal fat deposition. Findings most consistent with ulcerative colitis. No evidence of perforation or abscess. Cecum and proximal ascending colon are spared. Small bowel is normal.BONES, SOFT TISSUES: Some ossification is seen in the region of the gluteus muscles consistent with myositis ossificans bilaterally correlate for trauma.Postsurgical changes anterior abdominal wall in the midline.OTHER: No significant abnormality noted
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Findings consistent with active ulcerative colitis with subtotal colonic involvement and sparing of the cecum and proximal ascending colon. No evidence of perforation or abscess.Splenectomy with hypertrophy of accessory spleen.Left adrenal nodule.Other findings as above.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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PainVIEWS: Right hand AP, right middle finger oblique and lateral There is a Salter III fracture involving the base of the middle phalanx of the middle finger. There is soft tissue swelling at the PIP region. The remainder of the examination is normal.
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Acute Salter III fracture base of the middle phalanx of the middle finger.
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Generate impression based on findings.
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57 year old male s/p LAR for rectal cancer. Please assess for leak prior to takedown. There is prompt opacification of the J-pouch, sigmoid, and descending colon with expected postsurgical changes including end-to-side anastomosis. Trial straining showed appropriate descent of the perineal floor, and voluntary anal sphincter contraction demonstrated expected perineal elevation. No evidence of rectal prolapse. Formal straining and evacuation showed appropriate passage of neo-rectal contents without evidence of rectocele. No evidence of sinus tracts, fistulae, or anastomotic leaks.TOTAL FLUOROSCOPY TIME: 5:02 mm:ss
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Expected postsurgical changes s/p J-pouch creation without evidence of anastomotic leak.
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Generate impression based on findings.
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Female; 57 years old. Reason: interim placement of pleurx catheter History: persistent SOB CHEST:LUNGS AND PLEURA: Interval placement of Pleurx catheter with tip at the lateral costophrenic angle. Significant interval decrease in left pleural effusion, but a small left pleural effusion persists with small amount of loculated fluid near the apex and within the major fissure. Subtle areas of pleural thickening and nodularity at the anterior left lung base, consistent with tumor involvement (e.g. series 3/images 58-63).New trace right pleural effusion.Mild patchy atelectasis/consolidation in the left lower lobe, for which underlying infection cannot be excluded. Radiation changes in the anterior left lung. Minimal right basilar dependent subsegmental atelectasis. No suspicious pulmonary nodules or masses. MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. No visible coronary artery calcifications. Small hiatal hernia. No mediastinal or hilar lymphadenopathy.CHEST WALL: Sclerotic lesion in the left anterior fifth rib is unchanged (series 3/53). Status post bilateral mastectomy. Stable skin thickening and soft tissue infiltration overlying the surgical bed of the left breast.ABDOMEN: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: Stable small left renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1. Significant interval decrease in left pleural effusion status post Pleurx catheter placement with persistent small, partially loculated effusion.2. Subtle areas of left pleural thickening and nodularity, consistent with tumor involvement.3. Mild patchy atelectasis/consolidation in the left lower lobe, for which underlying infection cannot be excluded.
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Generate impression based on findings.
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Female 87 years old Reason: chest pain, tachycardia, and hypoxia History: see above PULMONARY ARTERIES: No acute pulmonary embolus. The pulmonary artery is normal in caliber without evidence of right heart strain.LUNGS AND PLEURA: Low lung volumes.Mild septal thickening with symmetric, moderately large bilateral pleural effusions and overlying compressive atelectasis.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy. Mild cardiomegaly without pericardial effusion.Extensive atherosclerotic changes of the aorta and its branches with mild coronary artery calcifications.CHEST WALL: Moderate degenerative change of the thoracic spine. Multiple acute-appearing, left sided rib fractures including the fourth and sixth left posterior ribs.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.Moderately large, bilateral pleural effusions and septal thickening consistent with mild CHF.3.Multiple left sided, acute-appearing rib fractures. PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable.
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Generate impression based on findings.
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Male 47 years old Reason: concern for pneumonia History: respiratory failure, s/p hypoxic arrest Motion artifact limits the evaluation of fine parenchymal detail, especially in the lung bases.LUNGS AND PLEURA: Low lung volumes with persistent mosaic attenuation of the lung parenchyma. There is chronic atelectasis and consolidation in the right middle and lower lobes with an absence of air bronchograms. The chronic atelectasis and consolidation is likely secondary to a persistently elevated right hemidiaphragm and a small right sided pleural effusion.In the left lung, there is atelectasis and scarring with pleural thickening.No specific evidence of infection.No suspicious nodules or masses, however, motion artifact limits evaluation of fine parenchymal detail.Innumerable calcified micronodules consistent with prior granulomatous infection.MEDIASTINUM AND HILA: Mediastinal lymphadenopathy is not significantly changed, however, evaluation is limited secondary to lack of intravenous contrast.Cardiomegaly without pericardial effusion.Atherosclerotic calcifications of the aorta with mild coronary artery calcifications.LVAD and ICD are grossly unchanged in position, however, evaluation is limited secondary to lack of intravenous contrast.Postoperative changes consistent with heart transplant.Tracheostomy tube above the carina. Bronchomalacia is unchanged and indicated by narrowing of the main bronchi on expiration.CHEST WALL: Left chest wall subcutaneous pacemaker generator.Median sternotomy fixation devices.Mildly enlarged left internal mammary chain lymph nodes are unchanged..UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Chronic elevation of the right hemidiaphragm.Cholelithiasis without evidence of acute cholecystitis..
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Persistent right lower lobe atelectasis and consolidation likely secondary to chronic elevation of the right hemidiaphragm, unchanged from 7-31-14.No specific evidence of infection.
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Generate impression based on findings.
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79-year-old male with history of multiple myeloma, recent left femoral neck lesion. Rule out bone disease.RADIOPHARMACEUTICAL: 11.3 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 109 mg/dL. Today's CT portion grossly demonstrates extensive atherosclerotic disease, including severe coronary arterial calcifications, left femoral head and neck orthopedic screw and long intramedullary rod, and heterotopic bone formation posterolateral to the proximal femur. Scoliosis and severe degenerative changes are additionally noted.Today's PET examination demonstrates no suspicious FDG avid lesion to suggest tumor activity. Mild diffuse activity posterolateral to the left hip is associated with heterotopic bone formation and therefore likely benign in etiology.
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No suspicious FDG-avid lesion to suggest current tumor activity.
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Generate impression based on findings.
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56 years, Male. Reason: ileus vs sbo History: minimal stool output despite tf and aggressive bowel regimen, distended abd Enteric tube coiled with tip adjacent to the Ligament of Treitz. Overall relative paucity of bowel gas. Note the far lateral aspects of the abdomen and the pelvis are outside the field of view. Right upper quadrant surgical clips.
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Overall relative paucity of bowel gas. No specific evidence of small bowel obstruction or ileus on this limited exam.
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Generate impression based on findings.
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Male 34 years old; Reason: Relapsed Hodgkin lymphoma, in need of restaging, pt lost follow upRADIOPHARMACEUTICAL: 10.8 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 95 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 the following findings: In the neck there are marked hypermetabolic lymph nodes in the left supraclavicular region markedly increased in size and activity with an SUV max of 11.3, previously 2.0. Another markedly hypermetabolic lymph node in the right inferior posterior triangle is new, consistent with progression of tumor activity.In the chest there are multiple markedly hypermetabolic bilateral axillary lymph nodes which are new, consistent with additional tumor progression. There is a large markedly hypermetabolic right posterior lateral pleural/chest wall based mass which has markedly increased in size and activity with an SUV max of 15.3, previously 3.8 and now causes significant destruction of the right ninth posterior rib. There is a new hypermetabolic right middle lobe nodule consistent with additional tumor activity.In the abdomen there are multiple new markedly hypermetabolic abdominal lymph nodes involving the celiac, retroperitoneum, and left psoas muscle (SUV max 18.0) consistent with additional tumor progression.In the pelvis there are numerous enlarged markedly hypermetabolic bilateral iliac, inguinal, pelvic peritoneal and left gluteal lymph node activity which is markedly progressed in size, number and metabolic activity. For reference, left inguinal lymph node has an SUV max of 17.4, previously 3.2.There is diffuse uniform mildly increased activity of the entire visualized marrow and spleen considered likely benign marrow stimulation than diffuse tumor involvement.
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Extensive markedly hypermetabolic tumor involving lymph nodes from the neck through the pelvis, a right lung nodule, and right posterior rib / chest wall, markedly progressed from previous.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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51 years, Female. Reason: assess for obstipation History: 51 y.o. woman with a history of constipation alternating with diarrhea. ? overflow diarrhea Nonobstructive bowel gas pattern. Moderate amount of stool throughout the colon.
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Moderate amount of stool throughout the colon.
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Generate impression based on findings.
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22 year-old female with history of pain. There is an oblique fracture through the distal diaphysis of the fifth metatarsal. Alignment is anatomic. There is mild soft tissue swelling about the lateral aspect of the foot.
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Fifth metatarsal fracture as above.
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Generate impression based on findings.
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Evaluate for aspirationVIEWS: Chest AP and lateral Cardiothymic silhouette normal. Cardiac apex and stomach left-sided. The stomach is distended. Minimal patchy atelectasis left lower lobe. No pleural effusion or pneumothorax.
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Minimal atelectasis left lower lobe.
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Generate impression based on findings.
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Panserositis (pericardial effusion, bilateral pleural effusions, and ascites) of uncertain cause. There is no evidence of mass lesions or significant cervical lymphadenopathy. The thyroid and major salivary glands are unremarkable. The major cervical vessels are patent. The osseous structures are unremarkable, including what appears to be reflux of contrast into several vertebral bodies posteriorly. The airways are patent. The imaged intracranial structures are unremarkable. There are large bilateral pleural effusions, left greater than right. There is minimal mucosal thickening within the maxillary sinuses.A subcentimeter sclerotic focus in the left mandible may represent an enostosis or benign odontogenic process.
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1. No evidence of mass or significant lymphadenopathy.2. Partially imaged bilateral pleural effusions related to serositis. Please refer to the separate chest CT report for additional details.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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Reason: structural lung disease, other abnormality History: heart transplant workup LUNGS AND PLEURA: Calcified right upper lobe nodule compatible with previous granulomatous infection.Moderate right pleural effusion with underlying compressive atelectasis.Small subpleural scar-like opacity in the right middle lobe.MEDIASTINUM AND HILA: Large calcified paratracheal lymph nodes compatible with previous infection.Very mild coronary artery calcification.Mild cardiomegaly.Minimal pericardial effusion.Normal size main pulmonary artery.Catheter tip in the SVC.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Limited evaluation with partially imaged kidneys. Exophytic hypodensity in the right upper renal pole consistent with a cyst.Small splenic calcifications consistent with previous granulomatous infection.
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Moderate right pleural effusion with underlying compressive atelectasis in the right lower lobe, compatible with CHF. No other significant pulmonary abnormalities.
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Generate impression based on findings.
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Fall on outstretched handVIEWS: Right wrist AP, oblique and lateral There is sclerosis at the distal diaphysis of the radius likely reflecting a healing fracture at this site. The alignment is anatomic. The distal ulna is normal.
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Presence of sclerosis at the distal radius likely reflecting a healing fracture at this site.
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Generate impression based on findings.
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Right partial thyroid lobectomy and left thyroid nodule. There is heterogeneous left thyroid mass that measures up to 5 cm with scattered calcifications. There has been right thyroid lobectomy. There is no evidence of significant cervical lymphadenopathy based on size criteria. The salivary glands are unremarkable. The major cervical vessels are patent. There is mild degenerative spondylosis. The airways are patent. The imaged intracranial structures are unremarkable. There is left maxillary sinus mucosal thickening. The imaged portions of the lungs are clear.
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A heterogeneous left thyroid mass that measures up to 5 cm with scattered calcifications is nonspecific and neoplasm cannot excluded.
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Generate impression based on findings.
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37-year-old male status post left acetabular fracture after snowmobile accident There is a complex comminuted fracture of the left acetabulum involving the posterior column. An angulated fracture fragment is displaced slightly laterally. The proximal femur appears intact. The remainder of the pelvis is intact.
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Complex left acetabular fracture. If further evaluation is clinically warranted, CT should be considered.
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Generate impression based on findings.
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59-year-old male with history of pain. Left knee: There are enthesopathic and posttraumatic changes at the inferior aspect of the patella. Additionally, there are tricompartmental osteophytes and joint space narrowing worse in the patellofemoral compartment compatible with moderate to severe osteoarthritis. The patellar tendon is thickened. There is a small joint effusion.Right knee: Fractured hardware overlies the patella and distal quadriceps tendon. Deformity at the inferior aspect of the patella is likely posttraumatic. There are tricompartmental osteophytes and joint space narrowing worse in the patellofemoral compartment with bone on bone apposition compatible with severe osteoarthritis.
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Degenerative and posttraumatic changes as above.
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Generate impression based on findings.
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Reason: anisocoria, r/o malignancy History: none LUNGS AND PLEURA: 3-mm right lower lobe subpulmonic micro-nodule image 47 series 3, the lungs otherwise unremarkable.MEDIASTINUM AND HILA: There is no mediastinal or hilar lymphadenopathy.Moderate focal coronary artery calcifications are present, the heart and pericardium otherwise normal in appearance.Large hiatal hernia, with dilation of the esophagus proximal to this. CHEST WALL: Degenerative abnormalities affect the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Cholelithiasis without evidence of cholecystitis.
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1. No evidence of malignancy, sarcoid or similar abnormalities.2. Cholelithiasis.3. Very large hiatal hernia.
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Generate impression based on findings.
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58-year-old female with worsening left hip pain Mild to moderate osteoarthritis affects the left hip. Severe degenerative disk disease affects the lower lumbar spine with vacuum disk phenomena. There is grade 1 anterolisthesis of L4 on L5. Surgical clips project over the left ischium.
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Degenerative arthritic changes as described above.
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Generate impression based on findings.
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53 year-old female with left foot pain Pes planus and hallux valgus deformities. Two screws transverse the first metatarsal. Postoperative changes of first metatarsal osteotomy. Mild osteoarthritis affects the first MTP joint and midfoot.
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1. Degenerative and postoperative changes as described above.2. Pes planus and hallux valgus deformities.
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Generate impression based on findings.
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29-year-old female with pain There is prominence of the femoral head-neck junction suggesting a CAM deformity. A small os acetabulare is noted.
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Prominence of the femoral head-neck junction compatible with a CAM deformity.
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Generate impression based on findings.
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37-year-old male status post injury. There is a comminuted fracture of the tibial plateau without significant cortical step off along the articular surface. The comminuted fracture predominantly involves the lateral tibial plateau, but a transverse fracture line extends beneath the tibial spines with a vertical component extending to the articular surface. There is a complete transverse patellar fracture with superior displacement of the distal fragment by approximately 2.4 cm relative to the inferior fragment, as well as marked soft tissue swelling overlying the anterior soft tissues. There is comminuted fracturing of the inferior patella fragment. The extensor mechanism is obscured by soft tissue swelling.
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Comminuted tibial plateau and patella fractures as described above.
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Generate impression based on findings.
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11-year-old male with knee painVIEWS: Left knee AP/lateral, right knee AP/lateral, bone length radiograph (5 views) 02/05/15 No acute fracture or malalignment is evident. No joint effusion. No loose bodies. Undertubulation of the osseous structures. Metaphyseal flaring is present. Foreshortening of the femur with metaphyseal flaring. The fibula is longer than the tibia. Mild tibia vara bilaterally.
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No acute fracture malalignment is evident. Other findings as above.
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Generate impression based on findings.
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Female; 25 years old. Reason: evaluation of osteosarcoma preoperatively lung mets History: sob CHEST:LUNGS AND PLEURA: Multiple solid and partially ossified nodules and masses in both lungs, compatible with osteosarcoma metastases. For future reference, the largest lesion is in the right posterior costophrenic angle and measures up to 32 mm (series 6/73), mildly increased since prior study when it measured 26 mm. The remainder of the lesions are grossly stable. No new lesions. No pleural effusions.MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. No visible coronary artery calcifications. Residual thymic tissue. Right jugular central venous catheter tip near the superior cavoatrial junction.CHEST WALL: Mild left axillary lymphadenopathy is similar to prior study. Left humeral prosthesis is partially visualized.ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Status post cholecystectomy. No suspicious liver lesions.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1. Osteosarcoma lung metastases with mild interval increased size in the largest lesion, which is in the right lower lobe. The other metastases are grossly stable in size. No new metastases.2. No evidence of metastasis in the abdomen.
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Generate impression based on findings.
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12-year-old male with bilateral left knee pain x 1 month along medial and lateral aspectsVIEWS: Right knee and left knee AP/lateral (4 views) 02/05/15 No acute fracture or malalignment is evident. Small left joint effusion is present. No loose bodies. The articular surfaces are smooth. Mild cortical irregularity along the medial aspect of the distal right femoral metaphysis may represent a normal variant.
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1.Small left joint effusion.2.Mild cortical irregularity along the medial aspect of the distal right femoral metaphysis. This may represent a normal variant and correlation with clinical examination is recommended. MRI may be considered if pain persists.
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Generate impression based on findings.
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Reason: 58 yo female with history of AML; pre-allo SCT evaluation History: evaluate LUNGS AND PLEURA: Small calcified granuloma in the right lower lobe compatible with previous infection.No active disease and no pleural effusion.Elevation of the right hemidiaphragm, unchanged.MEDIASTINUM AND HILA: No lymphadenopathy.No visible coronary artery calcification and mild calcification in the aortic root.No pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Very limited evaluation with no gross abnormalities.
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No acute abnormalities.
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Generate impression based on findings.
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Reason: possible follicular neoplasm of the thyroid History: r/o mets LUNGS AND PLEURA: No significant abnormality noted, specifically no evidence of metastases. MEDIASTINUM AND HILA: Left lobe thyroid heterogeneous enlargement, status post right sided thyroidectomy.Water attenuating "node" in the right paratracheal region image 39 series 3 is cephalad extension of the superior aortic pericardial recess, not to be mistaken for adenopathy.No adenopathy is identified.Moderate coronary calcifications are noted, the heart and pericardium otherwise. CHEST WALL: Degenerative abnormalities affect the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Cholelithiasis without evidence of cholecystitis.
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1. Enlargement of the left thyroid lobe, the right having been resected.2. No evidence of metastases.3. Cholelithiasis without evidence of cholecystitis.
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Generate impression based on findings.
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22 year-old male with gunshot wound, evaluate for foreign body or fracture A moderate joint effusion is noted. There is a radial head and neck fracture with minimal displacement. A crescentic density adjacent to the medial epicondyle may represent a small avulsion fracture. No radiopaque foreign body.
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Radial head and neck fracture and small avulsion fracture of the medial epicondyle. Joint effusion. No radiopaque foreign body.
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Generate impression based on findings.
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HPV-positive T2N2B right tonsillar cancer, status post left tonsillectomy, right tonsil biopsy, and CRT on 9/26/14. There has been interval right neck dissection with fluid collections in the surgical bed. There has also been resection of the right internal jugular vein. There is no evidence of significant lymphadenopathy in the neck or measurable mass lesions in the right tonsillar fossa. There is edema in the right supraglottic region with effacement of the right piriform sinus. The thyroid and major salivary glands are unchanged. There is mild plaque at the carotid bifurcations. The osseous structures are unchanged. The imaged intracranial structures are unremarkable. There is fluid within the left maxillary sinus. The imaged portions of the lungs are clear.
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1. Interval right neck dissection with fluid collections that likely represent seromas.2. No measurable right tonsillar mass.3. Fluid within the left maxillary sinus is suggestive of acute sinusitis.
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Generate impression based on findings.
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18 year-old male jammed right index finger A faint density volar to the proximal aspect of the middle phalanx may represent a small capsular avulsion injury. There is overlying soft tissue swelling.
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Questionable small volar capsular avulsion injury about the PIP joint as described above.
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Generate impression based on findings.
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56 year old female with history of pain. There is deformity and chronic flattening of the humeral head with bone-on-bone apposition. Additionally, there is sclerosis about the humerus. There is moderate osteoarthritis affecting the acromioclavicular joint.No acute fracture is evident.
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Severe osteoarthritis and other findings as above.
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Generate impression based on findings.
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46-year-old female with reported history of ankylosing spondylitis. Right hip: Mild osteoarthritis affects the hip. There is no evidence of acute fracture or dislocation.Left hip: Mild osteoarthritis affects the hip. There is no evidence of acute fracture or dislocation.SI joints: There is mild left greater than right sclerosis about the SI joints. There are small osteophytes along the inferior aspect of the left SI joint.Right shoulder: Mild osteoarthritis affects the glenohumeral and AC joints. No acute fracture or dislocation.
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Degenerative changes with no specific radiographic evidence of ankylosing spondylitis. If clinically warranted, an MRI of the SI joints may be obtained.
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Generate impression based on findings.
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Male 51 years old; Reason: pT3b N1 prostate cancer now on ADT with PSA of 0.19. Evaluate for bone metastases. No abnormal osseous foci are identified to indicate metastatic disease.There are mild degenerative changes of the lower thoracic spine as compared to same day CT study.
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No evidence of bone metastases.
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Generate impression based on findings.
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58-year-old male with history of low back pain. There is moderate degenerative disc disease especially at L4-5. There are small osteophytes projecting from the anterior aspect of L3, L4, and L5. Vertebral body heights are maintained. Surgical clips project over the lower abdomen.
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Moderate degenerative arthritic changes as above.
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