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Generate impression based on findings.
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Cough and shortness of breath. History of asthma with abnormal low res CT question ABPA. LUNGS AND PLEURA: Distal endobronchial debris/tree in bud opacities similar in distribution but appear slightly improved the posterolateral left upper lobe and right lower lobe but similar in appearance elsewhere. No pleural fluid or pneumothorax. Subpleural scarring in the lung apices, suspicious for sequela of is previous eosinophilic pneumonia.4-mm nodule in the right middle lobe lateral segment near the fissure may be within the parenchyma rather than endobronchial.No bronchiectasis or bronchial wall thickening.MEDIASTINUM AND HILA: Small hiatal hernia. Normal heart size. No pericardial fluid. Mild coronary artery calcifications. Mild atherosclerotic calcification of the thoracic aorta at the arch.CHEST WALL: Breast prostheses are minimally calcified. Minimal degenerative changes of the spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Limited scanning range is unremarkable.
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1. Slight improvement in pulmonary opacities in a pattern consistent with indolent endobronchial infection such as ABPA or atypical mycobacteria, the latter is included in the differential diagnosis given absence of bronchiectasis and large mucoid plugs.2. 4-mm right lower lobe nodule may be followed by CT in 1 year if patient is at high risk for malignancy, otherwise no follow up is necessary. 3. Mild coronary artery calcifications.3. Subpleural scarring in the upper lobes, query history of eosinophilic pneumonia which may be associated in conjunction with ABPA.
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Generate impression based on findings.
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Ms. Salter is a 43 year old female recalled from screening mammogram for calcifications in the left breast. An ML view and five spot magnification 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. Spot magnification views re-demonstrate a loose cluster of round, punctate calcifications in the left upper outer breast, anterior depth, with a benign appearance. There is no new mass or areas of architectural distortion identified in the left breast.
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Benign round, punctate calcifications in the left breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation 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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Female, 42 years old, postoperative RFO evaluation. Suboptimal exam secondary to technique. Enteric tube seen with tip extending into gastric antrum. No definite unexpected radioopaque foreign body seen. Incompletely imaged left basilar consolidation/atelectasis. Symphysis pubis sclerotic changes.
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No unexpected radioopaque foreign body, discussed with surgeon Dr. Roggin at 11:27 a.m. on 2/6/15.
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Generate impression based on findings.
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Female 73 years old; Reason: METASTATIC COLON CANCER EVALUATE FOR INTERVAL CHANGE History: METASTATIC COLON CANCER CHEST:LUNGS AND PLEURA: Upper lobe scar like opacity is unchanged (series 5, image 31) measuring 5 mm.MEDIASTINUM AND HILA: Left chest wall Port-A-Cath with tip in the cavoatrial junction. Reference mediastinal lymph node measures 1.6 x 1.0 cm (series 3, image 48) previously 1.6 x 1.0 cm. No pericardial or pleural effusion.CHEST WALL: Right internal jugular vein occlusion.ABDOMEN:LIVER, BILIARY TRACT: Multiple hypoattenuating liver lesions are stable and likely represent hepatic cysts. No suspicious liver lesion is identified. Patent hepatic vasculature. Status post cholecystectomy.SPLEEN: Status post splenectomy.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Multiple prominent porta caval lymph nodes are stable.BOWEL, MESENTERY: Postsurgical changes in the colon. Soft tissue around the antrum and duodenal bulb is not significantly changed compared to prior. Persistent mild peritoneal nodularity. BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality noted.UPPER PELVIS:UTERUS, ADNEXA: Not imaged.BLADDER: Not imaged. LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Please see above.BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality noted.
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1.Stable examination without significant change in size of reference lesions.2.Stable appearance of soft tissue thickening about the gastric antrum/pylorus.
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Generate impression based on findings.
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Reason: 55 yo with HCC please screen for mets History: none LUNGS AND PLEURA: Micronodules at the right apex and a few small subpleural scars, compatible with previous infection.No suspicious nodules and no pleural effusions.MEDIASTINUM AND HILA: No significant lymphadenopathy.Small right tracheal diverticulum in the high right paratracheal region.Severe coronary artery calcification.No pericardial effusion.CHEST WALL: Healed fracture of the right seventh rib.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Limited evaluation, with findings in the liver and gallbladder as described on a recent MRI scan compatible with cirrhosis and cholelithiasis. A lesion compatible with HCC is not clearly visualized on this nonenhanced scan.
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No evidence of metastatic disease in the chest.
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Generate impression based on findings.
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9-year-old male with abnormal lung examVIEWS: Chest PA/lateral (two views) 02/06/15 Aortic arch, cardiac apex, and stomach are left-sided. Cardiothymic silhouette is normal. No pleural effusion or pneumothorax. No focal pulmonary opacities. The osseous structures are within normal limits.
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Normal examination.
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Generate impression based on findings.
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14-year-old male status post ORIFVIEWS: Left knee AP/oblique/lateral (3 views) 02/06/15 Cast material obscures fine bone detail. Two orthopedic screws affix a tibial tuberosity fracture in near anatomic alignment without evidence of hardware complication. No joint effusion.
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Fixation of proximal tibial fracture in near anatomic alignment.
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Generate impression based on findings.
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33-year-old male with history of atraumatic pain. We see no acute fracture or dislocation. Alignment is anatomic. The soft tissues are unremarkable.
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No radiographic findings to account for the patient's pain.
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Generate impression based on findings.
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40 year old with a small mass in the left breast at 3 o'clock position detected by recent ultrasound study (1/30/15), presents for ultrasound guided biopsy. Left ultrasound re-identified the target lesion for biopsy. The lesion to be targeted is a hypoechoic mass measuring 9 x 7 mm at the 3 o’clock position with mildly increased vascularity, 3 cm from the nipple. The lesion was readily visible.PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip and post-procedure unilateral mammogram were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure.The left breast was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a inferior to superior approach, three 14-gauge core needle (Inrad) specimens were obtained of the lesion. Targeting was judged very good. All specimens floated in the prefilled container of 10% formalin. Specimen quality was judged good.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Hydromark clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Post-procedure digital left CC and ML views revealed the percutaneously placed clip to be in the expected location at 3 o'clock position. No evidence of hematoma or other complication.A pressure dressing was positioned over the biopsy site and an ice pack positioned over the pressure dressing. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and left the Breast Imaging Department in stable condition.The procedure was performed by Dr. Abe.
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Successful ultrasound-guided core biopsy of the left breast lesion and clip placement. Pathology is pending at this time.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.
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Generate impression based on findings.
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Male 74 years old; Reason: renal mass seen on US History: hematuria ABDOMEN:LUNG BASES: Cardiac conduction device in situ.LIVER, BILIARY TRACT: Hypoattenuating lesion in the right hepatic lobe is suggestive of a hepatic cyst.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate nonobstructing right renal calculus. On delayed images there is prompt and symmetric secretion of contrast into the collecting system. There is no filling defect. There is no focal renal mass. There is a duplex left collecting system.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diverticular disease without CT evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.No focal renal mass. Punctate non obstructing right renal calculus .
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Generate impression based on findings.
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Tuberous sclerosis. Evaluate angiomyolipomas. ABDOMEN:LUNG BASES: Stable fat densities within the myocardium of the left ventricle and right right ventricle. The inferior most aspect of vagal nerve stimulator is noted within the paramedian soft tissues of the back.LIVER, BILIARY TRACT: Scattered subcentimeter fat attenuations within the liver are unchanged in the prior examination.SPLEEN: Normal size and attenuation without focal lesions.PANCREAS: Normal attenuation and morphology without focal lesions.ADRENAL GLANDS: Normal size and enhancement.KIDNEYS, URETERS: Innumerable well-circumscribed heterogeneous lesions are again identified within both kidneys. The lesions appear slightly more conspicuous on today's examination, which is likely due to phase of contrast enhancement. Overall, no significant interval change in size or number is evident. The largest is present within the interpolar region of the left kidney and measures 2.1 x 1.5 cm (image 58 of series 5).RETROPERITONEUM, LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: Moderate fecal burden within the cecum.BONES, SOFT TISSUES: Minimal anterior wedging of T11.OTHER: No significant abnormality noted
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1.Renal lesions consistent with angiomyolipomas without significant interval change.2.Scattered fat attenuating liver lesions unchanged.3.Cardiac lipomas unchanged.
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Generate impression based on findings.
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Male; 82 years old. Reason: eval encapsulated thymoma History: eval interval change LUNGS AND PLEURA: Moderately severe centrilobular emphysema in the upper lobes.Large bulla occupying the anteroinferior portion of the right hemithorax with adjacent compressive atelectasis of the right middle lobe not significantly changed. Right middle lobe lateral segmental airways are not visualized, either due to extrinsic compression or occlusion.Dense peripheral nodular opacities in the right lower lobe persist, increased in size and extent of nodularity. The adjacent subpleural lung laterally is spared. Although this could represent cryptogenic organizing pneumonia, an underlying indolent neoplastic process cannot be excluded.MEDIASTINUM AND HILA: Sharply circumscribed mass in the anterior mediastinum (image 53, series 3) measuring 31 x 22 mm, unchanged.Precarinal lymph node measuring 9 mm in short axis, unchanged.Moderately severe aortic and coronary artery calcifications.CHEST WALL: Degenerative disease in the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality.
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1. Increased nodular consolidation in the right lower lobe, indeterminate. This could represent organizing pneumonia or less likely indolent atypical mycobacterial infection, but primary lung neoplasm cannot be excluded. PET-CT evaluation can be obtained for further characterization.2. Stable anterior mediastinal mass, most compatible with a thymoma.
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Generate impression based on findings.
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66 years, Female. Reason: re-evaluate NG tube placement after adjustment. NG tube sidehole in gastric fundus. Pelvic drain and skin staples again noted. Catheter in right flank likely represents the patient's reported IP port. Nonobstructive bowel gas pattern. Basilar atelectasis.
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NG tube sidehole in gastric fundus; suggest further advancement.
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Generate impression based on findings.
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Ms. Kolkmeier is a 70 year old female with a personal history of right breast lumpectomy in 2002 for cancer followed by radiation therapy. She is also status post bilateral breast prosthesis removal. Family history of breast cancer in mother. She has no current breast related complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. A linear marker was placed on the scar overlying the right breast. There are stable postsurgical changes including architectural distortion, increased density, and surgical clips present within the right lumpectomy site. Surgical clips are also present in the right axilla. Multiple benign-morphology circumscribed masses in the left breast are stable. Scattered benign calcifications are present bilaterally. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast.
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Stable postsurgical changes of the right breast and stable benign breast masses 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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Patient was struck by industrial equipment at proximal first metacarpal on palmar side. Pain in first metacarpal and wrist. An orthopedic screw affixes a fracture of the scaphoid waist in near anatomic alignment. The fracture line remains visible. I see no additional fracture. Moderate osteoarthritis affects the distal radioulnar joint. Minimal osteoarthritis affects the distal interphalangeal joints.
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Orthopedic fixation of scaphoid fracture; I see no additional fracture. Osteoarthritis as described above.
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Generate impression based on findings.
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Reason: r/o mass, herniation risk History: needs LP to r/o meningitits The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a hypodense focus present in the subcortical white matter of the right frontal lobe.A small hyperdense focus is present in the right basal gangliaThe 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.No evidence for acute intracranial hemorrhage mass effect or edema.2.Any subcortical white matter the lesion identified in the right frontal lobe is nonspecific it could be vascular related.3.A small lesion in the right basal ganglia is nonspecific. It could represent a lacunar infarct of indeterminate age.4.If deemed clinically appropriate, MRI may be helpful in further assessing the above described small lesions .
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Generate impression based on findings.
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Evaluate healing osteotomyVIEWS: Left forearm AP and lateral Again noted compression plates and screws affixing the osteotomies of the mid radius and ulna without hardware complication. These osteotomy sites are indistinct with periosteal reaction reflecting interval healing. Disuse osteopenia and soft tissue swelling again noted.
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Healing osteotomies as described above.
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Generate impression based on findings.
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Hemoptysis rule out mass or pneumonia. LUNGS AND PLEURA: No pleural fluid or pneumothorax. No focal air space opacities, nodules or masses. Diffuse faint ground glass opacities with a peribronchovascular distribution bilaterally with very mild bronchial wall thickening. Relative sparing of the lung apices and costophrenic angle regions. No bronchiectasis. No endobronchial debris. No nodules.MEDIASTINUM AND HILA: Nonspecific calcifications in the thyroid gland. Mild atherosclerotic calcifications of the thoracic aorta and its branches. Moderate calcification involving the left main and left anterior descending coronary arteries. Mitral annulus calcifications. Normal heart size. No pericardial effusion. No lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Limited scanning range. No significant abnormality.
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Faint diffuse groundglass opacities with mild bronchial wall thickening most suggestive of viral bronchitis with early pneumonitis. The radiographic appearance is not typical of pulmonary hemorrhage though if the patient is at high risk short-term reduced dose CT follow-up may be obtained to exclude evolution of findings. Moderate coronary artery calcifications.
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Generate impression based on findings.
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Knee pain status post remote history of tibial plateau fracture status post ORIF. Four views of the left knee are provided. Orthopedic screws affix the proximal tibia. I see no hardware complications. Mild deformity of the proximal tibia represents the known healed tibial plateau fracture. I see no acute fracture. Severe osteoarthritis affects the knee. Small ossicles overlying the anterior and lateral aspects of the knee may represent loose bodies, but this is equivocal.Moderate osteoarthritis affects the right knee as seen on the frontal view.
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Postoperative/posttraumatic changes of the left knee with osteoarthritis as described above.
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Generate impression based on findings.
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Heart transplant workup. LIVER: The liver measures 15.3 cm in length. No intrahepatic ductal dilatation or dominant liver lesions. Portal vein is patent with flow towards the liver on color Doppler imaging.GALLBLADDER, BILIARY TRACT: No significant abnormality noted. Common duct measures 3 mm which is within normal limitsPANCREAS: No significant abnormality noted.SPLEEN: Spleen measures 7.8 cm in length. No focal lesions.KIDNEYS: No hydronephrosis of either kidney. The right kidney measures 9.5 cm in length and the left kidney measures 10.1 cm in length. Probable right renal cyst.ABDOMINAL AORTA: Proximal abdominal aorta measures 2 cm in diameter, the mid abdominal aorta measures 2.2 cm in diameter, and the distal abdominal aorta measures 1.8 cm in diameter. Aortic calcifications probably reflect atherosclerosis.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: Bilateral small pleural effusions.
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Bilateral small pleural effusions. Right renal cyst.
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Generate impression based on findings.
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Medullary thyroid cancer. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Thyroid bed is incompletely visualized. At the origins of the left common carotid and right innominate arteries, there is eccentric mural thrombus. The origin of the left common carotid artery lumen measures 3-4 mm, consistent with stenosis, unchanged.Normal heart size. Physiologic volume of pericardial fluid. No visible coronary artery calcification. No lymphadenopathy. Right paratracheal air cyst.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Index lesion measures 6.6 x 5.8 cm, previously 6.4 x 6.3 cm (3/95). Abnormal perfusion the remainder of the left hepatic lobe may be due to vascular shunting by the mass.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: Atherosclerotic calcification of the the thoracic aorta and its branches. The proximal left common iliac artery is slightly narrowed by eccentric calcified plaque (3/144).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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No significant change in size of hepatic mass. No pulmonary metastases. Stenosis of the left common carotid artery origin.
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Generate impression based on findings.
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Male 19 years old; Reason: reassess retroperitoneal lymphadenopathy History: see above CHEST:LUNGS AND PLEURA: No focal pulmonary lesion. The pleural spaces are clear. The central airways are patent.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. There are few scattered small mediastinal lymph nodes.CHEST WALL: Small axillary lymph nodes.OTHER: ABDOMEN:LIVER, BILIARY TRACT: Small hypodense focus in segment 3 of the liver likely represents portion of gallbladder. No suspicious hepatic lesions. Hepatic and portal veins are patent.SPLEEN: The spleen is normal in size.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Multiple small retroperitoneal lymph nodes. The reference left paraortic lymph node measures 1.0 x 0.8 cm (image 118/series 3) and is unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.Stable exam with small lymph nodes in the axilla, mediastinum and retroperitoneum.
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Generate impression based on findings.
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Pain Interval recent surgery with new osteotomy and shaving of distal bony excrescence and possible heterotopic bone extending from the fourth and fifth metatarsal bases the first through third remaining digits are otherwise unchanged. Proximal aspects are also similar. Mild soft tissue swelling
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Recent postsurgical excision and revision of amputated first through fifth metatarsal bases
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Generate impression based on findings.
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Pain. Evaluate for psoriatic arthritis. Three views of the left hand are provided. There is narrowing of the radiocarpal and midcarpal articulations with erosions along the distal radius and ulnar styloid. There may be additional small carpal bone erosions as well. Severe osteoarthritis affects the first carpometacarpal joint. There is equivocal mild narrowing and erosion at the fifth MCP joint. Mild osteoarthritis affects scattered interphalangeal joints with equivocal erosion at the DIP joint of the middle finger.Three views of the right hand are provided. There is narrowing of the radiocarpal joint and midcarpal joint, with erosions of the distal ulna and radius. The lunate bone appears small and sclerotic which may represent sequela of chronic erosive remodeling or perhaps osteonecrosis. Severe osteoarthritis affects the first carpometacarpal joint. I suspect that there are erosions along the bases of the fourth and fifth metacarpals as well. There is erosive deformity of the second metacarpophalangeal joint. There is narrowing of the fourth and fifth MCP joints, and I suspect small chronic erosions at these joints as well. Narrowing of the first MCP joint with osteophyte formation is compatible with osteoarthritis. Mild osteoarthritis affects scattered interphalangeal joints although there may be mild chronic erosion at the PIP joint of the middle finger.Three views of the left foot are provided. There is an orthopedic screw within the head and neck of the first metatarsal with mild deformity of the surrounding bone reflecting bunion correction surgery. Mild osteoarthritis affects the first metatarsophalangeal joint. There is dorsal dislocation of the proximal phalanx of the second toe relative to the second metatarsal head. Mild deformity of the third metatarsal head and neck may reflect old trauma. There are mild chronic-appearing enthesopathic changes along the base of the fifth metatarsal. There are plantar and posterior calcaneal spurs. There is mild diffuse soft tissue swelling.Three views of the right foot are provided. There is an orthopedic screw in the head and neck of the first metatarsal with mild deformity of the surrounding bone reflecting prior bunion correction surgery. Mild osteoarthritis affects the first metatarsophalangeal joint. There is mild deformity of the second and third metatarsal heads which may reflect old trauma. There is also mild deformity of the base of the proximal phalanx of the second toe which may reflect old trauma or alternatively chronic erosive remodeling. Mild osteoarthritis affects the midfoot articulations and the tibiotalar joint. There is mild diffuse soft tissue swelling. Posterior and plantar calcaneal spurs are noted. A small focus of heterotopic ossification is seen within the soft tissues beneath the calcaneus.Four views of the left knee are provided. Severe osteoarthritis affects the knee, with bone on bone apposition of the medial tibiofemoral compartment and a mild varus deformity of the knee. There may be a small joint effusion, but this is equivocal. I see no definite erosions.Four views of the right knee are provided. Severe osteoarthritis affects the knee with bone on bone apposition of the medial tibiofemoral compartment.
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Bone and joint abnormalities as described above representing a combination of osteoarthritis and inflammatory arthritis such as rheumatoid arthritis or psoriatic arthritis.
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Generate impression based on findings.
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Male, 19 years old, with tuberous sclerosis, assess for SEGA, cortical tubers. Multiple areas of cortical/subcortical hypoattenuation are again seen compatible with tuberous lesions. Within the sensitivity limits of CT, no significant interval change in size or number of these lesions is detected.A prominent calcified lesion along the margin of the right lateral ventricle, at the level of the foramen of Monro, is also unchanged. This lesion shows at most minimal associated enhancement. Scattered smaller calcified subependymal lesions along both lateral ventricles are also not appreciably changed. Finally, a striated pattern of calcification within the right cerebellar hemisphere is unchanged.No definite evidence of any new lesion is seen. No intracranial hemorrhage or any abnormal extra axial fluid collection is detected. The ventricular system is normal in size and morphology.The osseous structures of the skull are intact. Patchy thickening and/or secretion is seen in the ethmoid air cells and left more than right maxillary sinuses.
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Multiple stigmata of tuberous sclerosis without significant interval change.
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Generate impression based on findings.
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Metastatic breast cancer receiving chemotherapy. Malignant pleural effusion, right-sided Pleurx catheter. CHEST:LUNGS AND PLEURA: Innumerable pulmonary nodules compatible with metastases, not present on the 2013 examination. Moderate loculated right pleural fluid collection. Right pleural thickening new from 2013 and increased from the non-staging PE study of 12/1/2014. The Pleurx catheter enters the pleural space anterolaterally at the lung base, traveling medially and posteriorly as it courses towards the upper thorax to terminate at the level of the right posterior fifth rib. No pneumothorax.Index mass at the right lung base is larger, measuring 4.1 x 4.9 cm (5/47), previously 2.5 x 3.3 cm.MEDIASTINUM AND HILA: Unchanged mild cardiomegaly. No pericardial effusion. No enlarged lymph nodes, though there is stranding of the pericardial fat.CHEST WALL: Bilateral mastectomy and axillary dissection. Right chest tube enters the pleural space at the sixth/seventh rib interspace laterally. No skeletal lesions are appreciated.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Assessment for solid organ pathology somewhat limited due to phase of contrast.LIVER, BILIARY TRACT: Lesions seen on the recent PE CT are not visible, likely related to phase of contrast.SPLEEN: Unchanged subcentimeter focus of hypoattenuation in the spleen, likely benign.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: 1.5 x 1.3 cm hypoattenuating lesion in the right kidney (4/93) poorly visualized to the phase of contrast but is new from the exam of 5/2013; a metastasis cannot be excluded.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. Innumerable pulmonary metastases with increase in size of index right lower lobe mass. 2. Loculated right pleural effusion with slight increase in pleural thickening since the previous study presumably metastatic.3. No mediastinal lymphadenopathy or skeletal metastases are appreciated. 4. Indeterminate hypoattenuating lesion in this right kidney may represent a metastasis. 5. Hepatic lesions identified on a recent PE CT are not visible on the current examination due to phase of contrast; assessment of the solid organs of the upper abdomen is limited. If further evaluation is required, consider a dedicated hepatic protocol CT of the abdomen.
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Generate impression based on findings.
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Ankle fixation Medial malleoli are and distal fibular fixation appears unchanged without evidence of hardware complication. Interval partial healing of the comminuted distal fibular fracture. Medial malleoli or fracture plane is also less distinct compatible with partial healing. Decreased soft tissue swelling and persistent alignment
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Interval healing
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Generate impression based on findings.
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Neck pain No radiographic abnormality, specifically no findings to suggest instability. Soft tissues unremarkable
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Normal
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Generate impression based on findings.
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Left shoulder pain Small punctate calcific density projected over the humeral head suggesting a benign bone island. The shoulder otherwise demonstrate minimal degenerative changes largely involving the glenoid. No superimposed additional acute abnormality. Alignment preserved.
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Minimal degenerative changes without additional abnormality
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Generate impression based on findings.
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Left leg pain Age consistent growth plates and osseous structures, without additional superimposed focal acute abnormality. Specifically no periosteal reaction or soft tissue abnormalities.
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Normal
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Generate impression based on findings.
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Male 56 years old; Reason: mets lung cancer, ALK+, has been on Crizotinib x 3 yrs. Increased pleural based lesion on recent CT. Pls c/w previous study and evaluate dx status. History: lung ca ABDOMEN:LUNG BASES: Refer to chest section for a dictated report.LIVER, BILIARY TRACT: Nonspecific hypodense foci in the liver. No definite evidence of metastatic disease.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Calcification and right adrenal gland. Left adrenal gland is unremarkable.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Nonspecific mild mesenteric thickening in the pelvis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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Stable abdomen and pelvis CT exam with no definite measurable disease.
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Generate impression based on findings.
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Rule out acute fracture after fall on concrete. Status post meniscal repair in October 2014. Pain. Inability to ambulate or flex knee Four views of the right knee are provided. I see no fracture or malalignment. I see no large joint effusion.The left knee likewise appears normal as seen on the frontal view.
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No fracture or other specific findings to account for patient's pain are evident.
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Generate impression based on findings.
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63 years old Male. Reason: New Metastatic melanoma of posterior chest wall. Needs staging PET Scan. History: New metastatic melanoma on posterior chest wall. Needs PET Scan for staging. RADIOPHARMACEUTICAL: 15.2 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 198 mg/dL. Today's CT portion grossly demonstrates two soft tissue nodules in the subcutaneous tissue of the back of the chest. Enlarged lymph nodes are seen in the right supraclavicular region and the right and left axillary regions. Multiple gallstones are seen in the gallbladder. Multiple cysts lesions are seen in the kidneys. The joint effusions are noted in both knees. Degenerative changes are seen in the lumbar spine.Today's PET examination demonstrates increased metabolic activity in the soft tissue nodules in the subcutaneous tissue of the back of the chest. Increased metabolic activity in the lymph nodes is seen in the right supraclavicular region and bilateral axillary regions. The maximal SUV in the right axillary lymph nodes is 8.9.There is no abnormal FDG uptake in the multiple cysts lesions in the kidneys. Diffuse FDG uptake in both knees is noted, which is consistent with the arthritis.Physiological activity is seen in the liver, spleen, kidneys, intestines and bladder.
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1.Soft tissue metastases in the back of the chest.2.Nodal metastases in the right supraclavicular region, and the bilateral axillary regions.3.Multiple renal cysts.4.Bilateral knee joint effusion and arthritis.5.Cholelithiasis seen gallbladder.
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Generate impression based on findings.
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Reason: r/o ICH History: seizures, persistent, AMS The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.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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No evidence for acute intracranial hemorrhage mass effect or edema.
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Generate impression based on findings.
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Dog bite. Evaluate for fracture. I see no fracture, malalignment, or foreign body.
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No fracture evident.
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Generate impression based on findings.
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Reason: AMS, tremulous activity History: AMS, tremulous activity The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening and mucous retention cysts. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
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1.No evidence for acute intracranial hemorrhage mass effect or edema.2.CT is insensitive for the early detection of acute nonhemorrhagic cerebral infarction.
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Generate impression based on findings.
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Right lower leg pain I see no specific findings to account for the patient's pain. Apparent sclerosis of the medial aspect of the body of the talus may simply represent summation artifact.
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No specific findings to account for the patient's pain. If there is clinical concern for stress fracture, repeat radiographs may be obtained in 10 to 14 days; alternatively, MRI may be considered.
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Generate impression based on findings.
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CT CHEST W 2/6/2015 12:51 PM LUNGS AND PLEURA: Small focus of pulmonary interstitial emphysema along the posterior aspect of the left mediastinal border adjacent to the descending pulmonary artery minimally larger, but no pneumothorax (5/49).Left pleural tumor not significantly changed. Loculated moderate left pleural fluid collection similar in volume. Some of the larger pleural nodules are necrotic. Reference lesions on the left as follows: Pleural thickening at the level of the aortopulmonary window measures 15-mm at the reference level, image 34, unchanged.Confluent pleural lesion abutting the fissure measures 3.8 x 2.9 cm, previously 3.6 x 3-cm (5/40). Circumferential bronchial wall thickening surrounding the airways of the left lung about the same. Atelectasis and mosaic attenuation of the lung parenchyma at the left lung base with septal thickening. Right lung remains clear.MEDIASTINUM AND HILA: Trace pericardial fluid collection unchanged. Heart size upper normal. Tumor involves the pericardium adjacent to the left ventricle and left atrial appendage with a loss of epicardial fat plane in some areas.Left hilar, necrotic ipsilateral interlobar and subcarinal lymphadenopathy not significantly changed.CHEST WALL: Poorly defined left internal mammary chain lymph node (image 41) and soft tissue extending into the region of the left internal mammary chain (image 30), about the same.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Abdominal images will be separately reported.
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No significant change in left hemithorax disease and no new sites of tumor involvement.
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Generate impression based on findings.
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Pain. Preop. Three views of the left knee are provided. Moderate osteoarthritis affects the knee with medial compartment narrowing and tricompartmental osteophytes. Components of a right total knee arthroplasty device are situated in near-anatomic alignment as seen on the frontal view.Mechanical axis radiograph of the left lower extremity shows the aforementioned right knee osteoarthritis. There is approximately 5 degrees of varus alignment of the knee with respect to the neutral mechanical axis.
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Osteoarthritis and mild varus deformity of the left knee as described above.
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Generate impression based on findings.
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Reason: h/o chronic SDH; no neurosurgical intervention History: surveillance Since the prior exam a left-sided subdural collection is slightly less dense than the thinner. It currently measures 9 mm in thickness whereas it previously measured 15 mm in thicknessThere is redemonstration of hypodense foci in the basal ganglia bilaterally are suspected to represent perivascular spaces.Periventricular and subcortical white matter hypodensities of a moderate degree are present.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses demonstrate partial opacification of the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The left eyeball lens is thin. There are scleral calcifications present adjacent to the insertion sites of the ciliary bodies most likely representing scleral plaque.Atherosclerotic calcifications are present along the distal vertebral arteries. Atherosclerotic calcifications are present along the distal internal carotid arteries.
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1.Continued evolution of a left sided subdural hematoma which is now smaller on the current exam compared to the prior.
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Generate impression based on findings.
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46 years old Female. Reason: elevated metanephrines and calcitonin, adrenal hyperplasia, lung micronodules, and enlarged mediastinal and retroperitoneal lymph nodes. History: concern for pheochromocytoma or other neuroendocrine tumor. RADIOPHARMACEUTICAL: 13.5 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 95 mg/dL. Today's CT portion grossly demonstrates multiple small lymph nodes in the prevascular space and precarinal region in the mediastinum and bilateral axillary regions. Multiple small lymph nodes are seen in the retroperitoneal cavity in the abdomen and pelvis at external iliac regions on both sides. The patient is status post right mastectomy with surgical clips in the right axilla. Breast implant is seen on the left chest. Right coronary artery stent/calcifications are noted. Patient is status cholecystectomy. Please refer to the report of the recent diagnostic CT was the details of CT findings.Today's PET examination demonstrates mild FDG uptake in the multiple small lymph nodes in the bilateral axillary regions, retroperitoneal cavity at left para-aortic region, and in the pelvis at bilateral external iliac lymphatic chains. The maximum SUV in the right axillary region is 2.1. Mild FDG uptake is also seen in the bilateral inguinal normal-sized lymph nodes. Minimal FDG uptake is seen normal-sized multiple lymph nodes in the superior mediastinum, prevascular space and precarinal regions in the mediastinum.There is no definite abnormal FDG uptake in the bilateral adrenal glands. Linear areas of mildly increased activity in both hips over the greater trochanters are most likely due to bursitis.Physiological activity is seen in the liver, intestines, stomach, kidneys, adrenal glands, ureters and bladder.
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1.No definite evidence of FDG avid tumor. No abnormal FDG uptake in the bilateral adrenal glands.2.Multiple normal-sized lymph nodes with mild FDG uptake in the bilateral axillary regions, mediastinum, retroperitoneal cavity, pelvis, and the left inguinal regions are nonspecific. 3.Diffuse FDG uptake in the aorta is most likely due to atherosclerosis.
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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. There are postsurgical changes of anterior interbody fusion at L5-S1 with evidence of solid osseous fusion. Anterior plate and bilateral screws are intact and well positioned without evidence of complication. Bilateral pars defects at L5 and mild L5-S1 anterolisthesis, which is fused, is noted. There is minimal retrolisthesis at L1-L2, L2-L3, L3-L4, and L4-L5. Alignment is otherwise maintained.Multilevel degenerative changes are seen, as describe below:At L1-2 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L5-S1 there minimal narrowing of the right neural foramen from osteophyte related to facet arthropathy. No clear evidence of nerve root impingement. There is otherwise no significant compromise to spinal canal or neural foramina.Mild degenerative changes are seen at the bilateral sacroiliac joints with vacuum phenomena. Paraspinous soft tissues are within normal limits.
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1. Postsurgical changes of anterior lumbar interbody fusion at L5-S1 with solid osseous fusion.2. There is minimal contact of the exiting right L5 nerve root at the L5-S1 neural foramen with osteophyte related to facet arthropathy. Otherwise there is no significant spinal canal or neural foramina stenosis at any level.3. Mild degenerative changes at the bilateral sacroiliac joints with vacuum phenomena.
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Generate impression based on findings.
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Reason: h/o HNC and CRT, compare to previous measurements History: none CHEST:LUNGS AND PLEURA: No evidence of pulmonary or pleural metastases.Mild upper lobe centrilobular emphysema and left basilar linear scarring are stable.MEDIASTINUM AND HILA: There is no mediastinal or hilar lymphadenopathy.There are no visible coronary calcifications, and the heart and pericardium appear normal.A right jugular catheter terminates in the SVC/RA junction region.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Scattered hepatic cysts like punctate hypodensities are unchanged.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral extrarenal pelves.PANCREAS: Previously reported pancreatic hypodensities are stable, and may represent cysts or IPMNs.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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No sign of metastases, or other significant abnormality. Stable hypoattenuating pancreatic lesions, possibly IPMNs.
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Generate impression based on findings.
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87 year-old patient with shoulder osteoarthritis, pain in mid-humerus at night. Two views of the right humerus are provided. Severe osteoarthritis affects the glenohumeral joint. Mild osteoarthritis affects the acromioclavicular and elbow joints. The bones appear slightly demineralized suggesting osteopenia. I otherwise see no findings to account for the patient's mid-humerus pain.Two views of the left humerus are provided. Severe osteoarthritis affects the glenohumeral joint. Mild osteoarthritis affects the acromioclavicular joint and elbow joints. The bones appear slightly demineralized, suggesting osteopenia. I otherwise see no specific findings to account for the patient's mid-humerus pain.
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Osteoarthritis as described above, most severely affecting the glenohumeral joints bilaterally. If there is clinical concern for rotator cuff pathology, MRI may be considered.
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Generate impression based on findings.
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MVC with back pain. Three views of the thoracic spine are provided. I see no fracture or malalignment. I see no specific findings to account for the patient's back pain.Five views of the lumbar spine are provided. I see no fracture or malalignment. I see no specific findings to account for the patient's back pain.
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No specific findings to account for the patient's pain.
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Generate impression based on findings.
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IntubatedVIEW: Chest AP ET tube tip below thoracic inlet and above the carina. NG tube tip in the stomach. Cardiothymic silhouette normal. Bilateral perihilar and left lower lobe atelectasis increased in the interval. No pleural effusion or pneumothorax.
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Bilateral atelectasis increased in the interval.
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Generate impression based on findings.
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Medial midfoot pain. Foot fracture? I see no acute fracture or malalignment. Tiny osteophytes at the tibiotalar joint indicate minimal osteoarthritis. Tiny densities along the anterior aspect of the tibial plafond may represent capsular calcifications or less likely small loose bodies. There is a normal variant os trigonum posterior to the talus.
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Mild ankle joint osteoarthritis, but no fracture evident.
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Generate impression based on findings.
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Female 78 years old; Reason: follow up for bladder cancer recurrence s/p surgery History: hx of bladder cancer s/p cystectomy. The study is somewhat limited by motion artifact.CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Mild coronary artery calcifications.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. Subcentimeter hypoattenuating liver lesion is too small characterize.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left-sided percutaneous nephrostomy tube in situ. There is no hydronephrosis. Right-sided extrarenal pelvis.RETROPERITONEUM, LYMPH NODES: Shoddy retroperitoneal lymph nodes do not meet CT criteria for enlargement.BOWEL, MESENTERY: Postsurgical changes of urinary diversion to a right lower quadrant ileal conduit.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Arteriosclerosis of the thoracic aorta, abdominal aorta and branch vessels.PELVIS: Evaluation is limited by artifact from a left hip prosthesis.UTERUS, ADNEXA: Atrophic or surgically absent.BLADDER: Status post cystectomy.LYMPH NODES: New large necrotic left common iliac and external iliac lymph nodes. A reference node measures 3.8 x 3.5 cm (series 3, image 133).BOWEL, MESENTERY: Left lower quadrant ostomy.BONES, SOFT TISSUES: Nonspecific presacral soft tissue thickening is stable. Degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality noted.
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1.New enlarged necrotic pelvic lymph nodes suspicious for metastatic nodal disease.
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Generate impression based on findings.
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Chronic sinusitis and nasal obstruction. The right frontal sinus has not pneumatized. The paranasal sinuses are clear. The nasal cavity is also clear. There is moderate rightward deviation of the nasal septum. The lamina papyracea and ethmoid roofs are intact. The carotid grooves and optic canals are covered by bone. The nasopharynx, facial soft tissues, orbits, and imaged intracranial structures appear to be unremarkable. The mastoid air cells and middle ear cavities are clear.
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1. No evidence of sinusitis.2. Moderate rightward deviation of the nasal septum.
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Generate impression based on findings.
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IntubatedVIEW: Chest AP 2/6/15 ET tube tip below thoracic inlet and above the carina. NG tube tip in the stomach. Right internal jugular central line with tip at the cavoatrial junction. Cardiothymic silhouette at the upper limits of normal. Left lower lobe opacities minimally improved. Probable small left pleural effusion.
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Left lower lobe opacities minimally improved.
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Generate impression based on findings.
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Left buccal swelling/osteomyelitis status post facial reconstruction. There are postoperative findings related to partial left maxillectomy and left hemimandibulectomy with iliac bone and myocutaneous flap reconstruction, as well as total dental extraction, related to debulking of a left buccal region mass with lymph node metastases. There is slight interval progression of osteolysis in the remaining body of the mandible. Streak artifact from the mandible hardware otherwise limits characterization of the overlying soft tissues in this region. The mandible hardware is intact, without evidence of loosening. There is persistent diffuse edema in the surgical flap and other neck soft tissues. There are multiple heterogeneous masses in the partially-imaged upper neck. There is partial opacification of the left middle ear and mastoid air cells. There is now scattered opacification of the remaining paranasal sinuses. The imaged intracranial structures are grossly unremarkable. There are faint peribronchiolar opacities in the imaged portions of the lungs. There is a right apical bleb and a partially imaged right lung nodule.
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1. Extensive postoperative findings in the maxillofacial region with interval development of osteolysis in the remaining body of the mandible may represent osteomyelitis, although tumor involvement is a differential consideration. Streak artifact from the mandible hardware and the lack of intravenous contrast administration otherwise limits characterization of the soft tissues in this region. An MRI or tagged white blood cell nuclear scan may be useful for further characterization, if clinically warranted. 2. Persistent partially-imaged masses in the neck. Evaluation is otherwise limited without intravenous contrast.3. Persistent left middle ear and mastoid opacification may represent otomastoiditis.4. Scattered opacification of the remaining paranasal sinuses may represent sinusitis.
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Generate impression based on findings.
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DesaturationVIEW: Chest AP 2/6/15 ET tube tip below thoracic inlet and above the carina. NG tube tip in the stomach. Cardiothymic silhouette normal. Left chest tube removed in the interval. Minimal atelectasis left lower lobe in a background of chronic lung disease. There is a small left-sided pleural effusion. No evidence of pneumothorax.
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Patchy atelectasis with small left-sided pleural effusion.
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Generate impression based on findings.
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Female, 60 years old, with frequent sinusitis treated with antibiotics without resolution. History of sinus surgery. The frontal sinuses and frontoethmoidal recesses are clear. The sphenoid sinuses and sphenoethmoidal recesses are clear. The ethmoid air cell complex ease, anterior and posterior, are clear.The maxillary sinuses show no evidence of significant mucosal thickening or accumulated debris. A metallic post, presumably from dental implantation, projects through the floor of the right maxillary sinus. The maxillary outflow pathways are visualized and unobstructed, though there is some narrowing of the left.The nasal cavity is clear. The nasal septum is intact showing an S-shaped curvature in both the coronal and axial planes. Concha bullosa of the left middle turbinate is seen. Paradoxical curvature of the right middle turbinate is seen. The cribriform plates, lateral lamellae, and fovea ethmoidalis are intact and symmetric. The olfactory grooves are symmetric.
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No evidence of significant or active paranasal sinus inflammatory disease.
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Generate impression based on findings.
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T4N2M0 nasopharyngeal carcinoma treated with radiation and chemotherapy. There are post-treatment effects in the nasopharyngeal region with diffusely edematous tissues. There is residual heterogeneity of the central skull base, but no evidence of measurable residual nasopharyngeal tumor. There is no significant residual lymphadenopathy in the neck. The cervical vertebrae appear to be grossly intact. The thyroid and major salivary glands are unremarkable. There is a right internal jugular venous catheter. The major cervical vessels are patent. The airways are grossly patent. There is partial bilateral tympanomastoid opacification. There is decreased opacification of the sphenoid sinuses, but there is now fluid within the maxillary and ethmoid sinuses. There are secretions in the trachea. There is mild emphysema and apical scarring in the partially imaged portions of the lungs. There is mild multilevel degenerative spondylosis.
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1. Post-treatment findings in the nasopharyngeal region without evidence of measurable residual tumor or significant lymphadenopathy. However, MRI with contrast may be more sensitive for neoplasm.2. Findings suggestive of acute sinusitis and bilateral otomastoiditis.3. Secretions in the trachea indicate aspiration.
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Generate impression based on findings.
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There is no restricted diffusion to indicate an acute infarct. No susceptibility weighted abnormalities to indicate hemorrhage. Mild periventricular and subcortical T2/Flair hyperintensities are nonspecific but compatible with small vessel ischemic changes. No mass, mass effect, midline shift or herniation. No evidence of edema. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no extraaxial fluid collections or subdural hematomas. The pituitary gland is normal in size. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear.
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1.No evidence of mass effect, mass or edema to indicate an inflammatory process.2.Mild small vessel ischemic changes.
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Generate impression based on findings.
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Ms. Asbury is a 74 year old female presenting for a short-term follow-up for calcifications in the right breast. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is extremely dense, which lowers the sensitivity of mammography, unchanged in pattern and distribution. A small benign cluster of calcifications in the right upper outer breast and in the right central breast are not significantly changed from prior exam. Additional scattered benign calcifications are present bilaterally. There is no new mass or areas of architectural distortion identified in either breast.
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Bilateral benign calcifications. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation 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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58 yo female with recurrent clinical stage I uterine leiomyosarcoma with lung metastatasis, s/p wedge resection, recently completed 6 cycles of adjuvant chemotherapy History: increasing hilar lymph node on imaging, f/u exam CHEST:LUNGS AND PLEURA: Right perifissural nodule unchanged (image 62, series 4). Postsurgical scarring again noted in the left lung. Micronodule in the left lung apex (image 22; series 4) is stable to slightly decreased in size compared to prior examination.MEDIASTINUM AND HILA: Reference soft tissue along the lateral aspect of the left main pulmonary artery, has regressed and currently measures 1.4 x 0.9 cm (image 39; series 3). CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Multiple hypodense nodules scattered throughout the liver described in detail previously and thought to probably represent cysts appear stable.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cyst is unchanged.RETROPERITONEUM, LYMPH NODES: There is no evidence of retroperitoneal lymphadenopathy on the basis of size criteria.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality identified.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: The patient is status post hysterectomy and bilateral salpingo-oophorectomy, without associated enhancing soft tissues to suggest locoregional disease recurrence. There is trace free fluid within the pelvis.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormalities identified.OTHER: No significant abnormality noted.
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Regression of left hilar lymph node. Stable or slight interval regression of pulmonary micronodules.
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Generate impression based on findings.
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Male; 66 years old. Reason: h/o lung ca, s/p CRT, compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: Right upper lobe mass is decreased and measures up to 2.9 x 1.7 cm (series 5/20), previously 3.9 x 2.2 cm on 9/27/14 and 3.3 x 2.1 cm on 6/25/14.Scattered nodules and micronodules are not significantly changed. No new suspicious pulmonary nodules or masses.Increased subpleural and paramediastinal consolidation with reticular opacities and traction bronchiectasis in the right lung greatest in the right upper lobe and azygoesophageal recess, as well as minimally in the medial left upper lobe, most compatible with radiation change.Moderate emphysema.Small right pleural effusion, significantly decreased since prior study. Interval resolution of left pleural effusion.MEDIASTINUM AND HILA: Confluent necrotic mediastinal lymphadenopathy most pronounced in the right paratracheal and subcarinal regions has significantly decreased. Reference right paratracheal conglomerate lymphadenopathy measures approximately 2.2 x 5.6 cm (series 3/36), previously 4.1 x 7.7 cm and 9/27/14 and 3.8 x 7.3 cm on 6/25/14. Endoluminal extension of tumor into the right mainstem bronchus has decreased. Decreased mass effect on the right brachiocephalic vein and SVC. A non-index right paraesophageal lymph node is enlarged (series 3/70).Normal heart size without pericardial effusion. No visible coronary artery calcifications.CHEST WALL: Stable small nonspecific mixed sclerotic and lytic lesion in the lateral seventh rib (coronal series 80216/43). Stable small dense sclerotic focus in the posterior eighth rib, likely a bone island (coronal series 80216/9). Mildly prominent right axillary lymph nodes are not significantly changed, and there is no axillary lymphadenopathy by CT size criteria.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable left renal cyst. A small hypoattenuating lesions in the right kidney are too small to characterize but are likely due to additional cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.G-tube in place.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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Decreased right upper lobe mass and mediastinal lymphadenopathy, aside from a nonindex paraesophageal lymph node as detailed above.
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Generate impression based on findings.
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Male, 49 years old, status-post esophageal dilatation, now with odynophagia and concern for possible perforation, also with history of laryngeal cancer. No clear evidence of esophageal perforation is seen along the portion of the esophagus which is imaged on this study. No evidence of extraluminal air or any definite paraesophageal fluid collections are seen. Along the right aspect of the upper cervical esophagus, the wall may be thickened and somewhat irregular (image 62 of series 6) which is of uncertain significance and could reflect expected findings after dilatation or perhaps some degree of inflammation.A tracheostomy is in place, and the below the trachea is widely patent. The glottis remains distorted similar to the prior examination. Thickening and hyperemia is again seen affecting the hypopharynx and epiglottic folds, again similar to prior and likely related to treatment.No evidence of recurrent mucosal tumor is seen. No pathologic adenopathy is detected by size criteria. The salivary glands and thyroid are unremarkable. The cervical vessels enhance normally. No concerning destructive osseous lesions are are detected.
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1. No definite findings to suggest esophageal perforation. An area of mural thickening and irregularity is suspected at the right aspect of the upper cervical esophagus which may reflect a normal finding post dilatation, or perhaps some degree of inflammation. If concern for perforation remains high, an esophagram would provide a more sensitive evaluation.2. Demonstration of treatment related findings at the glottic and supraglottic levels. No evidence of disease recurrence is seen.
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Generate impression based on findings.
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Male 75 years old; Reason: 75 y/o male with met prostate cancer, evaluate for progression, IV contrast only. NO PO contrast History: met prostate cancer CHEST:LUNGS AND PLEURA: There are a few scattered micronodules. The pleural spaces are clear.MEDIASTINUM AND HILA: Heart size no no pericardial effusion. Left chest wall pacer with pacer terminals in the heart.CHEST WALL: Postsurgical changes in the lower cervical spine from a cervical spine fusion.OTHER: ABDOMEN:LIVER, BILIARY TRACT: There are multiple hepatic lesions. They are as followsSegment two lesion 2.5 x 2.6 cm (image 81/series 3) previously, 1.6 x 1.4 cm.Segment 7 lesion superior 7.7 x 7.3 cm (image 82/series 3) previously, 4.8 x 4.9 cm.Segment 7 lesion inferior 9.0 x 5.8 cm (image 95/series 3) previously, 5.2 x 4.6 cm.Segment 6 lesion 6.0 x 5.6 cm (image 106/series 3) previously, 3.1 x 2.9 cm.Segment 8 lesion 2.6 x 2.5 cm (image 98/series 3) previously, 1.1 x 1.1 cm.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Mild bilateral hydronephrosis. Mild bilateral cortical scarring.RETROPERITONEUM, LYMPH NODES: Reference retroperitoneal lymph node measures 1.0 x 0.8 cm (image 121/series 3) previously, 1.0 x 0.6cm.Additional lymph node measures 0.6 x 0.6 cm image 114/ series 3, unchanged.Mild calcific arteriosclerotic disease affects the aorta.BOWEL, MESENTERY: Postsurgical changes in the bowel. Right lower abdominal urostomy.BONES, SOFT TISSUES: Left ventral hernia containing portion of transverse colon.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Soft tissue mass in the prostate bed measures 4.7 x 2.3 cm (image 190/series 3) previously, 5.7 x 2.9 cm.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Sclerotic osseous metastatic disease to the L2 vertebral body. Compression fractures of the L1 and T11 vertebral bodies.OTHER: No significant abnormality noted
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1.Increase in the size of the reference liver lesions.
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Generate impression based on findings.
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Male 66 years old; Reason: metastatic prostate cancer, enlarged LN in pelvis, rising psa, restaging History: none ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Nonspecific subcentimeter hypoattenuating lesion in the right hepatic lobe is too small to characterize.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Horseshoe kidney noted. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes are nonspecific (for example series 3, image 41).BOWEL, MESENTERY: Small hiatal hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: The prostate gland is enlarged and heterogeneous. It measures 7.1 x 4.9 cm.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diverticular disease without CT evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Soft tissue adjacent to the right iliac vein does not have the morphology of a lymph node and is considered nonspecific. This measures approximately 1.7 x 2.0 cm (series 3, image 71)
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1.The prostate gland is enlarged and heterogeneous. 2.Soft tissue adjacent to the right iliac vein does not the morphology of a lymph node and is considered nonspecific.
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Generate impression based on findings.
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Female 20 years old Reason: mets lung cancer. s/p chemo and RT. pls c/w previous study and evaluate tx response. History: lung ca CHEST:LUNGS AND PLEURA: Status post right pneumonectomy and pleurectomy with unchanged peripheral pleural thickening. Reference nonspecific paramediastinal soft tissue thickening measures 4 mm (series 3, image 44) previously 6 mm.Reference right lower lateral soft tissue thickening measures 8 mm (series 3, image 68), previously 9 mm.No suspicious pulmonary nodules or masses in the left lung.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Reference left supraclavicular lymph node measures 4 mm along the short axis (series 3, image 5) and previously measured 4 mm. Normal heart size without pericardial effusion.No visualized coronary artery calcifications in this non-gated study.CHEST WALL: Changes related to pneumonectomy and pleurectomy in the right hemithorax, unchanged.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal bed surgical clips, unchanged.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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No specific evidence of residual or recurrent disease.
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Generate impression based on findings.
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metastatic medullary thyroid carcinoma status post thyroidectomy in 2009 and progression in 3/2010, currently on cabozantinib since 2/2014. There are postoperative findings related to total thyroidectomy without evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria. The major salivary glands appear unchanged. There is moderate plaque at the left carotid bifurcation. The internal jugular veins appear to be patent. The osseous structures are unremarkable. The airways are patent. The imaged intracranial structures are unremarkable. There is moderate opacification of the imaged paranasal sinuses. The imaged portions of the lungs are clear.
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Postoperative findings related to total thyroidectomy without evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria.
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Generate impression based on findings.
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Male 42 years old; Reason: PE? History: SOB, +acute DVT The comparison chest radiograph performed on 2/6/2015 demonstrates cardiomegaly with interstitial edema.The ventilation images show decreased ventilation in the left lower lung with abnormal retention of Xe-133 gas in the left lung base. The perfusion images show a matched perfusion defect in the left lower lung. There is mild decreased nonsegmental perfusion to the right lower lung.
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Low probability for pulmonary embolism.Findings were discussed with Dr. Andrew Hantel by phone on 2/6/2015 at 2:00 PM.
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Generate impression based on findings.
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ABDOMEN:LUNG BASES: Minimal subsegmental atelectasis. No consolidation or pleural effusions are seen at the bases.LIVER, BILIARY TRACT: Multiple hypoattenuating foci within the liver parenchyma, none of which show enhancement. Nonspecific but most likely benign cysts. No biliary dilatation or significant abnormality otherwise.SPLEEN: Small enhancing focus within the spleen, nonspecific but likely benign hemangioma.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Several small bilateral renal sinus cysts, without hydronephrosis or hydroureter.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No small bowel obstruction or free air. The appendix is within normal limits.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Mild prostate enlargement.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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Small bilateral renal sinus cysts, without hydronephrosis or other significant abnormality.
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Generate impression based on findings.
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Metastatic lung cancer status post chemo and radiation therapy. Please compare with prior study and evaluate disease status. There are partially imaged postsurgical findings from right pneumonectomy and supraclavicular lymph node dissection. There are unchanged borderline prominent level 2 cervical lymph nodes. For example, a right level 2 lymph node measures 11 x 11 mm, previously 12 x 10 mm. The thyroid gland, parotid glands and submandibular glands are unchanged. There is no local effacement or mucosal lesions of the aerodigestive tract. There are no soft tissue masses in the neck. The cervical vasculature is patent. The osseous structures are unchanged. The limited intracranial structures demonstrate a left anterior temporal convexity arachnoid cyst, but is otherwise grossly unremarkable. The imaged paranasal sinuses are clear. There is partial opacification of the bilateral mastoid air cells. There is an unchanged left pleural based lung micronodule.
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1. Unchanged borderline prominent level 2 cervical lymph nodes which are nonspecific. Otherwise, no significant cervical lymphadenopathy.2. Status post right pneumonectomy and left pleural based lung micronodule. Please refer to dedicated chest CT performed the same day for further evaluation.
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Generate impression based on findings.
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Male 39 years old; Reason: 39M with history of colorectal cancer History: colon cancer CHEST:LUNGS AND PLEURA: 6-mm nodule in the right middle lobe lobe (series 5, image 47 ) is indeterminate. Additional micronodules are also nonspecific, for example series 5, image 42.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Right-sided Port-A-Cath with tip at the cavoatrial junction. Subcutaneous air surrounding the chest port presumably relates to recent insertion.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post left hemicolectomy. In the region of the surgical anastomosis there is abnormal thickening of the bowel wall with adjacent extraluminal mesenteric soft tissue abnormality in the left upper quadrant at the level of the left renal hilum which measures 3.3 x 4.4 cm (series 4, image 114). This is also closely related to the greater curvature of the stomach and to duodenojejunal junction. Additional focus of peritoneal soft tissue abnormality in the left paracentral abdominal wall (series 4, image 128). A linear area of nodular peritoneal thickening is identified in the infra-umbilical abdomen in the midline (series 4, image 154). There is fascial thickening and trace fluid along the left paracolic gutter.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Nonspecific left external iliac lymph node (series 4, image 182).BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.Bowel wall thickening at the surgical anastomosis with peritoneal nodularity suspicious for locoregional recurrence.
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Generate impression based on findings.
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Head: There are small vague areas of subcortical hypoattenuation most prominent in the left superior frontal gyrus which seem to have been present as far back as 2011 and appear to be unchanged.No evidence of acute intracranial hemorrhage. The gray-white differentiation is normal. There is no mass effect or midline shift. The ventricles and sulci are normal in size. There are no extraaxial fluid collections or subdural hematomas. Maxillofacial:There is mucosal thickening and/or accumulated secretions in the maxillary sinuses and ethmoid air cells, which may reflect sinusitis. There is no significant nasal septal deviation. The lamina papyracea and ethmoid roofs are intact. The nasopharynx, facial soft tissues and orbits appear to be unremarkable.
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1.There are small vague areas of subcortical hypoattenuation most prominent in the left superior frontal gyrus which seem to have been present as far back as 2011 and appear to be unchanged. The etiology is uncertain and could represent normal variation. However, this would probably best be evaluated with MRI.2.Mucosal thickening and/or accumulated secretions in the paranasal sinuses which could reflect sinusitis.
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Generate impression based on findings.
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Esophageal dilatation now with odynophagia, concern for possible perforation. LUNGS AND PLEURA: Bilateral apical scarring consistent with radiation fibrosis. Multifocal groundglass opacities and mixed density nodules measuring up to 14-mm (4/39) are new since the previous study. Endobronchial debris within the left lower lobe airways with adjacent bronchiolitis.MEDIASTINUM AND HILA: No pneumomediastinum or paraesophageal fluid collections to suggest esophageal perforation.Mildly prominent low left paratracheal and mildly enlarged left subcarinal lymph nodes measuring up to 13-mm (3/48), not significantly changed.No pericardial fluid. Tracheostomy tube tip just inside the trachea at the level of the thoracic inlet. No visible coronary artery calcifications. Moderate paraesophageal hernia.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Limited scanning range is unremarkable.
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1. No CT signs of esophageal perforation. Specifically, no pneumomediastinum or mediastinal fluid collections. 2. Mediastinal lymphadenopathy is unchanged and in retrospect has been present since 1/13/2014. The distribution is atypical for the pattern seen in head and neck cancer metastases and likely has to do with the patient's known esophageal pathology. 3. Left lower lobe aspiration bronchiolitis. Multiple nodules and opacities of varying densities in the lungs bilaterally new from a recent exam of 1/19/2015 and and likely postinflammatory or postinfectious, probably related to aspiration.
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Generate impression based on findings.
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Headache, warfarin therapy, status post fall. Remote history of subarachnoid hemorrhage. No intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. No midline shift or uncal herniation. Gray-white differentiation is maintained. No extra-axial collections. Ventricles are within normal limits without evidence of hydrocephalus. There is evidence of prior right frontal burr hole and hypodensity involving the right frontal subcortical white matter which may be related to prior ventriculostomy.The visualized portions of the paranasal sinuses are clear. Mastoid air cells are clear. No calvarial fracture.
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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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57 year-old female with facial pain and swelling status post fall. 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 mild age-related volume loss. No extra-axial collections are identified. There are extensive areas of hypoattenuation in the periventricular and subcortical white matter, which are non-specific, not significantly changed from prior exam.A small hematoma overlies the right frontal bone, superior to the right orbit. However, no acute facial bone or orbital fracture is identified. The temporomandibular joints are intact. The globes are intact. There is no evidence of intraorbital hematoma or stranding. There is mucosal thickening along with layering fluid and frothy secretions in the bilateral maxillary and left sphenoid sinuses. The mastoid air cells are clear. There are scattered, prominent cervical lymph nodes, which are non-enlarged by size criteria. The patient is partially edentulous.
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1. No evidence of intracranial hemorrhage, extra axial collection or mass effect. 2. There is a small hematoma superior to the right orbit, without underlying fracture. 3. Air-fluid levels and frothy secretions in the bilateral maxillary and left sphenoid sinuses which may represent retained secretions or acute sinusitis in the appropriate clinical setting.
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Generate impression based on findings.
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Male 44 years old with Type II DM, abdominal pain, nausea, and vomiting. Evaluate for gastroparesis. Visually there was significant and progressive gastric emptying. Using anterior and posterior geometric means, residual gastric activity at the following postprandial intervals was calculated as follows:30 mins: 26.3 % of peak activity (normal >70 %)1 hour: 1.3 % of peak activity (normal 30-90 %) 2 hours: 1.1 % of peak activity (normal <60 %)
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Gastric emptying within normal limits.
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Generate impression based on findings.
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67 years, Female. Reason: NGT placement Dobbhoff tube tip now projects in the gastric antrum. IVC filter noted in the expected location. Pelvic JP drain and skin staples reflect recent surgery. Severe levoscoliosis. Nonobstructive bowel gas pattern.
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Dobbhoff tube tip in the gastric antrum.
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Generate impression based on findings.
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41-year-old female with hip pain Alignment is anatomic. There is no fracture or other specific findings to account for the patient's pain. The contralateral hip and pelvis appear normal for the patient's age.
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No specific findings to account for the patient's pain.
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Generate impression based on findings.
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Male 52 years old; Reason: lymphoma staging History: hx of CLL with left cervical LAD and bx suspicious for richter transformationRADIOPHARMACEUTICAL: 11.5 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 95 mg/dL. Today's CT portion grossly demonstrates collection in the maxillary sinuses. There is soft tissue fullness on both sides of the neck. There is subcutaneous emphysema in the right neck and right upper chest wall. There is large conglomerate lymphadenopathy in the superior mediastinum and prevascular, pretracheal, subcarinal, precarinal as well as posterior mediastinum. There are bilateral small pleural effusions. There is small pericardial effusion. There is compressive atelectasis in the right lung base. There are small lymph nodes in the left axilla. There is splenomegaly. There is generalized ascites in the abdomen and pelvis and probable lymphadenopathy in the retroperitoneal cavity. There is a sclerotic focus in the right iliac bone.Today's PET examination demonstrates increased metabolic activity of the lymph nodes in both sides of the neck and mediastinum including the superior mediastinum, paratracheal, subcarinal, precarinal, perihilar and posterior mediastinal regions most intense in the left neck level 2/3 lymph nodes with an SUV max of 6.1. There is increased activity involving lymph nodes in the mesentery, retroperitoneum in the abdomen as well as pelvic lymph nodes, with the mesenteric lymph nodes in the right abdomen having a SUV max of 3.1. There is increased activity in left upper quadrant near the splenic hilum. There is mildly increased activity involving the small lymph nodes in the left axilla suspicious for tumor activity. There is diffuse mild esophageal activity likely related to esophagitis. The right iliac bone sclerotic focus contains no metabolic activity.
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Intense lymphadenopathy in the neck, chest abdomen and pelvis with increased activity consistent with patient's known diagnosis of CLL.
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Generate impression based on findings.
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46 years old, Male, Reason: r/o adenopathy, recurrence History: h/o thyroid cancer. S/P surgery. No RAI MEASUREMENTS: Patient status post thyroidectomy.RIGHT LOBE AREA: Patient status post thyroidectomy with no suspicious nodules or masses.LEFT LOBE AREA: Patient status post thyroidectomy with no suspicious nodules or masses.ISTHMUS AREA: Patient status post thyroidectomy with no suspicious nodules or masses.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign appearing level 2 lymph node measuring 2.3 x 0.6 x 0.3 cm.OTHER: No significant abnormality noted.
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No evidence of local recurrence or lymphadenopathy.
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Generate impression based on findings.
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Ms. Finkelstein is a 40 year old female with bilateral silicone implants placed in 5/2013. Family history of breast cancer in mother (diagnosed at the age of 38) and maternal great aunt (diagnosed in her 90s). Two full field views and two implant-displaced views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is extremely dense, which lowers the sensitivity of mammography, unchanged in pattern and distribution. Bilateral retropectoral silicone implants are stable in size and contour. Benign morphology mass versus focal glandular tissue in the left lower inner breast is stable. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast.
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Bilateral silicone implants. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation 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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CHEST:LUNGS AND PLEURA: Mild apical predominant emphysema. Minimal right dependent subsegmental atelectasis/scarring.MEDIASTINUM AND HILA: Heart size within normal limits, and there is no pericardial effusion. No significant hilar lymphadenopathy. Right cardiophrenic nodule (17/97) measures 1.2 x 1.6 cm, previously 2 x 1.8 cm.CHEST WALL: Unchanged sclerotic left fourth rib focus, without additional significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Numerous hepatic metastases are again seen, with reference lesions as follows:- Segment 3 left hepatic lobe lesion (81412/119) measures 6 x 4.2 cm, previously 5.9 x 4.8 cm.- Reference segment 6 lesion (81412/124) measures 5.7 x 3.3 cm, previously 6 x 3.6 cm.Persistent small amount of perihepatic ascites. No significant biliary dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cysts are again noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Multiple loops of dilated small bowel are again seen, similar to prior, with contrast passing into the rectum consistent with partial small bowel obstruction. Previously seen enhancing lesion in the small bowel is difficult to visualize, however there is apparent nodular thickening/polyp in the distal small bowel (81412/140). Mesenteric mass measures 5.7 x 2.5 cm (image 152; series 81412), unchanged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Prostate is enlarged with coarse calcifications.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild/grade 1 anterolisthesis of L5 on S1.OTHER: No significant abnormality noted.
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No substantial interval change compared to prior.1.Multiple hepatic enhancing lesions consistent with history of metastatic tumor with measurements as above.2.Partial small bowel obstruction appears similar to prior.
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Generate impression based on findings.
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Altered mental status, evaluate for acute intracranial process No intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. No midline shift or uncal herniation. Gray-white differentiation is maintained. No extra-axial collections. Ventricles are within normal limits without evidence of hydrocephalus.Mild mucosal thickening in the paranasal sinuses, particularly the left sphenoid sinus. Mastoid air cells are clear. Calvarium is intact. There are secretions filling the nasopharynx related to intubation.
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No evidence of acute intracranial hemorrhage or mass effect. If there is continued suspicion for an intracranial process, MRI can be considered.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is mostly fatty replaced, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSA - Screening Mammogram.
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Generate impression based on findings.
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45 years, Female. Reason: Assess for passage of patency capsule through small bowel History: abdominal pain, mild narrowing seen on imaging in mid small bowel. Rectangular radiodensity projecting over the left lower quadrant is compatible with patency capsule within the distal descending colon. Average fecal burden with stool noted in the proximal colon. Nonobstructive bowel gas pattern with paucity of visualized small bowel loops.
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Patency capsule in the distal descending colon. Nonobstructive bowel gas pattern.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. History of reduction surgery for both breasts in 2014. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is composed of scattered fibroglandular elements. Breast volume is significantly reduced in both breasts due to recent reduction surgery. A surgical clip is present in the left breast at 6 o'clock position. Multiple benign calcifications are present in both breasts.No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram.
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Generate impression based on findings.
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63 years old male with a history of lymphoma. This study was performed for staging of plasmablastic lymphoma. RADIOPHARMACEUTICAL: 12.6 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 102 mg/dL. Today's CT portion grossly demonstrates multiple normal-sized lymph nodes in the bilateral axillary regions. Soft tissue density is seen in the pelvis at presacral space. In addition a soft tissue density is seen in the posterior pelvis on the left, lateral to the left seminal vesicle. The prostate is enlarged. An ostomy is seen in the right lower quadrant of abdomen.Today's PET examination demonstrates mild FDG uptake in the multiple in the normal sized lymph nodes in the bilateral axillary regions. The maximum SUV in the most intense lymph node in the right axilla is 2.4. Several foci of increased activity are seen in the costochondral junction of several right lower ribs.There is a focus of increased activity in the soft tissue density in the posterior pelvis on left, lateral to the left seminal vesicle, with maximum SUV of 4.0.There is a peripheral mild FDG uptake in the presacral soft tissue density in the posterior pelvis. Increased metabolic activity is seen in the left and right acromioclavicular joints, consistent with degenerative changes. Mild FDG uptake is seen at ostomy site in the right lower quadrant of abdomen, which is consistent with post procedural change. Minimal FDG uptake is seen in the soft tissue density in the subcutaneous tissue of the left lower quadrant of abdominal wall.Physiological activity is seen in the liver, spleen, kidneys, intestines and bladder.
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1.Hypermetabolic soft tissue density in the posterior left pelvis, lateral to the left seminal vesicle, which can be due to tumor or inflammatory change.2.Several foci of increased activity in the costochondral junctions of right lower ribs, which are most likely due to trauma.3.Nonspecific normal sized lymph nodes with mildly increased activity in the bilateral axillary regions.4.Soft tissue density with peripheral mild increased metabolic activity in the presacral space in the pelvis, which is most likely due to post-therapy change.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram.
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Generate impression based on findings.
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Male 81 years old; Reason: prostate cancer, PSA recurrence, evaluate for mets History: biochemical recurrence Increased uptake in the right maxillary bone may be due to sinusitis. Persistent increased uptake in the left shoulder, knees, left foot, cervical spine, and wrists likely reflect degenerative changes.
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Increased uptake in the right maxillary bone may be due to sinusitis. Suggest correlation with x-ray.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram.
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Generate impression based on findings.
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Male; 87 years old. Reason: h/o met thyroid ca, compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: Overall no significant interval change in the innumerable pulmonary metastatic nodules.Reference left upper lobe nodule measures 8 mm (series 4/38), unchanged.Reference lingular nodule measures 12 x 13 mm (series 4/74), unchanged.No pleural effusions or pneumothorax.MEDIASTINUM AND HILA: Heart size is normal without pericardial effusion. Severe coronary artery calcifications.No hilar or mediastinal lymphadenopathy. Calcified hilar lymph nodes.Postoperative changes of thyroidectomy.CHEST WALL: Unchanged severe degenerative changes about the visualized spine. Sclerotic focus within the left humerus is stable.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Hepatic granulomata. Cholelithiasis.SPLEEN: Splenic granulomata.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable left renal hypoattenuating lesion most likely a cyst.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Interval decreased size of small partially thrombosed left gastric artery aneurysm.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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Overall, no significant change in innumerable metastatic pulmonary nodules.
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Generate impression based on findings.
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4-year-old female with mouth breathing and mild OSA.VIEWS: Soft tissue neck lateral (one views) 02/06/15 Mild adenoidal tissue hypertrophy without obstruction of the nasopharyngeal airway. No prevertebral soft tissue swelling
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Mild adenoid hypertrophy without obstruction of the nasopharyngeal airway.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram.
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Generate impression based on findings.
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Female 55 years old; Reason: hyperparathyroid localization History: hyperparathyroid biochemically There is physiologic distribution of the radiopharmaceutical. There is a discrete focus of persistent activity on delayed images posterior to the inferior pole of the right thyroid lobe.The right thyroid lobe appears to measure 3.4 cm and the left lobe 3.4 cm in length.
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Findings compatible with parathyroid adenoma posterior to the inferior pole of the right thyroid lobe.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is heterogeneously dense. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. History of reduction surgery at age 22. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is composed of scattered fibroglandular elements. There are multiple skin calcifications in both breasts. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram.
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Generate impression based on findings.
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Male 75 years old; Reason: metastatic prostate cancer on treatment. needs disease reeval Persistent increased uptake at L2 and L5 vertebral body are unchanged. No new foci of abnormal osseous uptake are noted. Mild activity from T10 through L1 is stable and corresponds with degenerative and compression deformities. There is decreased activity along the posterior right aspect of T12 vertebral body which corresponds with degenerative changes. Right pelvis neobladder radiotracer uptake is again seen.
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No significant interval change.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram.
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Generate impression based on findings.
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Right mesial temporal mass. Surgical guidance. This exam is limited by technique and artifact from a halo. Pre-and postbiopsy scans were performed with a post-biopsy scan revealing a small right frontal burr hole and pneumocephalus. There is no midline shift.
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Intraoperative CT with expected post-surgical findings related to biopsy of a right mesial temporal lobe mass, within the limits of streak artifact. 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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61 year old male s/p gastric banding in 2001 who now presents with postprandial pain and vomiting. Assess band position. Scout radiograph of the chest was unremarkable. Single contrast visualization of the esophagus showed no gross structural abnormality. Fluoroscopic evaluation of esophageal peristalsis demonstrated a normal primary peristaltic wave.Postprocedural changes s/p gastric banding were observed, and the gastric band was in normal position with a Phi angle of 51 degrees. There was minimal delay in emptying of the distal esophagus, but contrast did traverse the band without evidence of obstruction. The gastric pouch proximal to the band was normal in size measuring 2.2 cm in width, and the stoma at the level of the band measured 3.9 mm, also within normal limits (series 22). The stomach distal to the band was normal in size, shape, and position. Spontaneous emptying of contrast into the duodenal sweep was observed. Early in the study, an air-fluid level appeared within an additional lobulated structure located adjacent to the gastric fundus (series 13). This structure appears to correlate with a loop of bowel with adjacent surgical clips seen near the lesser curvature of the stomach on outside CT from 1/13/2015, likely reflecting patient's prior "gastric clipping" per patient's daughter. TOTAL FLUOROSCOPY TIME: 2:44 mm:ss
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1.Gastric band normally positioned without evidence of obstruction. 2.Contrast containing outpouching adjacent to the gastric fundus which corresponds to a bowel loop or portion of partially excluded gastric fundus seen near the lesser curvature of the stomach on prior outside CT. Please correlate with patient's surgical history.
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Generate impression based on findings.
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17 year-old female with left chest tube removalVIEWS: Chest PA/lateral (two views) 02/06/15, 1323 hrs Interval removal of left chest tube now with a small hydropneumothorax. Left lower lobe consolidation. Streaky opacities in the right lung likely represents atelectasis. Small right pleural effusion. Cardiothymic silhouette is normal.
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Small left hydropneumothorax status post chest tube removal. Left lower lobe consolidation.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is mostly fatty replaced, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSA - Screening Mammogram.
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